SETTING UP A LOW VISION PROGRAMME

AUTHOR (S)
Hasan Minto: Brien Holden Vision Institute, Pakistan

PEER REVIEWER (S)

Jill Keefe: Centre for Eye Research Australia (CERA), Melbourne, Australia

INTRODUCTION

This chapter includes a review of:

 Essential elements of a low vision programme
 What constitutes a low vision programme
 What are the different levels of a low vision programme
 How to evaluate a low vision programme

ESSENTIAL ELEMENTS OF A LOW VISION PROGRAMME

In a country with a developed low vision service, a team of professionals carries out low vision assessment.
A social worker does the initial interview and history, functional assessment is done by a low vision therapist,
optometric assessment by an optometrist and follow-up visits to the client is again done by the social worker.
The low vision clinics in these countries are usually very well equipped and the aids are provided to patients on
long term loans, free of cost or are covered by medical insurance.
Unfortunately, this is not the case in most developing countries that have either poorly developed low vision services
or no services at all. Most of the clients come from a lower socio-economic group and cannot afford expensive
devices. Two major impediments encountered in developing a low vision service are paucity of trained people and
limited availability of low vision devices. However, the issue of the availability of LVDs has been greatly addressed
by the establishment of the Low Vision Resource Centre (LVRC) in Hong Kong that is a source of high quality, low
cost LVDs and other essential items to provide low vision care. Further information can be accessed at
http://www.hksb.org.hk/en/.
Under these circumstances, it is necessary to develop a low vision service that can fit into the existing health and
social welfare infrastructure of the country.

June 2012, Version 1-1 Setting up a low vision Programme, Chapter9-1

 Setting up a low vision Programme

ESSENTIAL ELEMENTS OF A LOW VISION PROGRAMME (CONT.)

 To formulate strategies and an action plan to develop appropriate, affordable,

high quality and sustainable low vision services for individuals with low vision
OBJECTIVES  To improve the availability of appropriate, affordable low vision devices
OF A LOW
VISION  To train a suitable cadre of practitioners
PROGRAMME  To improve awareness of the need for and benefits of low vision services
amongst the public as well as eye care professionals
Low vision devices
One of the main constraints in provision of low vision services is the high cost and
limited availability of low vision devices. To address this issue, LVRC has been
established at the Hong Kong Society for the Blind under the auspices of
Vision2020. This centre procures high quality affordable devices and assessment
tests from various sources and supplies these to programmes across the world.
Since its inception in 2003, over 120,000 low vision devices and assessment tests
have been shipped to over 76 countries to programmes in public and non-profit
sectors. There has been dramatic reduction in the cost of devices. For example, an
aspheric stand magnifier costs US$3 and a 6X Keplerian telescope costs US$13.
Research has been conducted to help develop affordable low vision devices and
vision assessment materials which are now being used globally. Research work on
the development of a new system for assessment of vision in infants is more
challenging but has been initiated and field-testing of a second prototype is in
process.
STRATEGIES IN Human resource development
THE DEVELOPMENT OF There is a need to identify and train a cadre of eye care workers to provide low
A LOW VISION vision services. Possibilities include ophthalmologists, optometrists, mid-level
PROGRAMME professionals and existing special education teachers. Whoever is trained in low
vision work will need to have a particular interest in this specialty.
In the short term, ophthalmic paramedics could be trained to provide very simple
devices in remote rural communities. Training of low vision professionals may need
to be provided by visiting experts until the expertise and experience is sufficient
within these countries to take on this development role.
Advocacy
Once low vision services are in place, there will be a need to create awareness in
the public, and improve awareness of the needs of individuals with low vision
amongst ophthalmologists and teachers of visually impaired children. Generally,
there already exists a cadre of community health workers in developing countries
who could assist to identify persons with visual handicap and refer them to
appropriate centres. This would entail inclusion of low vision in their primary eye
care training. For a sustainable development of low vision services, there is a
need to create awareness
amongst officials of health and special education/social welfare departments.

June 2012, Version 1-1 Setting up a low vision Programme, Chapter9-2

ESSENTIAL ELEMENTS OF A LOW VISION PROGRAMME (CONT.)

