Launching Universal School Eye Health in Africa

Summary

In 2023, EYElliance, in collaboration with Ministries of Health and Education, and the OneSight EssilorLuxottica Foundation, committed to launch Universal School Eye Health in Africa. Universal School Eye Health involves school-based vision screenings and provision of eyeglasses ensuring that children with poor vision have equal opportunity to succeed in school. Over the next three years, EYElliance will complement and cultivate Ministerial capabilities in Uganda, Ethiopia, and Kenya enabling them to lead national level school eye health as part of integrated school health and inclusive education. As a result of the commitment, an estimated 4,171,000 school children will be screened for vision problems and those who need a pair of eyeglasses will receive them for free. Leveraging strong relationships with UNESCO’s International Institute for Capacity Building in Africa, the Clinton Health Access Initiative, the World Health Organization, along with a donation of children’s eyeglasses and technical support from OneSight EssilorLuxottica Foundation, will accelerate scale up.

Approach

EYElliance will partner with Ministries of Health and Education that have prioritized school eye health to reach children with vision screenings and a pair of eyeglasses, if needed, on-site in schools. This will result in improved educational outcomes, test scores, literacy rates, and increased rates of primary school completion with positive implications for lifetime earnings. The Clinton Health Access Initiative (CHAI) and EYElliance are joining forces to complement and strengthen Ministerial capabilities enabling them to lead national level school eye health as part of integrated school health and/or inclusive education. The commitment will advance the following areas of work: 1) Assess current policies and eye health infrastructure to inform the development of national plans; 2) Identify pathways to sustainable financing,3) Integrate eyeglasses in government supply chains and operations, including quantification and inventory management; 4) Develop and implement monitoring and evaluation systems, including the integration of indicators into education and health information systems; 5) Develop curriculum and training materials for teachers and healthcare workers; and 6) District level implementation.
EYElliance has extensive institutional knowledge and codified learnings from facilitating government-led school eye health in Liberia. It also acts as a liaison with the eye care community of practice staying apprised of innovations and best practices. Leveraging strong and trusting relationships with the Global Partnership for Education (GPE) and the World Bank, EYElliance will also work with Ministries of Education to identify and advance opportunities to unlock new resources in support of school eye health.
CHAI is present in 40 countries as a trusted partner to the government, bringing a unique approach to technical assistance and with their offices often co-located at Ministries of Health. New normative tools developed by the WHO and UNESCO will create efficiencies and expedite curriculum development, training, and planning.
The OneSight EssilorLuxottica Foundation will donate children’s eyeglasses and manage shipping and delivery to countries.

Action Plan

Months 1-3:
Expand school eye health in 2-3 countries : conduct a landscape assessment of current resources, policies, and points of integration to inform the development of a costed national plan for integration and sustainability, including sources of financing for services and products.

Months 4-5:
Facilitate glasses donations.
Develop or revise training package that has previously been approved by Ministries of Health and Education.

Months 6-12:
Complete glasses shipment and distribution (e.g. in-country clearance) .
Work with Ministries of Health and Education supply divisions to integrate eyeglasses in supply chains.
Develop indicators to be integrated into education and health information systems Train national-level master trainers.
Inception meetings with local health and education officers.

Months 10-12:
Conduct quantification inventory control and sorting for first shipment.
Integrate tools for monitoring, supervision, and evaluation Initiate teacher trainings

Months 13-36:
Ongoing teacher trainings Implement delivery model: teachers or school nurses conduct screenings of students, eye health professionals perform eye exams and dispense eyeglasses if needed, and eye health professionals refer more complex cases for advanced care.
Conduct learning workshops, and incorporate school eye health into district health and education plans Scale to all districts based on national plan and year 1 findings.

Months 1-36:
Technical Working Group between Ministries of Health and Education and partners to oversee implementation of national plan for integration and sustainability.

Background

Untreated vision impairment and poor vision is one of the most common preventable disabilities for children and a growing public health and education problem. Worldwide, more than 300 million children (WHO World Report on Vision 2019) have poor vision that can be easily corrected with a pair of eyeglasses. A lack of routine, reliable access to glasses either through public health systems or the private sector is holding this problem in place.
The most common cause of vision impairment and poor vision in children is myopia. With this condition children can see nearby objects clearly but objects farther away, such as a classroom blackboard, are blurry. Myopia can affect children as young as six years of age but is commonly diagnosed between8 and 12 years of age and may worsen during adolescence. 90% of those living needlessly with impaired vision live in low- and middle-income countries (LMICs) (WHO, 2023) . NGOs have stepped in to fill the gap, pioneering and proving models of school-based vision screenings and eyeglasses provision (also called ‘school eye health’) , but the NGO-led approaches do not provide a pathway to national scale. Unfortunately, rates of myopia are rapidly increasing. If current trends continue, about half of the world’s population, or 4.8 billion people, will have myopia by 2050. (Holden, B.A. et al. 2016. “Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 through 2050.”Ophthalmology 123(5) :1036-42.) It is estimated that 80% of classroom learning during a child’s first 12 years occurs through vision. Children with poor vision have lower educational outcomes, such as lower rates of completion and literacy. Girls in LMICs are more affected by poor vision than boys as their access to diagnosis and treatment is more limited, further contributing to inequities. Children with poor vision are unable to benefit from other interventions designed to improve educational outcomes. The immediate, positive impact on learning outcomes associated with correcting children’s vision with eyeglasses will be a powerful tool in addressing the learning crisis.

Progress Update

EYElliance and CHAI are complementing and cultivating Ministerial capabilities in Uganda and Ethiopia to integrate school-based vision screenings and eyeglasses into their public education systems. EYElliance has enabled these Ministries to add the intervention into policy and practice and will support the incorporation of glasses into government supply chains. With its partners, EYElliance is building a world where national government-led school eye health initiatives reach millions of students, creating equal learning opportunities for students with poor vision.

In Uganda, new data have been generated on the magnitude of eye health conditions via a rapid assessment of primary school students. The OneSight EssilorLuxottica Foundation provided the ready-to-clip eyeglasses distributed to the students who needed them. The Ministry of Education has used the results to inform their plans to deliver eyeglasses to students in public schools.

In Ethiopia, the Ministry of Education is realizing its commitment to inclusive education by offering vision and hearing screening services in schools. In preparation, the teacher training manual has been updated to support vision screenings, and an in-depth mapping of the referral, supply chain, and data information systems is underway.

EYElliance is in conversation with partners to scope and plan school eye health efforts in other countries instead of Kenya as originally planned.

Beyond these country-level efforts, EYElliance enlisted UNESCO’s International Institute for Capacity Building in Africa (IICBA) to analyze the costs and benefits of school-based vision screenings to make a compelling case for governments. Initial findings from the analysis indicate that for every $1 invested in school eye health programs, benefits in the form of increased wages and earnings range from $6 to $26.

Partnership Opportunities

EYElliance is seeking philanthropic resources to scale the commitment to action as well as strategic support from Local Education Groups in Uganda, Kenya, and Ethiopia.,Members of Local Education Groups in each country will be encouraged to join this collaborative effort and support national scale of school eye health as part of integrated school health or inclusive education. At the culmination of the project, EYElliance will have a set of open-source, contextualized tools including costing and decision-making tools that will be available to all governments. In addition, EYElliance will be able to share insights into the feasibility of incorporating children’s eyeglasses into insurance schemes.