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“If you're imagining a situation like in the U.S. or any developed country," Susan explains, "then you're assuming that people realize they should see a doctor if they have a problem with their vision, that people know how to find a doctor, and that they can afford to get to the doctor let alone pay the bill. But it doesn’t work that way in poor, developing countries."

"Community ophthalmology looks at how to match up patients with the services," she continues. "We do research on operational questions like, 'Do people value cataract surgery enough to pay for it, and if so, how much?' That’s really relevant if you want to create financially sustainable systems. We also train hospitals and clinics in personnel management, and we're training people to set up community programs that we hope will serve the population and last over time."

Building a Bridge
"The way to get patients to come in to the hospital," says Joseph Banzi, Community Coordinator at KCCO, "is to get out of the hospital and go see the people. Our Direct Referral Site program sends teams to do eye exams in all the nearby rural areas. We treat people with minor eye conditions right there, and provide them with glasses. If a patient needs cataract surgery, we refer them directly to the hospital, and we provide transportation there and back — because they would never make it otherwise. We're building a bridge that connects people to eye care services."

With KCCO, the focus is always on building the capacity of local health providers, explains Joseph. "We provide training and technical assistance to a lot of partners, such as the Ministry of Health, staff from nongovernmental organizations, public health clinics in the communities, and the Kilimanjaro Christian Medical College, which has the largest hospital in the area and is our primary partner in Tanzania. That's our focus because it's going to take all of us working together to really make a difference in eye care."
 
Based on Susan and Paul’s groundbreaking research showing a significantly higher prevalence of cataract blindness among women in developing countries compared to men, KCCO is developing programs to boost the number of women who get surgery. Their community health programs also address nutrition and sanitation problems that play a role in eye conditions like trachoma.

Sustainability is the Goal
"In the past, most eye care services in Africa have been donor provided," says KCCO's Sustainability Planner, Edson Eliah. "But if donors withdraw, everything stops. So our work looks at how to make the program sustainable, how to make the programs work if the donors aren't there. In fact, our goal is to make affordable eye cares services that are there for the long run — even if KCCO is not there."

Edson is putting his background in economics to good use. "Part of my job is to help our partners figure out how to reduce their costs. If we can lower the costs of materials, and if we increase efficiency of labor, then eye care becomes more affordable. But we are also putting fee structures in place that can help generate revenue to keep it all going. If we can charge a small fee for things like eye glasses and eye drops, and if people pay for part of their surgery, then we're creating the basis of sustainability. Looking at the example of Aravind Hospital in India, we know it can be done. We just have to find the best ways to apply that model here in Africa."

KCCO has a vision for bringing top quality, high-volume eye care services to all of eastern Africa, home to 300 million people. Already, they are training staff and building networks to make it happen — and Seva is delighted to be a part of it.