Tag Archives: eye health

Eye health and the environment – why sustainability and inclusivity go hand in hand

David Lewis, CBM Focal Point for Environmental Sustainability, and Kirsty Smith, Chief Executive of CBM UK  on an important opportunity to  promote environmental sustainability in the eye-health sector amid a month of climate disaster.

The need for global responsibility cannot be plainer. Hurricanes in quick succession battering communities in the Caribbean, leaving many homeless and with little help, including people with disabilities. Hurricane Maria followed Harvey and Irma. Now Nate has struck. Sometimes it’s hard to feel optimistic that our efforts do enough, soon enough, to temper the onslaught of extreme weather following decades of en-vironmental damage.

However there is hope and CBM is determined to do our bit to improve the sustain-ability of all of our work. In September we logged in via Skype to Kathmandu to join the launch of an international working group for environmental sustainability, one of our biggest priorities if we are to see global health of the world’s poorest people improve.

The group has   been set up by the International Agency for the Prevention of Blindness (IAPB) after a proposal  from member organisations including CBM, Vision 2020 UK, Aravind Eye Care System as well as other interested individuals.

Our aim is to bring together well-researched and creative approaches to strengthen environmental sustainability in eye health organisations around the world.


Patients after cataract surgery at Caritas Takeo Eye Hospital, Cambodia. Open, airy verandahs allow for air movement, keeping the hospital cooler and creating a pleasant environment for patients to wait.

Central to CBM’s mission
Climate change and environmental degradation have a devastating impact on all parts of the world, but this is particularly true for the world’s poorest communities. What drives our determination is knowing people with disabilities and other vulner-able groups are among those most affected on a daily basis, and in every part of their lives.

Health and well being are at risk in polluted and dangerous environments. These communities often lack access to safe water and sanitation, to sustainable food and energy sources. They face increasing risks due to natural and man-made disasters and more often than not find themselves at the back of the relief aid queue.

In terms of  eye health, we know that the communities most susceptible to envi-ronmental degradation carry some of the highest rates of avoidable and permanent blindness.

CBM is acutely aware that climate change is predicted as one of the largest health threats of the 21st century and that health care itself is a large contributor to carbon emissions.  Working closely with high quality eye health services around the world puts CBM in a strong position to draw attention to the essential need to reduce carbon emissions.

Why sustainability and inclusivity go hand in hand
Environmental sustainability and inclusion have been at the heart of CBM’s work for many years. We want to improve the environment and at the same time make  sure people with disabilities and those from other marginalised groups participate in environmental programmes as their human right. Thanks to advocacy by CBM and others, the Agenda 2030 for Sustainable Development Goals agreed by world leaders in September 2015, became much more inclusive.
CBM has in recent years created a resource booklet to help and inspire those seeking to make eye health services, and health and development programmes generally, more environmentally sustainable. It includes case studies, checklists and ideas with input from our  global advisors and partners in the field.  We want to demonstrate the wide ranging actions possible to strengthen environmental sustainability, particularly in the poorest countries, and gather evidence of the effectiveness of CBM’s actions so that we can replicate our most effective interventions elsewhere.  As well as environmental sustainability and inclusion, – this booklet highlights the need for accessibility, gender equality , safe-guarding those at risk, and disaster risk reduction as keys to sound development practice.

Case Study, Cambodia
We were delighted to have one of our studies highlighted at the IAPB Council meetings in  Kathmandu, as an effective model  of environmental sustainability which others in the field can learn from, as well as contributing their own ideas.
We are particularly proud of what has been achieved during our partnership with the Caritas Takeo Eye Hospital from 1996 – 2013.
Cambodia is one of the poorest countries in  Asia, with the majority  of the population living in poor  rural areas, with low access to services. Blindness is a key factor  contributing to this poverty.
It was in 2006 when  the chance came  to innovate in all areas of hospital life. The old hospital had to be demolished and all the stake-holders  wanted the new one, from its construction, energy and water supplies, to its cooking equipment and even surgery techniques to be of the lowest impact on the environment possible.  The hospital is proving to be a great model, with ongoing assessment of things which could be improved.
The hospital offers excellent eye care in accessible buildings which like many of the other facilities are above ground to reduce the threat from flooding. The “3 R’s” are used everyday -reduce recycle re-use .

