Results in rural India offer window into what works to fight blindness

NEW YORK — Eye care education of untrained health practitioners has helped cut cases of blindness in half in the Sundarbans, one of India’s poorest and least accessible regions, according to new research by vision nonprofit Sightsavers.

“The ‘Seeing is Believing’ research proves what is possible in just a few years with the right approach. Five years ago, there were almost no easily accessible quality eye care facilities in the region, but now some of the Sundarbans’ most disadvantaged people know they can get their eyes checked by a qualified professional at a vision centre just 5-8 km from their homes,” RN Mohanty, chief executive officer of Sightsavers India, said in a media statement.

Approximately 1 out of every 100 people in India are estimated to be blind, but vision impairment is far more common in the Sundarbans, a cluster of low-lying islands in the Bay of Bengal that is home to 4.7 million people. There, 1 in every 40 people over the age of 50 were blind in 2013, according to Sightsavers. Now, that percentage has dropped to 1 in every 80 people.

Sightsavers India partnered with three local NGOs in the Sundarbans to develop 17 eye health centers within existing health facilities and to provide better training and equipment in five hospitals as part of their Sunderbans Eye Health Service Strengthening Project, which ran from 2013 through 2018. The project also included work with the government to support long-term infrastructure improvements in two district hospitals.

The research provides a unique window into the effectiveness of a development project targeting people with disabilities, according to Emma Jolley, global technical lead for health and disability research at Sightsavers U.K. But it is still challenging to parse what, specifically, led to the rise in vision care over a relatively short period, Jolley said.

“It was a package of interventions, and we cannot unpick which worked best and which worked less well,” Jolley told Devex. “It is important for research to be solutions-focused. No one needs a long list of the problems going on in a particular area.”

It could be helpful to better understand, for instance, why women and men in the Sundarbans have experienced a comparable rise in vision care access, Jolley said. This stands in contrast to the gender disparities that Sightsavers has found in other places, such as Mozambique, where men are far more likely than women to receive eye health care.

“It’s a completely different context from the Sundarbans, but our challenge [in Mozambique] is to think about how we can reach more women, especially older women,” Jolley said.

While the number of health facilities has risen over the past decade in India, workforce shortages are still common — and the availability of eye health care providers, in particular, remains limited, with approximately 1 ophthalmologist for every 90,000 people, according to Sightsavers.

India has been successful in increasing its cataract surgery rate by almost ninefold between 1981 and 2012, according to the World Health Organization, resulting in “modest reductions of vision impairment and blindness due to cataracts over this time period.”

Overall, India saw a reduction in blindness between the periods of 2001 to 2002, when the reported prevalence was 1.1%, and 2015 to 2018, when the prevalence fell to 0.45%, the WHO found in its first global vision report, released in October 2019.

While India offers cataract surgery and treatment of other eye conditions as part of its social health insurance, it remains unaffordable for many in the Sundarbans to pay for travel to or treatment at a clinic. A number of people in the Sundarbans also receive health and eye care from unlicensed and unqualified practitioners, Jolley said. Sightsavers conducted training for 1,964 of these practitioners on basic screening and diagnostics so that they can refer patients to a nearby vision center.

“Because it is a hardship location, it is hard to train doctors to work in Sundarbans, and there are not many formal medical services available. People are more likely to go to what is available,” Jolley said. “Instead of trying to cut [the rural practitioners] out, we want to harness the access they have to people by giving them some basic training and knowledge so they can do basic vision screening and make appropriate referrals.”

The program has doubled the number of people who said they would visit an eye doctor if they were unable to see clearly, according to Sightsavers’ research. Though the five-year program has ended, the new eye health centers are set to stay active.

More funding for research on disability programs could help identify solutions that allow people in remote and low-income settings to gain access to eye care, Jolley said.

“Until recently there has been generally less funding for programs on disability, but with the [U.N.] 2030 Agenda, there has been more focus on this,” Jolley said.

“To date, there is such little evidence, and what there is is such poor quality [that] it is almost impossible to say what works in terms of improving access not just to health, but interventions in education and social welfare. I can only hope that as the evidence becomes clearer, there has to be a prioritization,” Jolley added.

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.