Located in Southern Africa, Malawi is landlocked, sharing its borders with Mozambique, Zambia and Tanzania. The country has an estimated population of 18.6 million (2019), which is expected to double by 2038. It remains one of the poorest countries in the world despite making significant economic and structural reforms to sustain economic growth. The economy is heavily dependent on agriculture, employing nearly 80% of the population.
Eye health is included in the Malawi Health Sector Strategic Plans and in the Essential Health Package. Eye care planning is led by the National Prevention of Blindness Committee (NPBC which includes representatives from various public and private entities. There is a National Eye Health Action Plan and a national eye health coordination office under the Ministry of Health.
The Foundation began working in Malawi in 2009. The work in Malawi has included human resources for eye health development, school eye health, research and infrastructure development. In the last 10 years we have supported the development of sustainable eye care services, education and training programs in the country. These have been developed using in-depth research into the unique circumstances and needs of the Malawi population. The key projects are in; Mzuzu University – Training of Optometrists, Malawi College of Health Sciences – Training of Optometry Technicians and in hospitals across the country.
Schools of Optometry Project (SOOP)
SOOP began in 2009 and was in partnership with Sightsavers and Optometry Giving Sight (OGS). The host partners of the project were Mzuzu University and Malawi College of Health Sciences (MCHS) and the Ministry of Health. The primary objective of the SOOP is to address the dire shortage of optometric personnel in the Southern Africa countries of Botswana, Lesotho, Malawi, Namibia, Swaziland, Zambia, and Zimbabwe. The strategy was to develop a regional School of Optometry with 2 schools each training a separate cadre of Optometric-skilled personnel. The MCHS trains the ﬁrst level of Optometric personnel, Optometric Technicians, while Mzuzu University hosts the 4-year degree program leading to qualiﬁcation as an Optometrist. The project has completed 11 years of existence and has contributed 66 optometrists and 128 Optometric technicians to Malawi. The project has also successfully advocated for the employment of these cadres within the public health system.
The aim of this project is to develop a sustainable vision care model, including the establishment of vision care centres across the country integrated into the general health delivery system, research and advocacy as well as child eye health. It also focuses on;
- Improving existing infrastructure within government hospitals by refurbishing existing clinics and providing the necessary equipment.
- Strengthening existing systems such as referral and data collection with the ultimate aim of improving access to eye health services in the country.
- Improving access (distance and aﬀordability) to refractive errors services especially for the poor through the setup of vision centres with skilled personnel
Four Vision Centres were set up in different regions of the country and they continue to provide refractive errors services to the communities.
1. Spectacle Compliance Among School Children study. The study was funded by World Bank and it involved 2,993 children within Lilongwe urban of which 70 were found with significant refractive error. The average observed spectacle compliance usage among the 70 children was 53.5%. The report from the study is complete and a manuscript for publication is under review.
2. Survey to determine factors contributing to the low uptake of glasses in the Vision Centers was conducted in partnership with Essilor in 2014.
3. A research funded by Lions Club International Foundation (LCIF) SightFirst Research Grant is underway. Its primary aim is to develop and field test a protocol, including questionnaire, to assess prevalence of main causes of ocular morbidity and vison loss in a representative sample of all-ages of a population. The secondary aim is to determine how to ‘operationalize’ the ocular morbidity protocol, by determining appropriate sample sizes, approximate costs and resources required. This is part of a multi-country research that is also being conducted in Vietnam and Pakistan.
Cross Cutting Issues
Eliminating gender gaps in HReH Training
After 8 annual intakes into the Bachelor of Optometry Course at Mzuzu University which were characterized by 95-100% male students, 2018 saw female students outnumber males for the first time, 52% female and 48% male. This achievement is due to the continuous efforts of making the course appealing to female students and advocacy for the university to ensure a fair female representation in their admissions. Finally, the optometry department at Mzuzu University is the first department to recruit students based on gender split. The first group to implement gender split comprised of 22 students with a 50/50 split.