In this episode, we speak to Itfaq Khaliq Khan, Senior Programme Manager at Sightsavers Pakistan, about the successes of the organisation's Right to Health project in Pakistan and Bangladesh and what steps were put in place to make the project inclusive to marginalised communities. To find out more about the Right to Health project, head over to: sightsavers.org/programmes/right-to-health/
Noeleen Advani (00:11):
Hello and welcome to The Learning Post, a podcast dedicated to sharing insights from the UK Aid Match and UK Aid Direct funds. My name is Noeleen Advani, and I am the Learning, Monitoring and Evaluation Specialist for UK Aid Match and UK Aid Direct, and your host for this episode. This episode focuses on UK Aid Match grant holder, Sightsavers, and its Right to Health project, which worked to bring inclusive eye health to marginalised communities in Pakistan and Bangladesh. I'm speaking to Itfaq Khaliq Khan, Senior Programme Manager at Sightsavers Pakistan. We discuss the successes of the project and the steps that were put in place to ensure that the project was inclusive and accessible.
Noeleen Advani (00:50):
Thanks for joining us today, Itfaq. To start, can you tell us a bit about the Right to Health project and its aims?
Itfaq Khaliq Khan (00:56):
Yeah, sure. Thank you very much, Noeleen, for the introduction, and providing us with an opportunity to share some really exciting updates from the Right to Health project that we implemented in Pakistan and Bangladesh.
Itfaq Khaliq Khan (01:08):
Let me set a context first. Both Pakistan and Bangladesh are huge countries, in terms of population; a collective population of around 400 million, and a majority of them are living in the rural areas. These rural and peri-urban communities in both countries face considerable challenges in accessing eye healthcare, that include poverty and accessibility. Then we have some subgroups. For example, women, we have people with disabilities, transgender, and elderly. And these subgroups face some additional challenges, such as social restrictions, stigma, discrimination, based on their age, their gender, their disability and sexual orientation. So to address these challenges, the Right to Health project was aiming at improving the quality of and access to eye care services in project districts for people with and without disabilities, and other marginalized groups.
Itfaq Khaliq Khan (02:08):
And how we aimed to accomplish this, was through provision of screening and treatment for the refractive errors. For cataract surgeries and other eye conditions, maybe surgical or nonsurgical conditions, through working with the partner hospitals to make them more accessible and welcoming for people with disabilities, through organising the outreach screening camps for them to identify them, and then for the increase of uptake of services. And finally, through a successful advocacy with the government, with policy makers in both countries, to have a sustainable change in the future.
Itfaq Khaliq Khan (02:48):
I should say that this particular project was quite different from the traditional health service delivery projects of Sightsavers, because it was not only improving the service delivery, but also was focusing on addressing the challenge of inclusion and discrimination, social inclusion of the people with disabilities and other marginalised groups in communities.
Noeleen Advani (03:10):
Great. Thanks so much, Itfaq. Tell us a bit more about what steps were put in place to ensure that the project was inclusive and accessible to marginalised groups in Pakistan.
Itfaq Khaliq Khan (03:21):
To ensure that the project activities are accessible and inclusive for people with disabilities and other marginalised groups, the project has actually adopted a comprehensive approach on both demand, as well as on supply side. For example, we conducted disability access audits of the health facilities where we were working, we made infrastructural adaptations, we trained human resources, we filled the gaps of human resources and technology. Then we mapped out the marginalised groups, particularly people with disabilities, and the organisation of people with disabilities. We conducted targeted outreach to identify these people from these groups with eye conditions and then refer them to the uptake of services to the partner health facilities.
Itfaq Khaliq Khan (04:10):
But the most exciting step to me, was the collection of disability disaggregated data, because this is an area which is a global challenge. The availability of reliable data on disabilities has been a global challenge and is no different in Pakistan. So we used Washington Group short set of questions for the collection of disability disaggregated data, which is a tool used globally for disability data collection. And the analysis of the data collection tells us that around one half of the patients reaching the health facilities in Pakistan were the people who are the people with functional limitations, so this is the most important part to me.
Itfaq Khaliq Khan (04:55):
Just for the interest of those who want to know more, telling each and everything around disability data disaggregation is not possible here, but we do have analysis and reports available on the Sightsavers website for their reference.