Environment Sustainability Work Group – sharing expertise
CBM hopes the Cambodia study will help other IAPB members strengthen  high quality environmental practices and widen inclusivity in their own eye hospitals.

As a result of this and other expertise recognised within CBM, we had the opportunity to be one of the leads in  setting up the Environmental Sustainability Work Group for the IAPB.
Its launch in Kathmandu was a great success with CBM and other IAPB members setting out ambitious plans for innovation and learning, so that the best community eye services can be available while minimising their economic and environmental impact.
We are making progress.  Our determination to put the environment and inclusion at the epi-centre of the fight against poverty and inequality is moving forward.


Tomorrow we celebrate World Sight Day – make sure to read about it on our website! Also have a look at our newly released Neglected Tropical Diseases Report 2017.

Mitigating barriers in comprehensive eye care

In our 3rd and last piece for our blog series on the 10th IAPB General Assembly (10GA), Dr. Manfred Moerchen (Regional Advisor for Inclusive Eye Health in the Philippines) talks about mitigating barriers in comprehensive eye care.

Blindness and low vision have been identified as an important global cause of the years lived with disability, and empowerment of people who are blind or have low vision is one of the key cross-cutting principles of the WHO Global Action Plan 2014-2019 (“Universal Eye Health”). As only 2% of people in lower income countries have access to basic services and rehabilitation, CBM strives to improve the access for everybody, including people with all types of disabilities, to eye health programmes and to make sure that people with unavoidable blindness and visual impairment have access to low vision services and rehabilitation.

8 year old May has cataract in both her eyes and is nearly blind. She attends an inclusive school in the Philippines. Here she is being examined by Dr. Manfred Moerchen the day before her surgery.

8 year old May has cataract in both her eyes and is nearly blind. She attends an inclusive school in the Philippines. Here she is being examined by Dr. Manfred Moerchen the day before her surgery.

I was trained as an ophthalmologist in the nineties at a tertiary eye hospital in Germany, equipped with all types of state-of-the art expensive equipment. One day, when celebrating World Sight Day, we invited a self-help group of patients with unavoidable visual impairment. They were impressed by the technical possibilities but told us that it was difficult to orientate in the eye department as the building had obviously not been designed to facilitate access for people with visual impairment.


As an ophthalmologist, I was ashamed that even in one of the richest countries in the world we failed to address the needs of patients who needed assistance beyond purely medical treatment.

It strikes me that 15 years later, we still struggle with the same barriers to a holistic eye health service. Eye hospitals are designed without involving people with disabilities in planning. Access to phaco surgery is now often easier than access to low vision devices and people whose sight cannot be restored are constantly not referred to rehabilitation. Again, much more work is needed to mitigate barriers for people with additional impairments: How do we communicate with a cataract patient who is hearing impaired? Do we make sure that patients with Retinitis Pigmentosa and Usher Syndrome are referred to a hearing test? How do we communicate with a patient with Down Syndrome and refractive error?

The GA course will inform 10GA delegates about CBM’s approach to improve disability inclusive practices for strengthening comprehensive eye care with practical examples from eye health projects in Africa and Asia. For instance, delegates will gain insight into how a tertiary eye hospital can improve inclusive practices by employing people with visual impairment, by involving people with all types of disability in improving physical accessibility and by collaborating with Disability People Organizations in mass screening for cataract in the communities.

The 10GA has been an excellent opportunity to share experiences, discuss opportunities and challenges and elaborate on further steps. Practical examples have proven that this is possible, even for programmes with limited financial budget! We have also discussed the challenging aspect of monitoring inclusion to make sure that patients with disabilities are represented in our data and how that might contribute to Universal Eye Health. The goal to further reduce blindness and visual impairment will not be possible if everybody does not have an equal chance to access services.

