Our vision is that every child health worker globally knows how to detect and manage eye conditions in children, and that eye health becomes an essential part of every child health programme.
We are a multi professional group of doctors and researchers working in eye health and child health.
Our vision
Our Vision is to ensure all children can see clearly, in order to achieve their full potential. We need to prevent, treat and manage avoidable blindness in children.
We aim to ensure that every child health worker, everywhere, has the knowledge and skills to detect and manage eye conditions early. We believe that eye health should be an essential part of every child health programme, integrated into the care that children already receive.
By making this a reality, we can save and restore the sight of millions of children, allowing them to thrive in education and life. Ultimately, we can also save lives, because many of the same interventions that protect children’s sight also safeguard their overall health.
The challenge
Around three out of four children who are blind live in low-income countries, and the majority lost their sight by the age of five. Yet, over a third of childhood blindness could be prevented or treated with the right care.1
Many of the solutions already exist and are cost-effective, but too often they don’t reach the children who need them most. In many places, there simply aren’t enough trained eye care professionals, and as a result, children with eye problems go undetected and untreated.
Health workers, the people who see young children most often, often receive no training in eye care, and eye health is rarely included in national child health programmes or policies. This gap means preventable blindness continues to affect countless children and families around the world.
Our solution
We want:
- every child health worker globally to be trained in eye care
- eye care integrated into the health systems that children use
- health policies to include child eye health
The Global Child Eye Health Project seeks to achieve this through research and education projects. Our research aims to provide evidence that integrating eye care into health services, is feasible, practical and leads to better outcomes for children.
Find out more about our projects
- Burton MJ, Ramke J, Marques AP, et al. The Lancet Global Health Commission on Global Eye Health: vision beyond 2020. The Lancet Global Health. 2021;9(4):e489-e551. doi:10.1016/S2214-109X(20)30488-5
- Malik ANJ, Mafwiri M, Gilbert C. Integrating primary eye care into global child health policies. Arch Dis Child. 2018 Feb;103(2):176-180. https://doi.org/10.1136/archdischild-2017-313536
Completed Research
Training primary health workers in primary eye health
In 2010, we launched a pilot study in Dar es Salaam, training 28 primary health workers in the WHO’s “Ten Key Activities for Healthy Child Eyes.” Before training, most had limited knowledge of how to prevent, identify, and manage eye conditions in children. One year later, their ability to correctly diagnose and manage eye problems had more than doubled, and good practices, such as providing eye care for newborns, were reinstated in several clinics.1
Understanding how eye care into health systems
Building on these promising results, we conducted a more detailed study in rural Singida region.2 The research found that while over a third of health workers saw at least one child each week with an eye problem, most did not feel confident examining children’s eyes, highlighting the urgent need for practical training and stronger support for child eye health at the primary level.
Integrating eye care into the WHO / UNICEF programme in Tanzania
In 2020 we started training primary health workers in Tanzania on eye health by including it as a module within IMCI. This study was a success not only for building evidence but for changing policy. We showed that PHWs could be successfully trained as part of IMCI to check children’s eyes. This led to the government including the eye health module within their national guidelines and training a further 3000 workers, enabling thousands of children in Tanzania to receive treatment for eye conditions.3,4
Training primary health care workers to use a portable, cost-effective device to detect eye conditions
Following this, primary healthcare workers were trained on how to use a low-cost device, the Arclight, which allows people in remote or low-resource areas to assess eye conditions. Training videos were used during supported supervision to train health workers and 40,000 children were screened over 6 months.5 This again built evidence that PHWs were able to conduct screening and successfully detect sight and life-threatening eye conditions.
Current Projects
We currently have three projects that are leading us to our goal of improved child eye health:
Community Health Worker Training
Since early 2024, we have been training and empowering local community health workers in Tanzania to recognise the signs of child eye health problems and refer children appropriately when they visit communities in their villages.
This involves working with communities on the best approach within their area and ‘training the trainers’ including on the Arclight equipment and distance learning programmes. We have trained 60 community health workers with 70% of community health workers having increased their scores in knowledge of child eye health due to the programme. These CHWs are now screening children and we are monitoring the results and impact of the project.
CHERISH-Vision project
With a large grant (£4m) from the National Institute of Health and Research we will now build on our established evidence to create a framework for integrating child eye health globally.
This project includes 5 studies in Tanzania and Nepal, including a health system readiness study, randomised controlled trial, process evaluation, policy study and an economic analysis. The studies are testing a set of health system interventions including training within IMCI, strengthening supervision of health workers and screening using the Arclight.
This will lead to a validated health systems approach that can be taken up by governments around the world, integrating eye care into child health in their countries and ensuring every health care worker providing primary care for children can detect eye problems.
Find out more about this project.
Retinopathy of Prematurity
We are also running a study in Nepal to improve outcomes for Retinopathy of Prematurity (ROP), a condition that occurs in premature infants, primarily those born before 31 weeks or with a low birth weight. It is caused by abnormal blood vessel growth in the retina.
