• [User needs are well considered in the Indian. We’d love to learn how you are planning for the new context of other countries, especially, if CHWs will be used in more rural areas for outreach and screening?] Participation is one of the fundamental principles of our inclusive model. For this reason, we will work in partnership with the government and a leading national DPO, and we will hold regular consultations with people with disabilities, women, and other groups of individuals who may experience barriers in accessing healthcare. We will conduct focus group discussions, community meetings, key informant interviews and exit interviews with patients to monitor our progress and embed a human-centered design approach in our project. CHWs already play a fundamental role in our eye health programmes, particularly in mobilising people living in rural areas to attend eye screenings and take up referrals for eye surgeries. As part of the Inclusive Eye Health initiative, we will build capacity of CHWs around gender mainstreaming and disability inclusion, and we will work with them to identify and provide services to the most marginalised individuals in each community.
• [What have you learned to do differently as a resulting of testing this elsewhere?] In Bhopal we collected data disaggregated by disability using the Washington Group Short Set of questions (WGSS) with all patients accessing different facilities and outreach camps. This methodology proved to be extremely useful, as it allowed us to test the WGSS in our eye health project, and to collect and analyse a large amount of data. However, while feasible, this approach can also be expensive and time-consuming. Therefore, in Mozambique we would like to test a different method, collecting disaggregated data by disability at different stages of project implementation. Through this new approach we aim to collect enough quality data to measure progress and inform our inclusive strategy, but also to demonstrate a more feasible and manageable approach to embed the WGSS within health programmes in Mozambique and, more generally, in East Africa.
• [Is the team thinking of expanding this model to other areas? Is the team thinking about other partnerships?] We are very keen to test our approach in different areas, and we are planning to apply this inclusive methodology to our NTD programmes, which mainly focus on mass drug administration in rural areas. Additionally, we are currently finalising a partnership with another international NGO to test our model and tools within their sexual and reproductive health programmes in Africa in 2018. This collaboration will provide a fresh and critical perspective on our approach, and will illustrate to what degree our model can be replicated in different areas.
• [How are you measuring your impact?] We will develop a monitoring and evaluation framework comprising an M&E plan, tools and procedures. The M&E plan outlines indicator definitions, disaggregation, formulas, methodology, frequency and roles and responsibilities for data collection, collation and reporting. This will be stored on our centralised project management system, and every quarter the country office will enter data and attend oversight meetings on project performance with our global teams. A baseline study will be carried out at the beginning of the project to establish indicator baseline values, using our Quality Assessment Tool (QSAT), the Washington Group questionnaire and the Equity Tool. The endline study will use the same tools to ensure comparability of findings. A learning review will be conducted at the end of the project to identify what has worked well and where we faced challenges. Exit interviews with patients, consultations with people with disabilities and other groups of individuals, and review meetings with our government and DPO partners will be carried out throughout the project to ensure a participatory approach.
Thank you once again for the great feedback and questions, and for giving us a chance to bring our Inclusive Health work to the next level! Sightsavers Team
Thank you for the great feedback, and thanks to the experts who reviewed our idea! Please find below the answers to your questions.
• [How will you scale this idea?] Our long-term vision for Inclusive Health is three-fold. First, we want to embed inclusion in all our eye health programmes in 30 countries across South Asia and Sub-Saharan Africa. Second, we want to test and replicate our inclusive approach within our Neglected Tropical Diseases (NTDs) programmes and explore its feasibility in other types of health programmes. And finally, we want to influence other stakeholders, such as governments, multilateral organisations, national and international NGOs, to embed inclusion within their health programmes in developing countries. In order for this to happen, we need to develop simple, practical, flexible and cost-effective procedures and tools that can be used in a wide variety of programmes and settings. The Inclusive Eye Health Blueprint and the associated tools that we produced in Bhopal and that will be tested in Nampula serve exactly this purpose. Once these tools will be refined, we will us them internally within our programmes, and we will share them with external stakeholders to contribute to the development of more inclusive health programmes in the Global South, in line with SDGs.
• [What needs to be accounted for when considering how countries have uniquely structured health care?] While the private sector plays an important role in India, the majority of health services in Mozambique and most African countries are government-led. Sightsavers has a well-established partnership with the Ministry of Health in Mozambique, and we already provide eye care services via the Nampula Central Hospital and associated primary health units in various districts. For these reasons, we are in a good position to test our innovative inclusive model, and to support the government in embedding a more inclusive approach within the national health system.
• [What measures are in place to increase cost effectiveness?] Our Inclusive Eye Health approach is informed by universal design principles, and we look at inclusion as an integral aspect of quality healthcare services, rather than an add-on feature. Retrofitting can be very expensive, but factoring in inclusion and accessibility at the design stage can be highly cost-effective. For example, the production of information, education and communication (IEC) materials is a standard component of healthcare programmes, but accessibility is rarely considered at the design stage. Our goal is to identify best practices and accessible solutions by consulting with people with disabilities and other stakeholders, to ensure the IEC strategy meets their needs and reaches everyone in the community. This approach can be highly cost-effective, as it simply consists in adapting an existing process to make it more inclusive. At the same time, we are also aware that some additional activities may be required, such as accessibility audits and infrastructural interventions. Our Inclusive Eye Health Blueprint maps all the steps required to complete these activities, and provides a range of different approaches that could be adopted in different settings, including information on estimated costs based on our experience so far. Initial evidence from our Bhopal pilot suggests that embedding inclusion in eye health should cost between 5% and 7% more compared to standard programmes. However, more evidence is required and our research team is planning a series of costing studies to understand the cost of inclusion in health programmes: these will inform our Inclusive Eye Health strategy going forward, and will generate evidence on the value for money of inclusion in the context of the SDGs.
Thanks a lot for sharing. It’s quite exciting to see the incredible transformative power of new technologies, and how they can improve the lives of people with disabilities.
Considering that 80% of people with disabilities live in developing countries, one of the key challenges remains to develop assistive technology which can be afforded by people livening in some of the poorest regions of the planet. In Bhopal, for instance, our project focuses on people with disabilities living in urban slums, and it would probably not be sustainable to embed many of these technologies within our programmes.
However, we are very open to innovation and we are keen to experiment innovative and cost-effective solutions, so feel free to get in touch with us or share here other potential ideas.
A very successful example of technology embedded in Sightsavers’ work is the Global Trachoma Mapping Project, which saw surveyors collect and transmit data from 2.6 million people in 29 countries using Android smartphones. You can find more info here: https://www.sightsavers.org/gtmp/