CBM signs MoU with WHO at the 10GA

We’ve just signed an ambitious Memorandum of Understanding with the World Health Organization (WHO) Regional Office for Africa to eliminate Neglected Tropical Diseases (#NTDs). Read more on the website.

Regional Director of the WHO Regional Office for Africa (AFRO), Dr. M. R. Moeti (right) shakes hands with the Chairman of CBM International, Dr. R. Brockhaus (left) after signing the MoU. In the background is Ms. Kirsty Smith, CEO of CBM UK and Dr. Babar Qureshi, Director for NTDs.

Regional Director of the WHO Regional Office for Africa (AFRO), Dr. M. R. Moeti (right) shakes hands with the Chairman of CBM International, Dr. R. Brockhaus (left) after signing the MoU. In the background is Ms. Kirsty Smith, CEO of CBM UK and Dr. Babar Qureshi, Director for NTDs.

Connect with us and know more

Follow live coverage of the IAPB GA on the CBM website, Facebook and Twitter as well as the blog.

Inclusive eye health for all

Continuing our blog series for the 10th IAPB General Assembly (10GA), David Lewis OAM, Strategic Programmes Director, CBM Australia, writes about CBM’s experiences on inclusive eye health over the years.

I was sad to note the passing of a great pioneer of Community Ophthalmology in Asia, Professor Kazuichi Konyama, in June 2016. At VISION 2020’s launch in Vietnam in 2004, I recall him emphasising, ‘Every human being on the planet has the right to access quality eye health services’.

I was reminded of my work with CBM in West Africa in the 1990s. Working there was a great privilege, and yet, could also be very discouraging. Alongside some wonderful outcomes, we also encountered enormous need which we could not meet, and saw the destruction of vital services by the war in Sierra Leone.

David Lewis with a small patient in Niger in 2009.

David Lewis with a small patient in Niger in 2009.

Meeting Mariama, a young mother with bi-lateral cataracts in a remote Sierra Leonean village in 1992 was a profound experience for me. Mariama had not only developed cataracts in her mid-thirties and been totally blind for three years; she had also been profoundly deaf since she was a small child. We of course ensured that Mariama received cataract surgery, but her life could have turned out very differently. Without CBM’s partner community programme and eye hospital, Mariama may never have accessed the services she needed.  It is experiences like these, which make all of us connected with IAPB strive for a world where the most marginalised people can access quality services: This is both their need and their right.

Mariama’s condition is not unique; one billion people in the world– 15% of the world’s population—live with disability, including vision impairment. In 2009, CBM began a journey in Inclusive Eye Health. We tested approaches focused on strengthening good existing work in Vietnam, Cambodia, Pakistan, Indonesia and other countries.

By 2014, we were ready to share some of what we had learnt about inclusive practices with our partners and friends around the world. CBM launched Inclusion Made Easy in Eye Health Programmes, co-branded with IAPB and 13 other member agencies.

The guide helps address two key issues for people with disability:

  • How to make eye care services accessible and inclusive
  • How to assist people with permanent vision loss

In this context, CBM is proud to sponsor the GA course: ‘Inclusion Made Easy in Eye Health Programmes’. The course will explore up to date case studies from committed partners and IAPB member agencies around the world. We will consider a range of factors causing marginalisation, including disability, gender, age, ethnicity, religious minority, poverty, geographic isolation, access to education, and also how these factors intersect. Importantly, the course will bring practical solutions and discussions to strengthening inclusive practice in eye health programmes.

Please do attend the course, so we can strengthen our approaches together.

Connect with us and know more

Follow live coverage of the IAPB GA on the CBM website, Facebook and Twitter as well as the blog.