Noeleen Advani (05:10):
Great. That's really, really fascinating. The Washington Group questions especially are a real challenge, and something that people obviously want to know more about, on how to collect that disaggregated data. You've already mentioned some of this, but what have been some of the key successes of the project in Pakistan?
Itfaq Khaliq Khan (05:30):
Well, as a result of these steps taken, that I've just mentioned, to improve the inclusion and accessibility, the project has greatly contributed in terms of improved service delivery for the most marginalised, as well as making some strategic level achievements. For example, in Pakistan alone, I'll talk more about Pakistan because I know the context better, we reached around 1.5 million people with eye examinations during the project life, we supported around 38,000 cataract surgeries, while providing half a million refractive error examinations by qualified optometrist, and a half a million non-surgical treatments.
Itfaq Khaliq Khan (06:15):
But then through our programme work, we could also influence some of the policy changes. For example, we supported the formation of an inclusive eye health task force, under the umbrella of National Committee for Eye Health, which is working under Federal Ministry of Health. And the purpose of having the inclusive eye health task force was to take lead on inclusion work in the eye care sector.
Itfaq Khaliq Khan (06:42):
We also supported development of national and provincial integrated, people-centered, eye care plans for 10 years, from 2021 to 2030, which are completely aligned with the WHO's integrated and people-centered approaches, and this will be really helpful in changing the eye health landscape in coming years. In addition, we developed a sign language module for eye health professionals. It was a customised module, to help them, to equip them with the skills, so that they can take care of people with hearing impairment whenever they visit the health facility.
Itfaq Khaliq Khan (07:21):
And finally, we supported making national SDGs monitoring dashboard under the Ministry of Planning, Development and Special Initiative, make it disability inclusive through creating disability disaggregation against 67 indicators pertaining to disability, and that also includes SDG 3, which is around health, and particularly around universal health coverage.
Noeleen Advani (07:47):
Fantastic. Really, really amazing successes. And I guess you've covered this a bit already, but how sustainable are the changes that were achieved, and have you seen improvements in the health system infrastructure or policy making space in Pakistan?
Itfaq Khaliq Khan (08:02):
Yes. Sightsavers, as an organization, believes in strengthening of existing health systems and infrastructures, instead of creating parallel systems. So the Right to Health project has revitalized the existing systems, instead of creating the paralleled one, and making them inclusive for everyone, including marginalized groups. Most of the investments made through this project will sustain post-project, as these are well embedded into the systems.
Itfaq Khaliq Khan (08:34):
For example, we were very vigilant that the human resources trained under the project are the permanent staff of the partner organisations, and not the project-based staff, because if they are permanent staff, they will remain there within the organisation to serve within the sector for quite some time. Also, infrastructural changes that we made at the hospitals are well institutionalised, and the partner has made commitments to replicate them to the other hospitals as well. For example, they are constructing two new hospitals, and the changes that are needed within the infrastructure, they have brought them in right at the beginning. So this is how the changes are institutionalised.
Itfaq Khaliq Khan (09:19):
Then the inclusive eye health task force that we developed under the National Committee of Eye Health is a part of the Federal Ministry of Health, and will remain there to provide leadership oversight to the inclusion work within the eye health sector. So that is also one thing that will remain quite sustainable, even post-project.
Itfaq Khaliq Khan (09:46):
The sign language module that I mentioned is developed under the project, but that is integrated into the inclusive eye health curriculum at one of the public sector university within the curriculum of optometry, so that will also remain there as a part of the curriculum for the future, and will be replicated to the other institutions as well.
Itfaq Khaliq Khan (10:09):
And last but not the least, the IPEC plans, the integrated, people-centered plans, are endorsed by the national and provincial governments and health ministries. Additionally, we have signed MOUs with three of the provinces, just to ensure that they are committed to these plans and its implementation in coming years. So this is how we believe that the interventions and the changes that we made through this project will remain sustainable.
Noeleen Advani (10:41):
Really incredible hearing about all the amazing successes of the Pakistan project and the sustainability of it, and looking forward to seeing the impact of it in the future. Thank you very much for your time today, Itfaq.
Noeleen Advani (10:54):
To find out more about Sightsavers' Right to Health project, head over to sightsavers.org/programmes/right-to-health. Don't forget to subscribe to The Learning Post so you don't miss any future episodes, and please do go back and listen to our previous episodes. Thank you for listening.