Globally, women experience a disproportionate burden of disease and death due to inequities in access to basic health care, nutrition and education.[2]  Women’s leadership in global health is essential to address these inequities, because women know first-hand the unique barriers women and girls face when accessing health resources. Therefore, they need to be involved in decision-making processes in addressing these gaps in health provision.

Shortly after COVID-19 was declared a pandemic, United Nations Secretary General António Guterres urged governments to put women and girls at the centre of their efforts.[3]

“That starts with women as leaders, with equal representation and decision-making power…Gender equality and women’s rights are essential to getting through this pandemic together, to recovering faster, and to building a better future for everyone.” – António Guterres

Women as health leaders

In Kenya, our Country Manager Alice Mwangi provides overall strategic direction and leadership for our Kenyan programs. Alice is a public health specialist with a wealth of experience in developing, managing and implementing programs. In her role, she develops valuable partnerships with hospitals, the Ministries of Health and Education and other non-profit organizations. These relationships are essential for implementing our flagship Hospital-Based Community Eye Health model.

Women have been bearing the brunt of COVID-19 around the world.[4] Alice knows first-hand that it is important to empower women to become catalysts of change to address health issues and create a lasting impact. Under her leadership, our COVID-19 response in Kenya focused on training female community health volunteers to provide critical health information to their communities. In total, these community health volunteers provided health education on COVID-19 to 602,366 individuals.

Women in eye health

Globally, 55 percent of people experiencing vision loss are women or girls.[5] This is partially because women tend to live longer than men and are therefore at a higher risk of age-related eye health issues such as macular degeneration. In many of the countries where we work however, women face more barriers than men when accessing eye health services.

We’re working with communities to empower them to take ownership of their eye health needs, starting with female community health workers. Women like Pinky, an Operation Eyesight-trained community health worker from Berasia, India, are champions of eye health in their communities. Pinky, who is a single mother, visits households in nearby villages to screen people for eye conditions and refer them for follow-up care if needed. In this role, she is not only able to help people in her community, but she’s also able to independently support herself and her daughter without assistance from male family members. 

Because of this, Pinky has become an inspiration to many young girls in her village. They look up to her for her tireless work ethic and independence. She says she finds her work so rewarding that she hopes that her daughter will one day also choose to work in the eye health sector. Pinky and many other female community health leaders like her are helping move the dial on eye health inequity.  

In celebration of #IWD2021, we #ChooseToChallenge inequities in eye health and support female leadership in global health.

[1] https://www.lshtm.ac.uk/research/research-action/women-leaders-global-health
[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4167801/
[3] https://www.unwomen.org/en/news/stories/2020/4/statement-sg-put-women-and-girls-at-the-centre-of-efforts-to-recover-from-covid19
[4] https://news.un.org/en/story/2020/09/1071502
[5] https://www.iapb.org/learn/vision-atlas/inequality-in-vision-loss/gender/

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The pandemic has forced organizations in nearly all sectors to shift their approach to work. This is particularly apparent in the international development sector, which in the past, has relied heavily on staff travelling from high-income countries to implement and monitor programs in low- or middle-income countries. With travel restrictions in place for the foreseeable future, many organizations are having to rethink their strategies.

Fortunately, Operation Eyesight’s approach of providing locally-driven solutions meant we were well-positioned to continue implementing and monitoring our programs in the long term, despite the challenges presented by the pandemic. Although Operation Eyesight is Calgary-based, a significant factor in our success is that we have team members in five countries across three continents. In our experience, we have found that the best way to ensure the success and sustainability of our work has been to apply the principle of localization to our work.

What does localization mean? The International Council of Voluntary Agencies defines localization as a process where international humanitarian actors shift power and responsibilities of development and humanitarian aid efforts toward local and national actors. Localization helps ensure that those who would benefit from the proposed initiative are a part of the solution, meaning they are consulted during every stage of the project, from design through implementation. When local actors are part of the solution, it ensures accountability and the long-term sustainability of the initiative. By strengthening the capacity of local and national actors, we can also enhance the speed, quality and scale of international development and humanitarian response efforts.

As an international development organization, we know we have a responsibility to increase the meaningful participation and leadership of local actors within our work – and we’re accomplishing this through our international and intercultural team, community-focused programs and network of local partners.

Equipped with knowledge of the local language and culture, the staff from our country offices tailor our programs to ensure they are meeting the specific eye health needs of the local communities. This helps to ensure that our initiatives are culturally appropriate and work within existing systems. It also meant that we were able to respond to the pandemic quickly by pivoting our day-to-day activities and utilizing our local team members to help our partner hospitals respond to the immediate threat of COVID-19.

Our program model is community focused. We believe in local solutions by local people. Operation Eyesight-trained community health workers empower people by giving them the knowledge and tools they need to care for their families. By amplifying local actors and engaging them in the solution we can effectively increase the sustainability of our programs.

Partnering with local governments and hospitals is the cornerstone of our work. We work with our network of over fifty-five partner hospitals to ensure they have the personnel, facilities and supplies available to provide quality eye health care to everyone in the surrounding communities. We also establish vision centres that serve as a link between the hospital and community. Vision centres are local eye health facilities equipped with the staff and resources to perform eye health screenings and basic eye health treatment procedures, eliminating the need for long-distance travel to regional eye hospitals. These vision centres are locally owned and financially self-sustaining, which helps to ensure the long-term impact of our efforts.

Operation Eyesight is committed to continuously improving and strengthening our model to ensure we carry out our mission to prevent blindness and restore sight in the most sustainable and impactful way possible.

