Targeted Low Vision Awareness Creation and Interventions enhance learner livelihood: Lessons from the

Thuto le Pono Boswa Pilot Programme in Botswana

Authors: Julia Tebogo Bothasitse, Alice Lehasa, Beauty Abbey

Objectives: 1. To demonstrate that increased access to low vision services leads to improved academic performance among learners with low vision

2. To prove that early identification of low vision leads to successful intervention and better livelihood

Background: Low vision is a form of disability that has health, development and educational advancement challenges. Universal access to education at both global and national level may not be achieved if special needs of learners such as learners with visual impairment are not addressed. The 2011, Botswana Population Census revealed that from a population of over 1.7 million there were 59,103 individuals with Disabilities (IWDs), approximately 28 000 are blind or have severe low vision. According to some studies conducted in Botswana, prevalence of blindness is approximately 0.5/1000 per life birth; 360 blind children under 15yrs. 33% of children develop a VI due to uncorrected refractive error, lack of routine vision screening, limited access to refractive services and cost of spectacles. Studies further revealed that Botswana has limited access to ophthalmic care, lack of resources and capacity. Furthermore, learners with Visual Impairment (LVI) face barriers in accessing the curriculum because schools lack teaching and learning materials for LVI and limited access to assistive technologies. Lack of support from the parents and families, inadequate support from school management and ineffective School Intervention Team compound the problem. The interaction of these factors has far-reaching impact on academic performance of LVIs as well as their quality of life (Moswela, etal 2017).

Description: In 2016, The Government of Botswana through the Ministry of Health and Wellness and Ministry of Basic Education, entered into an agreement with the Royal Dutch Visio with the aim of enhancing quality of low vision services in Botswana: Thuto le Pono Boswa (Education and Vision is your right, your inheritance). The programme was implemented in four sites being; Mochudi, Kweneng, Serowe and Francistown. The overall goal of the programme was to provide quality eye health care and education for Visually Impaired (VI) children aged 0-13 years in Botswana to achieve the following outcomes;

i. Increased parents and care givers awareness on needs of and support for learners with VI in selected areas of Botswana.

ii. Strengthened institutional capacity for provision of eye health care and education for learners with VI in Botswana.

iii. Increased screening and assessment of learners for Visual Impairment.

iv. Increased enrollment of children with low vision in regular inclusive schools.

Activities: The programme initiated education and awareness activities, facilitating outreach activities to the otherwise hard to reach and resource limited settings, enhancing collaboration between schools, health facilities and community (parents and guardians). Considerable resources were invested in building capacity of 58 teachers to identify and refer learners for screening and assessment by eye health professionals. A total of eight (8) Ophthalmic nurses and visual impairment teachers were trained to conduct low vision assessment through facility based, and outreach sessions. Those diagnosed were provided with necessary intervention such as devices, treatment and appropriate school placement.

Indicator % Target Reach # MOBE officials reached with awareness on Inclusive Education policy 55% 100 55 # of parents and care givers reached with information on needs and support for LVI 140% 120 168 # of community members reached with information on VI 5% 3000 150 # of assistive devices procured 72% 60 43

# of learners screened for VI 268% 5600 15000 # of teachers trained on screening for learners with VI 187% 31 58

# of parents/ care givers sensitized on screening for LVI 125% 120 150

# of health care professionals trained on assessment for VI 67% 12 8 # of VI assessment equipment procured 67% 108 72 # of learners referred for VI assessment 83% 60 50 # of learners assessed for VI 1667% 60 1000

# of learners diagnosed with low vision 373% 45 168 # of project team members trained in Monitoring, Evaluation and Reporting 100% 12 12

Results:The intervention from 2016 to December 2018 reached the following:

These translated into great benefits to the learners, strengthened collaboration between community members (parents/guardians) and Health Care workers to identify, follow up and refer for appropriate intervention.

Cited delayed intervention post diagnosis as a major challenge

Evaluation reported increased academic performance among learners with VI. Learners reported improved self-esteem and independence as they could do certain chores without seeking assistance. Other achievements were expressed by respondents where some parents shared that learners who dropped out of school due to loss of sight managed to go back to school and continued their studies. The improved vision led to increased school performance. “These brought hope to us as families and the children improved on their self-esteem and confidence. Improved vision instilled a sense of independence on the learners and reduced self-stigma”. Parent

Conclusion:Investing in early identification of low vision through outreach is more effective and efficient as it reaches out to resource limited settings and cases that would have been missed. Community awareness and education on low vision has the potential to increase access to eye health services and improved lives.

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An evaluation of the programme conducted in January-February 2019 consisting 26 learners with low vision, 15 parents and guardians as well as 12 key informants provided positive results from the pilot programme.

Evaluation