A Clear Vision for Ethiopia
An innovative initiative to expand vision care in rural Ethiopia aims to transform the lives of millions of people who currently lack access to affordable eye exams and glasses.
For 15-year-old Mekelit Daniel, going to school had become increasingly daunting. The trouble began about two years ago, when she started struggling to see the blackboard clearly in the classroom.
“I couldn’t read well,” she recalled. “I didn’t do well in school that year.” Her worsening vision also made it difficult to help out at home and eroded her confidence in public spaces, where she could no longer recognize faces from a distance.
“There are many children who don’t even know they have problems. Because of that, there are children who drop out of school.”
Daniel is one of an estimated 8.83 million people in Ethiopia affected by vision problems. Among school-age children, cases of refractive error — a condition in which the eye fails to focus light correctly on the retina, leading to blurred vision — are increasing, likely due to more time spent on near-vision activities such as reading and screen use. “There are many children who don’t even know they have problems. Because of that, there are children who drop out of school,” said Mulunesh Girma, an optometrist at Nigist Eleni Mohammed Memorial Comprehensive Specialized Hospital in Hossana, in southern Ethiopia’s Central Region.
Visual impairments are also common among adults, especially those aged 40 and above. If left uncorrected, refractive error can worsen and even lead to blindness. Yet, the condition is easily treatable with something as simple as a pair of glasses.
“Poor vision is not only a health problem,” said Dr. Dereje Duguma, Ethiopia’s state minister of health. “It is a social and economic problem, because people with poor vision are dependent on other family members.” The problem is particularly prevalent in rural areas, where limited access to eye care services, lack of infrastructure, and a shortage of trained eye health care workers can make it difficult to receive treatment.
Daniel (right) and her friend, Lechame Mekango, in the classroom.
Daniel (right) and her friend, Lechame Mekango, in the classroom.
Since receiving her new pair of glasses, Daniel is able to see the blackboard clearly again.
Since receiving her new pair of glasses, Daniel is able to see the blackboard clearly again.
Wash Kota secondary school in Bonosha, where Daniel is a student.
Wash Kota secondary school in Bonosha, where Daniel is a student.
Closing the Rural Eye Care Gap
A network of rutted, uneven roads, some still under construction, connects Daniel’s hometown of Bonosha with Hossana. Though Bonosha has a primary hospital and a nurse specializing in eye care, there is no trained optometrist — meaning the facility, until recently, was unable to offer full eye exams and prescribe glasses. Instead, residents of Bonosha with vision problems would need to make the one-hour journey to the Nigist Eleni Hospital in Hossana. If prescribed glasses, patients would have to buy them from private opticians, at a cost of up to $70.
Daniel’s family managed to gather together the money needed for the trip in order for her to receive an eye exam and purchase glasses, but she was unable to make the annual return visit advised by the optometrist. Over time, she noticed that her glasses were becoming less effective, indicating a change in her vision and the need for a new prescription.
Auto rickshaws — known locally as bajajes — line the streets of Hossana town in Ethiopia.
Auto rickshaws — known locally as bajajes — line the streets of Hossana town in Ethiopia.
The rural road from Bonosha to Hossana.
The rural road from Bonosha to Hossana.
A street in Bonosha.
A street in Bonosha.
Now, Bonosha Primary Hospital is among 200 facilities across Ethiopia that have begun offering telerefraction services. The approach enables a trained telerefractionist — usually an ophthalmic nurse — to carry out eye examinations under the virtual supervision of an optometrist or ophthalmologist, via a phone or tablet. Patients can then receive a pair of prescription glasses directly in the primary facility, at a lower cost than what’s available from private opticians.
On a busy morning at Bonosha Hospital, a queue of patients waits to have their eyesight assessed by integrated eye care nurse Kedir Seid. Seid, the hospital’s only eye care nurse, sees around 20 patients a day. He estimates that one-third of them need glasses, while others present with conditions such as trachoma, cataracts, and glaucoma.
Inside the examination room, he holds a tablet up to a patient. On the screen, Girma, the optometrist at Nigist Eleni Hospital in Hossana, appears via video link to remotely guide the exam. “People used to struggle to find vision care services and can now receive it here, making them very happy,” Seid said. “It’s additional work that’s different from what I used to do before, but it’s fulfilling and exciting,” he added.
