Industry: International development charitable organization
Applicable SDG: SDG 3: Good Health and Well-being
Operation Eyesight has brought sight-restoring and blindness prevention treatment to millions of people since we were founded in 1963. Today, our work is focused on nine countries in South Asia (India, Nepal, Bangladesh and Sri Lanka) and sub-Saharan Africa (Kenya, Ghana, Zambia, Ethiopia and Liberia) – places where blindness can be deadly, especially for those who are marginalized and live in poverty. Our primary focus is SDG #3: Good Health and Well-Being. Everything we do is in the pursuit of good eye health and well-being for those most in need of assistance to achieve this goal.
Since our beginnings as a charitable organization dedicated to improving the backlog of cataract surgeries in India, Operation Eyesight has expanded to provide support for eye health in hospitals and rural communities. Our programs now support other SDGs such as #1: No Poverty by preventing blindness and restoring sight to help people keep their jobs or return to work, breaking the cycle of poverty. We support #5: Gender Equality and Women’s Empowerment by training primarily women as community health workers, and by ensuring that women and girls receive equal access to eye health services, thereby improving their ability to gain an education, and work to support their families. We support #6: Clean Water and Sanitation by working with communities in Africa to drill boreholes to provide fresh water, and by educating communities to promote good hygiene and avoid the bacterial infections that can cause digestive illnesses and blinding trachoma. We support #17: Partnerships for the Goals by establishing long-standing relationships with governments and Ministries of Health in the countries we work to ensure the sustainability and effectiveness of our work.
Ultimately, everything we do is tied into our mission to prevent blindness and restore sight, which is integral to good health and well-being. Blindness impacts individuals, families and entire communities by keeping adults from earning a living and limiting the ability of children to learn and play. When people suffer from poor eye health, quality of life is diminished and the cycle of poverty is perpetuated.
Our programs are designed to provide quality eye care to all, regardless of age, gender or ability to pay. Through our community eye health model, we train local community health workers to conduct door-to-door surveys, screen patients and refer them for treatment, and educate the community on eye health and other health topics, including maternal and newborn health, immunizations and nutrition. As a result, we’re able to provide care to people who would otherwise go unreached, and these communities become healthier and stronger.
The WHO’s 2019 World Report on Vision (WRV) estimated that at least 2.2 billion people suffer from vision impairment or blindness, and at least 1 billion of these live with vision impairment that could have been prevented or has yet to be treated. The report also warned that this is likely to increase dramatically in the coming decades due to population growth, aging, urbanization, and behavioral and lifestyle changes. The report recommended dramatic changes to the current state of health care to address this issue. Furthermore, this report was released in October of 2019, before COVID-19 began to take over health systems around the world. If no significant investments are made in eye care at this time, an even larger proportion of world’s population will suffer from blindness and vision impairment. This means greater loss of livelihood opportunities, dependency, hunger and malnutrition, and poverty.
Our organizational vision is the elimination of avoidable blindness. A reliable supply of quality eye health care is one of the most effective ways to bring communities out of poverty, increase life opportunities and improve productivity. This issue can be addressed, leading to more positive outcomes if appropriate investments are made in eye health and in other determinants of eye health such as maternal, newborn, immunization and nutritional services. If this is not taken seriously, the negative impact of neglecting eye health and its determinants will be a dire concern. To ensure eye health doesn’t become an overwhelming burden on health systems and economies, it needs to be addressed immediately. By following the WRV’s recommendations and incorporating Integrated People-Centred Eye Care into Universal Health Coverage, countries will be taking the first step towards ensuring that vision impairment doesn’t hold their citizens back in a cycle of poverty. Solutions exist right now, and the sooner countries employ them, the better off their citizens will be. Operation Eyesight is at the forefront of facilitating the WRV’s recommendation through its proven community eye health model, which has been implemented in seven of the countries where we work.
This past summer, the World Health Assembly adopted a resolution to urge member countries to implement the recommendations of the World Report on Vision, elevating eye health as a priority that must be integrated into national health systems. By working with our partner governments and Ministries of Health to implement our community eye health model, we can help them achieve this, taking them one step closer to achieving good health and well-being for their most vulnerable citizens.
The specific targets we address in SDG #3 are 3.2, 3.8, 3.c and 3.d. The topics covered by these targets include infant health and mortality, access to safe effective quality and affordable health care (including medicines and vaccines), training and retention of the health workforce in developing countries, and strengthening the capacity for early warning, risk reduction and management of national and global health.
