At Operation Eyesight, we believe this needs to change. That’s why we’re working to strengthen areas of overlap between primary eye care and primary health care in our countries of operation. That means supporting the World Health Assembly’s integrated people-centred eye care (IPEC) resolution by working to integrate eye health into national health systems – and increasing access to free or subsidized eye health care.

It also means addressing the root causes of avoidable vision loss. In some regions in Africa, we bring fresh water and hygiene education to communities to help prevent infectious eye conditions. We also work to make sure our services offer more than just eye care, but can also link patients to other types of health care.

Why eye health can’t be treated in isolation

Health conditions rarely exist in silos – and vision loss is no exception. Diabetes, for example, increases the risk of eye conditions like cataracts. For 15-year-old Vanessa in Zambia, blurry vision was one of the first signs of the disease. When she started having problems reading the blackboard at school, a teacher sent her to our vision centre in her community of Matero for a checkup. From there, she received a referral to our partner hospital, where she learned that she not only had cataracts, but diabetes as well. Doctors helped her get her blood sugar levels under control, and then she got cataract surgery. Today, she is managing her diabetes and thriving in school, with dreams of becoming a doctor.

Vision problems can also cause a downward mental health spiral. Benson, a farmer in Kenya, lost his ability to work due to poor vision. As a result, he became angry and depressed, then turned to alcohol and drugs to cope with his situation. Luckily, his family got him into a drug and alcohol rehabilitation facility, where a visiting doctor diagnosed him with cataracts. Benson underwent surgery on both eyes, provided free of charge thanks to the support of our donors, and can see clearly now. Buoyed by his miraculous recovery, Benson finished up his time at the rehabilitation facility and happily threw himself back into farming.

Integrating eye care into Canada’s health system

In Canada, where Operation Eyesight is based, navigating eye care can be confusing. While the Canada Health Act covers medically-necessary eye health services, routine vision care like eye exams and prescription glasses often isn’t part of the deal. That leaves provinces and territories to fill in the gaps, and the result is a patchwork system. For example, seniors in Ontario get routine eye exams covered once they hit 65, but in Newfoundland and Labrador, those same seniors might have to pay out-of-pocket. It’s inconsistent, and it’s especially tough on vulnerable populations.

There is some support through the Federal Non-Insured Health Benefits (NIHB) program, which covers eye exams and eyewear for eligible First Nations and Inuit individuals. But even that has its hurdles: remote communities, limited healthcare infrastructure and cultural differences that make accessing care more complicated than it should be.

The passage of the National Strategy for Eye Care Act in 2024 was a major step forward in addressing these issues. As chair of the Canadian Eye Health Coalition, Operation Eyesight is helping shape a national framework that prioritizes equitable access to vision care. Our Global Director of International Programs, Kris Kelm, explains why it’s important that we have a seat at the table during the consultation period and beyond.

“We know that there will be many voices in this conversation with diverse interests, and we want to ensure there is representation from patients who have the least means and the least ability to access vision care,” he says. “The fact that we have over 60 years of experience working in this sector gives us a strong background to speak credibly to how we need to approach things in Canada, and our community partners can provide valuable insights to help shape eye care for all.”

He adds that Canada can learn from some of our countries of work, where eye health has been better integrated into the overall health systems and other public frameworks. As an example, he points to Ghana, where we work with the ministries of health and education to screen and treat students for eye conditions in the public school system. We have similar programs in Kenya and Zambia, too.

Another example is in India, where we are working with state governments to establish vision services in pre-existing government health centres. Building the capacity of vision care facilities within the country’s national health care system ensures that services reach the most underserved populations, as patients who are able to pay most typically seek care at for-profit facilities, rather than attending government services.

Community health workers: Integrating eye care at the community level

Shakuntala, in Madhya Pradesh, India, spends her days walking door to door through villages in her region, checking in on the health and well-being of families. She’s one of the million-strong network of Accredited Social Health Activists (ASHAs), employed by the Indian government, who deliver primary health care at the community level.

Her work includes providing pregnancy advice, supporting newborn care, educating parents about vaccinations and vitamins for children, and making all kinds of referrals to local clinics and hospitals. In 2022, Shakuntala added another set of skills to her toolkit: conducting primary eye health screenings, thanks to training provided by our Operation Eyesight team, in partnership with the Government of Madhya Pradesh. Shakuntala learned to measure visual acuity using an eye chart. She also learned to identify the signs and symptoms of various eye conditions. Once she identifies a patient with a possible eye condition, she refers them to the base hospital for diagnosis and treatment. In the meantime, she continues to provide advice and referrals on nutrition, vaccinations, prenatal care and other health concerns.

Shakuntala is just one of the thousands of community health workers we work with across the globe. In all our countries of work, we partner with existing health systems to recruit community health workers, mostly women, to help us deliver our programs. The health workers develop strong ties within the communities, resulting in high acceptance and trust in our programming.

Mabel, a community health nurse in Ghana, was trained in primary eye care so that she could identify eye health issues in addition to her regular duties. She says that being able to screen people at their home allows her to reach many women and girls who probably wouldn’t have left the village to seek eye health care, due to household responsibilities.

Water and WASH for sight

Anyone who has had a case of pink eye knows that having red, inflamed and itchy eyes isn’t much fun. But in some parts of the world, an eye infection can be a much more serious problem. Trachoma is an infectious eye disease that leads to vision loss and blindness in millions of people across the globe. It spreads easily through contact with eye discharge from infected people on hands and clothing, and through flies. If left untreated, chronic infections turn the eyelid inwards, causing intense pain and scarring of the cornea, which can lead to irreversible blindness.

