World Sight Day: Importance of eyecare at workplace

Professor AHM Enayet Hussain

Vice chancellor, Sylhet Medical University  

Chair, Bangladesh Chapter, International Agency for Preventing Blindness (IAPB)

President, Ophthalmic Society of Bangladesh (OSB)

Khaleda Islam  

Retired director, Primary Health Care, Directorate General of Health Services

Misha Mahjabeen

Country director, VisionSpring Bangladesh

Arshad Jamal Dipu  

Chairman, Tusuka Group

Director, BGMEA

Sohel Sadat  

Chairman and managing director, ShinShin Group

Syed Mahfuzul Huq

National professional officer, NCD, WHO

AKM Masum-ul-Alam

Programme officer, ILO-LAWC Cluster, ILO

Sabet Islam

Enterprise advisor and BW Project OSH Focal, ILO

Munir Ahmed  

Country director, Orbis International

Chair, INGO-Eye Forum

Amrita Rozario  

Country director, Sightsavers, co-chair, INGO-Eye Forum

Md Rofiqul Islam  

Executive director, Clear Vision Coalition (CVC)

Swapan Paul  

Regional manager, Sustainability-Responsible Sourcing, South Asia, Levi Strauss

Ms Salma

Swing operator, Denitex Ltd  

Abdul Aziz

Cutting and quality, Continental Fashion  

Abdul Quaiyum

Associate editor, Prothom Alo   

Firoz Choudhury  

Assistant editor, Prothom Alo

Today’s topic of the roundtable discussion is “Importance of eyecare at workplace”. The objective is to emphasize the importance of taking care of eyes at workplaces. We may also get some recommendations regarding this. Now Misha Mahjabeen will commence the discussion. 

Misha Mahjabeen

VisionSpring has been serving the population all over Bangladesh for last 17 years through its “Reading Glasses for Improved Livelihood” program. In 2018, we launched “Clear Vision Workplace (CVW)” program. It facilitates eye screening at factories and offices and provides eyeglasses at reasonable prices. In last 5 years, this program has screened more than 500,000 workers in Bangladesh, India and Vietnam. Of this, almost 300,000 belong to the readymade garments sector of Bangladesh. The partners of this success are the progressive businessmen of Bangladesh, some development organizations and international brands.

This year’s theme of World Sight Day is “Love your eyes at work”. The objective of this theme is to create awareness about the need of taking care of eyes at workplaces and encourage employers to facilitate eye screening for the employees.

Every workplace has numerous problems to be solved with limited resources. Hence the resources need to used to solve issues that will lead to more sustainable solution. Problems like vision correction not only improves workers’ quality of life, but also increases workplace productivity.

In 2018, world famous health journal Lancet published a Random Control Trial report to measure the impact of eyewear in some tea gardens of Assam where Visionspring has conducted vision screening. The result showed that the workers who had received eyeglasses had a productivity increase of 22 per cent and the ones aged 50+ had a productivity increase of 32 per cent. Later in another small scale study in the readymade garment factories showed that there was an 81 per cent reduction in defects, 88 per cent reported ease in threading a needle or sewing.

Every year the amount of financial losses globally accrues between 320-515 billion dollar due to vision related problems. However every dollar invested in correcting vision problems can give 10-50 dollar equivalent financial return. By working on vision correction, we can touch at least 5 SDGs.

More than 30 per cent of the workers screened under VisionSpring’s CVW program had to receive glasses, this number is increasing day by day. So no more neglecting of vision problems. Its time to ensure better access to eye care for employees so that they can be more productive to fast track the wheel of economy. No one can solve it alone. Government, private sector, social organizations, development organizations like WHO, ILO need to work together to tackle this problem. We also need to reduce the 78 per cent import duty for eyeglasses and its raw materials to create more access.

Universal coverage to eyecare should be the commitment of our healthcare system. 

Arshad Jamal Dipu

Tusuka group has been associated with Visionspring since the beginning. We have implemented this program in most of our facilities ourselves. As business persons, we want to invest in problems that is beneficial for all. The success of this kind of programs needs greater publicity. Plus more research is required in this sector.

To build trust among garment workers, it’s important to make them understand the value of eyes. Visionspring provided a professional service maintaining a very good standard.  Government and other organizations also need to come forward. Any initiative in RMG is successful when the buyers see the importance.