Operation Eyesight began as a charitable organization dedicated to improving the backlog in cataract surgeries in India. Over the next few decades, we grew our mandate, expanding into multiple countries in South Asia and sub-Saharan Africa and developing partnerships to increase our capabilities by providing mobile eye care units and to help in ways that went beyond just sending funds.
Early in the 2000s, we began to optimize a more purposeful and sustainable set of programs to move Operation Eyesight into the future. To date, our programs had saved the vision of millions of people, but the future of the organization transformed to provide a more sustainable model that would empower people in the countries where we work to take control of their own eye health.
Today, Operation Eyesight is known as a leading eye health development organization. We are declaring entire villages avoidable blindness-free, eliminating their need for our financial support in the future. We are supporting the growth of hospitals and vision centres to become completely self-sufficient, using the revenue from those who can afford to pay to ensure that those who can’t afford to pay receive the same quality of care. While there are many more villages in many more countries that need our help, this model represents progress towards a future where all communities will be able to provide quality eye health care for themselves, without the need for external aid.
Our community eye health model is powered by two key innovations. One is our method of mapping villages into territories or clusters, and accounting for every single household in each cluster. To do this we train community health workers (CHWs) to conduct door-to-door surveys, screening people for eye health problems, diagnosing conditions and referring household members to the necessary level of care. They ensure that no person in their assigned cluster who needs eye health care goes without it. They assess all members of the household and guide them toward the appropriate level of care (from local vision centres to more centrally located hospitals). By diligently following this method in all clusters, we can confidently declare entire clusters (and eventually, entire villages) avoidable blindness-free. CHWs also provide education around eye health, maternal and newborn health, immunizations and nutrition to residents of their assigned clusters, leading to better long-term health care-seeking behavior and a sustainable model that will keep the cluster avoidable blindness-free into the future.
A second innovation is employing members of the community as CHWs. A key issue with encouraging people to pursue eye health care is trust. Many people in these villages have concerns when it comes to seeking help for eye problems, including the fear of surgery complications, a lack of financial resources and superstitions around eye problems, among other things. If they are approached by someone with a similar background who understands their concerns and is more likely to have their best interests in mind, they are more likely to accept help and utilize available services.
Another strategic programmatic area for Operation Eyesight is hospital strengthening. We work with our hospital and government partners and Ministries of Health to ensure that the care available to these communities we are serving is high quality, and that the same quality of care is available to all citizens, whether they can afford to pay or not. We follow an inclusive approach, strongly advocating that sub-standard care is not an acceptable answer to shortcomings to existing facilities in middle- and low-income countries.
We work with hospitals to ensure adequate facilities, equipment and supplies are available, but the most important aspect of this initiative is training. In 2019, we trained 1,037 people to provide eye health care, from training primary health care workers in eye care to ophthalmologists and eye health technicians in regions where these roles are in high demand. By strengthening the capacities of these facilities to provide a supply of quality health care, we are balancing the demand generated by our community eye health programs.
After decades of success using this model, we have been invited by Ministries of Health to present it as a proven way of addressing gaps in current eye health offerings in a number of countries, including Zimbabwe, Malawi, Maldives and Sri Lanka. After seeing the impact of our programs on the lives of their citizens, we have been asked by the governments of Zambia and Arunachal Pradesh state in India to replicate our model in other parts of the country/state. We also provide input on governments’ national eye health strategies, advocating for the inclusion of eye health in primary health care programs, a critical component of achieving Universal Health Coverage and the SDGs.
With the onset of the COVID-19 pandemic, this past year we pivoted our approach to address the urgent crisis in the countries where we work. Building on strong relationships with government and hospital partners and Ministries of Health, we were able to help them address the immediate concerns caused by the pandemic, reaching out to communities to provide clean water, safety supplies and education to help them protect their families and prevent the spread of the virus. These efforts helped prevent our partner hospitals from becoming overwhelmed, giving them support to help them get back to a state where they are facilitating better health outcomes for their citizens, including eye health. The flexibility shown by our international team demonstrated that we have an important role to play to help our hospital partners manage health risks as they emerge, even those unrelated to eye health.
Our Sustainable Community Eye Health Model – Avoidable Blindness-Free Villages
The beauty of our community eye health model is that the confidence of success is built right into the model. By diligently charting out all households in each territory and employing community health workers to ensure every person in every single household is assessed and receives any necessary treatment, we know that these territories can be declared avoidable blindness-free. And with sustainable programs in place to educate community members and encourage them to seek eye health care in the future, we can move on to other communities that need our help with this model.
To date, we have declared over 1,150 villages avoidable blindness-free as a result of our community eye health model. This means that every child, woman and man living in these villages has been screened for avoidable blindness. Any person who required intervention has received it, and if possible, had their sight restored. These communities have also been educated to better understand how important eye health care is, and they have learned positive eye health-seeking behavior. They have become empowered to look after themselves, their families and their entire communities.