Development of models of low vision services delivery

The national programme for prevention of blindness needs to identify tertiary
resource centres that would be involved with human resource development and
provision of speciality services, low vision being one of them. There is a need to
develop Expert Centres (EC) of low vision as per need of the country, ideally within
established eye departments.
The functions of the EC would be to:
 Produce low cost, simple low vision devices
 Obtain or produce more sophisticated low cost, low vision devices
STRATEGIES IN
THE DEVELOPMENT OF  Train technicians in the manufacture of these devices
A LOW VISION  Train practitioners in assessing, prescribing, dispensing and maintaining simple
PROGRAMME (CONT.) low vision devices, as well as more complex devices
 Manage the complete range of needs of people with low vision, including those
with more complex needs
 Improve awareness through health education and continuing medical education
 Evaluate models of services delivery to determine its appropriateness to
that country
 Audit service provision
 The EC would train personnel and supply low vision devices to satellite clinics
run in smaller eye units.
Short term (1- 2 years)
 Establish an EC, and identify further eye units that can become ECs during
the first years
 Train practitioners to work in the EC, which may require input from
external experts in short term
 Produce low cost, simple low vision devices at the nominated centres
using locally available materials. This will entail establishing optical
workshop and training technicians
 Obtain sophisticated devices as required, form inexpensive sources of supply

Medium term (2- 5 years)

RECOMMENDATION  Consolidate and develop the ECs
FOR PLAN OF ACTION
 Start to develop the satellite outreach clinics, which will prescribe from a range
of simple magnifiers
 Improve awareness among health professionals and teachers in special
education of the needs of people with low vision and how these can be
met
 Improve awareness among the general public

Long Term (5+ years)

 Undertake epidemiological research to assess the need for low vision services
 Undertake operational research to evaluate the model of low vision
service delivery
 Produce low cost, sophisticated devices
ESSENTIAL ELEMENTS OF A LOW VISION PROGRAMME (CONT.)

1. Persons interested in low vision e.g. optometrists, ophthalmologists, special

education teachers and nurses
2. Clinic space for low vision practice e.g. in a hospital or clinic, government or
private or NGO run
3. A referral base of patients
4. An optical laboratory with optical technicians to support the production of high
power plugs and minus lenses
5. Opticians who are familiar with optical principles of magnifiers and telescopes
and can fit low vision devices
6. Semi-skilled/skilled technicians (e.g. lathe operators) who can cut moulds for the
low vision devices
7. Basic assessment equipment and materials like ophthalmoscope, retinoscope,
trial set, vision box, Lea tests and screeners, visual field perimeter, trial box of
low vision devices (these could be imported or locally made)
8. Awareness amongst eye care professionals and the general public
ESSENTIAL
ELEMENTS FOR 9. Availability of inclusive education / schools for children with low vision and
STARTING A LOW rehabilitation services for adults, infants and children
VISION SERVICE Most specialties in ophthalmology are costly to develop and require specially
trained people and sophisticated equipment. Low vision as a specialty is one area
that can easily be initiated in any ophthalmic or optometric set-up with a minimum
of investment and training. Most of the devices used for assessment can be
produced locally using indigenously available materials and appropriate
technology. The use of simple magnifiers can help children pursue education in
normal stream schools and improve the quality of vision in visually impaired adults.
Each country can identify its own relevant existing human resources and train them
in a short period of time to provide low vision care in a hospital or clinic setting.
Standard manuals on production of inexpensive low vision devices can be utilized
to make these devices. As experience is gained, and with some input from
expatriates, a cost effective and sustainable low vision service can be developed. It
would be preferable to plan the development of any such service so that it is
capable of fitting in the ongoing national health and social welfare programs. This
will not only ensure its sustainability and cost containment but also its early
acceptability and implementation.
PRIMARY LEVEL LOW VISION CARE

Low vision services should be integrated into the eye and health care, education and rehabilitation systems within a
country. Table 1-1 provides an outline of the integration of low vision services into primary or community-based care.

Table 1-1: Activities, personnel involved and the resources required to establish primary level low vision services

ACTIVITIES PERSONNEL RESOURCES

Awareness PHC / PEC Appropriate visual acuity tests (with pinhole)

Screening CBR Samples and instructions for non-optical devices
Referral Teachers WHO Low Vision Kit
Basic rehabilitation
(PHC: Primary health care; PEC: Primary Eye Care; CBR: Community-Based Rehabilitation)

In eye care at the primary level, it is the health or eye care worker who is involved in low vision care. The role in case
finding or screening to identify people with low vision is the same procedure as screening for people with cataract or
refractive error. The additional knowledge needed is of the needs of people with low vision and referral networks.
Appropriate low cost resources and a curriculum for training courses are available.

