Access to school-based eye health programs in Central Region, Malawi: a qualitative case study

Abstract

Summary Vision impairment among children is associated with lower levels of educational attainment. School-based eye health programs have the potential to provide high-quality and cost-effective services that assist in the prevention of blindness and uncorrected vision impairment, particularly in low-resources settings. The aim of this study was to identify key factors that inhibit or facilitate the provision of school-based eye health programs, including referral to eye care services, for Malawian children in the Central Region. In-depth interviews (n = 10) and focus groups (n = 5) with children, parents, school staff, eye care practitioners, government and NGO workers (total participants n = 44) in rural and urban contexts within central region, Malawi, were conducted. Taking a rights-based approach, we used the AAAQ (availability, accessibility, acceptability, quality) framework to identify barriers and enablers to school eye health programs. Complex factors shape access to school-based eye health programs. While intersectoral collaboration between ministries was present, infrastructure and resourcing restricted the delivery of school eye health programs. School staff were supportive of being trained as vision screeners. Parents voiced geographic access to follow up eye care, and spectacle cost as a barrier; and children revealed experiences of stigma related to spectacle as barriers to uptake. School-based eye care may be facilitated through teachers, community informants and health workers through; the provision of school vision screening; increased awareness of the impact of vision impairment on education and future employment; and through educational approaches that seek to decrease stigma and misconceptions associated with wearing spectacles.

Illuminating Perspectives: Navigating Eye Care Access in Sub-Saharan Africa Through the Social Determinants of Health

“…Two of the studies reviewed focused specifically on pediatric eye care and access in schools. Yashadhana et al [ 20 ] found that in primary schools in the central region of Malawi, visual acuity testing was not performed frequently enough, or even performed at all. There was distrust of medical providers and a general lack of education on the importance of eye care.…”

“…Several studies cited the heavy burden on tertiary care facilities. A lack of basic eye healthcare at the primary level, coupled with disorganized record-keeping, mismanagement of funding, and poor referral systems means that tertiary care centers are faced with large volumes of patients they are unequipped to handle [ 20 , 29 ]. This in turn contributes to the crowding in hospitals and long wait times that deter patients from seeking proper eye care [ 17 , 21 ].…”