‘Our aim is to work ourselves out of a job,’ says Dominic Haslam, Sightsavers’ director of policy and programme strategy. It is a statement indicative of the philosophy and outlook of an organisation fighting against avoidable blindness and for the equal inclusion of the visually impaired in society – it should not have to exist but it will until it is no longer needed.
Many working in optics will know of Sightsavers. Some may even support them in some way. But how much do you know about exactly what they do? How they operate? What drives their decisions? For example, did you know that the organisation underwent a ‘paradigm shift’ around 10 years ago that has significantly influenced the way it operates now?
We will get into that soon, but for now let us start at the top.
Sightsavers was founded in 1950 by Sir John Wilson, who was blinded by a chemical explosion as a schoolboy. Since that beginning, the organisation has grown considerably and now operates in 31 countries across the world. Its 642 employees work towards the organisation’s mission of helping ‘partners in developing countries to eliminate avoidable blindness and promote equality of opportunity for disabled people’.
The case for its work is staggering. According to the 2017 International Agency for the Prevention of Blindness (IAPB) Vision Atlas, there were 253 million people worldwide living with a visual impairment. Of these, almost 90% can be found in the developing world. One study commissioned by Prevent Blindness in 2013 estimated the global annual economic cost of vision loss to be in excess of $139bn. The human cost of vision loss – through diminished independence, impact on mental health, lack of employment opportunities, educational attainment and societal exclusion – is immeasurable.
Paradigm shift
For most of its history Sightsavers sought to redress this by operating as a charitable organisation, raising funds through campaigns and distributing them to the people who most needed help. However, 10 years ago it made a conscious and crucial change.
It was 2009 and Sightsavers was creating its current strategy. Its strategy document states: ‘Sightsavers made a paradigm shift in its modus operandi from a singular emphasis on service delivery to address immediate need, towards a development approach with a strong emphasis on systems strengthening.’
Haslam, who joined in 2006, recalls what an important moment the shift was for the organisation. ‘Before the change of approach the focus was very much on individual results and outcomes, all of which are good things to do, but in and of themselves didn’t necessarily create the impact that we wanted to as an organisation.’
Instead, Sightsavers decided to address vision loss through working far more closely with governments in the countries where it operated. A common and recurring critique of charity work in the developing world is that it removes the responsibility and onus from national governments to provide adequate care to its citizens as typically Western charities and money step in to fill the gap.
Sightsavers did not want to operate in that way. Now, its ultimate aims are to ‘ensure governments make quality eye care universally available as an integral part of wider health systems’ either through providing such services themselves or by ‘fostering the conducive political, legislative, policy and economic environment’ to allow other organisations to’.
‘Avoidable blindness is best addressed when health systems are aligned with government policy. All health programmes should support and strengthen national health systems,’ reaffirms its strategy document.
This recognition of working alongside governments is something that has come relatively late to global development institutions. The World Health Organisation (WHO), which has often been criticised in the past for its short-termism, released a report in 2008 stating: ‘The excessive specialisation of health care providers and the narrow focus of many disease control programmes discourage a holistic approach...and development aid often adds to the fragmentation.’
‘You’re there to provide medium or even sometimes long-term partnerships, but you’re not there to replace the role of government or local NGOs,’ says Haslam. ‘The real change came in 2009 when we started talking about systems strengthening, government responsibility and rights-based approaches, as opposed to individual outputs and actions of support and charity. That’s when the fundamental shift happened.’
‘I don’t think we realised what a significant change this strategy was at the time,’ he adds.
Under its new philosophy, Sightsavers has been deploying its resources in a way that builds towards its overall mission and through the use of an innovative Strategy Implementation Monitoring (SIM) Card.
Sightsavers’ SIM Card is, in short, a mechanism to determine how resources are allocated within particular contexts and in line with its overall organisational strategy.
‘[The SIM card] came about as part of our strategy development process and we felt that it was really important that we had something which we could communicate externally with,’ explains Haslam. ‘But also, something internally that meant members of staff could see themselves and their roles within the strategy of the organisation.’
‘I must say that it has been the most phenomenally powerful communication tool for external audiences because you can literally put it in front of anybody and illustrate what we do within that one page. I think that’s been great from an external communication point of view, but then there’s also the day to day use of it behind that.
‘I’m confident, at this point in time, that there’s nothing we are spending money on that doesn’t fit within that strategy and SIM Card.’
Holistic development
In order to best demonstrate this new approach, it is useful to look at an example of a project Sightsavers has developed. In 2016, it helped establish and deliver the pilot School Health Integrated Programming (Ship) project in Cambodia, Ethiopia, Ghana and Senegal.
Under Ship, teachers are trained to deliver basic vision screening for their students and refer children who need follow up care. So far, almost 60,000 children have been screened for eye problems – 20,000 more than the target. However, teachers are also trained to test for other health issues such as worm infections, nutritional health and more in an example of a holistic approach to development work the ties multiple health services together.
Sightsavers realised that the school setting was an ideal place to access large groups of children who could benefit from early intervention and prevention measures. What is more, they decided to work alongside local government to test for other pathologies that impact a child’s health in the pilot countries. The scheme demonstrated how to ‘integrate health promotion and education with screening and treatment services’ for the control of diabetic retinopathy, river blindness, glaucoma and more. It also significantly boosted student attendance through improved health outcomes.
