Testing what works: disability inclusion in eye health services
Sightsavers aims to develop an innovative and cost-effective model to make eye health services inclusive for people with disabilities
An Inclusive Eye Health outreach camp for people with disabilities organised by Sightsavers in an urban informal settlement of Bhopal, India. People with disabilities and their families sit under a tent as they wait to be registered and screened.
What problem does your idea solve?
People with disabilities face many obstacles in accessing healthcare, including prohibitive costs, limited availability of services, infrastructural barriers, inadequate skills of health workers, stigma and lack of inclusive policies. According to WHO 80% of all causes of visual impairment are preventable or treatable. Sightsavers mission is to eliminate avoidable blindness in developing countries and we want to test a new approach to make eye care services inclusive for people with disabilities
Explain your idea
Over the past 16 months we have piloted an innovative Inclusive Eye Health approach in Bhopal, India. This initiative focused on addressing barriers experienced by people with disabilities living in urban informal settlements in accessing healthcare.
We trained health workers on disability inclusion, organised awareness raising activities in the community, and networked with local stakeholders who provide services for people with disabilities and other marginalised groups. We conducted targeted outreach screening camps, providing free eye care services to thousands of people with disabilities who may not ordinarily have been reached by those services. We conducted accessibility audits of all our health facilities and worked with partners to remove infrastructural and communication barriers, and we measured the prevalence of people with disabilities accessing our services using the Washington Group Short Set of questions. We also held regular meetings with the local government to prompt collaboration, share our learnings, and support them in the implementation of inclusive policies.
Through this process we developed several tools, including an innovative and comprehensive Inclusive Eye Health Blueprint. We want to further test and refine these tools in a very different setting, and have identified our eye health programme in Nampula, Mozambique. Here we have a strong local country office and collaborative partners that will help us consolidate our Inclusive Eye Health model.
User experience map for Sightsavers’ Inclusive Eye Health idea.
The user is Salima, a 42-year-old woman. She has a physical disability and uses a wheelchair.
Salima works at the local market in her village, where she sells vegetables cultivated by her family. Lately, her sight started deteriorating and she now has difficulties in counting money. Her ability to work is compromised.
STEP 1: During a community meeting in her village, Salima receives information about the importance of eye health and discovers that a free screening camp will be organised there the following week.
STEP 2: Salima attends the screening camp organised by Sightsavers, where she receives a free eye examination and is diagnosed with cataract. The health staff record information in the patient’s record, including age, sex and disability status, and refer Salima to the hospital for surgery.
STEP 3: Salima is brought to the hospital with one of Sightsavers’ project vehicles. Thanks to Sightsavers’ intervention, the hospital is now accessible, and Salima can move independently from the registration counter to the screening room and the operation theatre.
STEP 4: Salima receives a cataract surgery and remains in the hospital for the night. Staff members have been trained on gender and disability, and know how to provide support to Salima and ensure she feels safe and comfortable.
STEP 5: The surgery was successful. Before being brought back to her village, Salima completes a patient satisfaction survey, providing feedback on the Inclusive Eye Health services.
STEP 6: After a few weeks, when the ophthalmologist visits her village, Salima receives a free eye check-up to ensure she is recovering well. She is prescribed spectacles and chooses her favourite design from a wide selection of quality and affordable glasses. Her sight is restored and she can go back to work.
People with disabilities living in the Nampula province, Mozambique, will be the direct beneficiaries of our project. However, experience from our pilot in India shows that programmes designed to be inclusive for people with disabilities also benefit other marginalised groups, such as people with HIV/AIDS. The families of those individuals receiving eye health services will also benefit, as we know that sight loss has a direct impact on an individual’s ability to contribute to the household.
An optometrist examines the eyes of a child with Down syndrome at one of Sightsavers’ eye care facilities in Bhopal, India.
