Visual impairment is one of the most common disabilities for children, and its prevalence is growing rapidly globally. The vast majority of cases of vision impairment in children can be corrected with a pair of eyeglasses, but especially in low and lower-middle income countries, the coverage of school-based programs that screen children for visual impairment and provide eyeglasses to the children who need them is very low.
Children with visual impairment who lack access to vision correction are at a disadvantage in terms of school enrollment, educational attainment, and learning. They may not be able to properly see what a teacher is doing in the classroom or what she is writing on the blackboard, especially when classrooms do not have adequate lighting. Children with visual impairment who do not have eyeglasses may also have trouble taking notes and they may not absorb the same amount of information as their peers. The challenge of achieving inclusive education for these children is substantial, but conversely, the opportunities that school eye health programs could provide are major as well.
Together with the EYElliance, the World Bank completed a study entitled Looking Ahead: Visual Impairment and School Eye Health Programs. The study(*) focuses on sub-Saharan Africa, but it also includes data for other countries for comparison purposes. In large part due to lack of vision correction interventions, after controlling for other factors affecting educational outcomes, children with visual impairment are five to seven percentage points less likely to ever enroll in school, complete their primary education, and be literate than children without disabilities. These estimates are based on regression analysis for 21 countries using census data.
In addition, children with difficulties seeing in the classroom (a proxy for visual impairment, albeit an imperfect one) perform less well on standardized student assessments. Data for 10 francophone countries in sub-Saharan Africa from PASEC (Programme d'analyse des systèmes éducatifs de la CONFEMEN) suggest gaps in learning outcomes in primary schools for children with difficulties seeing in the classroom. The negative effect associated with difficulty seeing clearly in the classroom is similar or larger than the effect of many other variables affecting learning performance.
Simply screening children for visual impairment and providing pairs of eye glasses to those who need them could make a major difference. Impact evaluations suggest that the benefits from school eye health programs can be large (see for example this study on China). With basic training, teachers can administer screening tests in schools with very high diagnostic accuracy.
Step-by-step guidance is available on how to implement school eye health programs in low and middle income countries (see this comprehensive guidance note as well as this shorter brief). The programs include three main activities: (1) school-based vision screening which can safely and effectively be done by teachers with minimal training; (2) school-based eye exams and referrals for more serious conditions; and (3) eyeglasses delivery.
Unfortunately, currently coverage rates for these programs tend to be very low. Our analysis suggests that in Francophone Africa, according to PASEC data for 10 countries, only 4.8 percent of students in grade 2 and 7.3 percent of students in grade 6 are likely to have received vision screenings. And yet, the cost of the programs is typically low. We conducted a survey of some of the largest non-governmental organizations implementing school eye health programs. The survey suggests that the programs are relatively cheap to administer.
The low coverage of school eye health programs in PASEC countries in francophone Africa is symptomatic of a broader problem in much of sub-Saharan Africa. Yet experiences are available to suggest that countries at various income levels can implement national school eye health programs. In Liberia, the Ministry of Education has committed to incorporating school eye health in its next national education sector plan.
One last note should be made about data availability. While our study relies on multiple data sources, including census, household survey, and student assessment data, as well as programmatic data from organizations implementing school eye health programs, data limitations persist in many counties. Even if the number of countries using Washington Group questions in household surveys and censuses is increasing, this is still not the case in too many countries. As for student assessment data in low-income countries, while they may include proxies for disabilities, they rarely specifically ask about various types of disabilities in their student questionnaires. Information on disabilities from Education Management Information Systems are also often lacking, as are detailed data on the cost and returns to interventions. To better serve children with visual impairment and other children with disabilities, additional efforts need to be undertaken towards stronger data collection and analysis.
(*) The study benefitted from support from the Trust Fund for Statistical Capacity Building at the World Bank and from the Disability-inclusive Education in Africa Program Trust Fund supported by USAID.