SAFE: trachoma control

The SAFE strategy aims to stop the spread of blinding trachoma through surgery, antibiotics, facial cleanliness and environmental improvements.

A close-up of a school student washing her hands using water running from a tap in a large water butt.

The SAFE strategy is endorsed by the World Health Organization as a way to control trachoma, the world’s leading infectious cause of blindness, which is transmitted via contact with hands, clothing and even infected flies.

The SAFE acronym describes the four methods that are used to control trachoma:

  • Surgery: to stop eyelashes from rubbing against the eyeball and helping to halt the cycle of repeated infection that can lead to blindness.
  • Antibiotics: medication called Zithromax® is used to treat the trachoma infection and reduce the spread of the disease. The treatment is often distributed at mass drug administrations, and is usually repeated annually for three or more years.
  • Facial cleanliness: teaching local communities the importance of face washing, to prevent the infection being spread through contact with an infected person’s eyes or nose.
  • Environmental improvements: to improve access to water and basic sanitation to reduce exposure and re-infection, and eliminate the conditions in which flies breed.

Watch the video below to learn more about the SAFE strategy.

63 million
antibiotic treatments were distributed by 2019

How has Sightsavers adopted the strategy?

Sightsavers led a five-year SAFE programme on behalf of the International Coalition for Trachoma Control, and funded by the UK government’s Department for International Development (DFID). Our programme, which ended in June 2019, supported ministries in Chad, Ethiopia, Nigeria, Tanzania and Zambia and achieved some great milestones. More than 112,000 people with advanced trachoma, known as trichiasis, received sight-saving surgery, and 18.5 million people were given antibiotic treatments.

From 2014 to 2019, the programme trained and certified 270 surgeons to carry out trichiasis operations. It also raised awareness in 106 trachoma-endemic health districts about the importance of facial cleanliness and environmental improvement practices intended to stop the spread of the trachoma infection.

Browse the photos in the gallery below to see images from the programme work.

112,000 people
were able to have sight-saving surgery

What we’ve learned

Sightsavers’ SAFE programme has generated a wealth of information for future trachoma programmes, as each country takes the final steps needed to eliminate trachoma as a public health problem. Three key lessons stand out.

A systematic, door-to-door approach to finding people who need surgery is the best way to ensure no one misses out.

A door-to-door approach helps to ensure all those with trichiasis, the most severe form of trachoma, are reached. It also enables marginalised people, such as those with a disability, to access services. This strategy helps to generate good data, which governments can then present to the World Health Organization (WHO) when they are ready to embark on the process of validating whether trachoma has been eliminated as a public health problem.

Plan for sustainability from the outset.

Plans to strengthen national health services and systems to support and maintain the gains made in controlling trachoma were part of the SAFE programme from the outset. In particular, careful consideration was given to sustaining facial cleanliness and environmental improvements once a programme has finished.

Integrating with both eye care and the NTD sector.

As countries move closer to eliminating trachoma, it is increasingly important to integrate services within general eye care and other NTD sectors. But as each country manages trachoma control differently, understanding how current systems operate and the relationships between various sectors, then building relations between and within these entities, holds the key to continuing success.

Looking to the future

While significant progress has been made, there are still considerable challenges that must be faced to control and eliminate NTDs. More funding, collaboration and support is needed to achieve this important goal. Together we can improve the health, quality of life and future wellbeing of people affected by NTDs.

A school student washes her hands using water from a large barrel.

Insights from the SAFE programme

In Zambia, more than 1,800 people have had sight-saving surgery thanks to the programme, and 3.1 million treatments were provided to 1.6 million people.

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