PROJECT EVALUATION: INCREASING EQUITABLE ACCESS TO EFFECTIVE CATARACT SERVICES IN WEST, SOUTH, AND SOUTH -WESTERN UGANDA
OrganizationFred Hollows Foundation Posted7 Nov 2023 Closing date21 Nov 2023
Introduction
The Fred Hollows Foundation (The Foundation) is a secular non-profit public health organisation based in Australia, which was founded in 1992 by eminent eye surgeon Professor Fred Hollows. The Foundation focuses on strengthening eye health systems and the treatment and prevention of avoidable blindness caused by Cataract, Trachoma, Diabetic Retinopathy, and Refractive Error. It operates in more than 20 countries across Australia, The Pacific, South and South-East Asia, and Africa. The Foundation was named The Australian Charity of the Year 2013 at the inaugural Australian Charity Awards.

Increased access to eye care services. A total of 300,000 people will be reached with community education/ sensitisation sessions on eye health of which 191,000 are expected to have their eyes screened. The project plans to conduct cataract surgery for 14,700 people, distribute spectacles to 7,346 people and provide other sight saving interventions to approximately 88,151 people.

As required under ANCP funding the project is required to meet the ‘Significant’ DAC Gender Mark and ‘Significant’ ANCP Disability Marker. Therefore, the project has a focus on activities that engaged marginalised people, women, people with disability, indigenous people and people living in remote hard to reach areas. The project will pay particular attention to reducing access barriers for marginalised people.

Outcomes and outputs

Outcome 1: Communities are aware of cataract and other eye health services and actively seek services.

Output 1.1: Community eye health education and promotion of eye health services is delivered in communities including pathways to access eye care services.
Output 1.2: Peek technology solutions rolled out for screening and referral.
Outcome 2: Equitable access to eye health services for women, men and other under-served populations in target areas.

Output 2.1: Awareness is increased among eye health workers on gender and disability related barriers to accessing eye health.
Output 2.2: Eye health awareness raising activities specifically consider and address barriers to access services for under-served populations especially women and persons with disability.
Output 2.3: Cataract surgical outreach services are delivered to under-served areas.
Outcome 3: Quality cataract and other eye health services available and delivered by implementing partner hospitals.

Output 3.1: Implementing district hospitals have adequate capacity to screen, refer and deliver quality cataract and other eye health services.
Output 3.2: HREH trained to deliver quality and comprehensive eye health services.
Output 3.3: Cataract Surgical outcomes improved and monitored.
Outcome 4: Accurate eye health information is available to inform decision.

Output 4.1: Rapid Assessment of Avoidable Blindness conducted in target area.
Output 4.2: CSOM systems are established and outcome data available for all cataract surgeries.
Output 4.3: Eye health data is integrated in HMIS and routinely analysed and reported to inform program decision.
Output 4.4. Advocacy work will be done to strengthen HMIS and increase eye health indicators at national level.
Outcome 5: Local governments in target area are effectively managing and resourcing eye health in respective districts.

Output 5.1: Technical support provided to district health offices to plan, manage, and coordinate eye health services.
Output 5.2. Advocacy work will be carried out with district health offices for an incremental budget allocation for eye care.
Part 2) Achieving Equity Through Integration of Health Services for Women
In Uganda, the Health Sector Strategic Plan has focused on ensuring universal access to a minimum healthcare package of services. While utilization of health services has improved over time, inequities in the use of health services have persisted. For instance, the Uganda National Household Survey Data shows that more women than men reported receiving no care and up to 50% of those reporting having received no health care are in the lowest and second lowest income quintile of the population.

Women in Uganda face considerable barriers to access health services. Evidence from various studies shows that distance to health facilities as well as the economic opportunity costs associated with travel to the health facility[1] are some of the major barriers to accessing health services. This project seeks to address these barriers by integrating eye health into maternal and other health services such that women accessing eye health services at Ruharo Mission are encouraged to seek other health services and vice versa. The rationale for this project is to improve health equity for women through integration of health services and thereby improving health outcomes for women through coordinated care and promoting preventive health care.

Lack of information on availability of services and transportation to the service points have been reportedamong the commonest factors limiting access to eye care, maternal and other health services. The project will seek to demonstrate the effectiveness of integrating eye health with maternal and other health services to increase access to services for women at a single point. This would be an effective approach to not only reducing the cost of transport and time spent accessing health services but an opportunity to access health services that may otherwise not been perceived as important due to lack of awareness.

The project has a two-pronged approach, 1) to integrate maternal and other health services for women accessing eye care services under the current FHF funded project, 2) integrate screening for eye health conditions among women attending the maternal child health clinic and other health services at Ruharo mission hospital. The project focuses on integration and delivery for the following continuum of services:

Eyecare screening and service provision
Screening for high blood pressure, care, and referral
Diabetes mellitus screening, care, and referral
Cervical cancer screening
Breast cancer screening
Eye screening for children attending child health days
Family planning
Counselling (including gender-based violence, and other health conditions)
HIV counselling and testing
Sexually Transmitted Infections testing and treatment.