Q&A: How one ophthalmologist set out to magnify impact by designing public health programs

BARCELONA — A pediatric ophthalmologist by training, Sandeep Buttan became curious as to how his decade of clinical experience could be applied at a wider community level and expand the impact of eye health care where it was needed most.

Working only within the walls of a clinic does not provide a full picture of the health status of a community and there is more to eye care than clinical medicine, Buttan told Devex. After studying for a master’s in public health, he decided to concentrate on designing public health eye care interventions. He is now the global technical lead for eye health in Asia with Sightsavers and provides leadership to eye health projects in India, Bangladesh, and Pakistan.

Buttan travels often for his work, which ranges from supporting the program teams in project design to providing strategic direction at both local and country levels. As well as helping carry out needs assessments to better understand stakeholders and build quality health systems that are affordable, he works with a range of professionals to gather and analyze evidence, integrating those findings into product development. With implementing partners such as eye hospitals and NGOs, he assists in the design of clinical protocols and training programs for health care workers, finding solutions for their day-to-day challenges.

Devex found out what obstacles Buttan faced in pivoting to community health work, what skills have been important to this career transition, and how he sees the impact of this work.

This conversation has been edited for length and clarity.

What are the biggest challenges of the job and what lessons have you learned to overcome these?

The first challenge, being a clinician at core, was to put on a public health hat. When we are designing interventions, there’s a huge difference in how you look at an individual with an eye disease or an ailment and how you look at that problem as a public health problem.

Also, in public health there’s so much existing knowledge on what we can do for our patients with avoidable blindness — like a simple pair of glasses or just a very simple cataract surgery — but there’s a huge gap between what we are able to implement on [the] ground because there is a complexity of systems.

[On] a day-to-day programmatic basis, the biggest thing is: How do we motivate people to work towards the areas where the need is the most? Normally, the services are quite unequally distributed, [with] most — human resources, technology, products — largely [found] in the major cities. But the needs are in the most remote areas, where the systems are so weak and the human resources are not available.

We keep trying to create new ways to make sure that this gap is filled and that we’re able to match the resources with the needs or come up with innovative ways where the lack of resources can be built into the system and we can create a model which works within those constraints.

How we’ve been able to overcome this is to look at issues from various perspectives — not only as a clinician and not only as a member of an organization that is designing projects, but also trying to look at it from the [perspective of the] person we are trying to help.

What skill sets have you found to be most valuable or have you focused on to progress in your career?

Having a good understanding of how clinical care works definitely has helped me, plus the knowledge that I got from my master’s in public health around what the challenges and the critical bases of applying public health concepts on the problems that we encounter. That public health lens is definitely a skill that comes in.

Communication is a very important tool because you are working in teams with people who are implementers in the programs: finance teams, technology partners, researchers, on-the-ground implementers. And how do you communicate technical concepts to them in a language that is not only understandable but also implementable?

Technology is changing every day, so having a good grasp of what are the recent advances in technology [is important] — and especially [those that] can improve the reach of care to the most underserved areas.

How do you see the impact of your work?

When you are looking at a post-evaluation for a project, you are able to see the outputs, the people who have benefited, and … if you have been able to change something in the society.

We ran a project in a rural area in India where, after four years, we had reduced the prevalence of blindness by almost half, so the attitude of people towards eye care was dramatically changed. They were more aware and more willing to take up health care compared with when it began.

That’s something that gives us a lot of satisfaction — even if we were not the direct implementers and were not on the ground treating people, but [knowing] a program that I helped design has created this change in the lives of people.

One other impact that we see is how much of it is scaled by other organizations, particularly the government, because the aim of our work is to create effective, sustainable, and viable models which can then be scaled up by other agencies.

How has the role of eye health professionals or organizations evolved in recent years as the sector has changed?

The sector has evolved quite a lot. As our understanding of health systems and of social determinants of health and the whole sustainability of development has evolved, we’ve realized that you can no longer keep it as a purely medical concept; you have to evolve it into a social and more developmental rights-based model.

We’ve realized that creating health systems which are responsible for the needs of the community is the only way of having the sustained, long-term impact of whatever work we do. That has opened up a whole area of opportunity for people with a good clinical background or good systems background to become the bridge between pure clinical work that gets translated into systems-level thinking of how it can be created into models and scaled up.

Changes … which are using technology as building tools for increasing service coverage and to reduce costs are, again, [opening] up the field for people who have technical backgrounds either in IT [information technology] or health informatics. Public health now requires a good amount of data, a good amount of analytics of technology and how it can be applied, and these are the things that are probably going to take the whole health development sector into the next phase.

Devex, with financial support from our partner Essilor, is exploring challenges, solutions, and innovations in eye care and vision. Visit the Focus on: Vision page for more.