Breaking Barriers in Eye Health: Advancing Equity and Inclusion for Vulnerable Populations in Cambodia

Context: Cambodia continues to face inequitable access to quality health services, with gender norms and socio economic barriers limiting women’s and girls’ ability to seek care. Distance, cost, and limited decision making power further reduce their access to eye health services. Women aged 50 and above experience bilateral blindness at nearly twice the rate of men, yet cataract surgical coverage remains consistently higher among males. The Vision Initiative (VI) program responds to these inequities by integrating equity focused service delivery, health system strengthening, and community led approaches.

Intervention: The VI program promotes inclusion and access to eye care by partnering with the Ministries of Women’s Affairs, Social Affairs, and Health to provide refractive error and cataract screening for marginalised groups through inclusive service models. It has developed policies and guidelines to support referrals for women and people with disabilities to receive cataract surgery, treatment, and spectacles. The program also integrates inclusive eye health screening into primary healthcare and strengthens demand through community awareness and social media.

Outcomes: By addressing gender inequality and focusing on eye health priorities for vulnerable populations, the program has demonstrated tangible impact. Collaboration with line ministries has resulted in policies and guidelines that enable more inclusive service delivery. School-based screenings reached a high proportion of girls (54%), while women accounted for 60% of cataract surgeries and 58% of all spectacles provided—marking a significant improvement from 2019 survey findings, when men’s cataract surgical rate was 1.2–1.7 times higher than women’s. Strengthened data systems now capture sex- and disability disaggregated data, enabling more accurate analysis of service gaps and targeted interventions.

Implication/conclusion: This innovative experience demonstrates the program’s strong contribution to the 2023 In Sight Strategy, highlighting how policy development and cross ministerial collaboration can strengthen implementation and enhance equity. Integrating screening and surgical services with the involvement of multiple line ministries, combined with robust sex- and disability disaggregated data systems, has significantly improved inclusive access for marginalized groups and provides a scalable model for future programming.

Key insights: The persistence of gender inequalities in country context continue to hinder the access for eye health services for women, girls and people with disabilities; the program address this challenges through engagement with other related line ministries government, communities engagement and health system to deliver inclusive services; and lastly enhance data collection for sex and disability disaggregation to inform policy advocacy and policy change and provide as the model for scalable program.