BGMEA is an association of the manufacturers and exporters. We often try to blame BGMEA and expect BGMEA to solve every problem. But we do not realize that BGMEA is not a Government body. In spite of being the second largest exporting nation in the world, we do not have a central Controlling body from government. We are controlled by our buyers.  Though there is a lot of debate, post Rana Plaza incident, the buyers implemented many work place safety related reforms through Accord and Alliance.

Most of the workers at the RMG factories are young. We have screened around 22,000 workers in our factories. Due to some social stigma like only management level or senior officials will wear eyeglasses, only 20 per cent of factory workers regularly wear the glasses in the factory. The young generations do not want to wear glasses. BGMEA is with any good initiatives related to the workers’ health and wellbeing.

Sohel Sadat

As business person, we always try to do something good. Visionspring’s initiative is amazing.  Most of the workers were not conscious about their eyes. They didn’t realize why they had uneasiness at eyes or headaches. Eye health is very important. So it needs proper attention. We have seen surge in confidence when we worked on this issue. Vision screening not only addressed their vision problems, it has improved productivity too. The workers are now happier and more comfortable. This kind of services need to be more accessible and reasonable.

We are the founding member of Bangladesh Business Development Network (BBDN). We have ensured that disable workers can work with us. Now we have 110 disable workers. We took some training from an NGO for guidance. Honestly speaking, these workers are more sincere than others. We need to work together to create more secured and health-friendly working environment for all workplaces including RMG.

Mohammed Rofiqul Islam

Clear Vision Collective is a combined effort of multiple organizations who work with vision. It started as a pilot project in 2018 from Sherpur. The local government, Orbis, Essilor, Brac, Islamia, Visionspring are working together as part of this collective. Many versatile works are taking place in this area through pharmacies, eye-mitras, vision centers, community health workers, outreach programs, school screening and eye hospitals. The objective of this program is to announce Sherpur as refractive-error free district. In the baseline survey at Sherpur, we had 20 per cent coverage which improved to 50 per cent during the midline survey. We will be able to better assess the impact of our collective action after the end line in 2024.

Most of the vision related problems can be corrected through just a pair of eyeglasses which is very cost effective. Unfortunately, 1.1 billion people on earth could have had a clear vision if they had a pair of glass. We do not have enough optometrists in our country. To address this issue, the workplaces that have medical centers can engage optometrists or at least an MLOP to offer basic eye care services. We have to take eyecare to every home. National Eye Care (NEC) has established 200 Community Eyecenters in the Upazilla Health Complexes. NGO and other private organizations have established 235 vision centers, but we need at least 1,600 such centers to ensure greater coverage.

Swapan Paul

Two things are important for business. One is worker welfare and the other is to understand what will be beneficial/profitable for the business. For Levi Strauss & Co. worker well-being is no less important than the core business. We were highly impressed when we learned about VisionSpring’s work and the impact it generated. Supporting vision health improves worker’s quality of life and productivity in the workplace. We went into partnership in 2018 because of our aligned missions and started this program in one of our factories.

At the beginning, it was obviously challenging, because we had to convince the factory management on why this program can be beneficial for them. But after the first successful implementation at the factory and after communicating the impacts with factory management, we never had to look back. They were motivated themselves and came forward in implementing it. Even one of the companies directly went into agreement with Visionspring and got 30,000 of their workers screened.

In last five years, we have covered 50 per cent of our factories with vision screening service and screened almost 50,000 workers. This is a very important subject because it benefits the workers, the factory and the brand. Other companies also need to come forward to take this initiative ahead. We must understand expenditure in the health and wellbeing of workers is not an expense, it is an investment that generates positive return.”

Abdul Aziz

I have been working at Continental for more than 10 years. Recently I started having blurry vision and headache hampering my regular work. Our factory arranged vision screening through VisionSpring. After getting my eyes checked, I received an eyeglass. I am thankful to my management for this privilege and to VisionSpring for a very professional caring service.

Salma

I have been working in Denitex for last two years. I was having difficulty while working as I couldn’t see properly. Due to financial problem, I couldn’t go to a doctor. Later I heard that factory is arranging eye screening. I went to the camp and received a glass. Now I can see clearly and do more production than before.

Munir Ahmed

Orbis International has been working in Bangladesh since 1985. We have provided eye care services in every sector including tea gardens. Workers fail to realize their vision problems until they face a major barrier in their work.