‘We developed this programme and our experience has been very good so far,’ says Haslam. ‘It is more cost effective to do it that way and there are benefits of combining those things together. It provides some additional capacity to teachers who are trained to do the screening and we think, although it’s still early stages, that it’s a relatively sustainable programme as well.
‘After the project has ended, we don’t have to go back and do the it all over again – that’s the last thing we want – as teachers are often in the same place for a number of years. For me, long lasting projects that prove to be sustainable are the platinum standard of what we should be doing.’
Haslam, who was recently awarded an OBE for his services to people with disabilities, explains that finding the right balance between good sites for intervention and not overloading already stretched teachers was vital. ‘We had to get that dynamic right. We didn’t want to make things worse by trying to do something helpful and I think that’s a really important question for development organisations in general.’
In 2018, the Ship project launched a three-year programme in Liberia to train 2,400 teachers to screen children and distribute medication. It was established in partnership with both the Ministry of Health and Education.
SIghtsavers School Health Integrated Programming project in Cambodia, Ethiopia, Ghana and Senegal.
New strategy and challenges
After successfully reoriented its operations toward a more developmental position, Sightsavers is now working on its new strategy that will likely run from 2020 to 2030. During that period some modifications and adjustments may be made but it will provide the framework for the organisation’s policy over the next decade.
Haslam says in order to construct it, Sightsavers has had to be ‘really honest with ourselves about how we’ve done’ in a strategy development process that has three separate strands. Strand one involved a thorough examination of all its project data over the past 10 years in order to assess what has worked well and what has not. Programmes and policies that had shortcomings were then ruled out or reworked.
Second, Sightsavers conducted what Haslam calls a ‘horizon scan’, where it looked outside of the eye health sector and, instead, at the development sector more broadly. ‘What’s going on in the world and what’s changing? What are the disruptive factors in terms of health and technology that we will have to deal with in future?’
Third and finally, it undertook an organisation audit from its staff. Ten groups of staff from across the organisation got together and identified any issues or problems with the organisation that needed to be addressed in the new strategy.
The three separate strands will coalesce to form Sightsavers’ new strategy and Haslam says it will have a greater focus on the strengthening of eye health systems and access to care. One of the challenges facing its new strategy, identified through its horizon scan, are future pressures in terms of demographic changes, increases in certain types of eye conditions and climate change.
Aging populations in Sub-Saharan Africa will mean more cataracts and age-related conditions, while dietary changes could potentially create higher incidences of diabetes and in turn diabetic retinopathy, Haslam suggests. Furthermore, after cataracts, glaucoma is the leading cause of vision loss in Africa, responsible for 15% of blindness. Africa’s population growth rate is by far the highest in the world (2.52%) and, in a continent that has some of the poorest countries on the planet, the combination of these factors could see cases of blindness and vision loss skyrocket unless the right systems are put in place.
‘So, if we know these things are going to happen, how do we react to that?’ asks Haslam.
‘In most cases the answer is still to ensure that there is a decent provision of eye health services, especially around cataracts which is still the leading cause of avoidable blindness. If you put systems in place to deal with cataracts, then you’ve got the starting point, the foundations of a system that can deal with diabetic retinopathy down the track.’
When it comes to climate pressures, Sightsavers has carried out an environmental audit. Haslam thinks that some reactions to the climate crisis, such as stopping flying altogether, are ‘knee-jerk reactions’ and unpractical for organisations like his. Instead, Sightsavers has taken steps to reduce its environmental impact in ways that do not hinder its work. It has placed a priority on hiring local people in the countries it works and is looking at training and distant learning through online materials. However, ‘there are obviously times when global staff need to travel so we just need to think about that situation carefully,’ he adds.
With myriad mounting pressures and a greater recognition of the intersections in the delivery of health care in the developing world, Sightsavers’ understanding that effective eye care depends on strong healthcare systems more generally is a positive and well thought through step in the right direction.
Another great example of this holistic approach to development work came during the Ebola crisis in West Africa. Haslam explains: ‘During the Ebola crisis we actually stopped providing support to eye health services. Not everybody did. But we did that for a couple of reasons. Firstly, there were higher priorities for the health services in Sierra Leone and Liberia to respond to. So, we gave our vehicles and provided support to systems responding to Ebola.
‘Secondly, and more directly, if you bring a whole population together to do a screening exercise in the middle of an Ebola outbreak, guess what happens? You start spreading Ebola.
‘One of the questions we’re asking ourselves more about is how much we get involved in that broader humanitarian space,’ adds Haslam.
If you are a UK practitioner looking to support the organisation’s work, Haslam says to check out its website for the projects that interest you. Short of funding and donations, which are vital and ‘always welcome’, he says getting people involved in projects they are passionate about is the best way to ensure long-term support and lasting change.
Guided by its SIM card and overall organisational mission, Sightsavers will continue to make a huge contribution to people’s quality of life in countries where eye care provision is inadequate.
Now, perhaps more than ever after its paradigm shift, it is a cause worth supporting.