My colleague Vikas Gora and I had the privilege of interviewing Dr. Babar Qureshi, a wise man and wearer of many hats. In addition to being Director of Inclusive Eye Health and Neglected Tropical Diseases at CBM, Dr. Qureshi is also Vice President of the International Agency for the Prevention of Blindness (IAPB) and Chairman of the International Trachoma Initiative’s Trachoma Expert Committee. Before joining CBM in 1997, Dr. Qureshi spent three decades working as an ophthalmologist, first in Nigeria and then in Pakistan, before making his way to the UK.
In partnership with Operation Eyesight and others, CBM has just launched the “Vision Impact Project Kenya,” with the goal of reducing the presence of visual impairment and avoidable blindness in five counties.
We sat down with Dr. Qureshi to learn more about his career and CBM’s approach to providing inclusive eye care.
We know that vision isn’t just about sight; it has a much bigger impact on health care, education, development and more. Looking at your career so far, is there a project or program that stands out for you in terms of its impact?
One program, which started as a project, that stands out for me is the Pakistan National Eye Care Program, a major success story in terms of scalability, applicability and government ownership. It started as a simple yet complex question: how do we ensure people all over the country get eye care?
Through a small situation analysis, we learned that there were good tertiary eye care centres that had been developed and that the primary (community) eye care was there, albeit patchy. But there were either no secondary units available, or where there were secondary units present, secondary eye health services (medical, surgical and optical services) weren’t available. This was because the unit didn’t have enough equipment or human resources, or it didn’t have the proper infrastructure. People from the communities would go to a secondary centre only to discover that they couldn’t get the service they needed and had to travel hours to a tertiary centre instead.
We started with one public secondary centre in a small district of a million people. We made a capital investment into equipment, infrastructure and training, with everything else being run by the government. After two years, the centre had gone from doing about 150 surgeries per year to now providing over 1,200. Seeing this success, we then scaled the program to 10 districts, then to 24 districts with a public-private partnership, and now essentially every district in Pakistan has a good health program with good primary and secondary eye care.
This has reduced the load placed on tertiary centres, allowing them to focus on research and specialized care. A national survey in 2004 found that the prevalence of blindness was 1 per cent, down from 1.8 per cent in 1989.
CBM’s work ranges from preventive care, to the treatment and care of people with disabilities, to the inclusion of those affected into society. How can more organizations take an inclusive development approach, especially at the community level?
We look at eye health from the perspective of, ‘how can we make all of our services and all of our programs inclusive?’ We need to ensure that it is comprehensive and that we address all persons with disabilities and make the environment so user-friendly that it is no more an obstacle for people to come for services.
We proactively work with organizations of persons with disabilities and communities because they know exactly what is needed, and they guide us sincerely and straightforwardly. For example, the first thing that was brought to our attention was the simple thing that we were communicating through: our Information Communication Education materials. These materials had to be inclusive and therefore, we made them inclusive.
Then we were again guided by the fact that, after communicating with people in the community and referring them, they would then be visiting hospitals or eye units that also needed to be accessible.
Then we learned more; it wasn’t just about accessible materials or ramps, it was also about addressing all persons with disabilities, such as those who are deaf or hard of hearing. We needed to ensure that our staff learned sign language, so at least one person in a facility would be available to communicate that way.
While we focused on inclusion at the community level, we also advocated with the International Council of Ophthalmology to include a piece of curriculum on inclusion into the ophthalmology residency program and to provide training on inclusion in eye health.
We also advocated with national governments and are continuing to do so as we speak. We’re asking governments to make a task force on inclusion for eye health under their national committees, so that their national programs become inclusive. Together – CBM partners and all eye health organizations – we need to advocate for inclusive national eye care programs and for this inclusiveness to get taken through the different service delivery levels.
The United Nations eye health resolution set the target for eye care for all by 2030. How can countries make eye care part of their nation’s journey to achieving the Sustainable Development Goals, while also ensuring that this journey takes an inclusive approach? What role do you see partnerships playing here?
The UN resolution was a milestone in the history of eye care. The critical piece is that it takes you from eye health into a whole development agenda; it’s not just all about eye health, but it is actually contributing to the development agenda and translating this international priority into national governance. I think it will take a huge amount of advocacy because when you get to a national level, you find out that the priorities are many and the resources are limited.
I see the role of civil society as coming together and advocating with the national government – to provide that space, to provide the resources, to provide that position of eye health within their health systems – and then going wider into the development framework.
The clearest things coming out of the UN resolution are the two indicators that are now there: one is the effective cataract surgical coverage, and the other is the effective refractive error coverage. These are the targets and what we need to achieve. Now, we need to do even more work at the country level, so that countries can actually adopt it and implement it. This is where NGOs and public-private partnerships would work brilliantly, working together to ensure the resolution is implemented.