A classroom teacher in a regular community school, with on-the-job training, can

provide the basic needs for a student with low vision. Ideally these teachers receive
support from the secondary level, an itinerant teacher with training in low vision
who provides specialised support to all - the classroom teacher, the student, their
parents and the community. Resources and training for community-based teachers
need to be provided from a tertiary level resource centre.
TEACHERS Teachers also play an important role in eye health education for the prevention of
vision loss. In all countries, knowledge that most eye diseases can be prevented or
vision restored for most people with vision loss, should be basic information to be
included in health education. Health promotion to prevent vision loss and blindness
in children is particularly important in areas where vision loss is associated with
poor nutrition (Vitamin A deficiency), hygiene (trachoma), immunisation (especially
for measles) and where rates of trauma are high.
PRIMARY LEVEL LOW VISION CARE (CONT.)

This has a parallel with teachers, where existing community-based workers can be
trained to appropriately meet the needs of many people with low vision. In addition
to the roles of screening (case finding and referral), health promotion is the
provision of basic rehabilitation. Many people with low vision can participate in their
chosen activities with relatively simple modifications to their environment and
provision of non-optical devices. With an understanding of low vision, its impact
and ‘problem- solving’ skills, simple but effective changes can be made to enhance
participation in chosen activities.
An important area of work is the identification of children and infants with impaired
vision. Early intervention is an important role of community-based rehabilitation
COMMUNITY-
workers. Assessment of functional vision can be conducted using the comparison
BASED
of visual functioning with milestones of normal visual development. Support is
REHABILITATION
provided to parents and the community to stimulate vision and general
development of the child.
Low vision is a part of the spectrum of vision impairment and thus low vision
services should not be separate from services to people who are blind. Essentially
the same people and existing organisations will provide care. Similarly in the
provision of eye care, low vision is part of that care, utilising the same personnel
(with training in low vision) and often using the same facilities. What is needed to
ensure low vision care for all who need it, are trained personnel to assess needs
and provide specialised skill training for people with low vision and the special
equipment and materials.
Training of primary or community level workers is mainly to detect people with low
vision, refer them for diagnosis, treatment and low vision assessment and care,
and to provide basic rehabilitation. An understanding of low vision and the specific
needs of people with low vision are necessary in any training
course. This understanding should include knowledge of the elements of vision:
 Distance and near vision (size and distance of objects)
 Visual field
 Contrast
TRAINING  Illumination
COMMUNITY- BASED
WORKERS Another important aspect is the need to create awareness through health
promotion about low vision as part of the national program for prevention of vision
loss and reducing its impact. The other topics are:
 Vision testing for screening
 Nature and implications of low vision
 Basic rehabilitation techniques

The emphasis will vary depending on the roles of the workers involved and
their previous training.
The need for training is that they can carry out case-finding and make referrals.
They also need knowledge of the services at secondary and tertiary levels so that
they can follow up recommendations for care.
The minimum topics for training in low vision are:
PRIMARY EYE / 1. Vision screening
HEALTH CARE 2. Referral pathways
WORKERS
3. Health promotion
4. Basic rehabilitation

This training can be conducted in a minimum of one day but up to 2 days.

