According to the new World Health Organisation (WHO) action plan, adopted in May by the World Health Assembly, people with disabilities should have access to all health services offered to the general population.
Last year, CBM updated and launched a ‘how-to’ guide on inclusive eye health, providing comprehensive guidance to eye care service providers to ensure that all people with disabilities can access adequate eye care services. We speak here with Dr Babar Quereshi, a medical adviser for CBM’s Eastern Mediterranean Region, about how CBM is working on inclusive eye health with partners in Pakistan.
A CBM inclusive eye health program in Pakistan.
CBM is working hard in Pakistan to spearhead inclusive access to eye health care. How have you been doing this?
“We’ve been working with CBM partners and discussing inclusive eye health. We held partner workshops where our manual, Inclusion made easy in eye health programs, was discussed to ensure that our partners begin to implement inclusive practices in their projects and programmes. Implementation is going to be in phases and every year our partners will report their progress.”
How long will it be until changes are seen in practice?
“Since the first version of the manual was launched one or two partners have started to implement it. We’ve seen changes in physical access made to buildings and healthcare workers being trained in sign language. But it is too early to see big changes. We’ll probably see results coming over the next five years. Though of course some partners will implement things faster than others, it’s not a fast-track process.”
What about where CBM hasn’t got partners?
“We’ve been addressing inclusive eye health from two perspectives and the second part of our strategy has been to go to Pakistan’s national eye care programme. With our partners, we can only have limited reach. With the national programme we can implement in every single district of Pakistan. Government works slowly, but the infrastructure and reach is much bigger and so the impact will also be much greater and sustainable.”
How did you set about such an ambitious task?
“We went to a lot of advocacy meetings and made a lot of presentations with policy makers and the national committee on eye health – the Ministry of Health’s top policy body on eye care. Pakistan’s national eye care programme has been in operation for more than 20 years and every district of that country now has a state-of-the-art eye care programme. We said, ‘The essentials of the eye care programme are there, but what you need to do next is to make it inclusive for people with disabilities.’ ”
How open were policy makers to what you had to say?
“There was resistance but this wasn’t because people wanted to resist becoming inclusive, but because people weren’t clear what inclusion meant. They thought, ‘Are we now going to be looking after people with physical disabilities? Are we going to be doing hearing care?’ We had to explain that that wasn’t the idea. We had to say, ‘You are still involved with eye care, but we want people with disabilities to be able to access your services too.’
“Then it was like a curtain lifting off their eyes – ‘Oh that’s what’s meant by inclusion of other people with disabilities in eye care.’ It was about breaking what we want to see down into simpler, understandable pieces.
“The national committee has now appointed a task force to recommend to government the steps that need to be taken at all districts in Pakistan to make eye health inclusive, as well as to consider the cost.”
So what are the next steps in Pakistan?
“The next important challenge is considering who is going to actually put the recommendations in the manual into practice. For the partners it’s easier. They can look at their workplace and think of what they need to do and how they’re going to do it. For the national eye plan it’s about how they’re going to operationalise the whole programme.
I’ve been asked to work with the task force to break it down into small, achievable steps so implementation doesn’t become a monumental task. CBM can play an instrumental role in providing successful models of inclusive eye health in one or two districts.”
Are there any successful models you can point to at the moment in Pakistan?
“When the primary healthcare initiatives (PHIs) to reconstruct the flood-hit areas in the Union Councils of Charsadda, Abazai, Bakook, Hassan Zai and Shack No 6. were launched after the severe flooding in the summer of 2010, we set about trying to make the PHIs inclusive. That was a good experience and people were very engaged, very motivated. We’ve since seen a massive influx of patients, and access to eye health by people with disabilities has improved by 200%-250%.”
What are the main challenges in implementing inclusive eye health programmes?
“Changing the mindsets of people about disability is the biggest difficulty – at a project, programme, national and policy levels. That’s what takes a lot of time and it shouldn’t be underestimated.
Just by having a workshop or sending people a manual doesn’t mean things will change. There has to be continuous reinforcement of the ideas so they begin to register people with disabilities as individuals, they need to consider when planning and implementing. There needs to be continuous advocacy, continuous mentoring.”
What’s next after Pakistan?
“We’ll be slowly taking the inclusive eye health programme out to other countries. Later this year we’ll carry out a similar exercise for the Middle East region. The whole region is aware of inclusive eye health care and the manual has already had good exposure there. It’s just a matter of closer follow-up in the implementation and facilitating understanding where it’s needed.”