Alemayehu Sisay (MD), with public health background in profession, is an Ophthalmologist; specialized in eye care and treatment and working in the area for over 20 years. He also engaged in a number of Ophthalmology research undertakings. Alemayehu joined Orbis International Ethiopia 20 years ago as Project Manager for rural communities in Southern Ethiopia.
In addition, he was a principal investigator in improving integrated eye care works. That way, he grew his expertise and promoted to Country Director position at Orbis 10 years ago. Currently, in addition to his position in Orbis, he is member of the Global Trachoma Mapping Project.
Operating in Ethiopia since 1998 in saving sights and combating blindness, Orbis International Ethiopia is celebrating its 25 years of service. In connection with Orbis’s Silver Jubilee Anniversary, The Ethiopian Herald had a short stay with Dr. Alemayehu to discuss issues related to the critical challenges in combating trachoma, Orbis’s achievements and its next plans as well as the role development partners can play to achieve the 2030 World Health Organization (WHO) trachoma elimination target in Ethiopia.
Trachoma remains a major disease in less than 44 countries of the world; it becomes no more public health issue in the rest of the world. As trachoma is preventable, WHO set a target to eliminate it from the planet by 2030.
To achieve the target, the Organization recommends the implementation of SAFE strategy which implies surgery, antibiotics, facial cleanliness and environmental sanitation across the countries where still active trachoma remains a public health issue. The SAFE strategy needs huge resource mobilization; and financial and technical support of development partners is critical in this regard.
Ethiopia is among the countries with high burden of active trachoma prevalence. As trachoma remains among the major public health issues, the country, jointly with stakeholders, is investing its maximum capacities to lessen the burden and eliminate it by 2030.
In this regard, though a lot remains, Ethiopia’s relentless effort to combat trachoma has brought about huge success, Alemayehu said.
Mentioning that as a result of rapid socio-economic development and the proper implementation of SAFE strategy, trachoma has been eliminated in most countries, Alemayehu said: “currently, trachoma is a public health problem in 44 countries and Ethiopia takes 57 percent of the global burden of the disease.”
This, according to him, clearly indicates that trachoma requires critical attention by decision makers, the donor community and stakeholders. To overcome the burden of the disease, and achieve Ethiopia’s target of eradicating trachoma by 2030, the role of development partners is crucial.
Citing the data from 2013/14 Global Trachoma Mapping Project, Alemayehu said that the mean trachoma prevalence in Ethiopia 10 years ago was 28.33 percent. However following the sustained implementation of the SAFE strategy by the Ministry of Health (MoH) joining hands with the donor community, today it decreases to 12.81 percent at national level.
“The success is significant in terms of reducing the burden though there is still a long way to go to bring the percentage down to less than five percent,” he remarked referring WHO’s trachoma elimination definition standard is being lowering the active infection below five percent in children aged between 1-9 years.
For him, more than 80 percent of the causes of blindness or visual impairment are either treatable or preventable cases. By improving the eye healthcare system and empowering the community, blindness can be decreased by 80 percent.
“In Ethiopia, as Orbis, we started our program by conducting trachoma surveys; general eye care assessments, blindness and low vision appraisals. By identifying the critical gaps, Orbis engaged in significant capacity building works and training for eye health professionals to improve the diagnoses and management of the different eye diseases,” he stated.
In addition, infrastructural development, human resource development, and integrating eye-care in to the healthcare system were the priority areas of the Orbis over the years.
“In terms of human resource, before Orbis’s engagement in Ethiopia, all ophthalmologists were general ophthalmologist. Understanding the problem, the first thing what Orbis did was send ophthalmologists abroad to get trained in different sup-specialty areas like Pediatric of Ophthalmologist, Anterior Segment Surgery, Glaucoma and other surgery specialties.” 26 ophthalmologists were trained abroad for sub-specialty and Orbis provides trainings for thousands of health workers at home, he stated.
According to Alemayehu, Orbis is providing help communities residing in 48 districts to achieve the WHO elimination definition of trachoma prevalence. Once they achieved the standard, making trachoma no more a health problem in the areas, it will continue investing on behavioral change aspects of health education, facial cleanliness, and environmental sanitation in these communities. In addition, 17 districts have achieved Trachomatous Trichiasis (TT) prevalence to less than 0.2 percent which met the WHO recommended standard in the adult community, he stated.
Critical challenges in combating trachoma
While talking about the critical challenges in combating trachoma, Alemayehu said that even though there are encouraging developments and achievements, there is still a lot to be done to eliminate trachoma in Ethiopia.
As to Alemayehu, due to other computing priorities in the health sector including limited resource, eye care has got less attention. What is more, limitations in resource allocation, human resource development, provision of supplies to health centers and failure to integrating eye care into the health system are among the existing challenges.
Especially, limited domestic resource mobilization is a critical challenge in combating blindness. For Alemayehu the globe is moving towards domestic resource mobilization as country ownership, leadership and domestic resource mobilization are the critical areas in the WHO strategic plan to eliminate trachoma by 2030. Hence, local resource mobilization should be given an attention to achieve the set target, he underlined.
According to the Country Director, there should also be investments to sensitize the public about trachoma and provide information particularly in environmental sanitation. Limitations in implementation of SAFE packages also remain another challenge. “If we address all these critical challenges and strengthen collaboration of donors horizontally; and with MoH, I am sure trachoma elimination will be realistic by 2030,” he added.
Praising Ethiopia’s efforts in tackling the disease, Ethiopia would achieve the elimination target, Alemayehu said optimistically. “All endemic districts with the prevalence of trachoma are already covered by development partners. In terms of geographical coverage, we are 100 percent there. Strong coordination of stakeholders and proper implementation of the SAFE strategy would facilitate the elimination efforts,” he stressed.
Still, the role of development partners is to provide technical and financial support to the healthcare system and it is up to the healthcare system and political leaders to execute all those program tools and interventions, as to him.
Next five year plan
“While we are celebrating our 25 years of activities, there are still gaps requiring development partners’ engagement,” he stated. Hence, Orbis develops strategic plans to be implemented in the coming five years. “Trachoma elimination is the critical part of Orbis’s strategic plan in the coming five years,” Alemayehu underlined.
Orbis is operating in Southern Nations, Nationalities and Peoples’ State (SNNPS), Sidama and Southwest Ethiopia Peoples State directly and in other parts of the country by supporting other partners’ engagements. Hence, the priority of the organization for the coming five years is to continue its support for trachoma elimination, particularly in the Orbis operating regions. “Ensuring that trachoma is no more a public health issue in the three regions in the coming five years is our strategic plan and we are determined to do that.”
In addition, by working with MoH and other development partners, Orbis will support the implementation of SAFE strategy in other regions so as to work towards one major goal. Child eye health starting from community to tertiary level remains the other strategic priority for the coming five years, Alemayehu reiterated. Capacity building, infrastructural development, referral networking and investing in quality assurance will be its focus areas for the coming five years so as to support Ethiopia’s trachoma elimination endeavors.
Recently, MoH stated that from 2016 to 2022, Ethiopia conducted over 800 thousand cataract surgeries across the country and antibiotic distribution continued throughout the country. Though, Ethiopia is still working by mobilizing resource on hand, further financial and technical efforts of the donor community and development partners is crucial to achieve the 2030 trachoma elimination target.
BY DARGIE KAHSAY
The Ethiopian Herald August 17/2023
