Transforming systems to provide eyeglasses in Cambodia
“My name is Sri Sros, I'm 14 years old. At school I had difficulty seeing things at a distance since I was 12. It was so blurry when I was looking at the whiteboard. Sometimes when I looked at other people I had blurry vision too. I couldn't attend class regularly and couldn't enjoy playing with my friends. One day a teacher came to screen us and then an eye care professional visited and performed eye exams. They confirmed I have myopia and provided me with eyeglasses to wear. I wear them every day. It helps me to see things clearly. It is easy while I'm reading and comfortable to play with other friends. If I didn't have glasses, I couldn't study well.”
The Principal of Sri Sros’s school agrees that screening for eye care has transformed the educational prospects for many of his pupils.
“Through participating in basic vision screening training I acknowledge it's so useful to students who have poor vision. It helps children in their learning journey.” said Mr Norng Savry, School Principal.
Sros is one of thousands of children and adults in Cambodia who have benefited from a project called ‘Scaling up Refractive Error Services in Cambodia’ or ‘SURES Project’ implemented in partnership by The Fred Hollows Foundation, funded by USAID, in support of ATscale, administered by UNOPS.
Research and evidence
Over the initial two-year phase of the project from 2021-2023, a SURES Steering Committee led by representatives from various government ministries, and provincial and other local partners worked together to establish the foundational components of a functioning, public refractive error market, able to deliver quality refractive error services to those most in need. Ownership and collaboration among stakeholders to create a shared vision for the future of eye care in Cambodia has developed meaningfully, and paves the way for future advocacy and ongoing engagement.
Over two years, the SURES project used research and evidence to inform school eye health policy, programming and resourcing, and scaled up services to children through an integrated national school eye health programme in 16 of 24 provinces of Cambodia, screening over 300,000 children.
The project worked with The National Institute for Public Health Cambodia to conduct research and analysis on the refractive error market, policy, structure and systems resulting in evidence that informed policy recommendations on the costing and feasibility of including glasses in the national health insurance and social protection schemes. This comprehensive research also contributed to the costing of intervention options, and the outcomes were used to provide guidance for consideration for target issues identified in the Cambodian National Strategic Plan for Blindness Prevention and Control.
Watch this short video to find out more about the SURES Project
Strengthening governance
Governance processes are now stronger as a result of a National Vision Center Manual, endorsed by the Ministry of Health, which is the first of its kind. The manual provides a national vision for delivering quality refractive error services at 27 newly established or upgraded public vision centres.
“The National Program for Eye Health is proud of the progress made during the SURES project. In two shorts years, in partnership, we have established a National Public Vision Center Manual that together with the human resources trained, equipment and vision centres ensures delivery of quality Refractive Error services to those most in need,” said Professor Meng, Chairman of the National Program for Eye Health, Ministry of Health, Royal Government of Cambodia.
“In Cambodia, uncorrected refractive error is the main cause of early visual impairment in people over age 50. This can be easily fixed with a pair of glasses. The public vision centres established during SURES provide that service at an affordable price, ensuring quality services to those most in need,” said Tokyo Bak, Country Manager, The Fred Hollows Foundation Cambodia.
The project also worked to establish centrally-procured supplies of optical products for the vision centres, including donated stock from a strategic partnership with Onesight EssilorLuxottica Foundation and the Vision Catalyst Fund.
“The SURES project is shaping the systems needed to ensure all Cambodians have access to quality optical products and we are pleased to be part of this important work.” Yvonne Siow, Head ASEAN, Onesight EssilorLuxottica Foundation.
The project provided training and strengthened the capacity of human resources to provide quality refractive error services at the provincial level across all 27 centres.
“We focused on building the capacity of the national refraction trainers to deliver training to eye nurses and refractionists. This activity will improve the quality of refractive error services delivered to the community especially in the public vision centres where services are only delivered by trained personnel,” said May Ho, Optometry and Primary Eye Care Advisor at The Fred Hollows Foundation.
Driving awareness on available treatments and building consumer demand for eyeglasses was a key focus for the SURES project, which implemented this through innovative community engagement strategies. In consultation with the SURES Steering committee and The Fred Hollows Foundation, the Ministry of Women’s Affairs also finalized a digital health promotion campaign targeting women to build awareness of the importance and benefits of prioritizing eye examinations for themselves and their families.
“Improving access to assistive technology is crucial to USAID’s mission to promote a world that is truly inclusive of all people. As a result of the SURES project, more than 300,000 children have been able to access routine eye care, including more than 8,000 children who were referred to specialists and hospitals for further screenings. Our Agency is excited to continue working in Cambodia and beyond to ensure people of all ages have the resources they need to participate fully and equally in their communities,.” said Bama Athreya, Deputy Assistant Administrator for the Gender Equality and Women’s Empowerment Hub and the Inclusive Development Hub, Bureau for Bureau for Development, Democracy, and Innovation, U.S. Agency for International Development.
Impact in numbers
The impact of the SURES project so far has been significant. For example:
Training
1,911 (803 women) schoolteachers were trained across 163 schools on primary child eye care, refractive errors and how to conduct simple vision screening and eye education messages
46 ophthalmic nurses and refraction nurses were trained clinically
7 national refraction trainers received training on pedagogy and advanced refraction skills with a focus on paediatrics.
Service delivery
317,493 beneficiaries (157,845 women and girls) received vision screening through school screening activities
38,074 (21,270 women and girls) beneficiaries received vision screening through Outreach or Community vision screening
26,028 (13,730 women and girls) people received spectacles and have better vision and quality of life as a result
2,449 adults were identified as having problems through visual acuity screening and were referred to medical hospital for early diagnosis and treatment.
8,000+ children were referred to an eye clinic, suspected of needing further treatment.
3,245,972 (1,756,195 women and girls) beneficiaries benefited from eye health education activities and are now more likely to seek out a vision examination.
Research and advocacy
17 Partnership Agreements were signed with 15 local Provincial Health Departments as well as the National Program for Eye Health, Ministry of Health and the Ministry of Education, Youth and Sports
“Having good vision is incredibly important for people’s quality of life across the world, but we know that many adults and children are simply unable to access and afford eyeglasses. The SURES project has strengthened policy, systems, and service delivery across Cambodia, increasing access to high-quality, affordable assistive technology for communities nationwide. We celebrate the success of the project, and look forward to engaging with the government and its partners on the next stage of implementation,” said Pascal Bijleveld, CEO of ATscale.
Looking to the future
This demonstration project has established the evidence and learnings needed to further strengthen the eye health system in Cambodia to provide quality refractive error services to those most in need at the provincial level. This systems change approach has also set in motion Governance conversations and initiatives at the national level that will continue to improve the quality of refractive error services provided in the public sector, and it is expected to influence the quality of care provided through the private sector in the future too.
Photo credit: Meas KimSan, The Fred Hollows Foundation Cambodia
Photo taken at a school screening activity in Prey Veng Province, Cambodia.