Thirty patients wait patiently under a makeshift awning, awaiting cataract surgery in the small town of Elubo, Ghana. Outside of the clinic, a line of community members wraps around the building, as each patient awaits their visual acuity test.1 These patients are a few of the 200,000 per year who will receive eye care and sight restoring surgeries thanks to the assistance of Unite for Sight, an organization dedicated to eliminating patient barriers to eye care.2
The New Haven, CT based organization Unite for Sight establishes partnerships with local clinics and ophthalmologists to identify factors hindering access to eye care, and to implement accessible, quality visual acuity tests, diagnoses, and sight-restoring surgeries. Unite for Sight partners with clinics in three major locations – India, Honduras, and Ghana – and it fosters collaboration between local doctors and Unite for Sight Global Impact Fellows, many of whom are undergraduate U.S. students. The current state of health policy in Ghana raises important issues and provides an interesting context in which to analyze Unite for Sight’s programs.
In nations such as Ghana, where 28.5% of the population is below the country’s poverty line3, visual impairment has serious effects on quality of life, employment, and leadership status. One study examining visual impairment among economically disadvantaged populations observed that 80% of women with vision loss experienced a decline in authority within their families, and 50% of men and women experienced a loss in social status among the community.4 A further complication observed by Unite for Sight volunteers in Ghana is the cultural expectation that family members, including young children, must quit school or their jobs in order to become caretakers for their relatives, stymieing development and exacerbating financial concerns.5
To examine the specific initiatives that Unite for Sight has established, it is important to understand the guiding health and insurance policies in Ghana, and the issues they raise in providing quality, accessible eye care. The Ghana healthcare system is comprised of a public and private sector. The public sector is run by Ghana Health Services (GHS) and teaching hospitals, while the private sector is primarily composed of faith based, for-profit organizations.6 The Ghana Health Services includes three tiers of healthcare: a district hospital, community health planning and services zones, and ten regional hospitals. In the community health services zones, community volunteers work with health officers to increase access to healthcare, though the success of the initiative has yet to be proven.
Insurance in Ghana has undergone a number of changes since Ghana gained independence in 1957. Originally, the entire Ghana population was granted access to free healthcare, paid for by cost recovery policies, taxes, and voluntary health insurance. Due to declining economic strength, Ghana implemented user fees for insurance, which resulted in a sharp decline in usage of health services and decreased access to healthcare for the impoverished. Today, Ghana uses a National Health Insurance Scheme, which provides free healthcare to all citizens and is funded by taxes on goods and individual premiums. The objective of the National Health Insurance Scheme was to increase the affordability of drugs and healthcare services, especially among the poor, an unusual attempt in sub-Saharan Africa to implement universal health insurance. However, while all citizens are required to enroll in the program, only 34% have done so, which helps explain the disparity seen in access to eye care today.7
The World Health Organization and Unite for Sight identify a number of consequences that result from these policies and healthcare systems. Economic cost is a leading factor that prevents people with visual impairments from exploring treatment options.8 Even if surgery is free, transportation, medications, and loss of work time may render treatment too costly. Other challenges presented within the healthcare system include insufficient quantity of medications, poor patient attendance at clinics, lack of patient education, and lack of staff. Rural settings pose further challenges, as there are often not enough providers to serve the population. Unite for Sight’s concept of the partner eye clinic is working towards addressing these issues by training the local doctors and healthcare providers to implement higher quality vision care, and providing the clinics with the capacity to hold outreach clinics in the most rural areas of Ghana. The organization focuses on training local leaders and hiring community members, to increase employment and financial security in the villages.
Through a unique program in which undergraduates conduct global health research, Unite for Sight is gaining a better understanding of how to address the challenges Ghana’s healthcare system faces. Yale undergraduate Elle Dupler served as a Global Impact Fellow with Unite for Sight in Ghana for nine weeks, conducting research on the relationship between poverty and eye health. She described her experience as “easily… the most challenging and rewarding and fun experience I’ve had.”Dupler observed a number of barriers to eye care and she noticed that “[patients] cited fear and a lack of knowledge as the primary reasons that they hadn’t come for cataract surgeries, etc. sooner”. Dupler recognized the impact of Unite for Sight’s services, explaining that, “Thanks to Unite For Sight, many Ghanaians can get subsidized medication, eyeglasses, and surgeries for many different eye conditions.”
While the healthcare policies and insurance system presents serious challenges to eye care health, Unite for Sight is identifying these issues through strong partnerships with local clinics and research contributions from undergraduates, and is creating sustainable change in the field of eye healthcare.
1. “Dispatches from Crystal Eye Clinic’s Unite for Sight Outreaches in Ghana.” Unite for Sight Facebook Page. Updated February 26, 2013. Accessed November 2, 2014.
2. “Annual Summary.” Unite for Sight. Updated 2013. Accessed October 31, 2014.
3. “Ghana. CIA The World Factbook. Updated 2014. Accessed November 2, 2014.
4. Wright, H., Turner, A., and Taylor, H. “Trachoma and poverty: unnecessary blindness further disadvantages the poorest people in the poorest countries.” Clinical and Experimental Optometry. 90.6 (2007): 422-428. Accessed October 31, 2014.
5. “Module 2: Patient Barriers to Eye Care.” Unite for Sight. Updated 2013. Accessed November 1, 2014.
6. “Ghana country assessment report on ageing and health.” The World Health Organization.(2014); 17-21.
7. Blanchet, NJ, Fink G, Osei-Akoto, I. “The Effect of Ghana’s National Health Insurance Scheme on Health Care Utilisation.” Ghana Medical Journal (2012): 46(2): 76-84.
8. “Module 2: Patient Barriers to Eye Care.” Unite for Sight. Updated 2013. Accessed November 1, 2014.