Sightsavers International Uses the EquityTool to Improve Service Delivery in Comprehensive Eye Services and in Outreach Camps


Program Background

Sightsavers International works in more than 30 low- and middle-income countries to eliminate avoidable blindness and promote equality of opportunity for people with disabilities. They support the development of comprehensive eye care services and provision of treatments for neglected tropical diseases. Learn more about the organization.

Equity Measurement

Sightsavers seeks to provide care for the most vulnerable individuals as defined by a number of factors including disability, gender, age, and socioeconomic status. In order to inform new programs on urban eye health and surgical services camps, Sightsavers incorporated the EquityTool questions in two programs to measure client wealth. The first program looked at urban clients receiving comprehensive eye care services in India and Bangladesh, with a focus on provision of services to slum dwellers. The second looked at the wealth of clients coming to trachoma outreach camps in Malawi that provide eyelid surgeries to patients with Trichiasis; a painful condition caused by repeated trachoma infections where the eyelashes turn inward and scrap the cornea; which can lead to irreversible blindness if left untreated.

Experience with the EquityTool

To understand how well they are meeting their mandate to serve the most vulnerable individuals, Sightsavers incorporated the EquityTool questions along with other measures to evaluate client vulnerability. Because the EquityTool contains a shortened survey and can be completed in only a few minutes, they were able to add the questions in Bangladesh, India, and Malawi as part of baseline surveys and routine data collection. Data was collected via tablets and smartphones. Furthermore, with Sightsavers’s work in India and Bangladesh, the ability to compare the population to an urban-only population was helpful to better understand the client profile.

Lessons Learned

Sightsavers learned that urban slum-dwellers were not always the poorest when compared to the rest of the population; showing a potential for introducing cost recovery mechanisms and improving the sustainability of urban eye health programs. And in Malawi’s outreach camps, Sightsavers learned that approximately 70% of individuals coming for services fell in the wealthiest three wealth quintiles. Because trachoma is especially prevalent among the poorest in the population, they would like to reach the lowest two wealth quintiles to extend and grow their impact. Sightsavers is now looking at their outreach and program delivery in more detail to better understand how to reach those most in need, and plan to roll out the EquityTool questions in four additional countries.

One of the biggest challenges Sightsavers faced in incorporating the EquityTool was sensitizing a staff that was already busy collecting a variety of data, and worried about further commitments and distribution of resources. After demonstrating the EquityTool’s brevity and ease of use, combined with statistical rigor, the staff was quick to accept the tool. Although Sightsavers hosts advanced statistical analysis teams in the London Headquarters and in a few regional offices, they were pleased with the automated analysis that allowed any staff member to collect and analyze results.

Sightsavers plans to continue using the EquityTool and to conduct follow-on research to understand more about clients receiving services, wealth reporting, and how to reach the poorest individuals in the communities where they work.


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