Changing policy through research: Child Eye Health in Tanzania
July 1, 2025
In Tanzania a health worker shines a bright orange torch into a baby's eyes

Photo credit: Aeesha Malik

Blindness and sight loss in early childhood has far-reaching consequences for a child, affecting their physical and mental development, education, future employment and wellbeing. Globally, 70 million have sight loss and 1.4 million are blind.

The majority of children with sight loss, up to 80%, are living in Africa, Asia and South America, and around 40-50% of them have a preventable or treatable cause of vision impairment. The earlier that interventions can be provided for a child with sight loss, the better their prospects.

The IMNCI is a strategy developed by the World Health Organisation to promote early years child health. It centres on a structured assessment of the child that leads to classification of the condition and a subsequent treatment plan. Despite the programme covering most areas of primary health, it currently excludes eye conditions.

During 2017-18 a pilot study by the International Centre for Eye Health (ICEH) in collaboration with the Tanzanian Ministry of Health was conducted to develop and test an eye health module for inclusion in the IMNCI strategy within Tanzania. Proving a success, the eye health module was included in the national strategy and IMNCI programme in 2019. Since then the Ministry of Health (MoH) has trained more than 3,500 primary health care workers with the new eye health module.

A recent paper by ICEH aimed to evaluate this policy change, seeking to understand the factors that led to its inclusion on the national programme, and to provide guidance for other countries looking to do something similar.

The authors interviewed key actors in the development of the module and the policy decision process, in person or online between 2021 and 2022. Thirty-one participants were interviewed together, including professionals from the WHO, Ministry of Health and NGOs.

The main findings as to why the policy inclusion was successful were:

  • Key decision makers in the field had a high level of cohesion on the issue, especially on newborn health, which led to clear communication and advocacy with the MoH
    • “All the experts and organisations – local and international – seem to be in agreement” was one response from a MoH representative
  • The institutions involved were noted as being capable and respected
  • Previous successful research, including a Theory of Change for the subject area were found to be useful or advocacy and inclusion
    • “We thought it may be difficult to include eye health but after seeing it has been implemented in parts of the country, we thought we can do this everywhere” – MoH representative
  • A high sense of ownership of the project within the MoH was recognised, as well as early involvement of the MoH in the initial research
  • An IMNCI strategy review by the MoH was planned for 2019 by coincidence, allowing the findings of the study to be ratified and included in national policy quickly
    • “The timing [of the IMNCI pilot study] was perfect” – MoH representative
  • Previous policy adaptations to IMNCI led the way for this new change
  • International policy discussions did not seem to have a major influence on the local policy decisions in the country, and indeed there was perceived to be lack of global leadership on the issue (lack of inclusion of eye health in IMNCI was noted)
  • Recent changes to reduce the length of IMNCI training also meant that this new module could be included
  • The policy change reflected new global priorities in child health, moving from ‘surviving’ to ‘thriving’
  • The availability of a simple, low-cost ophthalmoscope, the ‘Arclight’ was an important factor, as it enabled training of primary health care workers
  • Integration with IMNCI avoids the challenge of competing with other issues in healthcare

Collectively, the authors noted that “the key to successful policy change was good quality research within the local context, with all actors working together”.

Publication

Malik A, Spicer N, Mafwiri M et al. Integrating eye health into a child health policy in Tanzania: global and national influences, Health Policy and Planning, 2025. Health Policy and Planning. https://doi.org/10.1093/heapol/czaf029