A landlocked country, Zambia is one of the world’s poorest, ranking 150 out of 169 on the 2010 UN Human Development Index. In Zambia’s Luapula Province, often referred to as ‘the Valley of the Blind,’ poverty issues have allowed blindness to become a pervasive problem. Eye disease...

Bringing Quality Eye Care to Luapula Province

A landlocked country, Zambia is one of the world’s poorest, ranking 150 out of 169 on the 2010 UN Human Development Index. In Zambia’s Luapula Province, often referred to as ‘the Valley of the Blind,’ poverty issues have allowed blindness to become a pervasive problem. Eye disease is truly a disease of poverty, as it results from vitamin deficiency, malnutrition, poor access to clean water, inadequate sanitation and lack of access to proper health services.

In 2007, the Legatum Foundation launched a three-year, US $1,544,658 Strategic Initiative in the Luapula Valley to combat preventable blindness with an integrated strategy that focussed on both prevention and treatment for those afflicted. The Initiative was designed as an integrated programme executed by four implementing partners to reduce preventable blindness by improving access to appropriate health services and by improving community health through education, access to clean water and the use of pit latrines.


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Strategic Initiative

SECTOR

Health

TOTAL INVESTMENT

US$ 1,544,658

LOCATION

Zambia

LIVES CHANGED

471,296

SOCIAL IMPACT INDEX

41.4 (out of 100)

AVERAGE COST PER LIFE

US$ 3.28

Expand All

SI Breakdown:

Key Achievements

  • Communities educated on blindness prevention – 369,195 were reached with healthy eye care and blindness prevention education, a critical component of preventing the spread of eye diseases.
  • Increased rate of restorative surgery – A total of 2,061 people have undergone surgical procedures to restore or improve sight. The increased rate of surgeries from 150 to 600 per annum reflects a remarkable improvement in the region.
  • Improved access to professional treatment for eye conditions – A total of 52,175 people have received professional treatment for eye conditions.
  • Improved access to clean water and sanitation – About 35,000 community members experienced improved hygiene through the provision of wells, sanitation facilities, and education. Improved water and sanitation can directly reduce a community’s risk of developing eye disease.

The Problem

A landlocked country, Zambia is one of the world’s poorest, ranking 150 out of 169 on the 2010 UN Human Development Index. In Zambia’s Luapula Province, often referred to as ‘the Valley of the Blind,’ poverty issues have allowed blindness to become a pervasive problem. Eye disease is truly a disease of poverty, as it results from vitamin deficiency, malnutrition, poor access to clean water, inadequate sanitation and lack of access to proper health services. According to the WHO, 75 percent of blindness in poor countries is a preventable condition. Untreated conditions of preventable blindness due to inadequate clinical services and poverty are serious issues and this ailment has had a significant impact on Zambia’s economic and social development. Consequently, the government of Zambia has identified blindness prevention as a priority in health care.

Solution

In 2007, the Legatum Foundation launched a three-year, US $1,544,658 Strategic Initiative in the Luapula Valley to combat preventable blindness with an integrated strategy that focussed on both prevention and treatment for those afflicted. The Initiative was designed as an integrated programme executed by four implementing partners to reduce preventable blindness by improving access to appropriate health services and by improving community health through education, access to clean water and the use of pit latrines. Four implementers coordinated their activities for the widest impact. St. Paul’s Mission Hospital focussed on developing an integrated referral and treatment network for those in need of clinical treatment, training rural health centre staff and traditional healers on diagnosis and referral for eye conditions. Three other agencies were commissioned to provide prevention-related interventions. Copperbelt Health Education Programme (CHEP) was selected to undertake large-scale community sensitisation and health education; Jesus Cares Ministry (JCM) delivered a vitamin A supplement programme to first year entrants in primary school and trained teachers to teach ‘child to family’ health communicators; and Luapula Anglican Diocese Development Department (LAD) worked with communities to improve hygiene through the provision of wells, latrines, garbage disposal and hand and facial cleanliness. The goal was to reach approximately 330,000 people in four districts, and, as a result, to comprehensively reduce the occurrence of eye disease in the valley.

