Inclusive, Enabling Communities

Inclusive, Enabling Communities
Learning Brief

The Fred Hollows Foundation South Africa

Seeing the future: supporting comprehensive eye care in the North West Province

Category: Inclusive, Enabling Communities | Older persons | 1 March, 2013 - 13:05


The Fred Hollows Foundation envisions a world where no one is needlessly blind. The Foundation is inspired by the work of the late Professor Fred Hollows (1929–1993), an eye doctor, a skilled surgeon of international renown, and a social justice activist. In South Africa, it operates as the Sabona Sonke Foundation, which was invited by the North West Provincial Department of Health to support the development of a comprehensive eye health programme in the Province. The Foundation offers technical expertise in eye care management and health systems strengthening, and thus helps to guide and oversee that all planned programme activities are undertaken professionally and in accordance with the plan.  The overarching goal of the comprehensive eye health programme in the North West Province is to alleviate needless blindness and its inherent consequences.  

Currently, South Africa’s North West Province is not on course to meet the targets set out in the Vision 2020: The Right to Sight W.H.O. global partnership agreement. There are multiple reasons for this:

  1. Resource constraints for appropriate infrastructure and equipment
  2. Lack of tested procedures and systems
  3. Lack of specialized personnel in general, and personnel trained in best practice eye care in particular
  4. Competing priorities in health care (HIV/AIDS, Tuberculosis etc)

The Rapid Assessment for Avoidable Blindness survey conducted in 2010 helped determine the extent of the burden of blindness in the province.  The survey confirmed that the magnitude of visual impairment and blindness posed far reaching social, economic, and quality-of-life implications, unless some interventions were put in place.  Furthermore, an analysis of the district-level results showed that the Dr. Ruth Segomotsi Mompati district was the most underserved of all districts in the North West Province with high rates of blindness and low service delivery levels.

Lessons on strategic approaches to forming programme partnerships

The Sabona Sonke Foundation supports the development of sustainable, comprehensive, quality eye health services intended to serve marginalized communities through the creation of model, fully functional eye health units located within public sector institutions.

From the onset, programme implementation in the North West Province was strongly aligned to the Fred Hollows Foundation’s model for best practice entry into new areas. We have maintained a joint planning strategy that involves on-going communication with our public sector partners, district management teams, and clinicians. This has fostered a strong sense of ownership over the programme and has increased implementation adherence.

Our strategic approach is focused on 1) offering sound eye health services at the primary health care level, and 2) strengthening human capacity development.

Efforts have been made to align all programme interventions with the official provincial eye health plans, while applying the core principles enshrined in needs-based programmes.  This has called for consideration of appropriate institutional reforms which take into account joint education and health planning mechanisms.  

At Sabona Sonke Foundation, we believe that interventions aimed at institutionalizing core elements of programming in eye health are informed by innovative approaches with a strong advocacy focus on incorporating eye health services into the public sector District Health System.  This approach has the potential to assure lasting and desirable change, amongst service providers, who undergo a shift of mind-set, and amongst the beneficiaries who become well aware of the quality and menu of eye health services available to them.  The ultimate desired impact of well adjusted service providers within the confines of the public sector system of service delivery can be realized through acknowledgment of the need for simultaneous updates and improvements in the health care system

Lessons on improving programme implementation

Partner with district hospitals to improve service delivery

For maximum impact, a select number of public health facilities in each of the province’s four districts have been identified as key sites that offer eye health services.  In these sites, eye care units serve as the organizational framework within which fully functional, efficiently managed eye care services can be offered and integrated into the provincial health care system.  

According to the findings of the Rapid Assessment for Avoidable Blindness survey (2010), the Dr RSM District was the most underserved in the province. Therefore we concentrated on improving service delivery in this district. We also set up eye care screening services at multiple primary health care facilities throughout the district and saw a total of 446 people screened.  

The Foundation is negotiating to employ an ophthalmologist in the Dr RSM District, who will be stationed at Klerksdorp/Tshepong provincial hospital but service the entire district. This arrangement is essential as by law, specialists cannot be resident in district hospitals.  It is also working closely with the district leadership and local clinicians to ensure that eye care services in hospitals are developed into fully functional eye units.  

Build specialist capacity and develop human resources

An important aspect of our approach has been to support the development of a critical mass of appropriately trained eye health personnel, capable of delivering comprehensive eye care and restoring sight to all who are unnecessarily blind.  The Foundation provides training in key technical areas for provincial health personnel.  

A specialist ophthalmologist has been contracted to offer ad hoc, monthly training to four Medical Officers from district hospitals in Dr Kenneth Kaunda District. The foundation is also negotiating with the Department of Health to pick up from where this training stops and to take these four Medical Officers through cataract surgery training.   

Increase eye health awareness

The Sabona Sonke Foundation collaborates with other agencies to celebrate World Sight Day in October. We circulate information pamphlets and education and communication materials related to eye health to the public. During October we also accelerate eye screening programmes across the North West Province, paying specific attention to the effects of other chronic medical conditions linked to worsening eyesight (e.g. diabetes, hypertension, obesity, etc).

Support new policy development

The Foundation has endorsed existing guidelines and protocols for greater focus on the wellbeing and support to older persons.

The Foundation has also partnered with the North West Provincial Department of Health to design a comprehensive and strategic eye health programme that builds on the recommendations emanating from a baseline assessment and a gap analysis conducted in 2010.


49 Beach Road, Nahoon, East London 

 (043) 735 3646

In Short

Learn how the Fred Hollows Foundation supports municipal and provincial health care providers by developing new policy, and improving eye-care services for the public.

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