Trachoma is preventable, and clean water is key to curbing the spread. When communities have access to clean water, people can clean their hands, faces and clothing more often, which prevents it from spreading.

In countries like Zambia, we work with Water Affairs (the government department responsible for water) to drill, rehabilitate and repair boreholes near where people live, work and go to school, so that whole villages have access to clean water. We also provide training to local volunteers in these communities in WASH (Water, Sanitation and Hygiene) and borehole repair and maintenance to ensure the clean water continues to flow. In areas where trachoma is endemic, we also work with partners to distribute antibiotics, which both treats and prevents trachoma.

It’s another way that we work to address one of the root causes of avoidable vision loss, but it also helps us tie into improved health outcomes overall. Accessible clean water helps prevent dozens of infectious diseases. It also improves quality of life for women and girls, who are often tasked with the job of fetching water, which can take up hours out of the day and prevent them from participating in school, work or other activities. Moreover, clean water means people can grow vegetable gardens, raise livestock and keep entire families, and communities, happier and healthier.

Tying it all together

When we invest in sight, we invest in education, productivity and dignity. To eliminate avoidable vision loss, vision care needs to be recognized as a public health priority and integrated into national health strategies. Operation Eyesight’s global experience – from rehabilitating boreholes in Zambia to collaborating with partners on new policies in Canada – demonstrates that integrating eye health into primary care, addressing environmental determinants like access to clean water, and empowering community health workers leads to sustainable, measurable outcomes. Policymakers have a critical role to play in building resilient health systems that ensure equitable access to vision care for all.

Read more about our approach to Hospital-Based Community Eye Health.

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By signing this important piece of legislation, the Canadian government has established itself as a global leader by prioritizing eye health care as an integral part of universal health care, while also achieving many of the United Nations Sustainable Development Goals (SDGs). In Canada, health care is a right. This Bill now makes eye health care a right as well. The passage of Bill C-284 gives hope to the one in five Canadians suffering from a condition that puts them at risk of blindness (eight million people) and the 1.2 million Canadians living with vision loss, figures which come from the 2023 Report Card on Vision Health in Canada, released by Fighting Blindness Canada and the Canadian Council of the Blind. The report states that every year, our national economic burden from vision loss is 32.9 billion dollars. The passage of Bill C-284 is about far more than sight – it is about education for children, employment for adults and independence for seniors.

Kashinath Bhoosnurmath, President and CEO of Operation Eyesight Universal, says, “Today, Canadians have achieved the right to sight, as our universal health care will incorporate eye health care for all, with the passing of Bill C-284, the National Strategy for Eye Care Act, into law. Eye health care too is a priority now in Canada.  This impacts us all. The law will support the many Canadians who have eye conditions they do not know they have. It will also shine a light into the lives of the millions of Canadians who struggle not only with their vision but also with accessing the eye health care they need—across every part of Canada. This inclusive bill signifies that eye health care must be available, accessible and affordable, and it will support child development and learning, adult employment and productivity and senior connection and independence. We are delighted that Canada has the vision to step forward as a national and international leader. We can all see the benefits ahead.”

The importance of this legislation cannot be overstated. Universal eye health care is proactive, preventative and supportive. It includes regular eye exams, early detection of eye conditions, treatment and ongoing supports. For some, treatment can be as simple as getting a pair of prescription eyeglasses which can be transformative – recent research found that students who don’t get the eyeglasses they need learn half as much as students with good or corrected vision, according to the International Agency for the Prevention of Blindness. This research also stated that when vision is corrected in school it can influence lifelong earnings by up to 78 per cent. This example shows that eye health care impacts not only individuals but also local and global economies. Eye health contributes to several of the 17 United Nations Sustainable Development Goals (SDGs), which have been set to build a more peaceful and prosperous world. These include good health and well-being, quality education and poverty reduction. 

For decades, Operation Eyesight has brought inclusive eye health care to communities and regions in countries in Africa and South Asia. We do this by partnering with national, regional, and local governments and leaders, including the ministries of health and education. We act as a bridge between communities, connecting every child, woman and man to local eye health care.

In Alberta, we have been piloting eye health care programs by working with medically underserved communities. We are building relationships with and listening to communities to understand their unique needs, cultures, lived experiences and lifestyles (rural, urban and more), while growing our capacity to support this work in a good way. We know that inclusive eye health care works when people are aware of its importance, it is available and accessible when and where people need it – close to home, school or work – and it is open to all regardless of ability to pay.

We welcome the opportunity to collaborate with governments, organizations and community leaders in Canada to inform this new national eye care strategy. We look forward to contributing our voice to advocate for it to be inclusive so that it is accessible, affordable and available to all. We will continue to raise awareness of the importance of eye health and the need for eye health care in Canada. Together, let us take a long view of our collective right to sight. 

Kris Kelm, Global Director, International Programs, Operation Eyesight Universal 

Kashinath Bhoosnurmath, President & CEO, Operation Eyesight Universal

About Operation Eyesight Universal  operationeyesight.com

Operation Eyesight Universal is an international development organization and registered charity working to prevent blindness and restore sight. Our vision is the elimination of avoidable vision loss. Founded in Calgary, Alberta, Canada in 1963, we are now a global community spanning four continents – Africa, Europe, North America and South Asia. Our vision is global and our focus is local, with teams on the ground in communities of work. Through activities like community outreach, water and sanitation projects, and health education, we at Operation Eyesight are addressing the root causes of avoidable vision loss which contribute to six United Nations Sustainable Development Goals: no poverty, good health and well-being, quality education, gender equality, clean water and sanitation, and partnerships for the goals.

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