CBM a key sponsor and program partner of IAPB General Assembly

CBM is a key sponsor of the IAPB’s 10th General Assembly (10GA) from 27-30 October 2016 which will be held in Durban, South Africa. The 10GA is the biggest event in the 2016 eye health calendar and will bring together global experts in eye health, eye health institutions, NGOs, networks and government representatives to discuss public health issues related to blindness and visual impairment. With the theme “Stronger Together”, IAPB aims to build and strengthen partnerships and ensure a united voice.

The following blog is written by Dr. Babar Qureshi, CBM Director for Neglected Tropical Diseases on his part in CBM’s upcoming course, ‘Inclusion Made Easy in Health Programmes’, that focuses on disability inclusive practices for eye care.

Grarbet Tehadiso Mahber (GTM) -Trachoma Prevention Control Programm, P 3014 Ethiopia Trachoma outreach in Didamidore (Mareko district). Chaltu Egedo (27) and her daughter Jemanesh (2) have a trachoma infection. Ophthalmologe Dr. Lelissa Munduma examing their eyes.

Grarbet Tehadiso Mahber (GTM) -Trachoma Prevention Control Programm, P 3014 Ethiopia
Trachoma outreach in Didamidore (Mareko district). Chaltu Egedo (27) and her daughter Jemanesh (2) have a trachoma infection. Ophthalmologe Dr. Lelissa Munduma examing their eyes.

According to global figures, people with disability, including those with vision impairment, make up 20% of the world’s poorest and most marginalised people. It is therefore essential that everyone working in eye health, including planners, providers, evaluators and funders, understand key steps they can take at their own level, to build inclusion for all people.

Since 2009, CBM has been working on approaches to Inclusive Eye Health (IEH) with two key objectives:

  • People with all disabilities access eye health services
  • People with permanent vision loss access wider opportunities, i.e. in all areas of health care, rehabilitation, education, livelihoods, social inclusion, and empowerment

In this context, CBM established pilot projects in inclusive eye health in Cambodia, Vietnam and Pakistan in 2009-10. Subsequently, pilots were run in India, Indonesia and Sierra Leone. CBM is now working with a range of other countries to strengthen inclusive practices in eye health. In 2011, CBM published its first Inclusive Eye Health manual, and an updated version followed in 2014.

CBM recently commissioned a study to identify good practice, and evidence of strengths and weaknesses in the Pakistan IEH pilot, which was implemented in Charsadda district, Khyber Pakhtunkhwa (KPK) Province, through CBM’s partner CHEF International. This programme worked with 4 Basic Health Units at the primary level, one district hospital at the secondary level as well as a number of local schools. It was implemented in the context of the 2010 floods which had caused significant damage to the physical infrastructure of the local partners.

The key strengths identified in the study were:

  • Greater accessibility of eye health services
  • A new national government focus on inclusive eye health and integration into government systems
  • The creation of a sustainable referral system
  • Greater community awareness of services and a change in community perceptions of people with disabilities

The key areas for improvement identified were:

  • Better analysis of data needed
  • Further improvements to accessibility and referral systems needed
  • Further improvements for awareness within the community, particularly in terms of policies and referral services, needed

So, don’t miss CBM’s course on 29 October, to hear about the details of this study, and CBM’s wider work in Inclusive Eye Health.

CBM NTD Report 2016:
More than 1 billion people – one-sixth of the world’s population – are affected by one or more neglected tropical diseases (NTDs), and another 2 billion people are at risk, mainly in the tropics and sub-tropics. Take a look at our Neglected Tropical Diseases Report 2016 for more information about our work with NTDs.

Inclusive eye health:
‘Inclusion Made Easy in Eye Health Programs’ is designed for program staff in international development organisations. It is a practical guide on how to ensure eye-health programs are disability-inclusive. It is accompanied by a handy brochure/ poster with 10 tips for getting started.

Connect with us and know more

Follow live coverage of the IAPB GA on the CBM website, Facebook and Twitter as well as the blog.