In the evolving landscape of global eye health, partnerships and collaborations have been instrumental in driving capacity building and professional development. The impact of strategic alliances like VISION 2020 LINKS and the Diabetic Retinopathy Network (DR-NET) cannot be overstated, as they have played a crucial role in advancing eyecare services in Malawi.
These partnerships have not only supported clinical training and research but have also created opportunities to address significant gaps in ophthalmic care in low-resource settings. For me in particular, these partnerships have been instrumental in shaping my career so far.
Laying the groundwork: Role of VISION 2020 LINKS & Networks programme
I was first introduced to the VISION 2020 LINKS Programme in 2015 when, as a junior ophthalmology registrar at Queen Elizabeth Central Hospital (QECH), I took part in the Lead Forward project. This was a two-year multi-country project funded by the Department for International Development (DFID) through the Tropical Health and Education Trust (THET) and delivered under VISION 2020 LINKS [1]. The project sought to promote leadership within eyecare teams by imparting workshop facilitation skills and by motivating participants to innovate and implement various quality improvement projects. Two years into the project, when I was a final-year ophthalmology registrar, I had learned a lot from the project through regular interactions with colleagues of all cadres in our eye hospital. This experience helped me to develop the skills to facilitate workshops and lead quality improvement projects, preparing me to be better able to contribute on larger roles in the future.
"Reflecting on my career, it is clear that the partnerships and collaborations that I have been fortunate to engage with have played a critical role in both my professional development and the advancement of eyecare services in Malawi"
VISION 2020 LINKS also supported a long-term partnership between our hospital and the Royal Hospital for Children in Glasgow, through which a series of hands-on short courses focused on developing paediatric ophthalmology services in Malawi were provided [2]. Through one of these courses in 2016, I gained exposure to basic practical skills in paediatric ophthalmology that was valuable in my ophthalmology specialty training. This partnership not only equipped me with essential clinical skills but also inspired senior colleagues, such as Chatonda Manda, who went on to pursue a fellowship in paediatric ophthalmology, becoming Malawi’s second paediatric specialist in the field [2].
Unlocking potential: Academic growth with support from the Commonwealth Eye Health Consortium
The significance of these partnerships continued to grow when, in 2017, I attended the Educator Development and Leadership Review Workshop in Manchester which marked the conclusion of the Lead Forward project. A conversation with Claire Walker from the VISION 2020 LINKS team at the International Centre for Eye Health (ICEH) sparked my interest in furthering my studies in public health. I thereafter acquired knowledge about the learning environment at the London School of Hygiene & Tropical Medicine (LSHTM) from Simon Arunga, an ophthalmologist from Uganda who was undertaking PhD studies at the institution. Encouraged to pursue a Master of Science in Public Health for Eye Care (PHEC) at LSHTM, I applied and received a scholarship from the Commonwealth Eye Health Consortium.
Shaffi, on a supervision visit to one of the study sites in the Red Reflex Trial.
Between 2017 and 2018, I undertook the MSc PHEC, gaining insights into public health approaches to eyecare, epidemiology, health economics, and eye disease control programmes. My classmates entrusted me with the responsibility of representing our programme on the LSHTM Students’ Representative Committee (SRC) along with Helen Burn, who was an ophthalmology registrar from Buckinghamshire Healthcare NHS Trust. The experience I had gained from the Lead Forward project proved useful in helping me to represent the interests of our programme during meetings with the school’s administration.
I developed my MSc dissertation out of the Red Reflex Trial, a cluster-randomised study that was being conducted across Malawi, Uganda and Tanzania. This project investigated the effectiveness of training primary healthcare workers (PHCWs) to screen children for cataracts and retinoblastoma and it highlighted the importance of research partnerships in addressing local health challenges. After the MSc, I continued to oversee the implementation of the project across the three countries and also ran training workshops for PHCWs from facilities that were included later in the trial.
The training I received from the MSc coupled with the facilitation experience from the Lead Forward project played a crucial role in helping me to manage this multi-country trial. It was during this time that I began to develop a real-world understanding of how global partnerships could play a role in improving eye health services at the community level.
Broadening perspectives: The Diabetic Retinopathy Network (DR-NET)
After completing the MSc at LSHTM, I returned to work as an ophthalmologist at QECH and also as an honorary lecturer in ophthalmology at the Kamuzu University of Health Sciences (KUHeS). The continued research collaborations with partners from other countries gave me an opportunity to contribute to several of the subsidiary systematic reviews which informed the Lancet Global Health Commission on Global Eye Health [3].
I also found new opportunities through the DR-NET. This global initiative aims to build capacity for diabetic retinopathy (DR) screening and treatment services, particularly in low- and middle-income countries (LMICs). I was part of a team that offered DR-NET-sponsored training workshops in DR screening to mid-level eye health workers from across Malawi [4]. Under the continued mentorship of Covadonga Bascaran, I also took part in several rapid reviews on DR services in LMICs, through which the DR-NET contributed to the understanding of DR programmes from across the globe.
When global travel came to a halt during the COVID-19 pandemic, I regularly participated in DR-NET webinars that promoted shared learning in DR through discussions among leading experts who were implementing DR services in various parts of the world. This further improved my understanding of DR programmes, technology integration, and implementation challenges in LMICs.
Clare Davey facilitating year two of the Lead Forward project.
My improved understanding of DR programmes enabled me to contribute meaningfully to our eye health research group at KUHeS, alongside colleagues Petros Kayange and Thokozani Zungu. Together, we secured a grant from the Lions Clubs International Foundation to conduct a comprehensive situational analysis of diabetes and DR services in Malawi. This project identified critical gaps in service delivery and played a key role in informing the development of national guidelines for diabetic eyecare, which were published in 2021 [5].
