The Boresha Macho project: improving vision in Tanzania

Boresha Macho was one of the first projects to pilot Sightsavers’ accessibility standards and audit toolkit, which gives guidance on how to improve health care facilities in low and middle income settings.

‘Boresha Macho’ means ‘improve eyesight’ in Swahili – and the programme lived up to its name, providing more than 178,500 eye screenings and more than 17,900 cataract operations. It also made sure that people with disabilities, who are often excluded from accessing health care, could benefit.

While these huge numbers give a sense of how much the programme achieved, it’s the unique stories behind them that really show the impact. Four of these stories belong to Sarah, Hamis, Holo and Upendo, who all live in Singida, a central region of Tanzania.

Sarah is a leader in multiple organisations of people with disabilities (OPDs) in Singida.

“Polio is what made me who I am,” she says. “I have been working for the organisations [OPDs] since they were established (in the late 1980s). In those days I was just a member but as time went on, I became a leader of the national executive committee for 15 years. I want to show other people with disabilities that they have the right to be sent to school, get employment and get representation.”

Sarah took part in the Boresha Macho programme to make sure barriers affecting people with disabilities would be addressed. “I participated specifically to talk about accessibility and outreach,” she says. “I participated as a disabled mother to show – can I enter the building? These things are important.” By taking part, Sarah was able to highlight areas of concern for anyone with accessibility issues, and this has led to more accessible health facilities, including one new build that has been designated as a fully accessible model hospital.

“This project has helped a lot in solving the obstacles that exist in the health sector,” Sarah says. Many of the leaders were shocked about the things they had to do. I can see that this has opened many people’s eyes. Structures and methods have come out of this project and it has been a great success.”

Hamis, a shepherd from Singida who is blind, attended a training session led by Sarah on how to make eye care more accessible to people with disabilities.

“The training was about opening the minds of doctors and nurses in the health sector to not be biased and to accept all members of the community,” Hamis says.

After the training, he decided to participate in the programme to help change negative attitudes towards people with disabilities. As the work continued, he could see changes in the health sector as people learned how to better understand the requirements of people with different impairment types and cater for them in the best way possible. “It has really helped me, and them, and all of society,” he says.

Hamis is optimistic about the legacy of the programme. “We are currently seeing changes in society about people with disabilities. The programme has been beneficial in making the health sector know our needs – I loved the way Sightsavers involved us in all ways regarding [the sector’s] education. If you create friendly infrastructure, then a person with a disability can enter and get services.”

Hamis has taken the lessons he’s learned beyond health care settings and into the mosques. He shares his knowledge with religious leaders to make their venues more accessible for people with disabilities. “I am there to meet with the leaders,” he says, “but also with the committee of the mosque or the house of worship for improving the infrastructure so that people with disabilities can get spiritual service like other ordinary people.”

Hamis believes strongly that eye care services can help improve equality within society. “In the health sector, there is still a great need for eye specialists,” he says. He thinks there’s still more to be done in Tanzania to improve access to eye health services, especially in rural areas. “The mobile clinics have been of great assistance. They should not end only in the city but reach the villages where they have trouble getting services. If the mobile clinics reach the rural health centres, then a lot of people will get health care services.”

Upendo, an assistant doctor who specialises in eye surgery, works at the Singida Referral Hospital.

“The rural villages of Singida are very poor compared to other provinces. The Boresha Macho project was so important because the area has many people with eye problems and a majority are older people. When the project came, it helped us because we were able to extend our services to the villages, near those patients.

“Before the project, eye care services were poor. I remember in Singida referral hospital, the doctor who was there as a specialist did not have a single piece of equipment for work. Through the programme, we bought equipment and advertised the eye health services provided there.

“The testimony of people who had problems with their vision or in their eyes but are now able to see clearly… that is how we get many people. They come to our hospital through this good project that has helped in our province. We have continued to educate the community and people have seen the importance of treating eye problems.

“My knowledge is increasing day by day. When we do outreaches, we call the doctors who are specialists. They do the surgery but at the same time they help junior surgeons [which supports capacity building].”

“My greatest achievement is that I have helped so many people here in Singida. Many came with various eye problems; some I had to advise to go to a bigger hospital to get treatment, but there are others I was able to help with my own hands. They could not see, now I have operated on them so they can see. That is my biggest success.”

Holo, a 70-year-old farmer, is one of many people who benefited from the programme when a mobile clinic visited her village.

Rachel, Holo’s daughter, talks us through what happened. Holo had started to completely lose her sight and was getting a lot of headaches, which made her day-to-day activities difficult. She had been taken to a referral hospital but her eye issues persisted. One day while Rachel was in town, she spoke to Upendo, who advised that skilled doctors would be coming soon as part of a mobile clinic.

Before her cataract surgery, Holo was scared and stressed about what would happen. Rachel managed to convince her the operation was necessary, and Holo agreed to go ahead. By the time she came out of surgery, Holo was happy and relaxed, and the pain she had felt was already reduced.

Holo’s now a convert to the importance of good eye health and is going to tell her brother to access treatment for his eye issues. Asked how she feels about having her sight restored, Holo says simply: “It is quite joyful.”