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The Gambia eye care programme

This step discusses a plan that became a model for the global VISION 2020 programme.
PROFESSOR ALLEN FOSTER: So in 1985, Dr. Hannah Faal from The Gambia did a survey of eye diseases in The Gambia. And she showed that there were 7,000 blind people in The Gambia, mainly from cataracts and trachoma. She was working as an ophthalmologist in the country. She could’ve just carried on doing her work day by day and so on, but she decided no, that change was needed to address this problem of avoidable blindness in The Gambia. So she set about a plan. Now to do that plan, she had to sit down. She had to kind of think where are we?
What’s the situation today, and how do we want it to be in the future, and what do we need to do? And gradually she developed that plan. And that plan was all about training guide care teams to address the problem of cataracts and equipping them, and also addressing the issues of trachoma through primary health care and training primary eye care workers. And gradually, year-by-year, she implemented that plan bit-by-bit, step-by-step. And she didn’t do it for one year or two years, she kept doing it. But at the end of 10 years, a survey was done again in The Gambia, and that showed that blindness had been reduced by 40% over the 10 years.
More than 2,000 people had been saved from blindness. And the cost of doing it was actually less than $0.10 per person, per year, so it was a very kind of effective programme. It wasn’t very expensive, but it made a big difference in the lives of people. So there was a plan, taken quite a long time to develop. But a plan to change from one eye doctor in one hospital to several cataract surgeons in the country, and all the health workers being trained in prevention of blindness and good eye care. And she managed to achieve it, so that’s a good example of what was done.
And that then actually became a model for the VISION 2020 programme to replicate that district by district.

The first 10 years of the Gambia eye care programme saw blindness in the country reduced by 40%. More than 2,000 people were saved from blindness and the cost of doing it was actually less than 10 cents per person per year.

In this video Professor Allen Foster describes the steps that Dr Hannah Faal, an ophthalmologist from the Gambia, took to develop and implement this plan and explains why it became a model for the global VISION 2020 programme to end avoidable blindness.

As you watch, reflect on how Dr Faal used epidemiological information to support public health eye care development in the Gambia.


The epidemiological data from the first survey provided information on magnitude, age, and geographic distribution and the main causes of visual impairment in the Gambia. It was used to shape a successful service delivery programme.

What are the strengths of population based data to initiate change and which stakeholders do you think should be involved?

Human resource development was key to the success of the Gambia Eye programme. Over 1000 village health workers (‘nyateros’, or friends of the eye) were trained in primary eye care, health promotion, identification, and referral of cataract and trachoma cases. All nurses also received some training in eye care and some specialised as community ophthalmic nurses. Development of mid-level health personnel as cataract surgeons improved availability and accessibility to services and the programme was not dependant on the few ophthalmologists available.

What are your thoughts on the human resource development approach?

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Global Blindness: Planning and Managing Eye Care Services

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