Bringing eye health closer to Indigenous Communities

In the Philippines, at least 10 million people belong to Indigenous groups. Estimates show that 10-20% of the population are Indigenous, and most of them live in isolated rural areas.

Indigenous Peoples – locally known as IPs – often face poverty and inequality. Living far from the population centres, IPs are less able to access economic opportunities and public services such as education and healthcare. Differences in language, beliefs, and cultural practices also prevent IPs from enjoying the full range of social services available to their mainstream counterparts.

Although there are still no studies on the prevalence of vision impairment among Indigenous Filipinos, global trends show that IPs are more likely to be blind. For instance, in Australia where the health system is more developed, Aboriginal and Torres Strait Islander Peoples are three times more likely to be blind than other Australians.[1]

This eye health gap needs to be closed.

Following the footsteps of its founder Professor Fred Hollows, who championed Indigenous eye health in Australia, The Fred Hollows Foundation has ramped up its efforts to support Indigenous communities in the Philippines.Here are some lessons from years of experience working with IPs:

1. Break assumptions in program design. In its first project in the country, The Foundation trained barangay (community) health workers to conduct vision screening in the Indigenous communities of Tarlac. Despite the health workers’ efforts and enthusiasm, the uptake of eye health services remained low among Indigenous people.What works in mainstream settings does not necessarily apply in Indigenous settings. With this in mind, The Foundation conducted a study on the knowledge, attitudes, and practices of IPs as it started a new project in Surigao del Norte. Backed by solid evidence, The Foundation was able to conduct programs that were sensitive to the needs and context of Indigenous communities. This in turn, has resulted in more IPs accessing eye health services.

2. Partner with established institutions. The Foundation has partnered with institutions that already work with Indigenous communities, such as the National Commission on Indigenous Peoples (NCIP). All activities involving IPs are co-led with NCIP representatives, thus increasing trust among the community. This strategy also ensures the sustainability of eye health programs, even beyond the end of projects.
3. Train tribal health workers and nurses. Tribal healers are the first point of contact when IPs encounter health problems. NCIP nurses who look after Indigenous communities serve as a link to the public health system. Recognising the crucial role they play, The Foundation has trained both tribal health workers and nurses on vision screening.

By training people trusted by the community, vision problems are detected early, and blindness is prevented. This addresses the problem of people seeking eye treatments only when it’s too late.

4. Engage Indigenous leaders. Like nurses and tribal health workers, Indigenous leaders are trusted and respected by the community. When leaders and trusted figures are engaged in advocacy to promote eye health, the community listens. When leaders themselves use eye health services, the community is quick to follow and develop positive health-seeking behaviours.
5. Support out-of-pocket costs. Out-of-pocket costs are additional expenses beyond the actual treatment. This includes expenses on transportation, food, and lost income for the person accompanying a patient. These costs often pile up for Indigenous Filipinos, as they need to travel long distances – sometimes across seas and mountains – to reach major urban areas where health services are available.

While cataract surgeries are paid for in the Philippines’ national health insurance, out-of-pocket costs prevent IPs from seeking proper treatment. To address this, The Foundation has partnered with other donors such as the L’Occitane Foundation to shoulder out-of-pocket costs and encourage IPs to use eye health services.

6. Co-create eye health messages. In its pilot project, The Foundation designed communication materials to encourage IPs to use health services. The communication materials contained all the information they needed to know, including photos showing different eye conditions. But the materials weren’t enough to motivate people to seek treatment. The uptake of eye health services among Indigenous people remained low.

With this in mind, The Foundation conducted a series of Behaviour Change Communication workshops to not only consult, but also co-create eye health materials with Indigenous representatives. All messages were crafted by the IPs, written in their own language, and customised to their context and culture. The result was an increase in trust, and the health-seeking behaviours of IPs.

7. Train eye doctors and nurses to be culturally aware. Doctors and nurses are at the final step in the journey to access eye health services. The Foundation trained eye doctors and nurses to be culturally aware and be mindful of the unconscious biases they may have towards IPs. By doing so, doctors and nurses win the trust and confidence of Indigenous patients.

The Fred Hollows Foundation is committed to close the gap in eye health. By embedding these practices in our programs, The Foundation continues to bring quality eye health services closer to Indigenous Filipinos.

[1] https://www.aihw.gov.au/reports/indigenous-australians/eye-health-in-aboriginal-and-torres-strait-islande/contents/summary