The surveys returned interesting results, and the quantitative and qualitative data collected gave us a hint on the eye health seeking behaviour of people living in the urban slums of Lahore. From the in-depth interviews we learnt that there is still stigma around wearing spectacles (though it is marginal). We also found that many women interviewed had to be accompanied by their husbands to receive consultation about health issues.
We’ve learnt that while some respondents were not accessing eye care services, more than half of the participants with eye problems (ranging from minor issues to severe visual impairment) have consulted and in most of the cases complied with the treatment prescribed.
Our ‘willingness to pay’ study has shown that a large proportion of the people living in slum areas would be willing to pay for spectacles or for cataract surgeries, with some important inequalities in terms of how much they can afford to pay. Overall, the eye health seeking behaviour does not seem to be drastically different from the rest of the urban population, but the results showed there is still a portion of the population that does not access eye care services due to a lack of awareness, and because of financial barriers.
The clinical assessment showed a higher prevalence of blindness among women and among the poorest households. It also showed that the prevalence of blindness was lower in the urban slums than in the rest of the country.
On top of clinical results, the sociodemographic information collected showed that urban slums or ‘katchi abadi’ are not necessarily inhabited by the poorest people. The diverse level of education (almost 50 per cent of respondents had at least primary education), the occupation level, and the relative level of wealth, confirmed the unequal access to education and wealth among slums.
The Urban Eye Health study in Lahore demonstrated that there is still a need to raise awareness on the importance of eye care, and that eye health services should be made available freely for the urban poor. And my hope is that through our study, we’ll have a better understanding of urban settings in South Asia. ‘Slums’ are diverse areas in terms of wealth, accessibility to education and health services, and this calls for a more tailored approach for our future programmes – we need better segmentation of urban areas (this is an area where Sightsavers’ equity tool, which measures the relative wealth of households, could prove very valuable). If we want to reach the people most in need of services, simply surveying ‘slum’ areas is not sufficient.
1 Stevens et al. 2014
*We acknowledge that the word ‘slum’ can be problematic. UN-HABITAT makes clear that the term ‘slum’ refers to living conditions, not people. It defines a slum household as one that lacks one or more of the following: 1. Durable housing of a permanent nature that protects against extreme climate conditions. 2. Sufficient living space which means not more than three people sharing the same room. 3. Easy access to safe water in sufficient amounts at an affordable price. 4. Access to adequate sanitation in the form of a private or public toilet shared by a reasonable number of people. 5. Security of tenure that prevents forced evictions.