Lessons from the Boresha Macho eye health programme in Tanzania

The three-year Boresha Macho programme has been a game-changer for eye health in the Singida and Morogoro regions of Tanzania. I’ve been involved with the project throughout its lifespan and seen for myself the impact it has had within communities.

Although the programme, funded by donations from the UK public and match funding from the UK government through UK Aid Match, has now ended, it formed strong foundations that governments and partners are now building on. Health budgets and resourcing have already been increased and Sightsavers is currently supporting a review of professional training curriculums.

It has made a huge difference in growing the number of eye health workers, making services more accessible and gender-inclusive, reaching marginalised groups and demonstrating the importance of data. But most of all, it has had a wonderful ripple effect, as each person who accesses eye health services becomes an ambassador for eye health.

Building the eye health workforce

When the programme started, we first addressed the eye health human resource aspect, making sure that all districts we work with had qualified human resources. The programme helped to roll out the World Health Organization Primary Eye Care manual in Tanzania, supporting the Ministry of Health to customise it to reflect the national context, and provided training for 533 primary eye care staff. We also strengthened eye health facilities at all levels, and we aligned with the World Health Organization’s six ‘building blocks’ by making sure that we addressed the issue of service delivery to the community.

The trained staff help provide eye health services at lower health facilities as well as referrals to patients who need cataract operations. Tanzania is one of few countries in Africa to implement the eye care manual and this is thanks to the UK Aid Match support.

Reaching remote communities

At Sightsavers, we do a lot of community outreach work. With Boresha Macho, we conducted 60-70 community outreach events – and whenever we go to rural areas for eye screening and surgical camps, we help a lot of people. The area that we work in is very remote. In terms of the average household income, many people struggle just to pay for transport to access health care, let alone the costs of the care itself. So community outreach is vital, and the programme has had a significant impact.

Demonstrating the importance of data

In Tanzania, most of the regions are not able to share eye health data. But the two regions we have been working in, Singida and Morogoro, have demonstrated it is possible for the ministry of health to receive quality eye health data from the district regional level and even lower-level facilities. For three consecutive years the two regions have been outstanding in terms of sharing quality data. This helps with policy lobbying for budget allocations and lobbying for human resource for eye health – not only in the two regions but also in other regions.

Beyond Boresha Macho

The programme has led to a lot of positive change throughout Singida and Morogoro, but there is still plenty of work to be done to improve eye health across Tanzania. Firstly, we need to look at the link between primary eye care and primary health care. Eye health should be well integrated into primary care facilities because that is where people on low incomes go whenever they get any eye issues.

We need to train more people. We need to integrate eye health with insurance to make sure eye health services are covered. We need to ensure eye health financing is in place, and that it is sustainable.

We also need to work on raising awareness of the importance of eye health. In Singida and Morogoro, 80% of the residents are farmers. Their farming depends on rainfall, and with climate change, now they’re farming once a year for a period of three months. That money will go to pay for school fees, to build a house, and to buy food. So when it comes to eye health, many people think, “I will not die if I have eye conditions. I can just live the way I am.” To address this, we need to address the challenge of their household income through economic empowerment programmes.

It is also important that we integrate eye health into education – especially early childhood development – to make sure we’re raising awareness at all levels.

The Boresha Macho programme allowed us to make great progress in improving eye care in Tanzania. UK Aid Match has helped make this possible and changed lives across the country for the long term. I’m so proud to have been involved, and I’m hopeful that the progress made so far will continue.

Author

Edwin Maleko is a programme manager at Sightsavers, based in Tanzania.