Innovative models of sustainable eye care

Blindness and vision impairment is impacting people all around the world, and the need for high quality eye care is growing. Sustainable and innovative models of eye care are needed to ensure preventable and treatable blindness doesn’t run rampant, and can be managed effectively.

COVER PHOTO: Michael Amendolia

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Why is Fred Hollows investing in innovative models of eye care?
4 examples of innovative models of eye care
How can I help achieve sustainability in eye care?

Why is Fred Hollows investing in innovative models of eye care?

The Fred Hollows Foundation and our partners have worked for decades to end avoidable blindness and vision impairment.

There are 43.3 million people who are blind and a further 295 million have moderate or severe vision impairment (MSVI). The International Agency for the Prevention of Blindness (IAPB) estimates that vision loss will rise to 1.7 billion people by 2050 without significant investment.

While we’ve made great progress, we have to increase our efforts. Most eye health cases can be treated with cost-effective and low-risk procedures, however many patients are not able to access eye care because 90% of vision impaired people live in low and middle-income countries.

Preventable vision loss and blindness cost the global economy $530 billion AUD in 2020 due to lost employment, according to the latest Lancet Global Health report. This highlights that the impact of restoring sight directly correlates to the socio-economic outcomes in vulnerable communities. This is why investing in eye health is so important.

Currently, The Foundation is unable to keep up with the growing global demand for eye health, but we do have a plan. Individual and institutional philanthropy is part of that plan. Philanthropists should step up and support the eye health sector, as it is one of the most affordable and effective ways to create an impact on both an individual and their family. It is also one of the most impactful interventions for the economy.

In addition to this, The Fred Hollows Foundation is investing in innovative alternatives to providing sustainable eye care, especially for marginalised populations. By helping to create an efficient and sustainable eye health system, The Foundation is reaching more people and making every dollar donated more impactful than ever through innovative models of eye care.

Photo credit: Ben Midberry

4 examples of innovative models of eye care

1. Alina Vision

Alina Vision is a social enterprise that uses an affordable eye care model to serve its core purpose of making high quality eye health services accessible to everyone, regardless of their financial situation. It uses a tiered pricing method, where fees paid by middle and upper-income patients for treatment are used to subsidise the treatment of low-income patients.

The Fred Hollows Foundation was a co-founder of Alina Vision and, together with partner Rohto, covered the initial costs to establish the pilot eye clinic in Vietnam.

After receiving its operating licence in late 2019, Alina Vision has been effectively working as a sustainable eyecare solution that provides low-cost and quality treatments to the most marginalised populations.

Alina Vision has screened almost 53,000 patients and has performed almost 3,600 cataract and other surgeries to date. The outcome of these surgeries has exceeded both the national average and World Health Organization’s (WHO) benchmark for visual acuity.

Alina Vision not only provides a sustainable and low-cost solution to eye health treatment, it also operates as a training centre to help expand the local eye health workforce. Over the past two years, it has helped to provide the training for two eye surgeons, three medical ophthalmologists, five refractionists and 21 nurses.

Following the success of the pilot eye clinic, Alina Vision expanded by opening up three new satellite vision centres across Northern Vietnam. With this expansion, Alina Vision continues to offer low-cost treatment and referral services to those who need it and to help train the local eye health workforce in quality eye care.

Photo credit: Aildrene Tan

2. Cameroon Cataract Bond

Launched in 2018, the Cameroon Cataract Bond is a new and innovative way of funding health care at the Magrabi ICO Cameroon Eye Institute, owned by the African Eye Foundation (MICEI). It’s goal is to support the first 18,000 cataract surgeries over a period of five years.

As well as providing vital cataract surgery, the hospital will train eye health professionals from across the region, helping to strengthen local health systems and ensure they are self-sustaining.

The bond is a form of impact investing that focuses on making both a financial return for investors while creating a positive social impact. Investors provide upfront funding, which is then repaid with interest by The Fred Hollows Foundation and its partners, The Conrad Hilton Foundation and Sightsavers.

The Cameroon Cataract Bond has already shown great results. It’s three-year total of 6,374 surgeries is ahead of its target, even with the COVID-19 pandemic posing challenges to health systems around the world.

The quality of surgeries that the MICEI provides continues to improve and currently exceeds the WHO’s standards. Due to both of these targets being met, investors will receive the highest agreed return for their investment.

The primary donor and founder of the hospital, Dr. Akef el-Maghraby, an internationally renowned ophthalmologist and Chairman of the Magrabi Hospital Group says: “We know that in Cameroon we need to carry out about 48,000 surgeries each year to treat new cases of cataract as well as addressing the current backlog of people who need cataract surgery. I am very proud that despite the devastating impacts of COVID-19 we have managed to achieve such good results at the end of our third year. I want to thank all of the members of the Coalition and the staff at MICEI for their contributions.”

