A photo of a Basic Health Unit with an accessible ramp entrance in Pakistan
Basic Health Unit with an accessible ramp entrance, Pakistan

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

Accessible health services for people with disabilities: With the aim of establishing a functioning inclusive primary health care system, the “Accessible health services for people with disability” project was implemented in two districts, making four existing Basic Health Units (BHUs) more inclusive. This included making infrastructure accessible; disability training for hospital staff and for Lady Health Workers (LHWs), who are attached to each BHU and are responsible for community outreach and referral. Disabled People’s Organisations (DPOs) were also set up in each local area. Photo shows front entrance of a Basic Health Unit with a concrete ramp entrance.

District Medical and Rehabilitation Complex (DMRC): A new district hospital was built to provide inclusive health care and disability services. This is the only provider of services for people with disabilities in Charsadda including in eye health, low vision and assistive devices for people with visual impairments. The DMRC is the main referral hospital for the four BHUs above and continues to be run by CHEF Intl. CHEF Intl provided free transport for patients to DMRC which helped increase attendance, particularly by women and girls. Photo shows a woman who is a wheelchair user being pushed by a family member inside the hospital approaching an internal opening with a ramp over the lip in the doorwary.

School renovation project: A school renovation project was implemented with the objective of converting 26 schools into inclusive education providers. In addition to improving accessibility of infrastructure, the project also included awareness creation workshops about disability and inclusive education for district authorities, community leaders and teachers. Handbooks dealing with inclusive education were designed for teachers. School children and members of the wider community were screened for eye and ear conditions and a number of teachers were trained in vision and hearing screening, as well as in community based rehabilitation and mobility. Photo shows the front of a school with a ramp entrance.

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.

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This article is from the free online course:

Global Health and Disability

London School of Hygiene & Tropical Medicine