TERTIARY LOW VISION CLINIC

The tertiary low vision clinic’s role and functions are as a service centre, training
centre, exchange centre, model centre, low vision services promotion centre and in
the planning of future development of low vision services.
Functions
1. Service centre – To provide direct clinical services, including diagnosis,
refraction, assessment of residual vision, and prescription and dispensing of low
vision devices etc. Also, to refer patients for medical management, rehabilitative
training and psychosocial support when necessary.
2. Training centre – To provide training to improve knowledge and skills of
existing local and overseas professionals serving the low vision patients, as well
as personnel for new low vision services.
3. Exchange centre – To achieve service improvement through exchange of
information, knowledge and skills with other centres to establish better referral
system. To learn improved vision assessment methods, be informed of more
cost- effective mode of human and other resources utilization, to obtain
ROLES AND information about new equipment and low cost quality low vision devices etc.
FUNCTIONS OF A
4. Model centre – The service structure developed and skills used by the centre
TERTIARY LOW
would be unique for the country and area that the centre serves. It can act as a
VISION CLINIC
model for places of similar culture and social organization.
5. Low vision service promotion centre – To increase public awareness and to
promote equal opportunity and better quality of life for the visually impaired
through interactions and cooperation with service providers and associations of
the visually impaired in referrals, joint promotional activities, studies on the
visually impaired persons’ needs etc. The activities can increase the
accessibility of low vision services to the visually impaired, promote public
awareness and social harmony as well as influence policy beneficial to the
visually impaired.
6. Plan the future development of low vision services – The mentioned roles
and functions clearly indicate that the clinic plays a vital role in the future
development of low vision services in its country and should be involved in the
service development planning: where should low vision services be extended to
in the next stage and its scale of operation; when the new services should start
and what kind of personnel should be trained to meet the new service needs;
whether the mode of operation should be more medical or rehabilitative oriented
etc.
Human resources
Services in a low vision clinic can be provided by a team of clinical and
rehabilitation professionals. These could include ophthalmologist and optometrist,
low vision therapist, counsellor, social worker, orientation and mobility instructor,
occupational therapist, administrator, special education teachers. However, it is not
essential to have all of them available in the same setting and a cross-referral
needs to be established to maximise the effectiveness of the service.
RESOURCES 1. Ophthalmologist and Optometrist
REQUIRED IN A
 Examine patients and identify those with treatable eye diseases and refer
TERTIARY CLINIC
them for medical management when necessary
 Assess visual functions and prescribe low vision devices and vision training
to improve visual ability
 Refer patients with rehabilitation, social and other needs to the
appropriate professionals for assistance
 Provide short and long term reassessment
TERTIARY LOW VISION CLINIC (CONT.)

2. Social Worker/Welfare Worker/Employment Advisor

 Assess a low vision patient’s social, financial and employment needs and to
provide assistance accordingly to enable the patient to resume social,
occupational and family activities hindered by visual impairment. Examples are
counselling and referral to patient support associations to give psychosocial
support to the patient; identify vocational training opportunity and educational
subsidies to improve the patient’s skills and abilities for better chances of
employment; arrange rehabilitation trainings in self-care, home maintenance,
communication for patient whenever necessary.
3. Low vision therapist / counsellor
 Training in visual skills
 Training in the use of low vision devices
 Advice on environmental modification
 Advice on daily living skills
 Support of emotional well-being
 Liaise with families, schools, and social welfare department etc
 Evolve the cross-referral mechanism
4. Orientation and mobility instructor
 Assess mobility skills and spatial orientation of low vision patient
 Develop strategies and provides training such as mobility skills in
RESOURCES unfamiliar environment and the use of public transport to improve the
REQUIRED IN patient’s mobility
A
TERTIARY CLINIC 5. Occupational Therapist
(CONT.)  To provide non-optical appliances and advices on skills, and
environmental modifications to improve independence in daily living
6. Administrator
 Coordinate various services inside the Clinic to ensure good communication
among different professionals and smooth delivery of quality services
 Liaise with other service organizations for the visually impaired and
associations of the visually impaired to understand and to meet the clinical
service needs of the visually impaired
 Develop literature on low vision for patients
 Organize publicity and advocacy for better public awareness of low vision, its
prevention as well as to improve the accessibility of low vision services
 To promote collaboration with related organizations and bodies to carry out
studies and researches on low vision, and to use the results for service
publicity and service improvements
7. Special education teacher
 Advise on the educational requirements of a child with low vision
 Advise on the medium of education
 Liaise with families and clinical staff to review progress

The above human resource combination clearly indicates that low vision service is
an integration of ophthalmic, rehabilitative and social services
TERTIARY LOW VISION CLINIC (CONT.)