To declare a village avoidable blindness-free, there must be no individual in the village (of any religion, caste, creed or gender) who has visual acuity less than 6/60 in the better eye as a result of avoidable or treatable conditions. Both the definition of avoidable blindness-free villages and the methodology for elimination of avoidable blindness that we follow are validated by the LV Prasad Eye Institute in Hyderabad, India.
Continuous monitoring of all activities within a community eye health program is carried out by the project coordinator daily, and by the hospital management on a weekly basis. The results of door-to-door surveys and cluster-based implementation plans serve as the basis for monthly and quarterly monitoring by the hospital management. Registers maintained by field staff are reviewed regularly, and necessary measures are taken to ensure projects stay on track. Steps that are a part of this monitoring include recruitment and training of community health workers, door-to-door surveys, cluster-based micro plans to meet the specific needs of the community, referrals and treatment and health promotion in the community.
Following completion of the project, the following steps must be taken to declare the village avoidable blindness-free:
In addition to the ultimate goal of declaring villages avoidable blindness-free, our programs also define other KPIs to determine success of the program, including the following numbers: people screened, sight-restoring eye surgeries performed, eyeglasses dispensed, mobile eye vans launched, existing vision centres strengthened, new vision centres established, hospital improvements made, community health workers trained and primary health care staff trained.
In 2019 we achieved the following:
Clean Water – Hygiene and Sanitation
An additional impact of our programs has been in providing access to clean water in sub-Saharan African countries where we work. Inaccessible or unsafe water can negatively impact hygiene and overall health, including eye health. The WHO estimates that approximately 1.9 million people suffer from vision impairment due to trachoma, a bacterial eye infection that, if left untreated, can lead to irreversible blindness. It is the leading infectious cause of vision impairment worldwide, but it can be easily prevented through proper hygiene and face washing. Without access to safe water, people must rely on surface water that could be contaminated or walk long distances to fetch water for their households. Operation Eyesight educates communities about the importance of face washing and hygiene, and provides access to clean water by drilling new boreholes and rehabilitating dysfunctional boreholes. In 2019, 21 boreholes were drilled or rehabilitated, providing clean water to 5,250 people. This creates a ripple effect of positive change. It helps increase the enrollment of girls in school, builds resilient communities, and prevents the spread of eye health-related illnesses.
Addressing Gender Inequalities
We have also seen the impact of the empowerment of women and girls through our programs. When communities don’t have access to clean water and sanitary facilities, women and girls bear the brunt of the opportunity cost. If women and girls have to travel long distances to collect water for their families, they miss out on important educational and social opportunities. In addition, the community health workers (CHWs) employed by our community health programs are primarily women. CHWs hold a respected position in which they carry out a very important job, earning the respect of others in the community.
An indicator of gender inequality is the fact that women and girls are more likely to be visually impaired than men and boys, because they are less likely to receive the necessary care to preserve or restore their sight. Our program model ensures that every person within a territory will be assessed and receive care, regardless of gender.
Third Party Recognition of our Impact
In 2013, our model was enthusiastically endorsed by Vision 2020 India, a national eye health advocacy group. Based on the success of our model to bring eye care to communities that are remote or have traditionally been marginalized, the group encourages all Indian hospitals to adopt Operation Eyesight’s model, regardless of whether they are in partnership with us. We have also been named a Top 10 Impact Charity in 2018, 2019 and 2020 by Charity Intelligence Canada, recognition that evaluates charities based on the level of impact created by every dollar donated.
Internally, it is critical that our employees are well-versed on the SDGs and their corresponding targets, and how we are working with our partners to achieve them. We have a staff member on the team dedicated to continually building and improving our SDG strategy and awareness, providing ongoing learning and development opportunities for our team. As an organization, we are implementing a management information system as part of our digital strategy – it’s important that our team members know exactly what KPIs we need to share that relate to our targets, and we need to have confidence that that data is accurate and reliable to ensure the validity of the progress we measure over time.
Internal dialogue around the SDGs is as important as our mission, vision and values in ensuring that the work we do every day ties into all of these, and will lead to progress in these areas. Our commitment to Good Health and Well-Being came into play vividly as our organization pivoted in response to the COVID-19 outbreak. We mobilized our local relationships to quickly support our partners and the communities where we work, addressing their urgent need. We know that eye health care is tied very closely to primary health care, and we saw the immediate need to support health care systems in any way we could to help keep them from becoming overwhelmed.
