Spotlight Eye Health

Eye health is one of the seven thematic priorities in health, which the Swiss Red Cross (SRC) supports through its Sister National Societies. Within the Red Cross and Red Crescent Movement, the SRC is recognized as a unique supporter in this health topic.

In 2021, Swiss Red Cross supported partners in Ghana, Togo, South Sudan, Kyrgyzstan, Nepal and Bangladesh in their endeavors to improve access to eye health, enhance the quality of care and induce behavior change practice among the population. As a member of the International Agency for the Prevention of Blindness, the SRC specifically contributed to strengthen eye health in Africa. Among the achievements are the launch of the World Report on Vision in the region, by supporting Primary Eye care trainings in Ghana and Zambia, by launching and training ophthalmologists in a Glaucoma toolkit, and by successfully advocacting to integrate eye health indicators in the national and regional health monitoring and information systems.

Key cumulative data 2021

The different eye health projects supported by the Swiss Red Cross (SRC) reached almost 475’000 people with eye health consultations, eye surgeries and eye health education and health promotion. The project teams trained 331 Red Cross and Red Crescent volunteers and staff and more than 200 eye health professionals, teachers and community workers in eye health.

Learn more about our impact in healthOpens a new window.

The examples represent snapshots of our work in the different intervention countries and highlight some of the specific output results of the year. The impact of the different country programmes in eye health are highlighted in the Programme Domain HealthOpens a new window.

Fostering ownership through strategic changes in eye health

Since 2005, the Swiss Red Cross (SRC) supports eye care services in the Northern Region of Ghana in collaboration with the Ghana Health Services and Ghana Red Cross Society. The project has restored the eyesight of hundreds of thousands of people in the region and therefore contributed significantly to the reduction of blindness and other eye health conditions. However, the project lagged behind in sustainably strengthening the national eye health system.

An evaluation revealed several weaknesses in the eye health system. It states the need for Ghana to develop a National Eye Health Strategic Plan consistent with the concept of Integrated People Centred Eye Care and with a focus on remodelling eye care services especially at the primary health care level. The stakeholder analysis showed that the current partnership process is project-oriented and fragmented. From a health system perspective, most partners contribute to consumables, equipment and training of staff. There is minimal to very limited input towards health information, health financing and improved leadership and governance. These findings have animated SRC together with the Ghana Red Cross Society and Ghana Health service to change the SRC strategic approach to eye care in Ghana. In the new project phase starting in 2022, SRC supports and strengthens Ghana Red Cross Society to further develop its capacity in community eye health and has thus transferred the responsibilities to the Ghana Red Cross. The new phase will support the National Eye Care Unit in the development of a National Eye Health Strategic Plan and support the implementation of the plan.

Due to Covid-19 the eye health project performed less well than in previous years. Long stretches of lockdowns restricted travel to the communities and eye health screening in schools was impossible due to school closures.

Pushing eye health forward in Kyrgyzstan

The Red Crescent Society of Kyrgyzstan (KRCS) is implementing an eye health project in the three Southern Districts Osh, Batken and Jalalabad of Kyrgyzstan since September 2018. Building on its huge network of volunteers and village health committee members, the project has been able to reach more than 200’000 people with eye health consultations and screening (including more than 43’000 children) in 2021. People eligible for further diagnostic and treatment, including cataract and other eye surgeries were referred to secondary and tertiary level eye hospitals. Eye health promotion reached 109’000 people, mostly in remote areas.

The mid-term review carried out in September 2021 commented the excellent prevention and screening work of the volunteers and teams. Alone in 2021, 224 volunteers and 42 staff were trained in eye health. Their work generates huge demand for diagnostic and treatment, more than the eye health system and its structures can cope with right now. In 2021, the Cataract Surgical Rate stood at 551/1.0 mio population in the target area. Ophthalmologists from four project-supported eye hospitals have carried out 1’708 cataract surgeries and 1’111 other eye surgeries. While quality of surgical outcomes is good (84 % of eyes with good visual acuity after 6 weeks of cataract surgery between 6/6 and 6/18), the health system urgently needs to increase efficiency in order to meet the demand. Policy changes are required to reduce hospitalisation days after surgery, and younger ophthalmologists need to get equal chances to enhance their skills and gain trust and reputation among the beneficiaries. The KRCS has entered into discussion with hospital directors and health system stakeholders to address the above-mentioned barriers in order to further increase the cataract surgery rate.

From partnership to ownership – the Surkhet Eye Hospital

In summer 2021, the Swiss Red Cross (SRC) concluded its partnership in eye health to the Nepal Red Cross Society (NRCS), after more than 30 years of operational and financial support. With the Karnali Eye Health project ending, the Surkhet eye hospital as well as the various community eye health centers in Bheri and Karnali zone are now operating under the sole operational, managerial and financial responsibility and ownership of the NRCS.

Despite COVID-19 restrictions, the hospital was able to provide 39’864 eye health care consultations between January and June 2021. 14’364 consultations were done in the Community Eye health centers or during outreach activities in eye camps.1’835 cataract surgeries were performed with 87% of eyes achieving a good visual acuity six weeks after cataract surgery in a range between 6/6 and 6/18.

New partnerships and effective collaborations have further contributed to the sustainability of the hospital. In 2021, the hospital management developed various partnerships and agreements with the Provincial Government, the Provincial Hospital, the health insurance, the local municipality and other eye health stakeholders and signed important long-term agreements. The hospital received, for example, equipment and supplies, pre-payment grants for cataract services to the most vulnerable people, financial and operational support to outreach services and reimbursement of service fees by the health insurance. All this has contributed that the level of cost recovery has reached 124% in summer 2021, allowing the hospital to make own investments in the future. The Surkhet eye hospital furthermore got the mandate to help establish and technically support seven more eye care units in rural areas under the local government’s management, contributing to increase access to eye health services in the rural areas of Nepal.

