In May 2022, the World Health Organisation (WHO) launched Universal Health Coverage and Eye Care: Promoting Country Action, a new guide on eye care. With more than 2 billion people around the world living with a visual impairment and of these at least 1 billion living with poor vision because of lack of access to eye health services, the guide highlights the importance of integrating eye care into Universal Health Coverage (UHC).
Following her MPH Public Health at Imperial College London, Commonwealth Alumnus Priscilla Ablordeppey has implemented initiatives to provide accessible and low-cost eye care services for rural communities in the Agona West Municipality in Central Region, Ghana.
Implementing the eye health outreach programme
Agona West Municipality is one of 22 districts in the Central Region and home to a population of 136,882. Between December 2018 to April 2022, Priscilla was the public health optometrist at St. Joseph’s Eye Clinic located at Agona Swedru, the capital of Agona West Municipality, where she managed the clinic’s community eye health promotion programmes and conducting clinical routines.
At that time, there were only two optometrists stationed across two eye care facilities in Agona West Municipality. In addition to inadequate numbers of trained staff, poor access to facilities combined to create a challenging environment for managing the community eye health needs. As such, rural communities within the municipality must rely on infrequent eye screenings conducted by eye health organisations located far away. Due to this, people identified with eye conditions usually don’t keep up with referral requests to receive more comprehensive eye care.
Given the inadequate resources for eye care in the region, Priscilla initially had doubts about taking up the role, but was soon convinced it could be a transformative opportunity.
“Initially, I was having second thoughts on the job offer. But I was convinced that it was possible to experience a fulfilling career journey and have an impactful effect irrespective of the location of job posting. The Commonwealth Scholarship empowered us to be the change we really want in our communities and with this, I decided to contribute in my own small way within the municipality.”
On taking up the position, Priscilla planned to organise free eye screening programmes to increase access for those living in the municipality’s rural communities and raise awareness of eye health. To deliver this, she needed to secure buy-in from the clinic’s administrative team and identify funding streams to deliver the programme.
Priscilla developed a proposal aimed at rural community eye health needs and subsequently addressing the clinic’s longer-term business strategy. By raising awareness of the importance of eye health, she believed she could increase the numbers visiting the clinic, leading to increased business whilst also contributing to reducing the number of people living with avoidable blindness and vision impairment in the area.
She received positive support from the clinic’s administrators who agreed to a pilot programme and allowed Priscilla to provide her services for free to screen rural community members within Agona West Municipality and its environs. With this confirmed, she turned her attention to securing funding to heavily subside the cost to conduct follow-up assessment in cases where poor eye health was identified.
“In public health, one of the approaches to promote eye care is eye screening. This provides the opportunity to detect eye diseases early, educate the public and refer persons with eye diseases to a professional. An inadequate eye care workforce and facilities, especially in rural communities, hinder comprehensive primary eye care and referral schemes post screenings.”
Priscilla identified local community members who were willing to donate funds towards these costs and approached the clinic’s medical supplier who agreed to provide medicines at reduced cost. This enabled Priscilla to procure glasses as well.
Interventions that change attitudes to eye health
Following the success of the pilot programme which reached approximately 100 people, Priscilla continued to deliver this service, targeting different groups, such as teachers through a collaboration with the Ghana National Teachers’ Association (Agona Municipal Chapter).
From these screenings, Priscilla detected a range of eye conditions such as uncorrected refractive error, presbyopia, conjunctivitis, cataract, traumatic eye injuries, glaucoma, and diabetic and hypertensive retinopathy.
All those who were diagnosed with conjunctivitis and presbyopia received free eye drops and reading glasses to improve their vision and ocular health. Among those who needed further in-clinic assessments, approximately 80% attended follow-up sessions at the clinic at a discounted cost. Priscilla is particularly proud of the follow-up rate as it is a strong indicator of increased eye health awareness amongst participants and helped to initiate behavioural changes towards this service amongst the target communities.
