When our team first met Esther, cataracts in both of her eyes had robbed this 79-year-old matriarch of her sight. For a year, she became completely dependent on her daughter-in-law for day-to-day care and was unable to play with her several grandchildren.  

“I was worried because I thought my blindness was irreversible and that I was going to be a bother to my children forever,” recalls Esther, who lives in the remote village of Kapnegtuny in Nandi County, North Rift, Kenya. 

“I felt very desperate.” 

Esther’s cataracts also prevented her from gardening and caring for her cows. She says she missed cooking at home and playing music at traditional celebrations in her village.  

I’m pleased to tell you that this grandmother’s story had a happy ending – she was able to receive cataract surgery at Operation Eyesight’s partner hospital, Meteitei Sub-County Hospital, free of charge.  

“I am very happy. I can now see again and can see my dear grandchildren again,” she explains. “Now, I can move around without help and do things on my own. I hope to go back to my house soon and even cook for my husband.” 

Barriers to gender equity in Africa 

As a mother of two girls, I found myself particularly touched by Esther’s story when I met her.  

Although Esther’s story had a happy ending thanks to the generosity of our donors and support of our partners, for many women – especially mothers – blindness and lack of access to eye care is often tied to poverty, economic exclusion and misinformation. This has been the experience of many of the women our teams meet in the field.  

These compounding factors often result in women and girls having reduced access to education, healthcare and participation in public life.  

Esther told our team that she was extremely anxious about receiving surgery and this was a barrier to her seeking care sooner. She made the courageous decision to undergo surgery thanks to the encouragement of a neighbour who had also received surgery from an Operation Eyesight partner hospital. 

“Though I feared surgery, I had to face it to regain my sight,” she told us.  

Why are so many women blind? 

We know that women and girls are disproportionately impacted by vision loss and blindness. Fifty-five per cent of those suffering from vision loss worldwide are women and girls, and those living in mid- and low-income countries are often more vulnerable to eye conditions and vision problems.  

Why? For starters, limited financial resources to travel and receive care often prevents many women from seeking help in the first place. To make matters worse, the prospect of travelling long distances through difficult and remote terrain, often across areas known for wild animals and bandits, frequently prevents women and girls from seeking the health services they need. 

Our teams working in communities across Kenya have also seen first-hand how lower literacy rates among women leads to misinformation about eye conditions such as cataracts and trachoma. This misinformation leads to fear among patients, and this unfortunately results in women frequently refusing to seek care, as was the case for Esther. 

Here in Kenya, the painful bacterial infection trachoma leads to irreversible blindness if left without antibiotic treatment. This disease spreads through flies and close contact with hands and clothing. Because of their traditional gender roles caring for children in the home, women are more likely to contract this potentially devastating infection, compared to their male counterparts. For every man infected with trachoma, there are three women who are blind from or infected with this painful condition. 

Removing barriers to care 

I’m proud of the work we do at Operation Eyesight because I see with my own eyes the difference our work makes in the lives of moms like Esther. So much of the work we are doing in communities is focused on addressing the root causes of blindness, including equity for women and girls.  
 
Last year, we trained more than a thousand community health volunteers who will provide door-to-door eye health screening and health education within their own communities. More than 80 per cent of these volunteers are women. It’s this focus on women and girls that allows us to impact the lives of women like Esther.  

I believe that together, this is just one way that we are dismantling the barriers that prevent many women and girls from accessing health services, including eye health care as well as maternal and child health information and resources.   
 
By recruiting and training female health workers and volunteers within a community, we are creating a culture that empowers women and girls in ways that go far beyond vision loss and blindness.   

For Esther’s family, who felt the strain of providing constant care to her, the impact of this work has been palpable. 

“Restoring the sight of our grandmother has helped us very much,” says one of her grandchildren. “We are now free and can go for our daily activities with no worry of who is going to assist her.” 
 
This is why our work matters. This is why we celebrate Mother’s Day.  

