KCCO at 25: The relationships that make eye care possible

Lessons from 25 years of working alongside African eye care teams to strengthen services through capacity building, continuity and shared learning

In 2001, Paul Courtright and Susan Lewallen founded the Kilimanjaro Centre for Community Ophthalmology (KCCO) at Kilimanjaro Christian Medical Centre in Moshi, Tanzania. KCCO was founded to help put the ambitions of VISION 2020 into practice in Africa.

Twenty-five years later, programmes supported by KCCO have reached more than 1.9 million people, with partner hospitals performing more than 165,000 cataract surgeries. These shared achievements were made possible by government and mission hospitals, health authorities, communities and their leaders, funders and eye health professionals.

On 6–7 August, we marked our anniversary in Moshi with current and former partners and friends of KCCO. Others who could not attend sent video messages. Watching people reconnect, sometimes after years apart, reminded us that relationships are not simply a result of the work. They are part of how the work gets done.

Clinical training, equipment and consumables are essential, but strong services also depend on connections. Eye department teams need support from hospital managers and health authorities. Hospitals need effective relationships with communities. People need to know what care is available, how to reach it and what to expect when they arrive.

Much of our work involves strengthening the connections on which eye health services depend: between eye departments and hospital leaders, between hospitals and health authorities, and between services and communities. This work is less visible than providing equipment, but it can determine whether people receive care and whether services withstand setbacks.

Our community ophthalmology approach takes this work beyond the hospital doors. Together with hospital teams and communities, we plan around the needs of whole populations, including people who struggle to reach care. Across our programmes, we have helped train more than 10,000 community volunteers as case finders and eye health ambassadors. These have included community health workers and members of women’s microfinance groups. Because they are known and trusted in their communities, they can help people talk through their concerns, learn that treatment may be possible and feel more confident about seeking care.

Within hospitals, we combine management and leadership training with long-term mentorship. Our relationship does not end when a course does: we continue working with teams as they apply what they have learned, encounter setbacks and adjust their plans. Many of our staff have been with KCCO for years. They remember earlier challenges and understand the pressures facing eye department teams. That shared history makes it easier to speak honestly about what needs to change and to work together towards more sustainable services.

The experience of one hospital in Tanzania’s Mara Region shows why this matters. During a period without a resident eye surgeon, cataract services were at risk of interruption. KCCO worked with hospital leadership and health authorities to arrange visits by ophthalmologists from another region, while supporting doctors from the hospital to undertake ophthalmology training. Today, the hospital has two full-time ophthalmologists.

One government partner shared with us: “You have been there for us through ups and downs … you are always there. Just keep on doing that so that we can help as many people as possible.”

Over time, this way of working builds social capital: trust, shared experience and confidence that partners will support one another. That social capital grows when people stay engaged and work through difficulties together. It is hard to count and therefore easy to overlook when health programmes are designed and assessed. Yet it shapes cooperation between organisations, relationships between hospitals and communities, and whether improvements last.

As we look towards the Global Summit for Eye Health in November 2026, we have pledged to continue working alongside partner eye hospitals and hospital-based eye departments across sub-Saharan Africa, including through long-term mentorship and capacity building.

For us, turning commitments into lasting services means investing in the people, organisations and relationships that connect hospitals, health authorities and communities.

At our anniversary, we felt deeply grateful to everyone who has worked alongside KCCO. Our partners have shaped our work and taught us much of what we know. As we begin our next 25 years, we will continue strengthening these connections and helping more people receive the care they need.