Case study: Pakistan eye health

In this article, Dr. Babar Qureshi, Director of Neglected Tropical Diseases and Senior Medical Advisor at CBM, provides a case study example of inclusive health services, specifically eye health. He introduces inclusive eye health and highlights a Pakistan inclusive eye health case study.

What is inclusive eye health?

Around 15% of the world’s population, or one billion people, live with disability. People with disabilities are the world’s largest minority group and 80% live in low and middle-income countries. ¹ Furthermore they make up 20% of the world’s poorest people.²

Inclusive eye health (IEH) means ensuring eye care services are accessible and welcoming to all members of the community, including people with sensory, physical and intellectual impairments, and those with mental health conditions. This is important, as many people with visual problems may also experience other impairments.³ It also means proactively ensuring that people with long term vision impairment access their right to wider opportunities in rehabilitation, health, education, livelihoods and social inclusion. IEH is essential for reaching the poorest people.

Achieving IEH requires responding to attitudinal, physical, communication and policy related barriers at all levels: national, regional, community & individual.

Pakistan IEH case study

Following the 2010 floods, CBM, an international non-government disability organisation, developed an inclusive eye health initiative through its local partner CHEF Intl in Charsadda district, Khyber Pakhtunkhwa (KPK) province in Pakistan. This was the first disability inclusive initiative at primary and secondary level in KPK Province.

Key intervention areas at different levels

1. Policy level: Creating an inclusive eye health taskforce as part of the National Committee for the Prevention of Blindness

2. Organisational level: Training CHEF field and headquarter staff in inclusive eye health

3. Service delivery level: Making facilities accessible and welcoming, including the training of staff in the following areas:

   • In 4 Basic Health Units (BHUs)

   • In 1 NGO unit, the District Medical and Rehabilitation Complex (DMRC)

   • Linked to one inclusive education project (26 schools)

4. Community level:

   • Training Lady Health Workers (LHWs) who conduct outreach at household level
   • Creation of four Disabled People’s Organisations (DPOs)

Inclusive projects, Charsadda

Key Strengths of the project

1. National focus on inclusive eye health

   Recent recommendations of the National Committee of Eye Health state that “National and Provincial Eye Care Cells should strengthen and expand existing capacities for human resource development in eye health in an inclusive manner and make it part of the national and provincial eye care plans.”

2. Integration into government system and government ownership

   The inclusive projects successfully cooperated with existing government structures, such as the LHWs, BHUs, district eye care providers, and schools. The government took responsibility for the primary health care project at the end of the project period.

3. Replicable best practice model for the Pakistani context

   Inclusive eye health services at the district level not only benefited people with disabilities, but also women and girls who have limited travel opportunities due to cultural barriers. By offering gender inclusive and sensitive services, including free transport, the number of women and girls who participated increased.

4. Community awareness increased and perceptions changed

   In some communities, people with disabilities are considered a burden and cursed by God for sins committed by the family. In communities witnessing the positive change that rehabilitation, assistive devices and empowerment have made to the lives of people with disabilities, there has been some change in perception. Training at school level has also strengthened understanding among school principals and teachers.

5. Sustainable referral system

   Through coordination with the different stakeholders, a sustainable referral system for people with disabilities and other poor people was established using existing transport hubs, which ensures referrals from community level up to primary and district level services.

6. Systems strengthened

   Capacity has been built where participation of people with disability was lacking, e.g. DPOs have helped strengthen the management committees of BHUs to promote inclusive practices in planning, implementation, monitoring and advocacy.