This International Development Week, we invite you join us as we #GoForTheGoals. Click here to learn how our work contributes to the achievement of the Sustainable Development Goals.

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When countries invest in UHC, they are investing in their greatest asset: people. Good health keeps people out of poverty and allows them to fully contribute to their families and communities. Men and women can go to work and children can go to school and learn. Good health enables prosperity for all.

A common misconception of UHC is the notion that all health services are available to everyone for free, regardless of the cost. Each country has its own path to achieving UHC. What coverage looks like will depend on a country’s resources and the needs of its people. It is important to note that UHC emphasizes the importance of access to health services and information as a basic human right.

UHC is not a new concept, it is based on the 1948 WHO Constitution which declares health a fundamental human right and commits to ensuring the highest attainable level of health for all. In recent years UHC has gained significant momentum. In 2019, at the United Nations General Assembly, world leaders adopted the goal of working together to achieve UHC by 2030 as part of the Sustainable Development Goals.

The COVID-19 pandemic has disrupted health systems globally. Countries everywhere have experienced shortages of hospital beds, medical supplies and health care workers. It has exposed gaps in public health care and has exasperated inequities. Many of the gains achieved towards achieving UHC have been lost due to the pandemic. The time to act is now.

Eye health, a critical component of UHC, has been severely impacted by the pandemic. Over 2.2 billion people globally suffer from vision impairment or blindness. Avoidable blindness is a global issue that has been made even worse by the strain COVID-19 has put on health systems particularly in low- and middle-income countries.

The pandemic has brought many challenges, but it also brings an opportunity to re-think how we deliver health care and services. At Operation Eyesight, we are focused on ensuring our hospital partners and community health workers can deliver care in a safe environment by protecting themselves and their patients. Looking ahead to 2021, we are imagining new ways to bring affordable, sustainable, quality eye health care to more people than ever before. This includes innovations and technologies to bring eye health services closer to communities, reducing the need to travel long distances to reach a hospital. 

Operation Eyesight is committed to providing the highest quality of care to everyone regardless of their ability to pay. We work to address the root causes of avoidable blindness and remove barriers to access to care for women, girls, men and boys. In celebration of UHC Day 2020, we invite you to join us in eliminating avoidable blindness for the most vulnerable.  Together, we have an opportunity to build a safer and healthier future for all.

References:

https://www.who.int/health-topics/universal-health-coverage#tab=tab_1

https://www.who.int/news-room/fact-sheets/detail/universal-health-coverage-(uhc)

WHO. (2019, October). World Report on Vision.

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The theme of International Women’s Day 2020 is an equal world is an enabled world. We know that a gender equal world benefits everyone, not just women. We imagine a world where women and girls no longer needlessly suffer from vision impairment because they are not prioritized for treatment. We envision a world where women and girls have equal access to essential care and are empowered to take ownership over their eye health needs. In 2015, the United Nations set out 17 Sustainable Development Goals (SDGs) as a blueprint for a better world. Access to quality health care for all is paramount to SDG #3 – Good Health and Well-Being. To achieve both the SDGs and the World Health Organization’s VISION 2020 goals, we must eliminate all forms of inequity in access to eye care for women and girls.

Eye screening being performed by a community health worker

In spirit of IWD 2020, we are sharing the successes and challenges eye health organizations have had in their gender equity programming. This gives us an idea of where we’re presently at with integrating gender strategies into global eye health, while also highlighting the gaps that still need to be addressed going forward.

Two of the biggest challenges to gender equity programming that we face in eye health are addressing cultural barriers, and getting the full buy-in and support from local partner organizations. The Fred Hollows Foundation addressed these challenges by partnering with the Ministry of Women’s Affairs in Cambodia to conduct gender equity and eye health training within communities. They also partnered with the Ministry of Health to further embed gender equity within health programs. SDG #17 – Partnerships for the Goals, advocates for inclusive partnerships between governments, the private sector and civil society. By partnering with local, regional and national levels of government, we can address gender barriers to eye health and ensure the long-term sustainability of our efforts.

To achieve gender equity in eye health, we need the full participation of women and girls and men and boys. Operation Eyesight promotes this by training community health workers who conduct door-to-door surveys in their communities. They identify all people in need of eye care services and refer them to vision centres to ensure that they receive appropriate treatment. They also counsel the patient’s family members to ensure nobody is left behind. A champion of Operation Eyesight is Jaya Raju. Jaya is a widow who lost her husband in a fatal accident and was disowned by her in-laws. She suffered from severe depression following the accident, which was compounded by her fear regarding how she could support her child and aging parents. While looking for work, Jaya learned of an opportunity to work as a community health worker for Operation Eyesight and decided to apply. Although Jaya had very little experience, her determination and commitment landed her the job. Now, Jaya travels for two hours a day visiting households, talking to people and listening to their problems and concerns. She is now the breadwinner of her family. Her parents call her “Shanni Jaya” (Smart Jaya). They say, “she has now found the purpose of her life.” Jaya is an inspiration to other women in her community. Her willingness to learn and step outside of her comfort zone has allowed her to realize her full potential and achieve her dream of helping people by eliminating avoidable blindness from her community. 

The International Agency for Prevention of Blindness (IAPB) Gender Equity Working Group brings together eye health organizations working to eliminate avoidable blindness and eliminate all forms of inequity for women and girls. Collectively, we are addressing SDG #1 – No Poverty, SDG #3 – Good Health & Well-Being, SDG #5 – Gender Equality, SDG # 6 – Clean Water & Sanitation, and SDG # 17 – Partnerships for the Goals.  

Thank you to Fred Hollows Foundation, Seva, Mission for Vision and Operation Eyesight for their contributions to this article.

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