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Advancing Inclusive Eye Care Policies in Pakistan: An Interview with Sumrana Yasmin

Sumrana Yasmin is a leader in eye care policy in Pakistan and the Deputy Director of Eye Health for Sightsavers, an international NGO dedicated to addressing preventable blindness and advancing the rights of individuals with disabilities. 

This interview has been edited for clarity and length.

AY: How did you first become involved in the eye care space in Pakistan, and why have you continued to dedicate your time to this work?

SY: I started my career working in the corporate sector, but in my heart, I always knew that it was not enough. I wanted to be part of an impactful, positive change that could lead to a more equitable future. An opportunity to work at Sightsavers came up, and I grabbed it with both hands. I have had myopia (near-sightedness) since I was in 4th grade, so I understand the challenges that a child, particularly a girl, faces when she cannot see clearly and must wear spectacles. The mission of Sightsavers, to prevent avoidable blindness and promote equality for people with disabilities, resonated with me, and I have been working in the eye care sector since then.

My first project was in relation to inclusive education and children with low vision. As soon as you start working with kids with vision impairment, it changes you. It changes the way you look at life. It changes the way you want to do something for your community and want to engage with people, so I think that was a turning point for me: that initial contact with kids who had low vision, who were in the special education system, and who, Sightsavers, as one of their pilot initiatives, was trying to include in the mainstream education system. 

Currently, we are in a global vision crisis. There are 1.1 billion people who have an untreated or preventable visual impairment. Women account for more than half of blindness and visual impairment across the world. My work at Sightsavers allows me to contribute towards addressing these challenges, so I think that has kept me engaged within this sector.

AY: That is wonderful. Can you tell me a little bit about some of the key mentors you have had in your life that have shaped your policy work? How have you developed these relationships?

SY: I think the first person that I would like to say would be my life partner. He was very actively involved in education policy development in Pakistan. He supported me, pushed me, and helped me in moving towards this direction significantly.

Then, in the professional space, I would say quite a few people. Obviously, one was my line manager when I joined Sightsavers, a huge name when it comes to eye care, not only in Pakistan but globally: Hasan Minto. He supported me and made sure that my understanding developed in the context of not only health policy but also ensuring that disability inclusion, gender-related concepts, and environmental-related concepts are integrated into those policy discussions. So, I would say, there has been a massive contribution from Hasan when it comes to whatever role I have managed to play in this space.

Then there is a long list of people. My colleagues, my teams. In the past few years, I have been working closely with the World Health Organization — integrating their thinking, their guidance, their tools into policy discussions at the national level. If I start naming the names, it is going to be a long list.

AY: That makes sense. How are you able to encourage Pakistani policy makers to advance health equity in eye care for individuals with disabilities? 

SY: If you look at our eye health or refractive error strategies, we are talking about inclusive eye health. We are talking about inclusive refractive error services, and we have been talking about it for a very long time.

Through different initiatives, we demonstrate how this can be done by working very closely with multiple stakeholders, including governments, organizations of people with disabilities, people with disabilities, and district and provincial level stakeholders. 

I will just share one example. One approach we use in our eye health program is that when we start, we conduct accessibility audits of eye health facilities. We do that in partnership with our OPTs working at the community level or at the provincial level. Based on those accessibility audits’ findings, we make sure resources are available to make those changes recommended through them.

It is not only people with disabilities who benefit from these interventions. The elderly population might need similar sorts of accommodation to access facilities. Also, pregnant women. In this way, we make a service facility inclusive for so many other population groups.

AY: That is exciting to hear. You have touched on this a little, but how do you promote gender equity in eye care policy in Pakistan? 

SY: If you look at where we talk about equitable access to eye health, within that, gender is one of the core areas. Unfortunately, the cultural, socioeconomic, and other dynamics in Pakistan are such that, in addition to women having higher levels of vision impairment, their access to care is also more limited.

Even today, we see instances where women will come to the facility, they will get their eye exam done, but when it comes to getting spectacles or cataract surgery, they do not have that decision-making power. So, these women will say, “We will go back. We will discuss, and we will get it.” But they hardly ever come back.

Another issue is having these facilities primarily based in secondary or tertiary care institutions. When you do not have to travel long distances or you do not have to have a male companion from the family with you to access health care, it is easier for women and girls to have access. If you look at Pakistan’s integrated people-centered eye care plans, they heavily focus on bringing services closer to the community. They are heavily focused on integrating primary eye health into primary health care reforms and mechanisms.

Another area we have been focused on is encouraging more girls to join the optometry field. If you look at Pakistan’s optometry schools’ enrollment, you will notice over 70% of the students are girls. Having a woman optometrist based in a primary or secondary eye health facility automatically helps us to break cultural barriers. Female patients might be hesitant to get their eye exam from a male optometrist. So, from different angles, we are trying to make sure that we are addressing gender inequities in Pakistan’s programs. Again, still a long way to go. But….

AY: But progress is being made. Are there any personal values you hold that guide your eye care policy work that we have not discussed?

SY: Quality. Quality of care. Ensuring a high quality of services, that the mechanisms of quality assurance are integrated in the programs, and that there is continuous quality improvement that is monitored and implemented throughout the cycle of different initiatives is really critical.

Another value I strongly believe in is ownership at the local level. Unless we manage to mobilize that local ownership, nothing we do is going to be sustainable. Community engagement plus local ownership by local stakeholders is key. It is important to ensure that local stakeholders are at the table from inception through the implementation and evaluation processes. They are not just there to tick the box. They are there to voice their concerns. They are there to recommend what makes sense in their local context. We have seen repeatedly that when you include local stakeholders throughout the process, you automatically are ensuring the success of your intervention because it is coming from within the community.

AY: If there is one thing you would want policy makers to most understand about eye care in Pakistan, what would that be?

SY: Pakistan is at a stage where we have dynamic youth with huge potential to change the trajectory of our development. If our youth, including young girls and women, do not have access to eye health and cannot see clearly, they will not be able to contribute towards that change in a meaningful way. So, our policymakers need to look at investment in eye care as an investment in the future of Pakistan. That is the message to be very honest. If a child cannot see clearly, he will not be able to study. He will not be able to tap into opportunities in the future and we will be losing this huge potential. So, it is not about cataract surgery. It is not about a pair of glasses. It is not about a certain assistive product for a child with low vision. It is about the future of Pakistan. It can only be brighter if our young generation can see clearly.