Children and women with disabilities and representatives of disability organisations take part in a focus group discussion organised by Sightsavers in Bhopal, India. Participants reflected on key barriers experienced by girls and women with disabilities in accessing healthcare services. Key obstacles emerged from the discussion include infrastructural barriers, stigma and discrimination, and limited skills of health workers.
How is your idea unique?
Our idea is unique as we aim to test and consolidate a practical, efficient and cost-effective approach to embed inclusion in mainstream health programmes in developing countries, bridging the gap between theory and practice. The Inclusive Eye Health Blueprint developed during our pilot initiative in India defines 10 key domains of intervention and a standard set of activities for each domain, along with a pool of outcome and output-level indicators, means of verification, timeframes and budget recommendations. This is a unique and innovative approach, as it maps all the components of standard eye health programmes in developing countries and describes practical steps to make them more inclusive and measure change. With support from Open IDEO and DFID, we will be able to deliver more inclusive eye care services for people with disabilities in Mozambique, and to consolidate our inclusive model, share learnings with the development sector and contribute to the achievement of the SDGs.
Tell us more about you
Sightsavers is an international organisation working with partners in over 30 countries to eliminate avoidable blindness and promote the rights of people with disabilities. In 2016 we performed 12 million eye examinations and over 344,000 surgeries. We’ve been working in Nampula since 2007, supporting the Ministry of Health to deliver quality eye healthcare, improve health infrastructure and increase the capacity of health workers. In 2016 we screened 84,796 people and performed 2,050 surgeries.
On 3rd December 2016, art students in Bhopal painted striking murals along the wall of a major hospital to mark International Day of Persons with Disabilities. The purpose was to raise awareness of the rights to equitable access to education, healthcare and jobs for people with disabilities. The mural art was part of Sightsavers’ Inclusive Eye Health project in Bhopal, developing ways to ensure people with disabilities and other marginalised groups get equitable access to eye health services.
What are some of your unanswered questions about the idea?
We developed our Inclusive Eye Health approach in an urban setting in India. We want to know whether it can be applied elsewhere, such as a rural programme in East Africa, to validate its utility in different regions so that it can be scaled up to all our programmes.
We are also still exploring how to best demonstrate that our Inclusive Eye Health approach is cost effective and ensures efficiency, quality of service and value for money. Testing and monitoring new approaches requires economic investments, time, technical expertise and human resources. Support from Open IDEO and DFID will help us develop the most suitable strategy to adapt and consolidate our model and tools, and to help other stakeholders benefit from our learnings.
Where will your idea be implemented?
Experience in Implementation Country(ies)
Yes, for more than one year.
Expertise in Sector
I've worked in a sector related to my idea for more than a year.
We are a registered non-profit, charity, NGO, or community-based organization.
Early Growth/Roll-out/Scaling: I have completed a pilot and am ready or in the process of expanding.
How has your idea changed based on feedback?
We held single-sex focus group discussion (FGDs) with DPO members in Nampula, and consultations with the Eye Health Department at Nampula Central Hospital and the team of ACAMO, a leading national DPO. All welcomed our idea, and provided practical suggestions to improve it.
Several participants of the FGDs recommended using radio programmes to raise awareness; they also highlighted the need to address language barriers, as many people with disabilities lack formal education and don’t speak Portuguese. These recommendations will be incorporated in our information, education and communication (IEC) strategy.
Some participants also suggested including a module on disability in the training curriculum of nurses and doctors. This activity is currently beyond the remit of Sightsavers’ standard eye health programmes; nonetheless, we recognise its value and we will try to leverage the Inclusive Eye Health initiative to advocate for the inclusion of disability in the training curricula.
Women and men with disabilities affiliated to local Disabled People's Organisations (DPOs) pose for a group photo after the focus group discussions organised by Sightsavers in Nampula (Mozambique) during the Feedback Phase of the Amplify Challenge.