In the long-term, the screenings have contributed towards the national and international aim of reducing avoidable blindness and vision impairment by making eye care services available, affordable, and accessible.
After each community eye health engagement, Priscilla communicated with the Municipal Health Directorate about the uptake and results to further promote awareness of her work on eye health, demonstrate the success of the programme, and obtain approval to continue conducting screenings.
Harnessing local knowledge to raise awareness
Priscilla emphasises that delivering free eye screening only addresses part of the problem. Due to limited access to eye health services in the municipality and a general lack of eye health awareness, people often resort to a ‘wait and see’ attitude or ‘traditional herbal medicine’ when they experience ocular problems. The use of unauthorised or unprescribed medicines such as herbal extract can result in corneal blindness.
Understanding these alternative harmful methods is valuable to Priscilla’s wider work in raising awareness of eye health and highlighting the importance of seeking clinical treatment.
In one case, Priscilla saw a child who had suffered a severe ocular injury and the parents had applied cassava juice on the affected eye for several weeks. By the time the child’s parents reached her clinic, severe secondary complications with permanent damage had occurred. This outcome for the child was sadly avoidable. Priscilla highlights the importance of interacting with communities about eye health issues, especially where poor transport infrastructure and a lack of eye health facilities make that accessing immediate emergency eye care difficult.
“Getting stories from the communities helps me to know and understand what issues to tackle. I find such stories as a window of opportunity to educate. For example, education on why cassava leaf is not a prescribed method of attending to ocular diseases and how such substance aggravates the eye condition.”
For approximately 80% of communities in the Agona West Municipality, farming is the dominant economic activity and finding time to deliver important information on eye health can be difficult. Religion is well observed amongst the community and as such Priscilla approached church leaders to be granted time to deliver information sessions following church services. These were well received by community members and Priscilla received further requests to join other services to share eye health information.
Being flexible to the needs of the community and respectful of their time and priorities has enabled her to raise awareness of eye health and encourage more people to be screened and seek medical attention.
“The beauty of working in these particular rural settings is that if you give one patient a wonderful eye care experience, trust me, such patient will spread that information creating a domino effect in the community. It was a joy to serve these rural communities.”
Reaching a wider audience
In 2020, the COVID-19 pandemic and resulting restrictions halted eye screenings and outreaches in Ghana and the work of Priscilla’s clinic. Despite these challenges, she wanted to find ways of continuing to raise awareness of eye health. To do this, she turned to her social media platforms and created a range of informational content to improve and promote eye health.
Her work brought her to the attention of Ob Malope, the co-founder of Eyefrica Media. The platform seeks to grow the eye care industry in Africa through the provision of information and resources to support eye care professionals across the continent. Ob approached Priscilla and commissioned her to produce further content including articles and videos on her experiences in Ghana.
This has been an exciting opportunity for Priscilla and has raised her visibility within the eye care sector internationally. In 2020, she was featured in Eyefrica media’s International Women’s Day campaign focused on Women in Eye Health which celebrated the impact of women in eye care.
Gaining confidence and skills to deliver change
Priscilla is proud of her work to date and of the decision she made, on completing her studies at Imperial College London, to immediately implement and test the things she had learned.
“My study prepared me with how to plan, undertake, effectively communicate/engage stakeholders and evaluate projects which I employed to influence the decision of my clinic’s administrative and in executing the community eye health programmes.”
With experience in implementing successful programmes and having achieved greater visibility for her work, Priscilla is keen to progress further and find new opportunities to apply her skills and knowledge.
“Working on the rural eye health projects made me appreciate the beauty and the importance of having strong community and corporate partnerships, specifically with respect to funding. It made me wish to work with well-established NGOs in the eye care industry, like Sightsavers and VisionSpring, in order to expand the reach of my eye care education program.”
Priscilla Ablordeppey is a 2016 Commonwealth Shared Scholar from Ghana. She completed an MPH Public Health at Imperial College London.