In our external communications, we share information about the SDGs and how our work aligns with them, linked directly from our home page (operationeyesight.com/sustainable-development-goals). We know that our prospective and current donors want to see that their donation will make a greater impact – beyond paying for the surgery of one person who needs it, they want to see that their donation will go towards sustainable programs that will help entire communities become more healthy and resilient. Our messaging around the SDGs informs our audience that we are working in line with a global effort to make the world a better place for all citizens. For those who are familiar with the SDGs, our alignment increases our credibility when we communicate with these stakeholders. Knowing that our work is not in isolation but activates a greater and stronger network is a powerful message.
We are also advancing awareness of the SDGs through our memberships, including the Alberta Council for Global Cooperation (ACGC), the Canadian Partnership for Women’s and Children’s Health (CanWaCH), the International Agency for the Prevention of Blindness (IAPB) and Cooperation Canada (formerly the Canadian Council for International Cooperation). For examples of our content that these organizations have shared, see the links below:
In addition to the foundational tenets of the SDGs and their targets, we keep our internal and external audiences informed on relevant news. One example is the recent resolution that was passed by the World Health Assembly in August of 2020, calling for member countries to implement integrated people-centred eye care (IPEC). The assembly recognized that IPEC is integral to the achievement of Universal Health Coverage. This is very important for us, as our people-centred model fits perfectly into this recommendation. We can provide a proven solution to Ministries of Health to allow them to integrate eye health into their national health systems in a way that is sustainable and provides additional benefits, including community buy-in, balance of supply and demand of health care services to ensure financial viability, improved health-seeking behaviors, more resilient communities, among others. The fact that the World Health Assembly has pushed forward with this resolution at a time when the world’s health systems are distracted by the effects of the COVID-19 pandemic truly demonstrates how foundational eye health is to Good Health and Well-Being.
People who live in poverty in low- and middle-income countries are even more at risk of facing negative consequences of COVID-19. As with blindness and vision impairment, people who face poverty and live in remote areas are less likely to have access to the information they need to protect the general health of themselves and their families, and they are less likely to know where to go for help.
When COVID-19 was declared a pandemic, Operation Eyesight pivoted our day-to-day activities to provide urgently needed aid in the regions where we work. For years, we have been working closely with government and hospital partners and Ministries of Health to help them map out a better future for their citizens who face avoidable blindness. With these strong partnerships in place prior to the pandemic, we were well positioned to help support current efforts to address these urgent challenges to general health and well-being. It was our objective to support our partner hospitals to get them back to a state where they could facilitate better health outcomes for their citizens.
As part of our Phase 1 efforts, we focused our work on two main areas: Community Empowerment, and Clean Water, Sanitation and Hygiene. As a result, we were able to achieve the following:
As eye health activities have started to resume, we’re supporting our partner hospitals to strengthen their infection prevention and control measures so that they are able to deliver quality eye care services in a safe environment, as far into the future as such measures are necessary.
As the pandemic has had a significant negative effect on national economies and less developed countries are only getting poorer, we do anticipate a negative impact on eye health in the long term. However, by moving forward with the WHO’s recommendations through the 2019 World Report on Vision, NGOs such as Operation Eyesight can support governments by providing solutions to help them meet the commitments they’ve made through the World Health Assembly’s IPEC resolution, eventually leading to long-term improvements to the eye health (and general health) of their citizens. We will continue to work with Ministries of Health to provide them with solutions they need to achieve this.
As part of this integrated focus, we are pursuing private sector partnerships with aligned organizations, helping them achieve their social impact goals while advancing our mission. Our external communication around our alignment with the SDGs is very important in demonstrating a clear path to the mutual benefit of these partnerships. Our recent partnership with Essilor fits this objective. Essilor is the world’s leading ophthalmic optics company. They design, manufacture and market a wide range of lenses to improve and protect eyesight. By working with Operation Eyesight through the provision of eyeglasses to vulnerable communities, we are helping them achieve their goal of eliminating poor vision in a generation.
We are also working with other NGOs, pursuing an integrated approach to eye health. This allows us (and the partner organization) find new ways to reach the people we serve. One example is combining efforts with another organization that specializes in gender transformative work to deepen our approach to addressing gender inequities. We have recently partnered with Kilimanjaro Blind Trust, a partnership which allows us to provide a comprehensive offering of low vision services within our programs without having to expand our own capabilities within Operation Eyesight. We’ve also started a partnership with Farm Radio, an organization that uses radio to strengthen rural communities in Africa and improve access to information in remote areas. Working together with other NGOs gives us a broader ability to address the full needs of the communities we serve, now as we face the effects of COVID-19, and into the future.