Other resources required by a tertiary low vision clinic are space and facilities for
patient consultation, clinical training, library and access to electronic information,
keeping the inventory of low vision devices, and dispensing low vision devices.
It will require space to:
1. Provide low vision consultation (ophthalmic examination, vision assessment,
optical and non-optical low vision devices prescription, referral arrangement
etc.) to low vision patients.
2. Dispense low vision devices
3. Train patients in the use of LV devices and maintain an inventory
PHYSICAL RESOURCES 4. Keep literature about low vision care and provide access to electronic
information of low vision services to enable the clinic to keep up with
advancement in low vision services and to find new ideas for service
improvement to suit the local needs
5. Carry out studies to identify the needs of low vision patients and to plan service
provisions accordingly; conduct researches to improve skills and service quality.
6. Exchange low vision knowledge and skills with experts to improve the centre’s
services and to plan its future development
7. Provide training to local low vision service providers such as optometrists,
ophthalmologists, occupational therapists, and rehabilitation workers etc, to
improve service quality

Recommended standard lists for low vision equipment, tests and devices at tertiary, secondary and primary
levels, in addition to existing basic equipment in such a clinic

Table 1-2: Ophthalmic equipment required for low vision care at tertiary, secondary and primary levels

SECONDAR
TERTIARY PRIMARY
OPHTHALMIC EQUIPMENT Y LEVEL
LEVEL LOW LEVEL LOW
LOW
VISION CLINIC VISION CLINIC
VISION
CLINIC
Streak Retinoscope  
Direct Ophthalmoscope  
Lensmeter (Focimeter) 
Trial lens set (full aperture)  
Universal trial frames (2)  
Paediatric trial frames
 
(2 pairs of different sizes)
Trial lens holder 
Halberg clip 
Long handle occluder with pinholes  
Cross cylinders (0.5, 1) 
Pen torch with measuring tape   
TERTIARY LOW VISION CLINIC (CONT.)

Table 1-3: Vision assessment equipment required for low vision care at tertiary, secondary and primary levels

SECONDAR
TERTIARY PRIMARY
VISION ASSESSMENT EQUIPMENT Y LEVEL
LEVEL LOW LEVEL LOW
LOW
VISION CLINIC VISION CLINIC
VISION
CLINIC
Light box for Visual Acuity test 
Distant LogMAR test charts – letter,
 
number, tumbling Es, Landolt Cs (one of
each type)
Near vision tests (same as distant but
calibrated for 40 cm). Reading Acuity
 
test (Continuous text in English and
local language)
Symbol paediatric tests for matching
 
and pointing (with and without
crowding)
Preferential looking system 
Contrast
Contrast sensitivity test charts 
sensitivity test –
LEA screener
PV-16 Colour Vision Test (double set) 
‘Amsler’ grids 
Hand disc perimeter 
Tangent screen 
WHO Low vision Kit  
TERTIARY LOW VISION CLINIC (CONT.)

Table 1-4: Low Vision Devices required for low vision care at tertiary, secondary and primary levels

TERTIARY LEVEL SECONDARY PRIMARY LEVEL

LOW VISION DEVICES
LOW VISION LEVEL LOW LOW VISION
CLINIC VISION CLINIC CLINIC
Optical Low
Vision Devices

6D to 12D in 2D steps
with base in prisms
6D to 12 D in 2D steps
Spectacle 10-40D in 4D steps as
16D to 20D in 4D
magnifiers (half half eye, total 9 pieces
eyes) steps total 6 pieces
10-40D in 4D steps as
full aperture R+L, total
18 pcs
Foldable and hand-held
5D to 17D, 5D to 14D
magnifiers with and 5D to 42D, total 15
total 5 total 4 pieces
without built-in light pieces
pieces
source
Stand magnifiers with and without built-in with no built-in light
Four stand magnifiers
light source, from 13.5D source, from 13.5D to
Priority 4x and 5x from 13.5D to
to 56D, total 9 pieces 40D, total 6 pieces
40D
Dome and bar magnifiers total 4 pieces total 2 pieces
2.5X, 3X, 4X, 6X, 8X 4X to 8X with micro-
Hand-held and lens for Two
monocular 10X with micro-lens for 8X telescopes, total 4 telescopes
telescopes 8X and 10X telescopes, pieces , 4x and
total 5 pieces 6x
of 5 different shades
of 4 different shades
with UV protection and
with UV protection and
Filters luminous transmission
luminous transmission
of 40%, 18%, 10%,
of 40%, 18%, 10%
2% and
and 2%
1%
CCTV Devices
Colour

Television (20
inches)
Black and white hand-

held CCTV magnifier
Full colour hand-

held CCTV
magnifier
Computer Devices
Computer with laser

printer and scanner
Computer software
with text enlargement 
and voice output
TRAINING