In Bangladesh, children constitute forty percent of the population, who will grow up to either join formal or informal sectors. Since children are the future of a nation, we want children to be healthy, active, and productive. Eye problems among children are high. However, collaborative efforts of public, NGO and private sector significantly reduced child blindness from 0.8 to 0.6 per 1000 children.  Special care needs to be taken for those who are at risk of blindness or visual impairment.

With the national level campaign, Vitamin A deficiency related blindness among children has been eradicated. Now we face different challenges. One of them is the increasing birth rate of premature babies. Due to improved health care, the survival rate of premature babies has increased, but they need to be screened on a priority basis to identify any abnormalities or diseases.

Every year around 600,000 premature babies are born in Bangladesh. 20 per cent of them are at risk of blindness. Any child born before 35 weeks of pregnancy and /or with less than two of weight kilograms (around 10 per cent of all premature babies) are at risk of ROP on top of brain, eyes, teeth, hearing and behavioral related problems and if not screened just after birth they will be at risk of developing diseases or may be disabled permanently including blindness.

We all should work together to help our children lead a healthy future who can contribute positively to society and also to the national economy. The media needs to play a role to save the future generation from blindness.

Amrita Rezina Rozario

I want to discuss about disability inclusion. Government of Bangladesh passed the Rights and Protection of Persons with Disabilities Act 2013 in line with United Nations Convention on the Rights of Persons with Disabilities. It has covered 12 types of disability. According to the National Disability Survey the number of visually impaired person is 0.46 per cent and according to National Population and Housing Census 2022, 2.80 per cent people have any kind of disability.

Sightsavers is contributing on three tactical pillars keeping in alignment with the SDG’s “Leaving No One behind” philosophy; disability inclusion is one of them.

We screen and mainly provide cataract surgery. But population with disability has many other problems. How can they avail these services?  To create better access to this disable communities, Sightsavers has worked to create accessible entrances in hospitals. On top of that, they are trying to take the services within their reach.

More than 800,000 disable people are contributing in the economy of Bangladesh. All of them need eye screening. We have already created employment opportunities for more than 500 disable people and ensured their vision screening.

AKM Masum Ul Alam

Globally at least 411 billion US dollar is lost due to vision related problems and blindness. We do not have any such data for Bangladesh. We have all talked about the importance of working together and creating awareness. I agree to this too.

International Labor Organization (ILO) has international commitments. In the 110th International Labor Conference, the fundamental convention was increased to 10 from 8 earlier. One of them is occupational safety and health and the other is the promotional framework for Occupational Safety and Health. We have to work to assess these conditions in Bangladesh and how to make workplaces sustainable. 

A working plan has been developed at national level, which is definitely good news. There is a National plan of action on occupational safety and health. Unfortunately vision problem is not adequately represented in either of these frameworks. We have to think about mainstreaming eye care here. Refractive error needs to be considered as an occupational disease.

Quazi Sabetul Islam

Expenses in eyecare are rather an investment. This kind of roundtable creates better understanding and partnerships. We all work on vision problems with varying approaches. We all need to come to a together to a common ground. Someone might feel depressed the moment he/she knows about vision problems. In the Labor law of Bangladesh, there is a checklist for occupational safety and health. We need to ensure proper light at workplace too. Labors should have access to regular vision screening. According to the report “Eye health and the World of work”, it is mentioned that 2.2 billion people globally suffer from eye related problems, of which 1.1. billion is avoidable. It is said that 70 per cent of eye problems can be solved through a pair of eyeglasses.

Syed Mahfuzul Huq

Universal Health Coverage (UHC) is a philosophy. It has three dimensions. The first is to reach to all of those who need the service, the second is to ensure essential service, and the third is to ensure that it does not create a financial burden for the beneficiary. This is applicable for every health initiative including eyecare. To achieve that, the World Health Organization (WHO) helps its Member States to formulate and implement evidence-based policies, and review the progress.

To strengthen eye care, in 2019, WHO World Report on Vision was published and in 2020 the resolution on ‘Integrated, people-centred eye care, including preventable blindness and vision impairment’ was adopted at the 73rd World Health Assembly. In continuation to that, in the 74th World Health Assembly held in 2021, two important global targets were set, one of which is to ensure a 40-percentage point increase in effective coverage of refractive error by 2030. To achieve the target, WHO initiated SPECS 2030, which envisions a world in which everyone who needs a refractive error intervention has access to quality, affordable and people-centred refractive error services, and WHO is committed to support its member states to achieve this.