Innovative and equitable financing of eye health in Togo

In order to grant the most vulnerable people access to cataract surgery, the Swiss Red Cross (SRC) supported eye health projects in the Région Plateaux of Togo and introduced a voucher system. Trained volunteers of the Togolese Red Cross Society carry out community visits where they screen people for eye health problems. People detected with cataract undergo a second screening to determine their poverty level. Volunteers assist people to fill out an electronic questionnaire, which is analysed in real time by an independent team at headquarters. In order to evaluate the poverty status, it was decided with authorities to use the Poverty Probability Index. The cut-off point is at 58,5%. According to the score, the patient will receive a cataract voucher from the volunteer. The voucher includes the cost for the surgery, medicine and post-surgery follow-up. Thanks to this system, an increase in cataract surgery could be observed. Before the voucher was introduced, only 40% of the people where cataract was detected went to the eye hospital for operation. Thanks to the voucher, the uptake of surgery increased to 70%. Out of the 101 people (50 women/51 men) who went through the poverty screening in 2021, 63 people (34 women/29 men) received a cataract voucher. Out of these, 47 people (21 women) were operated in 2021. The remaining people will redeem their vouchers in the coming months.

COVID-19 seriously hampered the performance of the eye health programme because of repeated and lengthy lockdowns and school closure, which made community outreach work and school screenings almost impossible in 2021.

Eye health in emergencies

Good eye sight is important in all stages of life, and in all circumstances. In emergencies, other health issues tend to receive higher attention and priority than eye health. The Swiss Red Cross (SRC) supports people in protracted crises to get access to eye health.

Eye health in South Sudan

In the Bahr El Ghazal region of South Sudan, the SRC supported the Diocese of Wau and the South Sudanese Red Cross in conducting screenings and operations for the local people suffering from cataract and other eye diseases. Ophthalmologists and other eye health professionals from Juba hospital, the only functional eye clinic in the country, carried out the diagnostic and treatment in the Wau teaching hospital during an eye camp in April 2021. Screening sessions for people in Wau and in remote areas of the region helped identify eligible people for cataract operation. During screenings, it was possible to provide treatment to 2’400 people with allergic reactions, ophthalmitis and glaucoma. 548 people were finally operated for cataract (267 male, 281 female). 21 people even had both eyes operated in the camp. 97% of patients could see after the surgery. Building the local capacity in eye health remains central during these eye camps. However, due to COVID-19 related physical distancing and hygiene measures, only nine medical students were able to observe and learn from the cataract surgeries, which is less than planned.

In order to meet the high demand for eye health in South Sudan, the SRC explores further and more frequent engagement with the local partners and the Ministry of Health to encourage the training and education of eye health personnel.

Eye health in Bangladesh

In the camps of Cox Bazar, eye health services were provided to the displaced people of Rakhine State (Myanmar) in four Primary Health Care facilities run by the Bangladesh Red Crescent Society. The SRC supported these services through a partnership with the Fred Hollows Foundation. Throughout 2021, 4’932 patients (out of which 4.6% from the surrounding host community) were screened and 4’638 received some form of treatment. 492 patients received ready-made spectacles. Patients who needed surgery or special diagnostic for their vision deficit were referred to a secondary hospital. The primary health care facilities referred 454 patients for cataract surgeries and 71 patients for refractive errors.

Given the camp situation, referring patients to facilities outside of the camp areas remains a sensitive topic with the authorities. Partners need to cooperate closely to ensure all required procedures and approvals are followed, especially for non-emergency referrals.

Innovation in eye health – piloting the USee kit

Four Swiss Red Cross-supported eye health programmes tested a new diagnostic kit to detect and treat refractive error in secondary school children and adults in areas, where there are no optic shops. The so-called USee device allows a person to do a self-refraction under the guidance of a trained volunteer, who helps to determine the level of lens power required and assembles a pair of spectacles right on the spot. More than 150 community workers and Red Cross volunteers were trained. The USee kit has proved especially beneficial to people in remote areas. The kit helps to save transport costs and delay after having been prescribed a pair of spectacles. It also helps to reach more people in remote areas in an efficient manner.

In Kyrgyzstan, Ghana, Togo and Nepal, 8’359 people (3’699 male and 4’671 female) have undergone self-refraction with the USee kit, out of which 1’589 people were given a pair of spectacles right on the spot. 1’920 people were referred with other underlying eye health issues to the nearest eye health specialist. COVID-19 with its consequences of lockdown slowed down the roll out of the USee in the countries, however, all four countries are satisfied with the outcome of the pilot and interested to continue and scale up the use of the kits in order to contribute to reduce the high burden of undetected refractive error in the population.

The SRC will continue its engagement in eye health in the next years, thus making an important contribution to the Sustainable Development Goals, as highlighted in the World Report on Vision (2019)Opens a new window by the World Health Organization (WHO). Healthy eyes are needed to study and learn and thus meet ones’ potential in education. Healthy eyes are important to secure income, ensure economic growth and lift people out of poverty. Healthy eyes are key to life.

The SRC recognizes the close links between eye health and the remaining health priorities of the SRC such as for example non-communicable diseases, reproductive health, and aging and health. In the coming years, the SRC will advocate for and support partners in the implementation of integrated patient-centered eye health and embark on opportunities to scale up and scale out successful approaches in the existing as well as in new countries of intervention.