Of course, eye care for all by 2030 means just that, eye care for all. How can we ensure that no one is left behind?
What 2030 looks like for me is comprehensive eye health care being provided in all districts, integrated into the national health systems at the minimum, with the eye health service reaching everyone. And then, that it is specifically including persons with disabilities and all the vulnerable groups. As for the ‘how’, that would need to be contextualized in every country, because each country’s needs would be different, and their structures would be different.
The COVID-19 pandemic showed us all that diseases are not limited by borders and that global health is truly a global responsibility. How do you recommend we, as a global community, move forward from here?
The whole COVID era, which still continues, was quite a setback for everyone – organizations, governments and communities. But at the same time, it provided us with an opportunity to reflect and to see how we can still operate in an environment that can suddenly become so difficult that everything actually shuts down. That led us to two major outcomes: patient safety and patient protection.
We put a lot of work and thinking behind the safety of communities and the safety and protection of patients – not only from the virus, but then going beyond it as well, using the opportunity to ensure a whole comprehensive safe environment for the person. Then, considering the safety on the other side as well, making it safe for the providers and those on the frontlines; they need to be safe and secure as well so that they can treat people on a regular basis.
Despite having the initial setback, I think today we have reached an advanced place. We are in a position where I would say we are back 90 per cent and providing services to communities in a safe and secure environment.
Speaking from a public health perspective, I come from a very simple and straightforward background that, when it comes to global health, nobody is safe until everyone is safe – so we just have to make everybody safe.
That’s my message to everyone: let’s put in all our efforts and ensure that everybody that we come in contact with and everybody that we can influence, is safe.
Dr. Qureshi examines a patient. Photo courtesy of CBM.
You’ve been Vice President of IAPB for nearly a year now. Has IAPB made changes to its strategic approach? What were they?
IAPB has been working very closely, first with Vision 2020, which was launched by IAPB, the World Health Organization (WHO), Ministries of Health and NGOs together; it comes with a lot of history of members that have a very strong insight into the prevention of blindness, into eye health and into the sector.
Then we were also part of the 2019 World Report on Vision, which would set out a strategic road map by the WHO on what different milestones look like, going forward. This was certainly complemented by the Lancet Global Health Commission on Global Eye Health, which came out in February 2021 and actually gave us the burden of disease. It also pointed to the fact that, apart from other things, we should not forget things like uncorrected refractive error. Yes, there are about 1.1 billion people who are visually impaired, but in addition to that, we’ve got to ensure that we are addressing preventable sight loss, which is 90 per cent in low- and middle-income countries.
With that context in mind, in consultation with its members and partners, IAPB came up with its “2030 in Sight” strategic plan. If I were to summarize it, there were three main elements to it:
1) Elevating vision as a fundamental economic, social and development issue; embracing the Sustainable Development Goals framework and setting new targets; and unlocking political will and financing.
2) Integrating eye health into wider health care systems by taking a people-centred approach; looking at inclusive universal health coverage and the different technological solutions.
3) Activating or driving patient, consumer and market change, which is where we are looking at building more public-private partnerships and creating the right regulatory model; ensuring that we actually get into the space of public health with a slightly different model; and looking to the private sector to also play its role within the whole framework of development.
When you look back at the goals set out, what would you say is the key differentiating factor between Vision 2020 and “2030 in Sight”?
Simply put, I think the biggest shift is that we’ve moved from just being focused on eye health to now focusing on a systems change process with an integrated, development approach.
For Vision 2020, we were very focused on disease control and management, which is what we knew best. For example, we knew cataract, so we focused on cataract management and did that well. We also focused on trachoma and are reaching the point where we can eliminate it.
The change we see now is that we’ve realized that we cannot work in silos; we need to look at systems change. It’s going to be a much slower development, as system change will take time, but then it’s there to stay. What we have provided with the 2030 strategy is the road map for the coming decade.
When you look at the initiatives you’ve led, they have been tremendous in both scale and impact. What do you think has made you capable of being a leader of such tremendous change?
There are a few factors that influenced my growth to where I am today. One is being a good student. I believe that learning is a lifelong process. I have been very fortunate to have mentors and people who I could look up to, and that’s a big piece in my life that makes the difference.
Also, my family – my parents for providing me with a secure environment, and my wife and children for being patient with me as I travel away from home and sit in endless meetings at odd hours of the day.
I also think it has been working as a team player, which counts for a lot. If you are able to work as a good team person, only then can you become a good leader as well.
Thank you, Dr. Qureshi, for sharing your words of wisdom and supporting us all with our own life-long learning. When it comes to providing access to quality, inclusive eye health services, we are fortunate to have a clear roadmap before us – and to be working with dedicated, forward-thinking partners such as yourself and CBM.