Women with disabilities affiliated to local Disabled People's Organisations (DPOs) participate in a focus group discussion organised by Sightsavers in Nampula (Mozambique). The group reflected on barriers experienced by people with disabilities, and in particular women and girls, in accessing healthcare services, and provided feedback to improve Sightsavers' idea for the Amplify Challenge.
Men with disabilities affiliated to local Disabled People's Organisations (DPOs) participate in a focus group discussion organised by Sightsavers in Nampula (Mozambique). The group reflected on barriers experienced by people with disabilities in accessing healthcare services, and provided feedback to improve Sightsavers' idea for the Amplify Challenge.
Who will implement this idea?
Sightsavers Mozambique will coordinate the project, supported by technical teams in UK, Ethiopia, Kenya and Zambia. We will partner with the Ministry of Health and the Eye Health Department at Nampula Central Hospital. 55 staff members in five districts will be involved in the project. We will coordinate inclusion activities with the Ministry of Social Welfare and in partnership with people with disabilities members of ACAMO; this will involve 4 full-time staff and 2 volunteers in each district.
Using a human-centered design approach, you may uncover insights that lead to small or foundational changes to your organization’s existing strategy or processes in order to unlock the potential of your idea. How would your organization go about making such changes?
Sightsavers’ large-scale projects normally require approval from strategic decision-makers in different teams and final sign-off from senior managers. However, the idea we submitted to the Amplify Challenge is coordinated by an internal Inclusive Health Task Team comprising global and country office staff with different areas of programmatic and operational expertise. The Task Team aims to facilitate the embedding of inclusion in our health programmes through a coherent and strategic approach, and meets regularly to reflect on learnings and coordinate actions. Our first pilot was developed through an iterative process, and we now have a working hypothesis on how to make our programmes more inclusive. Hence we are in learning mode, and we are excited to discover what works and what doesn’t.
What is it that most attracted you to Amplify instead of a more traditional funding model?
Our idea is innovative in nature, and can have a significant impact on the work of Sightsavers and other organisations, but it is still a prototype which requires further testing. Traditional funding models focus on the end result, rather than the process, and leave minimum room for experimentation and learning from failure. Amplify, on the other hand, celebrates creativity, innovation, learning by doing and collaboration, and we felt it was the perfect model to test and refine our approach.
What challenges do your end-users face? (1) What is the biggest challenge that your end-users face on a day-to-day, individual level? (2) What is the biggest systems-level challenge that affects your end-users?
We held focus group discussions with representatives of DPOs and disability organisations working in Nampula. They shared that the biggest challenges faced by people with disabilities on a daily basis when accessing health services are the negative attitude of health providers and inaccessible infrastructure. Participants also mentioned that women with disabilities face more stigma then their male counterparts, particularly in accessing sexual and reproductive healthcare. According to the participants, there are inclusive policies in Mozambique, but the biggest systemic challenge remains their implementation. For example, there are provisions for free medicines for people with disability cards, but in reality people with disabilities are often unable to access these products for free.
Tell us about your vision for this project: (1) share one sentence about the impact you would like to see from this project in five years and (2) what is the biggest question you need to answer to get there?
IMPACT: By 2022, we aim to scale our inclusive approach to all Sightsavers’ programmes, reaching 1.8 million people with disabilities every year with eye health services in 30 countries, and to influence governments and other stakeholders to use our model and tools within health programmes in developing countries.
QUESTION: How do we refine our model to ensure flexibility and replicability across different regions and health programmes, demonstrating efficiency, quality and value for money?
How long have you and your colleagues been working on this idea together?
How many of your team’s paid, full-time staff are currently based in the location where the beneficiaries of your proposed idea live?
Between 5-10 paid, full-time staff
Is your organization registered in the country you intend to implement your idea in?
We are registered in all countries where we plan to implement.
My organization's operational budget for 2016 was:
If your team/idea/organization has a website, please share the URL below.
Inclusive health webpage: https://www.sightsavers.org/inclusive-health/