Many CBR workers will work with people with all disabilities. They require the
special knowledge and skills to work with people with impaired vision, and
particularly low vision. Their training would include all the same topics as for
primary eye care workers but with emphasis on assessment of functional vision
and rehabilitation techniques
COMMUNITY BASED
Whilst they will not normally prescribe low vision devices, they need training in the
REHABILITATION
knowledge of what devices are for and how they should be used. The knowledge of
(CBR)
the concepts of vision should be applied to obtaining or making non-optical low
vision devices.
Whilst much of the rehabilitation will be with older people, topics on early
intervention for infants and pre-school children are critical in CBR.
The aims of training for teachers in local/mainstream schools is so that they can
detect children with impaired vision and include the students with low vision in all
aspects of school life. Teachers can also be taught vision screening if others do not
conduct it regularly. They need to be able to test vision or conduct a functional
assessment to determine if a student has normal or impaired vision, and for those
TEACHERS with impaired vision, to assess if the student has low vision or is blind. Knowledge
of referral pathways is also essential.
For effective inclusion in school and community activities an understanding (and
assessment) of appropriate learning medium using the five categories of functional
vision is essential. Teachers need to be trained in assessment of functional vision
to make decisions about the most appropriate medium for each student (Table 1-5)

Table 1-5: Assessment of functional vision should use a variety of objects and materials and not just print

FUNCTIONAL VISION LEARNING MEDIUM

Normal vision As for normally sighted children

Low vision: Mild – moderate Regular print without low vision devices
Low vision: Severe Regular print with low vision devices or large print
Low vision: Profound Braille; use of vision for mobility, activities of daily living etc.
Blind Braille and other non-visual media

The categories of health personnel involved in the provision of eye care at different
EYE HEALTH levels vary from country to country. They include optometrists, orthoptists,
PROFESSIONA ophthalmic and dispensing opticians, and others involved in certain elements of
LS eye care, in particular refraction and low vision services.
 Expand the training opportunities (both quantitatively and qualitatively) for
mid- level eye care workers
OBJECTIVES  Standardize the existing training
 Adopt a uniform and standardized curriculum
 Offer a progressive career structure
TRAINING (CONT.)

 Increase coverage and uptake of high quality essential eye care services and
thus ensure quality and equity.
 Produce multi-purpose mid-level eye care personnel (MLECP) who can provide
primary eye care and low vision services at community level, and assist the
ophthalmologists and other eye care professionals at secondary or tertiary
levels in rendering services effectively.
EXPECTED OUTCOMES
 Meet the needs of refractive services of the communities through an additional
training in refraction with a special module for dispensing and low vision
services.
 Meet the needs of the tertiary eye care institutions by imparting training to
some of these MLECP in advance visual function skills, including low vision
assessments, ophthalmic technology skills, and public eye health care
management skills to work as ophthalmic technologists.
 Inadequate manpower available for service delivery
 Quality of training is not of desirable standards
CONSTRAINTS  Lack of standardized curricula and master trainers
AND
DIFFICULTIES  Resource centres for training do not have sufficient materials and equipment
 Insufficient exposure to practical work
To achieve the objectives, the following two strategies i.e. short and long term
are recommended.
Short Term: provide low vision human resources by training and
equipping existing personnel
 Extension of low vision modules in the existing training programmes
 Training workshops for existing cadres
 Curriculum standardization workshops & external faculty where needed
 Equipment for the training institute
STRATEGIES  Training of national focal persons in low vision & training of trainers
 Up-skilling of master trainer by exposing them to latest advances in the field
of low vision through attendance of training programmes, conferences etc
 Provision of necessary books, journals and manuals on the subject
 Extension of training module
 Advocacy at the relevant levels
 Resource mobilization
 Faculty support to conduct the module
 Up-gradation of teaching and training aids
  To conduct different workshops
 To equip the training centre
 Human resources as master trainers
 Institutional support to house the program
 Training material
RESOURCES REQUIRED  Logistic support
To deliver low vision services a huge gap exists between the need and what is
available human resource. The priority should be to train the maximum number of
personal and equipping them with essential knowledge in the shortest time. This
can be achieved by integrating the low vision training modules into the existing
training programmes for different cadres and by providing in-service training to
existing staff. The training should be appropriate and conform to the needs of the
countries and programmes.
EVALUATION OF A LOW VISION PROGRAMME