Critical Analysis

The Zambia Blindness Prevention programme has demonstrated how a narrowly prescribed geographical area can be successfully impacted by a concentrated and focussed development effort. The increase in the number of cataract surgeries from a mere 150 per annum before the project began in 2007 to an average of 600 per year now shows how sustained efforts have impacted the quality and effectiveness of the region’s public health services. St. Paul’s Eye Clinic, the central component of this Initiative, is an excellent modern asset, operating effectively and providing comprehensive clinical services. St. Paul’s Mission Hospital has also invested in training the staff of Rural Health Centres (RHC), but turnover and capacity of staff remained a major issue affecting the quality of services throughout the course of the programme’s implementation. Consequently, we will conduct an evaluation of the training programme during the next phase of implementation.

One successful component of St. Paul’s training programme, however, has been the training of traditional healers, who have been encouraged to move away from ineffective and sometimes harmful practices. Another partner overachieved with respect to its community sensitisation and training interventions, proving that sustained health awareness campaigns alert target communities to the issues of hygiene and sanitation, thereby influencing community behaviour. The number of people who now have access to latrines and safe water is another significant achievement. However, sustainability of the clinical aspects of this Initiative remains an outstanding challenge. It is apparent that had this Initiative not been extended for another three years, the management of St. Paul’s would have faced major barriers to maintaining services.

Based on our experience over the last three years, we plan to work primarily with JCM and St. Paul’s in the next phase. In the coming years, the Luapula Province will be able to shed its reputation as an area with the highest levels of blindness in Zambia, thanks to the work of this Initiative.

Lessons Learned

Successes:

Quality services for the poor are achievable – The central success of this SI has been the establishment of durable quality specialist services that will be widely utilised. Quality facilities also attract qualified staff. This SI has shown that, with the right commitment and investment, an essential public health service can be established to serve the poor.

Change is possible – Luapula Province now ranks second in the country for eye care. A qualified ophthalmologist now serves the area, there has been significant investment in infrastructure and equipment, and funds have mobilised community sensitisation and training activities to ensure sufficient dissemination of prevention activities and behavioural change.

Improved productivity and overall wellbeing – Beneficiaries of the programme who have received cataract surgery after being partially or almost totally blind have reported not only positive health outcomes, but also an improved ability to be productive members of their community. As we begin to explore the concept of prosperity and its impact from local development initiatives, we can look to the experience of this and other SIs and assess the degree to which they impact not just wellness, but overall wellbeing.

Mainstreaming of blindness into public health priorities – The prevention of blindness, like disability, is still not generally mainstreamed into development planning; it tends to be in the province of the specialist agencies. This programme has demonstrated that the issue of blindness is a priority for poor communities, as it is an issue of immense hardship for families struggling with poverty.

Challenges:

Stakeholder analysis and engagement – Although implementers have worked closely with the respective local and provincial authorities in the health, education and water/sanitation sectors, this has not resulted in sufficient adoption of the programme at provincial and district levels to create intra government ‘sponsorship.’ It seems that eye care still remains a ‘donor-funded’ cause, even though it is a component of the government’s national strategic health plan and overseen by a government agency. More analysis of the interests of various stakeholders would potentially have prompted a more deliberate strategy of collaboration.

Expectation of diagnosis and treatment at the RHC and community levels – The goals of training were overly ambitious in terms of expecting staff to diagnose and even treat infections. The best that can be achieved at RHC primary level is awareness of the need and a robust system of routine and emergency referral.

Baseline and training outcomes – Because of funding constraints, a proper baseline study for the Initiative could not be carried out as intended. The ability to compare current incidence and prevalence rates with those at the inception of the Initiative is key to demonstrating the impact of this programme.

High rural health centre staffing attrition – High staff attrition was identified as a risk to the training investment.

Zambia Blindness Prevention: Featured Projects

SII ScoreProject NameGrantLives ChangedCost Per LifeSector
61.20 Luapula Anglican Diocese$210,440179,119$1.17
54.00 Copperbelt Health Education Programme$272,306214,603$1.27
50.40 St.Paul’s Mission Hospital$794,74054,592$14.56
- Jesus Cares Ministries$267,17222,982$11.63
Note: The Social Impact Index Score reflects the relative social impact of a given development project. The lowest possible score is 20; the highest possible score is 100.

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