Sixty-year-old Anwara Begum lives in a poor, urban outskirt of Dhaka, Bangladesh. Anwara’s husband left her long ago when she bore him no children. With no relatives to support her, she works as a maid in the morning and in the afternoon sells combs, mirrors and other fashion accessories on a sheet upon the ground at the nearby marketplace. She earns US$5-$6 a month as a maid, and makes about US$1 a day selling trinkets.

But life is good for Anwara. She’s very happy. Not only does she have a steady income, but she has the steady support of her neighbors and friends. Best of all, after years of failing eyesight, she has her vision back — a precious commodity in a land of scarcities.

Anwara readily admits that she would probably be begging on the streets these days if it weren’t for the Sajida Foundation, a non-profit microfinance organization that provides small business loans to low-income Bangladeshi women and offers them an affordable health plan. Not only did Anwara qualify for a loan to grow her business, she also received free cataract surgery so she could manage her business. Her surgeon’s training, and the eye health facilities, were all provided by ORBIS International.

Cataracts wreak havoc on a meager living

Anwara cried all the time before her surgery, frustrated by her dwindling ability to manage her affairs. Because of her poor eyesight, she had lost her job as a maid. Her sales were suffering, as she couldn’t distinguish one coin from another. She couldn’t give the proper change, and she had no idea whether customers were handing her the right amount. Her night vision was so poor that she had to close up shop before the sun went down — hours before the other vendors did, causing her to lose valuable business. She couldn’t see well enough at night to cook her meals or leave her home.

Sajida Foundation steps in

The Sajida Foundation is a non-governmental organization (NGO) founded in 1987. Under the direction of Ms. Zahida Fizza Kabir, it has grown from a home-based health charity into a formidable microfinance institution with a health insurance program and hospital serving more than 60,000 women and their families in the slums surrounding Dhaka.

Anwara Begum is helped into the Sajida Hospital van following her cataract surgery. Anwara's cataract surgery was provided free of charge through an ORBIS partnership with the Sajida Foundation.

Microlending is widely known as “banking for the poor.” Clients need not have assets to qualify for a loan, which is generally made in small amounts — typically Tk 5,000-20,000 (US$70-$300). The loans enable clients to start or build a small enterprise, such as a sewing parlor or retail business. Once clients prove their ability to repay, loans of larger amounts are made available to enable their businesses to grow and acquire better equipment and facilities. Interest on the loans is far less than that charged by a commercial bank.

In 1999, the Sajida Foundation broadened its financial services to include a health insurance program.

“Good health is fundamental to economic growth and poverty reduction, and vice versa,” Ms. Kabir said. “People can’t earn if they aren’t healthy. Since 1999, our health program has served more than 240,000 patients.”

For Tk 380 (US$5.50) annually per five-person family, Sajida members receive a comprehensive insurance package that includes life insurance for normal and accidental deaths; disaster insurance covering floods, collapsed building and fires; legal counseling and education; scholarships for high achieving students; and health care. Members and their families eagerly make use of the health coverage and the substantial savings it offers on previously out-of-reach care. Amidst all of those services, though, Ms. Kabir began noticing one health issue that seemed to be falling through the cracks — eye care.

“We saw that there were a lot of patients with eye problems, particularly elderly ones,” she recalled. “But within our hospital we didn’t have a facility to treat them. We had to refer our members to hospitals outside our project area, which were very expensive and required costly travel. It made good sense to weave eye care into our basic coverage plan.”

In the developing world, it’s common for NGOs to include child and maternal care in their health programs, but not vision care. Recognizing the toll that vision problems were taking on patients’ abilities to contribute to their families’ well-being, Ms. Kabir decided that care for the eye was as important to fulfilling its mission of empowering financial self-reliance as care for the rest of the body.

Sajida and ORBIS partner to meet eye care needs

Unfortunately the cost of adding eye care equipment to Sajida Hospital was prohibitive. Having heard about ORBIS’s extensive involvement in vision care throughout Bangladesh, where ORBIS had been active since 1985 and where it had been operating a full-time country program since 1999, Sajida approached the organization for help.

“The time was ripe for us to enter into this kind of partnership,” said Dr. Zahirul Islam, a program officer at ORBIS Bangladesh. “We had been thinking about going into partnership with a microfinance institution in Bangladesh.”

As part of its mission to build the capacity of local health care institutions to include eye care, ORBIS renovated a unit within Sajida Hospital and donated several pieces of ophthalmic equipment and a full complement of supplies. ORBIS also provided training for two medical doctors in basic eye care, two paramedics in nursing, and two operating room nursing and medical staff. All of this support enabled Sajida to discount its vision care services as heavily as it discounted its other health care services.

For instance, a simple cataract surgery that costs Tk 5,000-6,000 (US$71-$85) in other hospitals is free at Sajida Hospital for members participating in the health plan. As a result, if just a single family member uses their insurance for cataract surgery, the family’s entire annual premium of US$5.50 is recovered.

Substantial eye care services now provided through Sajida

As part of its partnership with ORBIS, Sajida organizes eye camps on a regular basis. For Tk 5-10 (less than US$0.15), participants receive a basic medical exam and medications. Between 200 and 500 people are seen at each camp. The first line of defense is to see a primary eye care worker, who screens for cataracts, gives vision tests and refers those needing further care to the camp eye doctor, who is also the Sajida Hospital staff ophthalmologist.

The eye camps are advertised through bullhorn announcements from vehicles traveling through local neighborhoods as well as by a team of 100 “mobilizers” — Sajida members who work part-time going door-to-door looking for patients and organizing the community. Mobilizers receive special training and are awarded commissions for achieving new member recruitment targets.

Among the eye health messages that mobilizers are taught are how to detect signs of cataract and how to avoid eye injuries. Messages are given in very simple language, often visual, because most mobilizers and clients are illiterate.

“We couldn’t have afforded to add eye care without ORBIS,” said Ms. Kabir. “ORBIS helps with funding, technical assistance and networking. It sponsored me to go to India to learn from another organization how to set-up a successful, comprehensive insurance project. I learned a lot from them. Organizations like ours don’t have many opportunities to go outside our country to attend conferences and workshops. It’s just too expensive. ORBIS supports these kinds of initiatives, and they have made a tremendous difference to me, to Sajida, and to our patients.”

Going forward: Promoting healthy vision from the ground up

Just as the concept of microcredit has been replicated all over the world, ORBIS and Sajida hope that the eye health insurance model they created together will also be replicated.

“We’re very hopeful about the direction we’re taking,” said Dr. Islam. “By integrating eye care into the Sajida health program, the size of the program overall has increased in terms of equipment, patients and facilities. People now know that Sajida Hospital is a place they can come to for all types of care.”

Ms. Kabir is optimistic as well. “When we first partnered with ORBIS, we were a tiny little clinic with 10 beds. When ORBIS came along, we gained the confidence, the funds and the technical assistance we needed to grow. Adding eye care helped increase our volume immensely, and also helped us be a better resource for our patients. If ORBIS hadn’t been with us, we never would have dared.”

ORBIS plans to reach out to other organizations like Sajida to duplicate the success of its vision care program and to continue giving patients, like Anwara Begum, who had never before been treated by a medical professional, every possible incentive to come forward and seek the care they need for themselves and their families.

You can help

With your support, ORBIS can partner with other health care and microfinance institutions in developing countries to bring eye care to poor patients like Anwara Begum. Please donate generously generously so that others may see.