Investing in eye health research

The Fred Hollows Foundation invests in high impact research and innovation to discover new and better ways to reach more people with high quality eye care that is cost-effective and easily accessible. Research, innovation and the effective use of evidence underpins all that we do to end avoidable blindness.

COVER PHOTO: Aildrene Tan

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Click on the link below to go straight to the section you’re interested in the most:

Why is research and innovation needed?
Our approach to research and innovation
Understanding the scale of blindness and vision impairment
Improving the use of research evidence
Strategies to improve research use in international development
Applying action research in our own work

1. Why is research and innovation needed?

Research provides evidence to strengthen the case for investment in eliminating avoidable blindness as well as advocate for health system reform.
Research provides evidence that helps with decision-making around what eye health programs to run in different places, whether it’s Australia or overseas, and how to ensure that these programs are geared to succeed and help as many people as needed.
Research and innovation helps improve existing programs and scale up services where needed.
Research and innovation provide the opportunity to develop and test new interventions, strategies and tools.
Research and innovation initiatives can help create strong and effective partnerships across the eye health and development sectors, allowing the most vulnerable in our communities to access eye health services that would otherwise be not available to them.

We are inspired by the work of Fred Hollows, who was an avid researcher and contributor to major research initiatives, including the landmark study of the prevalence of trachoma in Australia during the 1970’s National Trachoma and Eye Health Program. Fred also catalysed innovation through the development of low-cost intraocular lens (IOLs), which are key to affordable cataract surgery to address the most common cause of blindness worldwide.

A dish of intraocular lenses.
Photo credit: Mark Maina

2. Our approach to research and innovation

All of the research supported through The Fred Hollows Foundation aims to improve our understanding of what works to tackle avoidable blindness and vision impairment. With programs in more than 25 countries worldwide, we are uniquely placed to undertake real world, applied research that has the power to create meaningful change in the way eye care is delivered to those most in need.

We believe in delivering the best possible solutions, backed by evidence. The solutions and insights gained through research allows us to improve our eye health programs, for example, making eye care more accessible to women and girls in Nepal or making cataract surgery more accessible in countries like Cameroon.

Our approach to research and innovation is tailored to suit the unique contexts of our programs, the priorities and capabilities of our partners, and the needs of the people we seek to serve.

Some are formal research projects that are designed to generate evidence (such as the mapping of trachoma prevalence in Pakistan as part of the Global Trachoma Mapping Project). And some are programming projects that incorporate formal research, such as research to examine the impacts of COVID-19 on vulnerable populations seeking to access our eye care programs. And there are also innovative projects that formally or informally generate programming evidence, for instance the Better Operative Outcomes Software Tool (BOOST), a free smartphone app to strengthen the quality and practice of cataract surgical outcome monitoring. All of our investments are guided by our Research and Innovation for Impact - 2020 to 2024 Strategy.

3. Understanding the scale of blindness and vision impairment

Today, more than 43 million people are impacted by blindness worldwide, while 1.1 billion live with some form of vision loss. 90% of those affected live in low and middle-income countries, where access to care is constrained by various barriers, with women, the elderly, people living in rural areas, and people with lower incomes often the worst affected. We also know that the need for eye care will grow as global populations age and increase, putting further strain on poorly resourced health systems.

We know the scale of these problems because we’ve supported globally significant research to measure the magnitude and causes of blindness and vision impairment around the world, led by the Vision Loss Expert Group.

Photo credit: Michael Amendolia

4. Improving the use of research evidence

While we know that research and innovation is core to our approach, and our extensive networks of global and local research partners, collaborators and projects have delivered significant impact, there are several challenges in the broader public health and international development sectors that constrain research use. These include lack of resources (financial and technical), limited opportunities to translate evidence into policy reforms, and the complexity and length of research processes.

To explore these issues, between 2019 and 2020, members of The Foundation’s Research and Knowledge Management teams participated in Improving Research Use in International Development: An Action Research Project. This initiative brought together collaborators from the Research for Development Impact (RDI) network, La Trobe University’s Institute for Human Security and Social Change, and 12 partner organisations (a mix of non-government organisations, private consultancies and universities).