Through a grant from the Malawi NCD BRITE consortium, our team also implemented a study in which we investigated the uptake of DR screening at a secondary-level health facility in Thyolo district in Malawi [6]. In addition, our work in DR was supported by the eXcellence in Ophthalmology Vision Award (XOVA) grant from Novartis which was administered through the College of Ophthalmology of Eastern, Central, and Southern Africa (COECSA) [7]. Through the grant, equipment and a record-keeping system for a DR screening service were introduced into the general diabetes clinic at QECH. This ensured that patients accessed eye examinations as a one-stop service along with general diabetes care without walking a long distance to the eye hospital.
Through these collaborative efforts in training ophthalmologists, research and improving eye health services for people with diabetes in Malawi, in 2021 I was honoured to be recognised by the International Agency for the Prevention of Blindness (IAPB) as an eye health hero in the ‘Change-makers’ category [8].
Leadership roles: Ophthalmological Society of Malawi and COECSA
Alongside these efforts, my role as President of the Ophthalmological Society of Malawi (OSM) has allowed me to advocate for improved eyecare services and foster collaboration among local and international partners. Being a member society of COECSA, the College has been instrumental in strengthening our involvement in national health policies, ensuring that eye health remains a priority on Malawi’s healthcare agenda.
In September 2022, COECSA provided technical guidance to support our society in hosting the 9th COECSA annual international scientific congress. To improve the planning of the conference and help make the subspecialty sessions high quality and locally and internationally relevant to delegates, VISION 2020 LINKS supported four organising committee members from our society to attend and learn from the Royal College of Ophthalmologists Congress in Glasgow, May 2022 [9]. Being a small society of 15 ophthalmologists at the time, the enormous task of hosting an international conference in Malawi was made lighter with the support that we received through these long-term partners. Most recently, COECSA sponsored our society to develop and disseminate national guidelines for the management of retinoblastoma, which the Ministry of Health endorsed in June 2023.
On a personal level, for the past three years, COECSA has provided me with the opportunity to serve as a council member and also as an examiner for the COECSA fellowship exams. Through these roles, I have been privileged to take part in shaping the future of ophthalmology in the region by contributing to the development of future ophthalmologists and upholding high standards of education and practice. COECSA is also a long-standing VISION 2020 LINK partner with the Royal College of Ophthalmologists and has gained as an organisation through this long-standing partnership.
Looking ahead: The power of partnerships
As I embark on the next phase of my journey, pursuing a PhD in Global Eye Health at LSHTM with support from a National Institute for Health and Care Research (NIHR) grant, the importance of partnerships continues to resonate. This project, which aims to model the integration of DR services into Malawi’s broader health system, is led by Covadonga Bascaran from LSHTM and Petros Kayange from KUHeS. It is a testament to how collaborative research and shared expertise can drive meaningful improvements in public health. Through the project, we hope to develop scalable models for integrating DR services into Malawi’s broader health system, with the potential to influence health policy not only in Malawi but also in other LMICs.
Reflecting on my career, it is clear that the partnerships and collaborations that I have been fortunate to engage with have played a critical role in both my professional development and the advancement of eyecare services in Malawi. Alliances with partners such as VISION 2020 LINKS, DR-NET and COECSA have not only facilitated access to advanced training and leadership opportunities but have also built a sustainable framework for the future of eye health in our country.
In a field where the burden of preventable blindness remains high, the role of partnerships in bridging gaps in care and building capacity is undeniable. By continuing to foster these relationships, we can work toward a shared vision of improving access to quality eyecare for all.
References
1. Etim B, Ibanga A, Okafor L, Zondervan M. The VISION 2020 LINKS Programme: Cascading leadership training in Calabar, Nigeria. Eye News 2016;23(3):35–9.
2. Lavy T, Msukwa G, Waterson J, et al. Paediatric ophthalmology training in Malawi through the Vision 2020 LINKS Programme: a decade of partnership. Eye News 2017;23(4):50–3.
3. Burton MJ, Ramke J, Marques AP, et al. The Lancet Global Health Commission on Global Eye Health: vision beyond 2020. Lancet Glob Heal 2021;9(4):e489–551.
4. Annoh R, Msosa J, Styles C, et al. Building capacity for diabetic retinopathy services in Malawi. Eye News 2019;26(2):28–34.
5. Malawi Launches Guidelines for Diabetic Eye Care and Glaucoma Eye Care (2022). The International Agency for the Prevention of Blindness.
https://www.iapb.org/blog/malawi-launches
-guidelines-for-diabetic-eye-care-and-glaucoma-eye-care/
6. Zungu T, Mdala S, Kayange P, et al. Uptake of diabetic retinopathy screening at a secondary level facility in Malawi. PLOS Glob Public Heal 2023;3(11):e0002567.
7. Xova 2020 Winners. The International Agency for the Prevention of Blindness.
https://www.iapb.org/news/xova-2020-winners/
8. Eye Health Hero: Shaffi Mdala. The International Agency for the Prevention of Blindness.
https://www.iapb.org/connect/members/
eye-health-heroes/eye-health-hero-shaffi-mdala/
9. Mdala S, Nyirenda CN, Zungu T, et al. Africa makes strides in tackling blinding eye diseases: highlights of annual conference. Eye News 2023;29(4):30–4.
[All links last accessed September 2024]
Declaration of competing interests: None declared.