We are testing a telemedicine screening model, which will allow non-specialists to screen for the condition. We will then compare human assessment of fundus images taken during screening against an AI algorithm.
The second phase of the study will then compare the current (more expensive) standard equipment against a newly-developed cheaper mobile camera.
The study is a prospective cross-sectional comparison study over three sites in Kathmandu.
The study aims to provide evidence that a) non-specialists can be trained to do ROP screening b) the AI model could help screen which babies would need to be referred, which would reduce the burden on doctors and allow scale-up of screening and c) the more cost-effective camera is comparable to the current standard device which would remove the barrier of high equipment costs.
Together this would reduce the numbers of children unnecessarily blind or vision impaired from ROP.
- Mafwiri MM, Kisegne R, Gilbert CE. A pilot study to evaluate incorporating eye care for children into reproductive and child health services in Dar-es-Salaam, Tanzania: a historical comparison study. BMC Nursing. June 2014. https://doi.org/10.1186/1472-6955-13-15
- Data on file
- Malik ANJ, Mafwiri M, Gilbert C. Integrating eye health training into the primary child healthcare programme in Tanzania: a pre-training and post-training study. BMJ Paediatrics Open. 2020 July; 4(1):e000629). https://doi.org/10.1136/bmjpo-2019-000629
- Malik ANJ, Spicer N, Mafwiri M, Gilbert C, Schellenberg J. Integrating eye health into a child health policy in Tanzania: global and national influences. Health Policy and Planning 2025. https://dx.doi.org/10.1093/heapol/czaf029
- Malik ANJ, Mnedeme GF et al. Evaluation of primary healthcare worker training to screen children under 5 years of age with a low-cost alternative to the direct ophthalmoscope, the 'Arclight', as part of the Integrated Management of Newborn and Childhood Illness (IMNCI) programme in Tanzania. BMJ Paediatr Open. 2025 Jun 18;9(1) e003520. https://dx.doi.org/10.1136/bmjpo-2025-003520
This project aims to improve child eye health globally by showing countries how they can integrate child eye health into existing primary health services. See the full rationale for improving child eye health on our About page.
To achieve this, the project is running 5 studies in Tanzania and Nepal, demonstrating a focus on low and middle-income countries where there is greatest need.
The 5 studies will:
Assess the health system at a primary level to identify further gaps
We will work with relevant stakeholders to co-develop our Global Child Eye Health Project model of five previously identified interventions (training module for staff, device for eye screening, supervision, including eye conditions in clinic registers and parent-held health cards).
We will also be collecting data from primary health centres in facilities in Nepal and Tanzania, informing the project about staffing, equipment, infrastructure and service delivery across institutions.
All these findings will be reviewed with key stakeholders to identify any gaps among the existing five interventions, and additions made for the further stages of the project.
Carry out clinical trials of the model in Tanzania and Nepal
The project will carry out a cluster randomised controlled trial (RCT) in each country to gather the highest level of evidence as to whether the proposed child eye health systems model increases access to eye care for children aged under 5 years old.
The intervention districts will receive all the interventions as part of the child eye health system model, and be compared to those districts who do not receive the intervention. Data will be collected on the number of children being managed at the primary care level for eye conditions. We will also measure the number of children being referred to hospital and those being diagnosed with serious eye conditions. At the end of the trial all the comparator districts will also receive the intervention.
Understand the impact of the intervention on the health system
We want to understand not just whether our child eye-health interventions work, but how and why they work in real communities. This means looking at how well the programme is being delivered, whether it reaches the children who need it most, and if there are any unexpected effects on families or the health system. This may also help understand why the results may differ from place to place and how best to strengthen the impact. To do this, we look at how the programme is delivered, whether any unexpected effects occur, and how local factors — such as resources, community needs, or health system challenges — influence what happens. We also explore how the intervention creates change and how differences in implementation might explain the results seen in the trial.
Assess the cost-effectiveness of the model
The economic viability of the model will be assessed by determining what the incremental cost of delivering the interventions would be, and the incremental cost-effectiveness in terms of Disability Adjusted Life Years (DALYs), along with years of blindness averted.
Including health system factors such as screening, treatment and follow up, and costs of training, the analysis will assess the full real-life cost of introducing the model. By defining these costs, the project can present the model to prospective decision-makers to implement elsewhere.
Undertake a policy analysis
This stage of the project will explore whether the new eyecare interventions in Tanzania and Nepal are adopted, scaled-up and sustainably incorporated into health systems, and the factors involved in this.
The analysis will take a health policy and systems research (HPSR) approach across both countries, ultimately informing policy lessons and recommendations for stakeholders in Tanzania and Nepal and those working in other countries in WHO’s Africa and Asia regions.
Each study will take place across both countries, and collectively the results will provide evidence and the incentive for governments (local and national) to integrate child eye health into services and improve outcomes for children with sight loss.
The findings have the potential to be rolled out in 100 countries (the countries that currently use the WHO IMCI) and help millions of children.
Thank you to National Institute of Health and Research for enabling this work.
