ORBIS’s Comprehensive Rural Eye Care in Ethiopia

Ethiopia has one of the highest blindness prevalence rates in the world, with 1.2 million blind people and an estimated 5 million people suffering from visual impairment.   Although over 80% of blindness and visual impairment in the region is preventable, tens of thousands of people continue to lose their sight simply because they do not have access to the basic eye care that is so readily available in the developed world.  ORBIS has been working in Ethiopia since 1998 to reduce the burden of avoidable blindness and visual impairment.  One of the ways we do this is by developing comprehensive rural eye care services for the millions of Ethiopians who live in remote, rural areas and find it difficult to access services. Our rural work has focused geographically on the Southern Nations, Nationalities and People’s Region (SNNPR) where we are working to tackle the leading causes of unnecessary blindness - trachoma, cataract and uncorrected refractive error.

ORBIS’s model for comprehensive rural eye care

Over the past 12 years ORBIS has developed a tried and tested framework for  providing  comprehensive eye care services in rural Ethiopia. ORBIS has a  long-standing partnership with the Ministry of Health, through which we work to develop the capacity of existing government health providers to provide eye care services at primary, secondary and tertiary level to reduce the  number  of people losing their sight to cataract, trachoma, childhood blindness and other eye diseases.

ORBIS  builds the capacity of local health services to provide eye care by training both community and health care workers in many aspects of eye care, from awareness of services, identification, diagnosis, referral and treatment.  We also supply  equipment and consumables to the secondary and primary units. Our rural programmes focus on strengthening primary and secondary eye care services,  and on  building effective referral  networks between primary, secondary and tertiary services to ensure that people are appropriately treated at the right level of the healthcare system to maximise their potential visual recovery. We also ensure that follow-up services are available. As  such, responsibility for community eye health is integrated within the wider health care strategy and therefore various tasks within blindness prevention are disseminated to specific levels of the system:

Community and Primary Units

• General screenings and eye health checks
• Training of cataract and trichiasis case detectors 
• Distribution of Zithromax
• Support Integrated Eye Care Workers’ outreach activity for trichiasis surgery (reversing in turned eyelids resulting from repeated trachoma infection)
• Conduct community awareness campaigns
• Refractive error services – delivered through partners

Secondary Level or Secondary Eye Care Units

• Adult cataract surgery
• Referral of complex eye disease such as glaucoma, corneal disease and childhood blindness

Tertiary Facilities

• Treatment of complex eye disease such as glaucoma, corneal disease and childhood blindness

Trachoma Elimination and World Health Organisation’s SAFE strategy

Trachoma is a huge healthcare challenge in Ethiopia with an estimated infection rate of 2 out of 5 children in SNNPR. ORBIS therefore anchors our trachoma elimination strategy within our comprehensive rural eye care framework. ORBIS implements the WHO’s SAFE strategy for eliminating trachoma:

Surgery:	training of local health care professionals to right the eyelids which have turned inside out to stop the eye lashes scratching the cornea and causing permanent sight loss.
Antibiotics:	can be distributed to prevent the infection but is only effective if all members of the community take them and if other strategy elements are in place, so infection cannot take hold again.
Face washing:	informing communities how best to wash their faces and hands to prevent infection from spreading
Environmental hygiene:	improving sanitary conditions and providing clean water prevents bacteria from breeding.

ORBIS focuses on the distribution of Zithromax  – the trachoma fighting antibiotic – to entire populations annually. ORBIS distributed Zithromax to 1.9 million people in 2010 alone. We train nurses to perform trichiasis surgeries at primary healthcare units. We build awareness and  teach community health workers,  teachers, local women’s group leaders and community leaders about eye health and environmental improvements to reduce the risk of trachoma. ORBIS also  works with partners to deliver the ‘F’ and ‘E’ components of the strategy.

Through our long-term commitment to Ethiopia, ORBIS has developed high quality programmes to meet the challenges of avoidable blindness head on. With your support we can roll out our model of rural comprehensive rural eye in more regions in Ethiopia to ensure that no one goes blind from causes that are preventable, treatable or avoidable.