Our Hospital-Based Community Eye Health Program model is powered by two key innovations. One is our method of mapping villages into territories or clusters, and accounting for every single household in each cluster. We train community health workers (CHWs) to conduct door-to-door surveys, screening people for eye health problems, diagnosing conditions and referring residents to the necessary level of care. They ensure that no person in their assigned cluster who needs eye health care goes without it. They assess all members of the household and guide them toward the appropriate level of care (from local vision centres to more centrally-located hospitals). By diligently following this method in all clusters, we can confidently declare entire clusters (and eventually, entire villages) avoidable blindness-free. CHWs also educate communities on the importance of eye health and general health, leading to better long-term eye health-seeking behavior and a sustainable model that will keep the cluster avoidable blindness-free into the future.

A second innovation is employing members of the community as CHWs. A key issue with encouraging people to pursue eye health care is trust. Many people in these villages have a variety of concerns when it comes to seeking help for eye problems, including the fear of surgery complications, a lack of financial resources and superstitions around eye problems, among other things. If they’re approached by someone with a similar background who understands their concerns and is more likely to have their best interests in mind, they are more likely to accept help and advice.

Were any partnerships leveraged or created?

Our Hospital-Based Community Eye Health Program (HBCEHP) model is driven entirely by effective partnerships. The turning point for a new approach to partnerships began in 2002 when we entered into a formal partnership with L.V. Prasad Eye Institute (LVPEI) in Hyderabad, India. With LVPEI, we began to optimize our partnerships to pursue a more targeted and sustainable model of aid.

Developed by our India staff and piloted in 2009 to 2010, our HBCEHP model was implemented with the partnership of local hospitals and community-based vision centres. The community health workers are employed by our partners and trained by Operation Eyesight. We work with these vision centres and hospitals to build capacity for treatment and improve facilities, allowing them to provide quality care to more people. We also work with them to develop programs whereby those who can afford to pay for treatment fund the facilities, with the understanding that everyone who seeks treatment will receive the same care whether they can afford to pay or not. This ensures sustainability of the facilities to independently provide quality care into the future.

Today we’re implementing our HBCEHP model in India, Nepal, Ghana, Kenya and Zambia in partnership with local government, private and NGO hospitals. We have plans to expand to other countries in South Asia and Africa, which will require us to develop more partnerships with local hospitals and the governments of those countries.

What communications strategy did you employ to share the initiative with your stakeholders?

Our key stakeholders are our donors – none of what we do would be possible without them. The most important communications objective with our donors is to ensure that they see that people are helped through their donations, so our main focus in all communications vehicles is to provide patient stories that demonstrate to donors how their donations are making a difference for individuals, families and entire communities.

For those who are interested in how our program works, we do also provide education around our Hospital-Based Community Eye Health Program model through a variety of communications. There is some detail about the program on our website, and we provide more information about the program through stories on our blog, in our SightLines print newsletter and in our Glimpse e-newsletter.

How were KPIs and the levels of success outlined and defined?

To declare a village avoidable blindness-free, there must be no individual who has visual acuity less than 6/60 in the better eye as a result of avoidable or treatable conditions. By diligently charting out all households in each cluster and training community health workers to ensure every person in every single household is assessed and receives any necessary treatment, we know that these clusters can be declared avoidable blindness-free. And with sustainable programs in place to educate community members and encourage them to seek eye health care in the future, we can move on to other communities that need our help implementing this model. Both the definition of avoidable blindness-free villages and the methodology for elimination of avoidable blindness that we follow are validated by a third party.

In addition to the ultimate goal of declaring villages avoidable blindness-free, our programs define other KPIs to determine success of the program, including the following numbers: people screened, sight-restoring eye surgeries performed, eyeglasses dispensed, mobile eye vans launched, existing vision centres established or strengthened, hospital improvements made, community health workers trained and primary health care staff trained.

In 2013, our model was endorsed by Vision 2020 India, a national eye health advocacy group. The group encourages all Indian hospitals to adopt Operation Eyesight’s model, regardless of whether they are in direct financial partnership with us. In 2018, Charity Intelligence Canada named Operation Eyesight one of the Top 10 Impact Charities, for the impact we’re able to create with every dollar.

How were reporting and monitoring conceptualized and undertaken?

Continuous monitoring of all activities within a particular Hospital-Based Community Eye Health Program is carried out by the project coordinator on a daily basis, and by the hospital management on a weekly basis. The results of door-to-door surveys and cluster-based implementation plans serve as the basis for monthly and quarterly monitoring by the hospital management. Registers maintained by field staff are reviewed regularly, and necessary measures are taken to ensure projects stay on track.

Steps that are a part of this monitoring include recruitment and training of community health workers, door-to-door surveys, cluster-based micro plans to meet the specific needs of the community, referrals and treatment, and health promotion in the community.

Following completion of the project, the following steps must be taken to declare the village avoidable blindness-free:

• Verification of cleared backlog cases identified through the initial survey
• A post-project door-to-door survey conducted under the supervision of an ophthalmologist
• Treatment of remaining cases and follow-up
• Certification from local authorities and ophthalmologists of patients who cannot be treated due to medical or other reasons
• A post-project survey to assess the community’s current level of eye health-seeking behavior.

A critical aspect of our Hospital-Based Community Eye Health Program (HBCEHP) model is the work we do to build the capacity of our partner hospitals. We follow an inclusive approach, strongly advocating that sub-standard care is not an acceptable answer to shortcomings to existing facilities in low-income countries. We’ve learned that, while ensuring quality “supply” will be there when people need it is important, we must also balance this with a community focus on creating the “demand” for eye care services. If our HBCEHP model is improving our partners’ capacity to provide “the best for the poorest,” we need to ensure that we’re driving low-income people to seek eye health care.

One example of this arose in Kathmandu, Nepal. We conducted a needs assessment of Nepal Eye Hospital and upgraded its operation theatre complex in 2016. We also provided training for eye health personnel and community health workers (CHWs). The CHWs conducted door-to-door eye screenings, referred patients to the hospital for treatment, and created eye health-seeking behavior in the community. The community’s response was even better than anticipated. The hospital couldn’t keep up with patient demand because its out-patient department (OPD) was outdated and overcrowded, and they couldn’t properly manage the flow of incoming and outgoing patients. Recognizing that the OPD was creating a breakdown in the entire system, we raised the funds needed to renovate the facility. The upgraded facility now has the capacity to meet patient demand and provide quality eye care services to more people.

What were the key impacts and results?

To date, we have declared 1,015 villages avoidable blindness-free as a result of our Hospital-Based Community Eye Health Program (HBCEHP) model. This means that every child, woman and man living in these villages has been screened for avoidable blindness. Any person who required intervention has received it, and if possible, had their sight restored. These communities have also been educated to better understand how important eye health care is, and they have learned positive eye health-seeking behavior. They have become empowered to look after themselves, their families and their entire communities.

An additional impact of our program has been the empowerment of women and girls. The community health workers (CHWs) employed by this program are primarily women. CHWs hold a respected position in which they carry out a very important job, earning the respect of others as health experts in the community. Also, women and girls are more likely to be blind than men and boys, because they are less likely to receive the necessary care to preserve or restore their sight. The HBCEHP model ensures that every person within a community will be assessed and receive care, regardless of gender.

Our goal is to declare at least 2,020 villages avoidable blindness-free by 2020. Using the lessons learned from our experience so far and by strengthening our partnerships moving forward, we are confident that we will achieve this goal – For All the World to See.