Country Statement Pakistan is located in South Asia, bounded by China, India, Iran and Afghanistan. With a growing population surpassing 220million, Pakistan encompasses a large middle-class population, which supports its position as an emerging and growth leading economy. With such rapid social and economic development, as well as a rural population of 61.2%, challenges such as access to affordable health care have arisen. In particular, vision impairment and blindness has become a challenge, with approximately 12 million people living with some sort of visual impairment. Program Statement Since we launched our operations in Pakistan in 2011, the focus of our interventions has been to integrate and align eye health into the existing health care system through our comprehensive, sustainable, local empowerment approach. In a country where an estimated 12 million people1 have unnecessary vision impairment due to uncorrected refractive error, our work ensures that affordable and quality eye health services such as vision screenings, eye examinations and provision of spectacles are accessible to those in need. From our School Eye Health Program to our Community based eye health services and Low Vision services, from our Social Franchise Optical Stores (SFOS) to the innovative Enterprise for Sight program – our programs thrive phenomenally in Pakistan ensuring accessible eye health services are available at household and community level while also creating livelihood opportunities. We recognise that the lack of access to a simple pair of spectacles presents a common cause of avoidable blindness in Pakistan, with women often being more affected due to cultural and traditional norms. We are explicitly and continuously addressing existing gender inequities in Pakistan by developing and implementing gender responsive strategies such as training women as micro social entrepreneurs to deliver eye health care to those with limited access to eye health services. Our effective and efficient referral pathways also ensure continuum of care and intensive support for those most in need. Program Highlights Child Eye Health (CEH) Under our Child Eye Health initiative and Our Children’s Vision Campaign in Pakistan, we started the School Eye Health program (SEHP) in 2011 aiming to provide accessible and quality eye health services to children enrolled in the public education system. Our program provides children with knowledge and skills about good eye health practices and encourages them to become agents of change. Believing in the distinct and lasting impact of children as agents of change, we successfully completed our program in partnership with Al-Ibrahim Eye Hospital in Karachi in 2014.Our work has not only contributed to improved vision outcomes for children but also improved their quality of life and helped them excel in education. We strive to provide eye health services to children from low-income families all across Pakistan by supporting our partner Layton Rahmatulla Benevolent Trust (LRBT) and have partnered with Save the Children to build the capacity of government employees in vision screening and school eye health.In partnership with the local government of Azad Jammu & Kashmir (AJ&K), we are implementing the School Eye Health Program. Our collaborative work led to the development of the first 5 year “Eye Health Plan” with School Eye Health integrated within the health and education systems of AJ&K.Intervening most of the geographical locations for the first time for CEH, we have provided quality eye health services to more than 0.8 million children including 47% girls till June 2014. Community based Eye Health Services, Low Vision Services and Social Franchise Optical Store (SFOS) Community based Eye Health Services Our community-based eye health services were initiated to bring eye health care closer to rural communities. Fostering public-private relationships for health promotion, we closely worked with National Lady Health Workers Program and Pakistan Diabetic Association to eliminate avoidable blindness due to uncorrected refractive error and identify non-communicable diseases such as diabetes and hypertension. Bridging the distance and reducing any unwanted transport costs, this program ensures women with near vision problems, the elderly and people with disability have access to quality eye care in their vicinity.Our Academic Vision Centre (AVC) at partner Al Ibrahim Eye Hospital (AIEH) not only serves as a training hub for Isra School of Optometry students and graduates but also provides good quality eye health services to low and middle-income communities. Our weekly eye health awareness raising and examination camps also continue to provide eye health services for the rural community. Low Vision Services As part of our comprehensive eye care, the Foundation launched low vision (LV) services at several secondary and tertiary level eye hospitals in partnership with Layton Rahmatulla Benevolent Trust (LRBT).In collaboration with the College of Ophthalmology and Allied Vision Sciences (COAVS), we have also established LV and paediatric refractive services across different district head quarter hospitals (DHQ) in Punjab. Our work focuses on integrating LV services in the broader health system and strengthening provision of comprehensive refractive services through building an eye health workforce at the district level.Between 2016-2017, LV and pediatric refractive clinics established at LRBT secondary hospitals and DHQ hospitals have provided low vision services