Evaluation of a low vision programme is useful because it provides an opportunity to take a step back and view the
whole programme holistically. It helps in measuring progress and seeing if objectives have been met; it allows one to
determine what has been achieved; it improves monitoring and management; it identifies strengths and weaknesses;
it determines the effectiveness and impact of the programme; it provides information on the efficiency or cost benefit
of the programme; it makes available information for revised plans and is a good opportunity and mechanism for
sharing experience.
The main steps in evaluation are:
1. Deciding when and how to evaluate
2. Selecting the objectives and method to be used
3. Carrying out the evaluation
4. Looking at the results
5. Using the results to improve the programme

RESOURCE MOBILIZATION FOR LOW VISION PROGRAMMES

Resource mobilization is an expression that is commonly used in development terminology. It simply means
enhancing or augmenting the means of support. In programme terms, this enhancement of means of support may
be financial, human, technical or in kind.
Resource mobilization is a critical element in low vision programme development and is vitally important because:
1. Programmes and projects cost money
2. They are usually in addition to on-going government eye care, educational and rehabilitation activities
3. Even long term horizontal programmes and interventions have vertical components and these need extra
resources
4. Pilot programmes are often required to effect a change in policy

Mobilization of financial and other resources can be ‘resourced’ from:

 National government, private funds or donations
 Governmental agencies
 Inter-governmental agencies
 Non-governmental organizations
 Other forms of funding – multilateral and bilateral aid, INGO support
RESOURCE MOBILIZATION FOR LOW VISION PROGRAMMES (CONT.)

In the planning stage of a low vision programme, it is vital to identify governmental

and non-governmental resources. In addition, it is essential to undertake an
assessment of current needs and document an inventory of existing activities. This
is usually followed up by a carefully prepared plan of action. A firm national
commitment can be very helpful in mobilizing external resources and assistance.
NATIONAL RESOURCES
Other strategies to harness the potential of national resources includes the need to
increase public awareness of blindness and low vision, generate support from
influential ‘opinion makers’ or celebrities, use of professional societies, print,
television and other media (mass media), and recognition and contribution of
NGOs and motivating them into increasing their support.
A variety of options exist for mobilizing support from the international agencies.
The WHO Prevention of Blindness and Deafness programme can offer
assistance to national programmes. International non-governmental organizations
INTERNATION can provide support to various components of a national programme. Multilateral
AL and bilateral aid is very useful in transfer of financial resources and creates a sense
COOPERATIO of responsibility. Technical Cooperation among Developing Countries
N (TCDC) is another mechanism for resource mobilization, particularly for training of
human resources and organization of low vision programmes.
The role of governments in the context of resource mobilization can be
summarized as below:
1. Policy and institutional framework for disabled persons
2. Adoption and facilitation of a national programme
3. Running schools with inclusive education (or schools for visually impaired
ROLE OF GOVERNMENT children where such a policy does not exist), and vocational training centres for
the disabled
4. Creating a fund for disabled persons
5. Providing grant and aid to disabled persons
6. Running Trainer of Trainers programmes
7. Supporting university departments of education and special education
The role of NGOs can be considered as that involving:
1. Support to training programmes – human resource development
2. Capacity building of existing institutions
3. Filling in gaps in programmes
ROLE OF NGO 4. Assistance in strengthening of government run components of the programme
5. Advocacy
6. Technical assistance, supplies and equipment
7. Support to organizational development and strengthening of
management structures at national, provincial and district levels

Resource mobilization is often equated with finances. However, a very important and oftentimes vital element of a
programme is the human capital. Initially, financial resources are required to roll out a programme (e.g. a low vision
programme), but as a critical mass of trained persons is reached, the programme growth becomes less dependent
on finances and its expansion and sustainability are to a large extent driven by the human resources developed.
Resource mobilization is one of the key components of a project cycle from planning, to monitoring and evaluation.
Opportunities to resource a low vision programme can be sought from various donor agencies (and oftentimes
significant funding can also be found in-country) through networking and presentation of a well conceived plan on
low vision as an integrated part of a larger national plan e.g. a national plan for prevention of
blindness/comprehensive eye care. Designing of a budget, which is segmented into different ‘fundable’ components,
also helps to attract donors that may wish to support a component or a set of components in a programme.