Inclusive eye health in Mozambique: an exciting new beginning

Sightsavers has collaborated with the Ministry of Health in Mozambique for about 10 years, supporting the provision of free eye health services to thousands of people in the Nampula province, and strengthening the health system overall.

In a country where more than half of the population live under the poverty line and over 65 per cent live in rural areas, accessing health services can be challenging. The situation is even worse for people with disabilities. Poor roads and transportation mean that many people with disabilities, as well as others with reduced mobility, such as older people, find it very hard to reach healthcare facilities in rural communities. Limited access to health information, widespread stigma and discrimination, and high rates of poverty and unemployment further marginalise people with disabilities and prevent them from accessing healthcare and other essential services.

Women and girls also experience cultural and systemic barriers. Gender inequalities are rooted within Mozambican society, and women have less access to formal education and employment, and limited family and community decision-making power. Traditionally, they are also responsible for running the house and raising children, and as a consequence tend to deprioritise their own healthcare.

This is a common issue in many African countries, not just an isolated problem in Mozambique. Sex-disaggregated data from Sightsavers’ eye health programmes confirms this trend, as we often see less women than men accessing eye care services, despite the fact that cataracts are known to be more prevalent among women.

These are some of the drivers for why we chose to rethink our existing eye health programme in Nampula to make it more inclusive and accessible for people who are marginalised on the grounds of gender, disability, age or other factors.

Collaborating with a variety of agencies and organisations is a core aspect of Sightsavers’ inclusive eye health approach: it is an effective strategy to maximise resources, strengthen collaborations among different stakeholders, and facilitate the provision of services to marginalised communities.

For this reason, at the end of October 2017 a small delegation from across Sightsavers travelled to the capital, Maputo, to meet key strategic stakeholders and partners.

The National Eye Care coordinator based at the Ministry of Health was convinced by our plans and ensured full support for the initiative.

Disabled people’s organisations (DPOs) are important partners in any inclusive health initiative, so we met with Cantol Pondja, a representative of FAMOD, the national DPO umbrella network. During our meeting he talked about the many obstacles that prevent people with disabilities seeking health services. We were thrilled when Cantol commended our commitment to inclusive health and agreed to work closely with us. From now on, Sightsavers will ensure FAMOD’s representatives are included in any decision-making forums related to the eye health project in Nampula.

Potential synergies were also discussed with representatives of the Fórum Mulher, the national women’s rights forum, and the Mozambican Civil Society Platform for Social Protection. We hope to continue more of this stakeholder engagement in order to maximise our impact in rural communities.

Back in Nampula, at the beginning of November, the Mozambique country office hosted a two-day participatory workshop to design the new inclusive eye health project, involving more than 30 representatives of the Ministry of Health, the Ministry of Gender, Children and Social Welfare, DPOs, and staff from five district hospitals.

The workshop kicked off with an introduction to inclusive health and the Global Goals, and our colleagues from Sightsavers India shared key learnings, challenges and recommendations from our first inclusive eye health pilot in Bhopal.

We were very pleased to be joined by a representative of Light for the World, who facilitated a disability assessment of the existing eye care programme using the organisation’s innovative Disability Inclusion Score Card (DISC). Both Sightsavers and Light for the World are very keen to develop more inclusive health projects and have agreed to share existing resources and approaches.

DISC proved to be a very effective tool to ease inclusive programming, and this became apparent on the second day of the workshop, when participants used results of the assessment, working in mixed groups of health providers and DPO members, to identify practical solutions and make the eye health programme more inclusive. Suggestions included training on disability and gender for hospital staff and community health workers, sign language training for key hospital staff, accessibility audits in all facilities and collection of disability disaggregated data using the Washington Group Short Set of disability questions.

Overall, it was wonderful to work with colleagues, government and hospital partners, but DPOs made the real difference during the workshop. They had a crucial role in promoting greater awareness among health partners and elaborating original ideas through a participatory approach.

We were extremely grateful for all of the valuable inputs generated through this process, and during the following days we consolidated them into an action plan using Sightsavers’ inclusive eye health manual.