Improving eyecare in Botswana

The visit informed our work supporting Peek Vision to replicate their National Eye Health Programme internationally, through exploring the potential of an outcomes-based agreement.

We began the in-country mission by assessing the scale of the challenge in Botswana, where around one in 50 Batswana suffer from untreated visual impairment (VI).

Peek, which is helping to facilitate Botswana’s National Eye Health School Screening Programme, estimates that about 50,000 children require treatment for eye health conditions and 30,000 of them could have their conditions resolved with spectacles.

Stakeholders at the Ministry of Basic Education tell us how these children are at risk of achieving poor learning outcomes and are sometimes wrongly perceived as slow learners in the absence of a diagnosis.

This is the first of multiple social costs of untreated visual impairment that can lead to poor psychosocial and economic outcomes as a child grows up.

50,000 is a striking number for a middle-income country, particularly when we consider that Botswana has the highest per capita ratio of eye care human resource in Africa yet also has the third highest prevalence of blindness and VI.

So what is causing so many children to suffer from untreated eye health issues in a middle-income country?

We know that it is not because these conditions are untreatable. Research commissioned by the Government of Botswana shows that patients can be treated with simple spectacles or eye drops in 85% of cases.

Instead, it might be to do with the fact that many children live in rural areas, while optometrists and other eye specialists are concentrated around cities.

We hear from the children’s nurse at Scottish Livingstone Hospital, in Molepolole, South-East Botswana, that there is a broader information problem, where many families, particularly outside the large cities, are unaware that refractive services exist or might be accessible. She tells us how she sometimes approaches parents of children in her local community, when she can spot the child’s myopia in their behaviour.

Not only this, but a poor child living in a rural area would struggle to meet the costs of eye tests even if they were accessible, with only three of the country’s 50 optometrists practising in the public sector.

Last year, we began working with Peek, a social enterprise with a mission to radically increase access to eye care worldwide.

In partnership with the Government of Botswana and with support from The Queen Elizabeth Diamond Jubilee Trust, Peek have agreed a programme to scale their school eye health programme nationally.

Shamini Saravanabavan, a doctor who is working to improve referral pathways for children requiring eye surgery, as part of Cambridge Global Health Partnerships, tells us how Peek Vision’s initial pilot in Goodhope, Southern Botswana, has brought about optimism for the national roll-out.

She quotes the local health lead in Goodhope, saying that ​“If Goodhope, which is in a far end [of Botswana], can shine, you feel other areas will do the same.”