5. Strategies to improve research use in international development

The Action Research Project brought together practitioners and researchers to investigate the drivers and challenges confronting research use in the international development sector in Australia. Over a 10-month period, each organisation investigated and trialled tangible changes or shifts in the approach to research production, sharing or use in their contexts.

Eight practical steps for improving research use in international development were identified by Maya Cordeiro, Elisabeth Jackson, Chris Adams and Anna Roche as part of their project - Improving Research Use in International Development: An RDI Network Action Research Project.

Start small: focus on a single issue or activity to test organisational appetite and see what might work, before scaling up investments in research activities.
Work on organisation-specific challenges: understand what challenges and opportunities for research use are relevant to your organisation, to ensure broader buy-in and realistic entry points.
Take advantage of change and disruption: such as strategic planning processes, organisational restructures, or program and policy reviews, provide opportunities to influence strategic decisions, or introduce new ideas and practices around research use.
Build on what’s there: efforts to improve research use are more successful when they build on existing goals or work plans, strengthen existing activities or practices, or exploit relevant opportunities like funding or policy cycles.
Work across the research cycle: strategies to improve research use need to be built into all stages of the planning and implementation of a research project, not just the development and implementation periods.
Bring others along the journey: involving stakeholders within, across and external to the organisation can enhance research use, improve collaboration and ownership, and ensure knowledge is shared widely.
Get ‘the right people’ involved: bringing together individuals from different parts of an organisation helps ‘unpack’ different understandings of research, challenge values, beliefs and behaviour undermining research use, and diffuse ideas.
Reflect and adapt: action research can be a useful approach to organisational change, as it can support teams to reflect on what they are learning and adapt their strategies accordingly. Critical friends who are external to the organisation can help facilitate the process and challenge thinking.

Photo credit: Meas Kimsan

6. Applying action research in our own work

As part of the project, The Foundation’s team examined the systems, processes and frameworks used to support evidence-based decisions for innovation projects. The team wanted to understand how evidence informs decisions on whether to pilot, evolve, scale-up or abandon ‘innovation’ projects at different points in the cycle. By identifying the information and evidence needs for decision makers at the end-stage of the innovation cycle, the group hoped to provide more consistent guidance, tools and processes to strengthen the quality, sustainability, acceptability and impact of different innovation projects. Effective scale-up can engage new funders and lead to broader acceptance and adoption of the innovation by target users.

This project provided a timely and useful opportunity to explore the ways in which evidence informs innovation and can strengthen decisions on how to expand, adapt, scale-up or abandon innovative ideas or products. Innovation will continue to add value in the international development sector, by helping to identify, test and improve solutions to some of the most pressing development challenges.

In addition, innovation and its potential to catalyse change continues to be an attractive prospect for potential funders, including through institutional and government mechanisms as well as private stakeholders. We believe the findings from this project, and particularly the evidence-based innovation assessment tool, will support future decisions on how to approach innovation within the organisation.

Learn more

Find out more about The Foundation and our work:

Find out about the 10 ways in which we can promote sustainability in eye care

Learn how restoring sight improves a person’s life beyond their eye health

Discover what we learned from our gender equity project in Nepal

About the Author

Elise Moo - The Fred Hollows Foundation

Elise Moo is an experienced research, policy and advocacy professional who has been working in the eye care sector for more than five years. Elise is a passionate advocate for advancing progress towards the Sustainable Development Goals and improving environmental sustainability in the health care sector.

About the Author

Cathy Malla - The Fred Hollows Foundation

Cathy Malla is the Knowledge Management Advisor at The Fred Hollows Foundation. Cathy supports staff with accessing and using evidence to inform effective programming and advocacy strategies.

About the Author

Yadira Perez-Hazel - The Fred Hollows Foundation

Yadira Perez-Hazel is the Senior Research Advisor at The Fred Hollows Foundation. Yadira is a cultural anthropologist with extensive public health experience in operational research, technical advising, project management, and strategic development with a focus on equity.