The SIB project in Zimbabwe has been pioneering efforts towards improvement in eye health services through supporting a Rapid Assessment of Avoidable Blindness and facilitating an Accessibility Audit with the main thrust of creating inclusive eye health services towards Vision 2020. During the first three years of the SIB project in Zimbabwe, a Rapid Assessment of Avoidable blindness (RAAB) was conducted in Manicaland Province in 2016. This research has been very useful in informing the project implementation and planning in order to enhance eye health service provision in the country.
Zimbabwe’s eye health sector has been poorly financed from the national budget, partly due to limited fiscal space, a shrinking tax base and lack of robust data to trigger recognition of the yawning gaps in this sector. The country has for long relied on the World Health Organization’s estimates on prevalence of blindness in the country. This lack of localized data was one of the reasons for conducting the RAAB exercise in Manicaland province. The results of the RAAB, which were endorsed in July 2017 by the Ministry of Health and Child Care, indicated that approximately 6,158 persons in a population of 201,811 aged 50 years or older are bilaterally blind. The prevalence of blindness in the province was found to be 3.1% which is very high when compared to the WHO estimate of 1%. This alone signals the importance of local data in the planning and resourcing of eye health programmes.
In an effort to relieve pressure on the national budget, the Government of Zimbabwe introduced a health fund levy of $0.05 for every $1 of airtime or mobile data used. Armed with this report, the department of Non-Communicable Diseases in the Ministry of Health and Child Care approached the Ministry of Finance to get a share of the Health Fund Levy to address the findings of the RAAB. $400,000 was allocated to the MoHCC for the specific purpose of procuring consumables and supplies for massive eye outreach surgical camps for Manicaland Province; an applauded gesture in the current economic context and an encouraging response to research by the Ministry of Health and Child Care.
Cost of accessing treatment, fear of surgery, distance to eye health facilities and lack of knowledge on the possibility of treatment for cataract, ranked among the top barriers to cataract surgery in Manicaland. In a bid to promote inclusion and break these barriers, the SIB Project in Manicaland has been conducting outreaches whereby the project vehicle goes into the hard to reach areas, where people identified to be in need of surgery but with resource constraints are picked-up and ferried to the base hospital for surgery. The Sakubva Eye Unit in Manicaland which is supported under the SiB project also conducts eye camps at local hospitals in rural areas to perform eye surgeries at little or no cost. This approach has been welcomed by the communities and in particular, the patients whose mobility is limited by age, cost and distance.
The SIB project has also been complementing the work by the Ministry of Health and Child Care by advocating for the continued implementation of the negotiated fee structure at the eye units. The price of cataract surgery for adults and children is currently at $70 and $40 respectively down from a possible $400. Compared to a market price of $150 or more for spectacles, children and adults are able to access these at a cost of between $6 and $35. This is an important initiative considering the economic situation in Zimbabwe where a larger percentage of the population is living under the poverty datum line and eye health becomes less of a priority. The complementary efforts by the SIB project has seen a lot of patients being able to access eye health services at a very low cost.
Recently, the project held a workshop on development of IEC material where several stakeholders participated. One of the basis for the messages on the material developed were the findings from the RAAB which indicated a lack of knowledge on preventable blindness, cataract surgery procedure and limited knowledge on availability of subsidized services. In an effort to respond to these issues, messages were tailor made to respond to the unanswered questions and diffuse myths in the minds of the target population.
Research is one of the best tools for advocacy that should be strengthened in eye health. It has great and untapped potential to unlock resources for the silent but vulnerable population segments.
Intern (SIB Project) – Zimbabwe Council for the Blind