to 6,803 individuals including 45% women and girls. We aim to provide low vision services while creating essential connections with the education, rehabilitation and social services. This contributes towards strengthening the National Eye Health plan and enhances education and employment opportunities for people with low vision. Social Franchise Optical Store (SFOS) Our innovative Social Franchise Optical Stores project “BHV Optical” has been successfully launched in Pakistan in partnership with Layton Rahmatulla Benevolent Trust (LRBT). Since, the optical market in Pakistan is largely driven and delivered by informal and unqualified personnel, BHV Optical project aims to improve access to affordable and high-quality spectacles and standardised optical services to a wide range of customers especially from low-income communities. Revenue generated from this project will be utilised to improve LRBT’s sustainability and the future expansion of Social Franchise Optical Stores and other eye health programs in Pakistan. Enterprise for Sight – Giving Sight to the People of Pakistan Addressing the huge unmet need for accessible refractive services at the household and community level, we developed and implemented the Enterprise for Sight project utilising social business principles to provide affordable comprehensive eye care services and sustainable livelihood opportunities for those residing in the project area.In collaboration with local partners, we have established Social Enterprise Vision Centres (SEVC) which are aiming to provide affordable comprehensive eye care services while increasing self-employment opportunities for optometry graduates from recognised institutions. Expanding our Social Enterprise approach, we started a new eye health specialty facility including BHV Optical, low vision, paediatric and ophthalmology clinics in Rawalpindi in 2017. At community level, women have been trained and equipped in primary eye care, vision screening and business management to set up their social enterprises and dispense near vision spectacles, sunglasses, and safety goggles in their respective communities while referring complicated cases to vision centres and district hospitals.In communities where employment prospects and eye care access are often limited, our innovative concept ensures availability of accessible and affordable quality eye care through micro social entrepreneurs whilst simultaneously enabling the entrepreneurs to earn a respectable livelihood.Until June 2018, BHV Optical have provided high quality eye health services to 118,000 people including 47% women and girls. Cross Cutting Issues Social Inclusion and Gender Equity With access to education and rehabilitation, people with disabilities have the opportunity to become more active and engaged citizens. Our interventions are focused on developing scalable approaches and engaging with other stakeholders to ensure a maximum number of people with disabilities are included in mainstream development.We support the development of low vision services at public hospitals and educational institutions where people with low vision have access to quality assessments and assistive technology. We particularly, support the development of training programs for health and education professionals in the area of Low Vision Management. We also undertake and support the research and development of appropriate and affordable technology suitable for the needs of people with low vision.Gender EquityPakistan ranks 121 out of 188 countries in UNDP gender inequality index 2015. Women constitute 48.6% of the total population in Pakistan while 61% women live in rural areas. A Rapid Assessment of Refractive Error (RARE) conducted by the Institute in 2012 has revealed that the prevalence of Uncorrected Refractive Error (URE) is 6.9% with a higher ratio among women (9.6%) compared to men (3.6%).Addressing specific issues that contribute to eliminating gender gaps and gender inequality means bringing the disadvantaged at par with the favoured, something that is yet to be achieved in health and education sectors. We strive to engender our programs by:Ensuring that we set gender responsive objectives and activities in our eye health and human resource development programs by adopting an affirmative action approach.Analysing different eye care delivery approaches to determine appropriateness in reaching both genders.Analysing gender segregated data and use the same to re-design our interventions.Engaging partners to restructure their programs.Our gender responsive Social Enterprise program trains women as micro social entrepreneurs empowering them to earn economic independence and improve their families’ standard of living. Women with near vision, the elderly, and people with disability who would otherwise not leave the house can now access eye care services at their doorstep through our women entrepreneurs.Advocating for gender equity we’ve developed and published an illustrated story book that promotes eye health and girls’ education. To encourage greater participation of female optometry students and on-site girls’ accommodation has been set up for female optometry students enrolled at Isra School of Optometry. Marking our strong focus on gender equity, our regional director of SEAEM Sumrana Yasmin participated in Economist Intelligence Unit’s (EIU) expert panel meeting on visual impairment and women’s empowerment where she shared future trends of Myopia and Presbyopia and their impacts on education and productivity of women and girls.