A locally led model for vision care
The telerefraction initiative forms part of a nationwide effort to expand access to vision care, particularly in rural areas, developed in collaboration between the Ethiopian government and the OneSight EssilorLuxottica Foundation.
Zeleke Alemu, country manager for Ethiopia and the Horn of Africa at the OneSight EssilorLuxottica Foundation, discusses why access to eye care services is an equity issue.
Under a “hub-and-spoke” model, a vision center, such as the one housed in Nigist Eleni Hospital, serves as the central hub, connected to four primary hospitals or health centers. The three-year project also includes vision care training for mid- and junior-level health care professionals, as well as the provision of eye screening equipment and glasses, which are available to patients at a price of around $10.
Currently, Ethiopia has 1.4 ophthalmologists and 2.9 optometrists per million population — a figure far lower than the World Health Organization’s recommendation, which is at least four ophthalmologists and 10 optometrists per million to meet minimum eye care service needs. “Even with the small number of eye care professionals, 50% of them are located in Addis Ababa, the capital,” said Zeleke Alemu, country manager for Ethiopia and the Horn of Africa at the OneSight EssilorLuxottica Foundation.
Volunteer traffic warden Desta Hibebo, who lives in Hossana, sought treatment for vision problems at Nigist Eleni Hospital.
By building on the existing public health infrastructure, the government and the foundation aim to make the project more resilient and sustainable in the long term, with the management of vision centers and rural hospital eye units gradually shifting to the Ethiopian government and local health institutions.
“We understood that three out of four facilities in Ethiopia are public facilities,” explained Alemu. “The infrastructure is already there … but those facilities lack basic instruments to perform eye screenings, and they lack human resources to provide eye care services,” he added.
Dr. Dereje Duguma, Ethiopia's state minister for health, explains the government's rationale for partnering with OneSight EssilorLuxottica Foundation.
“In Ethiopia, any project that comes to the health system should integrate into, if possible, the primary care system … so that if there is any challenge in financing [like] that we now see globally … we will continue with the available resources in the community,” said Duguma. Ethiopia, once home to one of the largest U.S. Agency for International Development missions in Africa, saw nearly $541 million in planned support cut following the Trump administration’s funding freeze.
Overcoming Barriers to Access
To reach even the most remote communities, the initiative also taps into Ethiopia’s existing network of 42,000 health extension workers who deliver essential community-based services throughout the country.
“Health extension workers are very important in vision care, because if they get adequate training, they can easily identify people with low vision and send those people to health facilities for more diagnosis and treatment,” said Duguma. This year, the OneSight EssilorLuxottica Foundation plans to train an initial cohort of 100 health extension workers to raise awareness about eye health and make referrals to the nearest telerefraction center.
While the telerefraction model has made eye exams more accessible in rural areas, an ongoing challenge is access to stable internet connectivity. “If that issue is resolved, I believe we could provide a better service,” said Seid, the eye nurse at Bonosha Primary Hospital. To address this, the foundation is working on developing an app for telerefraction that would allow eye care workers to conduct vision screenings without an internet connection and then upload the data when connectivity becomes available, said Alemu.
Another obstacle is the supply and affordability of glasses. At present, most glasses in Ethiopia are imported — a process that is often slowed down by customs procedures and high costs. Expanding Ethiopia’s local production capacity would ensure that they remain affordable in the long term for communities, said Duguma.
"Our motto is to leave no one behind."
A Long-Term Vision for Eye Health
The ultimate goal of the project is ambitious but clear: to reach 14 million Ethiopians with affordable, accessible eye care. It’s a crucial part of Ethiopia’s vision to achieve universal health coverage by 2030, said Duguma. "Our motto is to leave no one behind … that includes someone with low vision, and mostly they are found in very remote areas. Looking for those people will not be easy, but with a joint partnership, we can make it a reality."
At Bonosha Primary Hospital, Mekelit Daniel was among the patients to receive a new pair of prescription glasses. “I want to be an eye doctor,” she said, adjusting her new glasses. “In Ethiopia there are many other people that are sick, and I want to treat them.” That afternoon at school, Daniel is able to see the blackboard clearly again, her dream coming into sharper focus.
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CREDITS
Reporter / producer: Naomi Mihara
Videography / photography: Gonzalo Guajardo / Mulugeta Negussie
Translators: Ashenafi Habte / Selamawit Zeleke
Story editor: Richard Jones
Video editor / Shorthand producer: Lottie Watters
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