Poor vision affects women and girls to a greater degree than men and boys. Research suggests that 55% of people with vision loss are women and girls.
While access to vision care is, in many cases, limited for girls around the world, schools can still play a role in providing that access. But what happens if girls are not in school? And, what if they don’t return to school after the COVID-19 pandemic?
In an article from The Guardian last year, Malala Yousafzai, co-founder of the Malala Fund, wrote: “The Malala Fund estimates that approximately 20 million secondary school-aged girls may never return to the classroom after the pandemic, if dropouts increase at the same rate.”
She went on to say that “COVID-19 only exacerbated existing inequalities. Before the pandemic, 129 million girls were out of school – and millions more were in school but failing to hit minimum learning targets.” Schools are, in many places, THE place for access to health screenings, including vision screenings.
What role have schools played when it comes to eye health for girls?
Sumrana: Schools have been a vital platform to provide eye health, vision screenings, refractive and optical services to school children, teachers and support staff in many low- and middle-income countries. School eye health programmes, implemented in partnership with Ministries of Education and Health, have the potential to change the lives of schoolchildren and their teachers by detecting eye conditions and ensuring access to high-quality eye care. Health education and promotion interventions delivered at schools also promote health-seeking behaviours, compliance with spectacle wear and lead to reduce eye disease and visual impairment in the future.
What are the implications for girls if they aren’t able to return to school to get vision screenings as part of their education?
Sumrana: For many girls, especially those from low-income countries and the poorest communities, access to education was a challenge even before the pandemic. We were already struggling to ensure gender equity in education and health. This situation will be aggravated if girls are unable to return to school.
"There is no question that when a girl's access to education and health, including eye health, is cut short, the impact can be felt for generations."
It will leave a significant development gap in our communities, countries and the world. However, the current crisis also provides us an opportunity - while building back better, we must focus on “building back equal”. We need to advocate and ensure that eye health is integrated into school health policies and programmes and reimagine the ways girls’ access to vision care can be expanded, so that when schools reopen, the school health policies and programmes are more gender-responsive, inclusive and well-resourced.
What role can governments play to ensure that girls are not left out of the health system?
Sumrana: Women and girls are a growing portion of the global population, yet their health care needs are not appropriately recognized and resourced.
Girls' health is one of the most significant investments we can make for a brighter future.
Considering the reach and impact of the public health system, governments can play a significant role in ensuring that girls have access to health services at all levels of care. Ministries of health, education, and other stakeholders need to prioritize gender equity at policy and programme levels and apply a gender lens when health services are planned, resourced, implemented, and monitored. They also need to find ways to include women and girls in policy development and decision-making processes. Building in the needs of women and girls offers an opportunity for governments to “build back equal”.
How can we continue to champion the idea of the school model? How can we supplement it?
Sumrana: Schools are ideal platforms for reaching children with eye health services. They have relatively wide coverage and are staffed by a skilled and dedicated workforce who have a good relationship with local communities. School health and nutrition programmes have been promoted globally as an important strategy to increase access to health care, promote inclusion, and to achieve improved learning outcomes. Integration of eye health into school health policies and programmes is key to ensure access and continuum of care, sustainability and scale. Integrating multiple health interventions onto a single platform can translate into strengthened institutional capacity and improved cross-sectoral coordination. We have successful examples of this from our work in our School Health Integrated Programme (SHIP) in Liberia, where we are providing eye health and deworming services to school-aged children in collaboration with key stakeholders. Collaboration between ministries of health and education and all relevant stakeholders is critical for successful delivery. This can be promoted through a system-strengthening approach involving mechanisms for collaborative policy development and ownership; planning and resourcing; implementation and evaluation at national and local levels.
How can we use the findings of the latest research from The Lancet to support the future of girls’ vision health?
Sumrana: The findings of The Lancet Commission on Global Eye Health show that addressing vision impairment is a realistic and highly cost-effective way of unlocking human potential, enabling girls to gain an education, and improving equity for women and girls who are more likely than men to have poor vision and less likely to receive treatment.
The findings and recommendations of the Commission, along with the WHO World Report on Vision, are an important advocacy tool to influence policy change particularly in the context of LMICs. It also provides a road map to develop the eye health programmes that respond to the needs of everyone and benefit all equally. By applying the gender lens to these recommendations, we can support the development of eye health services that enhance equity and leave no one behind.
Do you have examples of approaches that ensure that girls get equal access to vision care?
Sumrana: Improving the lives of women and girls is a huge priority and cross-cutting theme for Sightsavers. To ensure gender responsiveness of our work, we apply a gender lens in our programming; policy and advocacy; assimilate innovative thinking and put it into practice in the local context. We recognize that gender equity interventions need to be context-specific, so we plan our programmes’ specific gender approaches by conducting baseline assessments and situation analysis; analyzing sex-disaggregated data on prevalence and coverage estimates; and then setting equitable targets for access to and uptake of services. In most of our programmes, bringing services closer to communities, engaging women’s groups and girls in programme design and implementation, and developing targeted approaches to reach more girls has helped us to improve access to vision care for girls.
What gives you hope when it comes to your work in vision and gender equity?
Sumrana: I strongly believe that women and girls are powerful forces for change with huge untapped and unique potential.
The growing realization of this fact by governments, policymakers, non-state actors, programme professionals and communities gives me hope that challenges of inequity can be addressed, and are not going to be institutionalized forever. At Sightsavers along with our partner organisations, we are committed to tackling systemic inequity and promoting meaningful change. We know that access to high-quality inclusive eye care and education can be life-changing for young girls as it opens the doors to knowledge, learning, opportunities and empowerment.
I believe that all of us, within our own small or big realm of power, has the responsibility to open these doors for our next generations. Our commitment and investment for a fairer and equal world is visible and gaining traction more than ever now.
I know that collectively, we can bring a real and tangible social change - and that keeps me optimistic!
Sumrana Yasmin is the Senior Global Technical Lead: Eye Health URE at Sightsavers. To learn more, please click here.