Alice Mwangi is Operation Eyesight’s Country Director for Kenya, where she has played a critical role in the transformative work happening in communities across the country. In addition to raising her two daughters, Alice provides overall strategic direction and leadership for our programs in Kenya. To drive forward our mission to prevent blindness and restore sight, Alice develops valuable partnerships with hospitals, the Ministries of Health and Education and other nonprofit organizations.

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Operation Eyesight has forged a partnership with the Ministry of Health in Kenya and supports implementation of the Kenya National Prevention of Blindness Strategic Plan. The plan is oriented towards provision of quality eye care services to all Kenyans, including the vulnerable members of the community. We work closely with the Ministry of Health through the Ophthalmic Services Unit and the County Departments of Health of seven counties.  We also engage with the County Departments of Education and Water where we have school screening and trachoma programs respectively. We recognize the importance of partnering with government in reaching a wider coverage in addition to project buy-in, ownership and support. Furthermore, partnership with government ensures integration of primary eye care into primary health care and continuity of eye care services after the project cycle.

We team up with other stakeholders to influence and develop policies at the national level. Through a collaborative approach, we have contributed to the development of the National Prevention of Blindness Strategic Plan as well as development and ratification of eye care guidelines and policies.

County governments are responsible for the health services in their areas. Operation Eyesight signs MOUs, with County Departments of Health, that define programs’ shared goals, objectives, expectations and roles and responsibilities of each partner. While the role of the County Departments of Health is to manage health services in the county, the eye units’ sole responsibility is to provide clinical eye care services.  Operation Eyesight provides grant, technical and program management expertise, including community eye health

County Departments of Health and eye unit teams are engaged from project identification and definition to cultivate project ownership and buy-in. Jointly with the partners, Operation Eyesight identifies gaps in the health system and plans the best way to narrow the gap within the context of competing needs and available resources. For instance, OE has, in the past, identified gaps in human resources for eye health and worked with County Departments of Health to identify staff and support them for specialized training in ophthalmology.  Upon completion of training, these personnel are deployed to serve in the eye units. Other gaps we have identified jointly include inadequate infrastructure; inadequate supply of essential medicines and consumables and inadequate diagnostic and theater equipment.

Beside training of human resources for eye health, OE’s support comes in form of donations of consumables, ophthalmic equipment and construction and renovation of eye units. We require that donated equipment is entered into the hospital’s asset inventory. Henceforth, the hospital is responsible for the security and maintenance of the equipment. Further, the County Departments of Health provide space where eye units are constructed or provide space to renovate and created eye unit infrastructure.

Our community eye health project entails training Community Health Volunteer (CHVs), a cadre recognized by the health system and responsible for prevention and promotion of health at level one of the health pyramid.  Our eye health programs recognize the critical role CHVs play, and we support their training in primary eye care to conduct door to door screening, identify eye conditions, provide counselling to patients and refer them to the nearest eye units.

For school screening programs, we work with the ministries of Health and Education through their established structures, which include County Departments of Education Resource Centers, Teachers Services Commission, Head teachers and School Health Patrons.

However, working with government has its own challenges; lack of prioritization of eye health resulting to limited allocation of resources, a challenge we have been struggling with over the years. Our advocacy is slowly bearing some fruits. Just recently, eye health is featuring in County Development Plans which is a huge step for consideration in allocation of resources. Frequent change of leadership at the county at times means delay in project implementation due to delay in decision making process.

Weak supply chain and limited resources often result in erratic supplies. To mitigate this, part of our support includes ensuring county procurement department is informed of essential drugs list and suppliers whose prices are affordable. Another challenge is high service delivery costs, pushed up by staff allowances for working away from their stations during outreaches. Operation Eyesight together with other Eye Care INGOs in Kenya and the Ophthalmic Services Unit agreed on some reasonable rates payable to ophthalmic workers to cater for their accommodation and meals when working away from their stations.

In conclusion, despite a myriad of challenges experienced partnering with government, the benefits of project sustainability override the challenges.

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