Using this model, the eye health sector can open up new markets for financing programs in low and middle income countries, while also providing a return on investment and a unique opportunity for investors to create real social change.

3. Health Financing in Kenya

In some cases, the most effective model of eye care is leveraging the existing health system and its funding mechanisms.

The Fred Hollows Foundation launched a project in 2019 to increase the uptake of cataract surgeries in several remote districts of Kenya. It focused specifically on increasing the availability and accessibility of cataract surgeries for low-income communities using the existing national health insurance scheme.

Just like Australia’s Medicare, this national insurance scheme covers the costs of various health treatments, including some surgeries like cataract surgery. However, in many countries these national health insurance funds are under-utilised by people and many experience severe out-of-pocket expenses when seeking medical assistance, limiting their ability to get help.

Both the demand and supply of quality cataract surgery in Kenya is low. In order to address this, The Fred Hollows Foundation uses several strategies to increase both the demand and supply of cataract surgeries.

On the demand side, The Foundation’s Kenya team raises community awareness surrounding the local health insurance schemes that cover the costs of cataract surgery. Additionally, outreach services are used to identify vulnerable, uninsured people with cataract to be prioritised for insurance registration and referred for surgery.

On the supply side, The Foundation has undertaken a costing study that details the true costs of a cataract surgery, and demonstrates that the cost of cataract surgery is outweighed by the revenue generated by the government subsidy for registered patients. Cataract surgery is in fact an effective way for Kenyan hospitals to generate revenue when the patient is registered by the national health insurance scheme.

However, many local hospitals are unaware of the return on investment for cataract surgeries. The Foundation works closely with these hospitals to raise awareness of the benefits, and helps to reduce their costs by supplying essential equipment and improving the quality of surgery.

After the initial support from The Foundation, the supply of high-quality cataract surgeries has increased. Along with the increase in patient demand, both work together to provide a sustainable solution to funding essential eye treatments for low-income individuals in remote Kenya.

Photo credit: Michael Amendolia

4. Women CAN in Bangladesh

Women CAN is a women-led entrepreneurship group, which offers basic eye care services to local community members and helps to reduce cases of vision loss and avoidable blindness, caused by refractive errors.

This business model works by identifying five to seven women with potential to form a group, and trains them in small-scale business management, human resource management, and bookkeeping, skills necessary for the success of their entrepreneurial endeavour.

Women in Bangladesh face a number of obstacles in accessing eye health services. By funding a women’s business group, The Fred Hollows Foundation is helping to reduce these barriers both for the women involved, as well as their customers who have easier access to both women-led services and low-cost solutions.

The Foundation will provide them with basic eye-screening equipment such as retinoscope, a trial lens box, Snellen chart, and other essential items as a starter kit, as well as their first batch of eyeglasses. The group will generate income through eye screening and selling glasses at an affordable price to local patients.

The money made on the first batch of eyeglasses sold will go towards hiring a refractionist and a data-entry person, as well as towards buying the next batch of eyeglasses.

This business model promises sustainability, as well as a quick recovery of the initial investment, as the cost of basic eye screening equipment and set up cost is minimal. It provides sustainable, low-cost solutions, while also providing an equitable way of increasing eye health access for women in Bangladesh. This is particularly important for women in remote areas.

What started as a pilot project is soon to be expanded, with several more Women CAN groups scheduled to start later this year.

Photo credit: Michael Amendolia

How can I help achieve sustainability in eye care?

The challenge we face is large and we need all the support we can get. Our founder, Fred Hollows had “great faith in the humanitarian nature of the Average Australian” and our supporters continue to keep that faith alive by choosing to support our sight-restoring work.

“There’s a lot of goodwill amongst the Australian people. This affords me great optimism. Australians like to help other people, they like to help people less fortunate.”
- Fred Hollows

By donating to The Fred Hollows Foundation, you are contributing to the variety of ways we are bringing eye health to rural and remote communities around the world.

Not only are you supporting eye treatments and training medical professionals, you are also investing in new and innovative approaches to bring eye care to some of the poorest and most vulnerable people in the world.

You can support our efforts to end avoidable blindness by donating here.

Interested in learning more about our work?

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ABOUT THE AUTHOR

Ryan Hamilton - The Fred Hollows Foundation

Ryan is a major gift fundraiser at The Fred Hollows Foundation who has an interest in international development, which he studies part-time. Ryan has a strong track record of connecting donors to The Foundation’s most impactful projects and believes that philanthropy can play a big role in supporting and empowering local people to address local problems.