Engendering Rural Eye Care for Access to Education
| Authors | Type | Stream | Full Paper |
|---|---|---|---|
| Ajita Vidyarthi, Rajat Chabba | Open call | Poverty |  en |
Background
While the ratio of girls to boys in primary, secondary and tertiary education in India is 91%, 70% and 66% respectively, only 18% of the total wage employees in the country are women. Their representation in the current Indian Parliament is a dismal 10% of the total house. In terms of health indicators, India has the highest number of maternal deaths in the world with less than half of the total births being attended by skilled personnel and more than 80% women suffering from anaemia. Moreover, there are 927 girls in India for every 1,000 boys. This gender deficit is attributed to female foeticide and infanticide, practised to this day in the country’s cities and villages.
Challenges related to gender and eye care in India
Over two thirds of adults over the age of age of 40 in rural Indian population with low vision secondary to cataracts, glaucoma, and refractive error had never sought eye care[1]. Women account for 67% of all individuals with visual problems, adjusted for age and irrespective of any biological attribute. Also, women were found to utilize eye care services 40% less than men. Another finding reveals that approximately two out of every three blind people in the world were women, most of who were over the age of 50 years, and ninety percent lived in poverty.[2] In no instances did biological differences explain these gender disparities. Instead, “women of all ages (including children) were more frequently exposed to causative factors, such as infectious diseases and malnutrition, and utilized eye care services less frequently than men”.[3] While higher life expectancy, lower levels of education, literacy, and income are proximate reasons for gender disparities in eye health, the root cause can be traced to the low social status of women in much of the developing world.
Aim of Research
To (1) understand policy level linkages between education and health of girls and women in India, (2) understand the nature of relationship between literacy of the girl child and her access to eye care and (3) propose an alternative education and eye care awareness model, based on a case study on eye care infrastructural access to rural Indian girls and women.
Participants or Sample Strategy
The data on women is retrospective data based on personal interviews, case studies, and interactions and unobtrusive observations in 50 camps accumulated in a period of one year. Through a questionnaire, prospective data has been analyzed. Focus is on rural women and girls. Principles of stratified random sampling were used to select our participants.
Methodology
The study analyses existing education and health related schemes and draws on pending bills, questions and debates discussed in the 14th and 15th terms of the Indian Parliament. This data is sourced from the Indian Parliament records. Through this analysis, an attempt has been made to link central education and health policies from the perspective of gender equality.
Primary data on eye care infrastructure availability and access for rural women has been sourced from Sankara Eye Centre, Coimbatore; spanning the study across the Indian states of Gujarat, Tamil Nadu, Karnataka and Andhra Pradesh. Sankara Eye Care Institutions (SECI), India works in the field of community eye care since 1985 and runs “Gift of Vision”, India’s largest community driven outreach program in eye care. They provide free eye surgeries to patients at their tertiary eye care hospitals with state of the art facilities.
A questionnaire survey of 45 girls in the age group of 4-19 years who were provided free spectacles through our outreach program was carried out in the states of Karnataka and Tamil Nadu through stratified random sampling.
Also, another aspect “Healthcare (eye care) as a medium of education for women” was studied through the unique mid level ophthalmic courses offered by Sankara National Tulsi Institute of Community Ophthalmology.
Limitations
Part of the data that this paper draws on was collected between the years 2001 and 2007 and thus may not be truly reflective of the realities of 2010. In the analysis on access of rural women to eye care, language barriers surfaced prominently and the qualitative data accumulated was at times subject to personal inhibitions and unwillingness to submit exact details. Though, the retrospective data was available for over 40000 patients, the prospective study has been carried out for 45 children so far and shall be continued in near future. Ongoing School exams and upcoming school holidays have delayed further data collection for the time to come.
Research Findings
Analysis of proceedings in the Indian Parliament:
Even though India fares among the worst countries in indicators of women’s empowerment, only 37 out of the total 5787 questions (0.63%) asked in the 15th term of the Indian Parliament highlight issues of women’s health and education. Demand for a fresh look at policies and caution against failure to meet the UN Millennium Development Goals have not been talked about. This lack of attention is reflected in the minimal allotment to health and education of women in the Annual Budgets of the country.
SECI’s initiatives at the Grass root level
SECI has a unique Gift of Vision Program which provides free eye care services to the poor and the needy. The burden of availability, affordability and accessibility have been tackled by providing free eye care services at the doorsteps of rural India (through camps) and transportation services to bring them to the base hospital for surgery. A retrospective study based on 43014 recipients of Sankara’s services showed that SECI’s unique methodology has made eye care services more accessible to women. In the last one year more than 56% of the services have been utilized by women with a success rate of more than 98%. This is well above the national statistics which suggest that women receive 40% less eye care services then men. The reasons behind this are the employment of female health workers, provision of transportation facility for women, persistent and empathetic counselling and affordability in the form of free eye care facilities ably supported by public private partnerships. This is well supported by similar studies done in Mumbai, India; Nigeria and Egypt. Also, the presence of opinion leaders and partnerships at grass root levels has made Sankara’s facilities more accessible to women. A study showed that 85% of men and 56% of women get back to work within weeks after a simple cataract surgery.
The prospective study of 45 school going girl participants in the age group of 4-19 years who had availed eye care services in the form of spectacles from Sankara was carried out in the states of Karnataka and Tamil Nadu. It was observed that 91.11% (41/45) of the girls were wearing glasses after prescription. 92.68% of the girls wearing glasses (38/41) showed improved performance at school. However, 4.88% (2/41) of the girls showed no change in their school performance. The major reason for improved performance was cited as better vision due to provision of spectacles (94.74%, 36/38) with increased understanding due to other reasons in another 5.26% of the children (2/38).
Eye Care as a medium of education for rural women:
Sankara National Tulsi Institute of Community Ophthalmology has initiated a Vision Care Technician course utilizing eye care as a medium to educate and uplift rural women. Women from remote rural areas are selected through an examination and interview process. The minimum eligibility for this is Class X and zeal to serve the community. Those selected undergo a comprehensive training for two years and are provided hands on training during this period at the state of the art healthcare facilities of Sankara. They are provided monthly stipend during the same along with food and accommodation and work as employees after the completion of training. Thus, Sankara has utilized heath as a medium to educate these women and provided them an access to the outside world. Sankara has also made them confident and financially self sufficient. Till now SECI has trained more than 160 Vision Care Technicians through its initiative. Based on personal interviews and unobtrusive observations, it was derived that these women have become emotionally strong and financially self sufficient through this unique course.
[1] Chang, M.A., Condon, N.G., Baker, S.K., Bloem, M.W., Savage, H. and Sommer, A. “The surgical management of cataract: barriers, best practices, and outcomes.” International Opthalmology. 28.4 (2008): 247-260. Accessed on 8 January 2009. <http://www.springerlink.com/content/2640634853477514/fulltext.pdf>
[2] Abou-Gareeb I, Lewallen S, Bassett K, Courtright P. Gender and blindness: A meta-analysis of population-based prevalence surveys. Ophthal Epid 2001;8:39-56.
[3] Shaikh, Alanna.http://www.seva.org/publications/SevaCanada_GenderandBlindness.pdf
