7 ways to make eye care more accessible to Indigenous Peoples

Indigenous Peoples of the world are often marginalised and discriminated against. While making up five percent of the world’s population, they disproportionately face extreme poverty, inability to access health care, education, and other social services, while facing high mortality rates. But there are ways to make eye care services more accessible to Indigenous Peoples.

COVER PHOTO: Aildrene Tan

According to the World Bank, there are between 370 to 500 million Indigenous Peoples spread across more than 90 countries worldwide.

According to Amnesty International, there are more than 5,000 different Indigenous Peoples who speak more than 4,000 languages.

Examples of Indigenous Peoples include the Aboriginal and Torres Strait Islander Peoples of Australia, Maori People of New Zealand, Lumad groups of Mindanao in the Philippines, Inuit of the Arctic, the Tupi People of the Amazon, the Maasai in East Africa, and the Sengwer and Sanya Peoples of Kenya.

In the Philippines, at least 10 million people belong to Indigenous groups. Estimates show that 10-20% of the population are Indigenous, and most of them live in isolated rural areas.

Indigenous Peoples often face poverty and inequality. Living far from the population centres, they aren’t able to access economic opportunities and public services such as education and health care at the same rates as other groups from the country.

Differences in language, beliefs, and cultural practices sometimes act as barriers preventing Indigenous Peoples from enjoying the full range of social services available to their mainstream counterparts.

Blindness and vision impairment among other health problems is prevalent in Indigenous Peoples around the world. For instance, in Australia Aboriginal and Torres Strait Islander Peoples are three times more likely to be blind than other Australians. This eye health gap needs to be closed.

The Fred Hollows Foundation has worked closely with Indigenous communities in the Philippines. Here are seven ways to make eye care more accessible to Indigenous Peoples based on lessons we learned while implementing programs in the Philippines.

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Break assumptions in program design
Partner with established institutions
Train tribal health workers and nurses
Engage Indigenous leaders
Support out-of-pocket costs
Co-create eye health messages
Train eye doctors and nurses to be culturally aware

1. Break assumptions in program design

In its first project in the Philippines, The Foundation trained barangay (community) health workers to conduct vision screening in the Indigenous communities of Tarlac. Despite the health workers’ efforts and enthusiasm, the uptake of eye health services remained low among Indigenous People.

What works in mainstream settings does not necessarily apply in Indigenous settings. With this in mind, The Foundation conducted a study on the knowledge, attitudes, and practices of Indigenous Peoples when starting a new project in Surigao del Norte.

Backed by solid evidence, The Foundation was able to conduct programs that were sensitive to the needs and context of Indigenous communities. This in turn, has resulted in more people accessing eye health services in that region.

2. Partner with established institutions

The Foundation has partnered with institutions that already work with Indigenous communities, such as the National Commission on Indigenous Peoples (NCIP) in the Philippines.

All activities involving Indigenous Peoples are co-led with NCIP representatives, which increases trust among the community. This strategy also ensures the sustainability of eye health programs, beyond the end of projects.

3. Train tribal health workers and nurses

Tribal healers are often the first point of contact when Indigenous Peoples encounter health problems. NCIP nurses who look after Indigenous communities serve as a link to the public health system.

Recognising the crucial role they play, The Foundation has trained both tribal health workers and nurses on vision screening in the Philippines.
By training people trusted by the community, vision problems are detected early, and blindness is prevented. This addresses the problem of people seeking eye treatments only when it’s too late.

Photo credit: Aildrene Tan

4. Engage Indigenous leaders

Like nurses and tribal health workers, Indigenous leaders are trusted and respected by the community. When leaders and trusted figures are engaged in advocacy to promote eye health, the community listens.

When leaders themselves use eye health services, the community is quick to follow and develop positive health-seeking behaviours.

Photo credit: The Fred Hollows Foundation

5. Support out-of-pocket costs

Out-of-pocket costs are additional expenses beyond the actual treatment. This includes expenses such as transport, food, and lost income for the person accompanying a patient.

These costs often pile up for Indigenous Filipinos, as they need to travel long distances – sometimes across seas and mountains – to reach major urban areas where health services are available.

While cataract surgeries are included in the Philippines’ national health insurance, out-of-pocket costs prevent Indigenous Peoples from seeking proper treatment.

To address this, The Foundation has partnered with other donors such as the L’Occitane Foundation to shoulder out-of-pocket costs and encourage the use of eye health services.

Photo credit: Hanh Tran

6. Co-create eye health messages

In its pilot project, The Foundation designed communication materials to encourage Indigenous Peoples to use health services.

The communication materials contained all the information they needed to know, including photos showing different eye conditions. But the materials weren’t enough to motivate people to seek treatment. The uptake of eye health services among Indigenous Peoples remained low in the Philippines.

With this in mind, The Foundation conducted a series of Behaviour Change Communication workshops to not only consult, but also co-create eye health materials with Indigenous representatives.

All messages were crafted by Indigenous Peoples, written in their own language, and customised to their context and culture. The result was an increase in trust, with more people seeking medical care.

7. Train eye doctors and nurses to be culturally aware

Doctors and nurses are at the final step in the journey to access eye health services. The Foundation trained eye doctors and nurses in the Philippines to be culturally aware and be mindful of the unconscious biases they may have towards Indigenous Peoples.

Paying attention to cultural safety allows health workers to gain the trust and confidence of Indigenous patients. Patients who have a good experience and health outcome then become great advocates of our sight-restoring work.

When Indigenous Peoples discover that the health care system is there to serve and help them, they are willing to share their positive experience within their local community. This word-of-mouth encourages more people to seek medical attention before it’s too late.

Photo credit: Hanh Tran

The Fred Hollows Foundation is committed to closing the gap in eye health. By embedding best practices in our program work, The Foundation is working to continue bringing quality eye health services closer to Indigenous Peoples in the countries where we work, such as the Philippines.

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ABOUT THE AUTHOR

Aildrene Tan - The Fred Hollows Foundation

Aildrene is a Global Communications Coordinator for The Fred Hollows Foundation. He frequently travels from his home base in Manila to collect stories of change and impact – often in Southeast Asia's remote and rural areas. He has spent the last decade working in aid and development programs throughout the region – covering health, education, inclusive innovation, and sustainable tourism.