Aeesha
Malik
Clinical Assistant Professor
Aeesha is a Clinical Assistant Professor in Child Eye Health at London School of Hygiene and Tropical Medicine (LSHTM) and a Paediatric Ophthalmologist. She leads the Child Eye Health Project. She is co-leading the NIHR funded series of projects to evaluate a health systems approach to improving child eye health in Tanzania and Nepal. She is also leading the development of telemedicine and AI screening model for Retinopathy of Prematurity (ROP) in Nepal and the project to train Community Health workers in child eye health in Tanzania.
Joanna
Schellenberg
Professor of Epidemiology and International Health
Joanna is a Professor of Epidemiology and International Health, and Head of the Department of Disease Control at LSHTM. She has 30 years of experience in child health research in low and middle-income countries (LMICs) and her main interest is development and evaluation of public health interventions for newborns, infant and children in LMICs. Notably, she lived in Tanzania for 9 years where she led the Tanzania component of the WHO multi-country evaluation of IMNCI.
Clare
Gilbert
Professor of International Eye Health
Clare is a globally recognised leader in the prevention of blindness in children. She is an ophthalmologist trained in epidemiology with several decades’ experience of research in LMICs in relation to eye disease in children. She supervised the original pilot study and was the Principal Investigator for the formative research in Tanzania. She has also led several trials with a range of study designs for interventions for eyes disease in children, including cluster randomized trials.
Godfrey Furahini
Paediatric Ophthalmologist and Senior Lecturer
Godfrey is a paediatric Ophthalmologist and strabismus surgeon at Kilimanjaro Christian Medical Center (KCMC) and senior lecturer in the Department of Ophthalmology-Kilimanjaro Christian Medical University College (KCMUCo) in Tanzania. He received his PhD from LSHTM in the Prevention of Childhood Blindness and Primary Eye Care for Children and has led several studies on child eye health.
Milka Mafwiri
Consultant Ophthalmic Surgeon and Senior Lecturer
Milka is an ophthalmologist and senior lecturer in Muhimbilli University Hospital and Allied Sciences, Dar es Salaam, Tanzania. She initiated the pilot study in Dar es Salaam, was Co-applicant on the formative research and is Co- investigator in the current project.
Philip Bahati
Community Development and Project Management
Philip James Bahati is a Community Development and Project Management. He has extensive experience in project coordination, safeguarding, inclusive development, community engagement, and eye health programming, particularly under CBM, BMZ, LSHTM, and VCF-funded initiatives. On this project, he will support project coordination, stakeholder engagement, implementation monitoring, reporting, and ensuring compliance with donor and organizational requirements to achieve project objectives effectively.
Florida Muro
Post-doctoral Senior Lecturer and Community Engagement and Involvement lead
Dr. Florida Joseph Muro is a public health expert at KCMC Hospital and a Senior Lecturer at KCMC University, Moshi Tanzania. Holding a PhD in Clinical and Public Health Science, she specializes in infectious diseases, antimicrobial resistance (AMR), and health systems strengthening. Currently, Florida is involved as a Post-doctoral Senior Lecturer and Community Engagement and Involvement lead under the Macho Imara/Cherish Vision Project in Tanzania, funded by the National Institute for Health and Care Research (NIHR) and focuses on child eye health. She leads this project by managing protocols, ensuring ethical compliance, analyzing data, and fostering local capacity through supervision and mentorship.
Sailesh Mishra
Executive Director
Sailesh has over 19 years of experience focusing on eye healthcare sector especially in implementing the program to eliminate trachoma from Nepal. He is currently associated with Nepal Netra Jyoti Sangh as the Executive Director, managing 28 eye hospitals and 157 eye care centers all over Nepal.
Khem Pockrel
Khem Pokhrel is a public health researcher with over 15 years of experience working in health systems in Nepal and internationally. His expertise includes health system research, intervention design, impact evaluation, and evidence synthesis. In the CHERISH-VISION Project, Dr. Pokhrel supports the design of integrated eye health interventions within child health services, contributes implementation of interventions and scientific publications, and facilitates policy dialogue to advance government-led scale-up of successful eye health interventions in Nepal’s health system.
Eli Pradhan
Eli is a Medical Retina consultant, currently working in Tilganga Institute of Ophthalmology, Kathmandu, specializing in Retinopathy of Prematurity. She is undertaking a PhD as part of the ROP project: "Evaluation of a New teleophthalmology Retinopathy of Prematurity Screening Program in Kathmandu, Nepal".
Please find below our educational videos aimed at training child health workers in examining the eyes of babies and children.
- How to irrigate a child's eye after chemical injury
- Examine a child with corneal ulcer or white cornea
- Examine a child with cataract or white pupil
- Check a baby or child's red reflex with an Arclight
- How to instil eye drops or ointment into a child's eye
- Checking the vision of a baby less than 6 months
- How to check the eyes of a baby more than 6 months old
See the rest of our videos on our YouTube channel.
Arclight project
- Arclight in 60 seconds
- How to Use the Arclight Direct Ophthalmoscope for Primary Eye Care (English)
- How to Perform the Fundal ‘Red’ Reflex Examination for Primary Eye Care (English)