Addressing the Gender Gap in Eye Health – Experience of the Seeing is Believing project in Tanzania

Sightsavers, in collaboration with Singida Regional Authority, implemented the Maono Project from April 2016 to March 2020. The main aim of the project was to contribute to the sustainable provision of eye care services in seven districts in the Singida region focusing on on-demand creation and improvements in current delivery mechanisms.

The Rapid Assessment of Avoidable Blindness (RAAB) conducted by Sightsavers in 2017, shows the cataract surgical coverage in Singida region is relatively low with only about 52.7% of those in need receiving cataract surgery. The coverage is higher in men at 65.1% which highlights the existing gender gap when it comes to access to eye care services.

Based on both the RAAB and a Gender Study carried out in Singida in March 2019, it is evident that several barriers come in to play when considering access to cataract surgery and other eye care services among women. Although both studies highlighted similar barriers, it was evident that there has been significant progress in the elimination of gender barriers in eye care.

Socio-cultural barriers limit women’s access to eye health as a result of factors such as low level of education, poor socio-economic status, competing household priorities and lack of decision making authority in the family that in turn lead to limited access to information as well as the capacity to seek eye health care. Some of the rural villages in Singida lacked proper infrastructure and health services including eye health services which in turn forced community members to travel long distances incurring high transport costs to access services.

This geographical barrier further exacerbates the plight of rural communities, more so for women who have a lot of household responsibilities in accessing eye health care. Provision of outreach services is also affected by this barrier as some areas are too remote and lack essential facilities e.g. electricity– necessary when setting up a proper theatre room. Women in rural Singida have limited access to income, which hinders their access to health services. Despite free cataract surgeries being provided during outreach sessions, the cost of transport from the villages to the outreach site led to financial barriers and in turn affected the willingness to access treatment. This went beyond the transportation costs whereby women had to forego treatment in consideration of ‘time lost’ and in turn, financial strain during recovery and post-surgery follow-ups as most family-related responsibilities lie on the women. This also comes into play when considering existing institutional barriers such as an insufficient number of specialists and the necessary eye care equipment that lead to long waiting lists/backlogs and dependency on referral to the Regional Hospital that is a distance away from most community members. Many women only go for screening but fail to go back for treatment and/or surgery services.

To address these barriers the MAONO project applied various strategies aimed at strengthening eye health services and bringing eye care services closer to the community, For example through the construction of eye clinics at district levels across the region rather than just at the Regional Referral Hospital, raising awareness as a way towards closing the gap, and ensuring sustainability of the project by supporting the government in strengthening eye care services.

More specifically, the project employed the following strategies;

• Human resource development: During the project, 4 (3 males,1 females) cataract surgeons and 16 (5 males, 11 females) Ophthalmic Assistant were trained to provide comprehensive eye care services in four districts in Singida Region. At the community level, 289 (133 males,156 females) primary health workers were trained to provide primary eye care services within the dispensaries and health centres in the villages.
• Improvement of Infrastructure: Five eye clinics were constructed in five districts (Iramba, Manyoni, Singida rural, Mkalama, and Ikungi) in a bid to bring eye care services closer to the community.
• Availability of Ophthalmic Equipment: To increase the efficiency and enhance the quality of the eye care system in Singida, the project equipped Singida Referral Referral Hospital and four eye clinics( Iramba, Manyoni, Mkalama, and Singida Rural).
• Enhanced Service Delivery: The project carried out 42 outreach services in collaboration with the Regional and District health teams within the region through which 8,800(3949M, 4851F) community members received cataract surgeries.
• Improved Health Management Information System (HMIS): HMIS staff and eye coordinators 16(5 males,11 females) were trained on the use and proper recording of data in the HIMS. The availability and use of this data has been used to advise the Regional Authority’s planning and resource allocation processes. Data generated from the system showed an existing gender gap, combined with the project’s advocacy efforts, the government has since committed to allocate resources towards the elimination of gender-related barriers.

These strategies led to an increase in the number of people screened for eye diseases from 15,594 (9200 males, 6394 females) in 2016 to 98,667(48727 males, 49940 females) in March 2020. The number of women accessing cataract surgery increased from 203 in 2015 to 3971 in March 2020. Despite gender inequality being a constant within the health sector, through the Maono Project, we have recorded an increase towards accessibility of quality eye health services among women.

This was achieved through collaboration and a combined effort from both Sightsavers and the Singida Regional Authority towards the elimination of existing barriers. Singida Regional Authority has since succeeded in obtaining an increased budget allocation for eye health services through its advocacy agenda of eye health financing. The region’s Human Resource Development Plan has also put in place action plans to ensure a well-trained and sustained eye health workforce to enhance the delivery of comprehensive eye health services. A key recommendation from the Gender Study is the need for continuous coordination and collaboration between local, regional, and national health teams and other sectors (governmental and non-governmental) in the provision of accessible and gender-friendly eye care services.

Author: Magdalena Focus, Project Coordinator., Sightsavers Tanzania, [email protected]