Learning review for eye care programme in Bangladesh

The Issue

Blindness is a serious public health problem in Bangladesh, affecting about 1.5% of the population above age 30. In April 2016, Sightsavers began a continuation of its eye care programme with a strategic change in design and implementation. The programme aims to develop comprehensive eye health services in some of the poorest areas through increasing demand for and access to quality eye health services, as well as strengthening health systems and facilities.

Tropical Health was commissioned by Sightsavers to work with its Bangladesh Country Office and Global Technical Lead – Asia to conduct a Learning Review outlining the advantages and challenges of transitioning to an approach that focused on district health systems strengthening rather than delivery of eye care services led by the partner.

Our Approach

Tropical Health used qualitative and participatory approaches (interviews and workshops) to distil learning from experience implementing a district-level programming focus. The scope was guided by eight questions or objectives, and field visits were made to four programme districts.

Tropical Health delivered a comprehensive report outlining what worked well and what didn’t in the areas of: design and planning, district planning and coordination, financing, procurement, eye health workforce development, quality of care, data and information sharing, monitoring and evaluation, advocacy, change management and capacity building. The report included a set of 24 recommendations and concrete steps.

Our Findings

Tropical Health found that Sightsavers’ Bangladesh Country Office has been implementing the complex strategic shift to a health systems strengthening focus without a tangible model on which to build. The office was resourceful in developing the approach and implementing it in the Bangladesh context. The transition faced challenges of prioritisation, since ambitious goals regarding number of surgeries performed and geographic coverage remained in place alongside longer-term health systems strengthening goals. Tropical Health provided recommendations regarding future programme design in general, as well as for Sightsavers’ Bangladesh Country Office, as the transition to a health systems strengthening focus continues.