Sightsavers from the Field: “Everyone Deserves Quality Eye Care Services”

In Uganda, an inclusive eye health programme has helped to protect people’s vision and build a sustainable eye care system for everyone.

First published in February, 2024 by Sightsavers. All images © Martin Kharumwa/Sightsavers.

Meet Dr Gladys Atto. An ophthalmologist working in Karamoja, Uganda.

Since she was a child, Dr. Gladys has wanted to become a doctor and help make people’s lives better. Sightsavers began working in the region alongside Dr. Gladys in 2015, most recently on a project funded by the UK government through UK Aid Match. Let Dr. Gladys introduce you to our inclusive eye health work in Karamoja.

Watch the video below to learn about the programme.

Dr. Gladys has achieved her goal of becoming a doctor and transforming people’s lives. She is now an ophthalmologist, thanks in part to previous support through Sightsavers, also funded by UK Aid Match, for her training. Following on from previous work in the region, our most recent project in Karamoja set three significant goals to achieve over 36 months.

Goal 1: Protect and restore people’s sight in Karamoja

Karamoja is a sub-region in the northeast of Uganda. Its population of just over 1.2 million people face high poverty rates in an arid climate with frequent droughts, which brings many challenges for farmers and livestock herders. Before 2015, the people of Karamoja also faced challenges accessing quality eye health services, due in part to poor infrastructure compared to the rest of the country. This meant that many people with preventable blindness conditions, such as cataracts, faced a lower quality of life, were restricted in their independence and participation, lacked economic opportunities and saw a decline in their mental health. With eye health playing such a pivotal part in people’s lives, we set ourselves a target of reaching as many people as possible and at the end of the UK Aid Match project, we had reached more than 58,000 people in Uganda.

Before Dr. Gladys started working in Karamoja, the region had never had an ophthalmologist. Alongside a team of community health workers, Dr. Gladys travelled across an area spanning 27,000 kilometres, conducting surgical and community outreaches while also spreading the word about the eye care services available across the community. Together, this team has conducted 58,336 eye examinations.

In Karamoja, untreated cataracts are the main cause of blindness – 39.3% of all cases in 2023. This is due to a number of factors, including being unaware that their blindness could be treated, a lack of access or a fear of surgery. But, through activities such as the project’s community health workers spreading the word and discussing treatment with patients, 3,431 cataract operations were carried out from October 2020 to October 2023 (we also reached more women than men – see goal three for more information). And each surgery is a potentially life-changing story.

The impact of these examinations and operations is immense and they create a ripple effect in every patient’s life. Eye health equals opportunities to gain an education and make a living, and contributes towards reducing poverty and inequality.

Goal 2: Build a sustainable eye health system

Over years of work in Karamoja, Sightsavers, in partnership with the Uganda Ministry of Health, has supported the building and strengthening of the region’s health system. The recent UK Aid Match funding has supported the training of two new ophthalmologists and six new ophthalmic clinical officers. These new recruits will deliver quality eye care services across Uganda over the following years and decades. Thanks to additional support from a group of generous donors, Sightsavers has supported the building of a new eye health facility at Moroto Regional Hospital, which also now has upgraded equipment.

Our work has also ensured all districts in Karamoja have functional eye units which treat common eye diseases and can refer patients to Moroto Regional Hospital if they require more advanced treatment. The improvements include supplying equipment, training staff and improving supply chains.

And by working with communities in Karamoja to encourage people to seek medical help when they have problems with their sight, there has been a rise in demand for services. This change in behaviour is instrumental to creating long-term change that will last beyond the end of the project.

We have also been working to secure commitments to eye health services at a national level. We’ve done extensive advocacy work, helped fund eye health meetings and supported the drafting and launch of the 2021-2026 National Eye Care Plan, which includes a pledge to increase the eye care workforce. This national commitment is a fundamental step in ensuring that people across Uganda can access eye health services.

Goal 3: Ensure people with disabilities and women are included

People with disabilities are more likely to have visual impairment than people without disabilities (14.1% and 2.6%). Therefore, disability inclusion and empowering people with disabilities to be aware of their eye health needs were key parts of this project. Gender inclusion was also a joint focus, as 64% of people who are blind are women.

From the very beginning of the project, we worked with organisations of people with disabilities (OPDs) and local women’s organisations to identify barriers to health care, explore potential solutions and implement changes.

We conducted audits on eight health facilities, alongside OPDs, to assess their accessibility for people with disabilities and two of these facilities are currently undergoing work that enacts these changes. And the people inside these facilities, 527 health care workers, also completed training on gender mainstreaming and disability inclusion.

With a lack of awareness and a fear of surgery being two of the many reasons why some people are hesitant to have a cataract operation, we ran several strategies for reaching people, specifically women who are more likely to have issues with their sight and less likely to seek treatment. We recruited community health care workers as ambassadors to encourage people – particularly women – to attend screening camps.

Our work over the past nine years in Karamoja was propelled by the relentless determination of the people we work alongside, like Dr. Gladys. And the newly trained clinical staff, improved facilities and equipment, government commitments and increased number of people seeking medical treatment creates lasting change that will continue beyond the programme.

Thanks to a variety of funding, including this project from UK Aid Match, eye health services have been vastly improved in Karamoja. But there is still more to be done both in Uganda and across the other countries where we work. Nobody should be blind from avoidable causes, and everybody to be able to get the eye care they need, regardless of who they are or where they live.

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Funded by the UK government and the British public through UK Aid Match, this inclusive eye health project aims to restore, save and protect the sight of people with and without disabilities in Malawi and Uganda by improving the accessibility and quality of eye care.