It’s all about the numbers: how economics is helping us to save sight in schools

In 2016, Sightsavers helped to develop and deliver the School Health Integrated Programming (SHIP) project in Cambodia, Ethiopia, Ghana and Senegal.  

As part of SHIP, teachers are trained to provide basic vision screening for their students and refer children with vision problems to a mobile team of optometrists. The SHIP projects in these countries have been a huge success, demonstrating how schools can be used to make sure children are screened for eye issues and intestinal worms, and given treatment where needed. To date, more than 57,000 children have received vision screening, exceeding our initial target of 40,000.

We know that children’s school performance is profoundly affected by their vision. I have first-hand knowledge of this: for many months I struggled at school because of poor vision and found it difficult to read the blackboard. This meant I became less confident about participating in class and frustrated at not being able to follow what was being taught. But this all changed when I was 10.  At a vision screening event at my school, I was diagnosed with myopia (short-sightedness) and started wearing glasses. School-based vision screening made a huge difference for me.

I now work at Sightsavers, in the health economics research team.  My experience at school means I can relate to the goals of SHIP.  But how could I contribute?

How can economics play a part?

The answer is economic evaluation. There is a major lack of information on the cost of vision screening, an issue which can prevent governments from allocating public resources to fund it. By using economics to generate evidence about the financial feasibility and affordability of SHIP, Sightsavers can help policy makers and planners to advocate or implement similar projects more efficiently.

So we used the SHIP pilot experience to estimate the cost of scaling up our school-based vision screening and treating uncorrected refractive error across our projects in Ghana and Cambodia.

As a starting point, we decided to look at the cost of two pilots to try to understand what resources were needed to implement a high-quality screening programme. We looked at how these costs were distributed to identify what would be the standard cost of implementing SHIP, using detailed financial data for each district.

After collecting the cost data, we developed a costing tool which, following SHIP’s guidelines, can be used to estimate the cost of carrying out school-based vision screening nationally in Cambodia and Ghana.

The results suggested that scaling up SHIP is affordable in these countries under the current health and education budgets. They also helped to build the financial case for a potential region-by-region scale up, if there is sufficient in-country capacity to deliver this.

There has been a lot of interest in the costing tool from our partners in Cambodia, particularly from the Ministry of Education, Youth and Sport (MoEYS), the Ministry of Health and The Fred Hollows Foundation. Together, we hope that the tool will help school-based vision screening to be included in the next education sector plan.