Khaleda Islam

To reduce the burden of blindness and ocular morbidity the Ministry of Health and Family welfare (MOH&FW) is implementing the National Eye Care (NEC) program. The program adopted the Integrated People Centered Eye Care (IPCEC) approach to achieve Universal Health Coverage (UHC). The NEC program is working to eliminate avoidable blindness and reduce unavoidable blindness by 2030.

The program emphasized preventive and promotive activities to reduce the rate of unavoidable blindness and eliminate avoidable blindness and promotion of eye health through creating awareness, engaging community, and involving all stakeholders.

The NEC program is doing screening, diagnosis and management of blindness, refractive error correction and other eye care activities through community eyecare centers (CEC) situated at Upazila Health Complexes (UzHC) where trained nurses do telecommunication with ophthalmologists at district or medical college hospitals receive the prescription, manage the patient and referral when required. We have an acute shortage of ophthalmologists and need to develop more optometrists and Mid-level ophthalmic personnel (MLOP) who are dedicated ophthalmic paramedics and nurses to provide primary eye care adopting task sharing and team-based approach.

Now if we would like to focus eye care at workplace specifically for the garment’s workers, we know they don’t have time to go to facilities. Also, it has been discussed that most of the garment workers are less than 30 years old. They may not need glasses now. But we must bring them under preventive and promotional activities and routine screening. We need to ensure that they are screened for vision, receive primary eye care at their workplace and those who need specialized care should have specific facility to be referred. There is a social stigma associated with wearing eyeglasses and we must work to remove this false belief and create awareness for eyecare among workers.

There is a huge demand in eye care in workplaces and the NEC program should take the lead to develop standard protocols for eyecare at workplace with a framework for monitoring and supervision as well.

These need coordinated effort of all stakeholders like garment owners, workers, professional organizations, INGOS, World Health Organization, International labor organization (ILO), UN bodies and the government. Everybody should come forward, take responsibility, and should play specific role to ensure eyecare of the workers which increases their productivity.

Professor AHM Enayet Hussain

I would like to start with a quote from Helen Keller ‘The most beautiful things in the world cannot be seen or touched. They must be felt with the heart’. Having problems in vision is such an issue which needs to be felt with the heart. Sustainable Development Goal (SDG) 3 for health and wellbeing also includes universal coverage for primary eye care as well by 2030.

Over the last 20 years, having government in the driving seat and with the help of all NGOs and other stakeholders working for eyecare, the rate of blindness in the elderly has dropped by 35 per cent. At the same time, childhood blindness has dropped from 8 to 6 per 10,000.

The theme for this year is 'Love your eyes at work' which implies taking care of the eyes in the workplace. This creates a huge impact of increased productivity at work.

In this era of technology, we are engaged with different gadgets, mobile phone, laptop etc.  without knowing the proper method of using it. The rule is while you work, after every 20 minutes, look at 20 feet and take a rest for 20 seconds which will help to keep your eyes healthy. We are unaware of this rule and don’t practice. 

We mostly don’t care about eye safety at the workplace, and you will find welding workers don’t wear safety glasses, same is implied for sawmill workers. The right quality of light is important for workplace, which increases safety as well as improves eye heath. We need to pay attention to all these small details at the workplace for eye health and safety.

Those who are engaged in garment factories and doing fine work of sewing, need regular eye examinations. Glasses should be arranged for them as required, which improves vision acuity as well as productivity. We worked with Orbis in tea gardens in Sylhet and provided eyecare and cataract surgery for 180 tea garden workers, who informed later that their productivity at work has been improved. We are ready for any assistance in the apparel sector. Unfortunately, in the occupational health and safety guidelines the process of monitoring by the labor officers is outdated, which needs to be reviewed and updated. It has been mentioned that most of the garment workers are under thirty and we need to find out the reason. We need to create awareness among people with ensuring access to nutritious food for everyone.

It is necessary to work through an integrated action plan with the participation of various government ministries and stakeholders at various levels. The government has a strong commitment and if we can make a multisectoral action plan for eye care, there will be lots of progress.