Trachoma affects Ethiopia more than any other country in the world. Eye care services are underdeveloped with only three ophthalmologists and four ophthalmic personnel per million people Trevelyan, J., 2017. IAPB Vision Atlas: Global Action Plan Indicators. There are shortages of skilled healthcare workers across all levels of the health system. Often, specialist eye health workers are located in urban areas, leaving people in rural communities isolated from the care they need.

Orbis provides training to doctors, nurses, and the wider eye health team to treat and prevent avoidable blindness. They have expanded their existing work in Kembata-Tembaro Zone and Halaba districts of Ethiopia by training community and primary health workers in eye care and building the capacity of existing health services. They have established 39 new primary eye care units and strengthened four more within government health facilities.

A health worker helps a child

Photo: © Orbis


Developing quality health services

Since 2011, Orbis has trained 104 Integrated Eye Care Workers, who can diagnose patients and perform trachomatous trichiasis surgery, or refer patients with other eye conditions (like cataract) to secondary eye care units for treatment. They are supervised for their first 30 surgeries, and certificates are dependent upon performance in the three months after training.

At the neighborhood level, Orbis works with government-funded Health Extension Workers, who are vital to Ethiopia’s efforts to improving access to healthcare, increasing health awareness and undertaking preventive health activities. Through Orbis, Health Extension Workers have received training in primary eye care, including trachoma, hygiene and sanitation, to add to their existing health interventions. Trained Health Extension Workers team up with Ethiopia’s Health Development Army to assist with community outreach, finding new cases to treat and signposting people for surgery. They play a key role in raising awareness of Mass Drug Administration (MDA) using Azithromycin, which is part of the World Health Organization’s (WHO) SAFE strategy for eliminating blinding trachoma (Surgery, Antibiotics, Facial cleanliness and Environmental improvement).

Implementing universal health coverage principles

Universal health coverage encompasses health promotion and disease prevention as well as treatment. The SAFE strategy to eliminate trachoma is grounded in cross-sectoral partnership, for example, with WASH (Water, Sanitation and Hygiene) institutions. Orbis worked closely with the government’s One WASH programme, constructing latrines in the communities they were working with, while Health Extension Workers and community health volunteers played a critical role in raising awareness and promoting behavior change around personal hygiene – particularly facial cleanliness and environmental sanitation – like the use of latrines.

Teachers have also been trained on these topics to enable them to promote eye health with their students and communities through school clubs, and Orbis worked with local radio stations to broadcast messaging on face washing and environmental sanitation to encourage people to protect their sight.

Empowering communities

Since 2011, Orbis’s partners have completed 15,459 trachomatous trichiasis surgeries – contributing to national efforts to clear the backlog of cases. These surgeries have been made possible through a comprehensive approach across community health workers and primary health care units, which has improved awareness and referral.

  • 502 community health volunteers and 392 Health Extension Workers were trained on the SAFE strategy and primary eye care
  • 362 teachers were shown how to discuss eye health and the SAFE strategy with their students
  • 104 new nurses received training on primary eye care and trachomatous trichiasis surgery so they can become Integrated Eye Health Workers
  • Over 203,800 people were screened for eye conditions – including trachoma, cataract, and refractive error

Out of eight districts, five completed their three rounds of Mass Drug Administration. Orbis’s 2016 Trachoma Impact Survey revealed that trachoma folliculitis levels in these five districts fell from 29.11% to less than 3% Global Trachoma Mapping Project, 2013, below the World Health Organisation’s ‘cut off’ point for elimination. In these areas, trachomatous trichiasis prevalence has also reduced, and they are making progress towards the elimination cut-off In the remaining three woredas, trachoma folliculitis prevalence was 41.05%, so five rounds of mass drug administration were required. An impact survey will be completed in these woredas after two more planned rounds of mass drug administration..

In 2017, the Government of Ethiopia signed a commitment to promote universal eye health and eliminate blinding neglected tropical diseases. Through Orbis’s efforts to integrate trachoma control within comprehensive rural eye care, more people in Kembata-Tembaro Zone and Halaba can receive the treatment they need. In doing so, Orbis is making progress towards a world where people have access to the health care they need to live healthy, productive lives.

This is part of Reaching a Billion, the fifth progress report of the London Declaration on NTDs. Read the full report.