"How well I See You Peru"

Dr. Edgar Medina Figueroa a Medical Surgeon by profession with postgraduate degrees in Public Health, and Health Services Management. I have over 20 years’ experience in public health and have directed projects with funding from USAID, the Peruvian Government, private foundations, and Peruvian businesses. The projects I have led range from maternal-child health, water and sanitation, community-level governance to innovative approaches to combat ultraviolet damage in the Andes Mountain regions.

My work in Peru with  150 local municipalities and 1,200 communities has contributed to the improvement of the quality of life of 350,000 people and 80,000 families. I am in constant search for new ways to address social problems which involve the active participation of families and community leaders, and local and regional governments.

I am currently the Executive Director of Management Science for Health-Peru (MSH-Peru), an independent national NGO affiliated with Management Science for Health in the United States.

The proposal seeks to ameliorate to two public health problems in poor and highly vulnerable populations: presbyopia and damage caused by exposure to solar radiation. Improving reading capability not only impacts the ocular health of the rural poor, it influences their self-esteem and economic productivity.

We propose to continue working with the Peruvian Government's PENSION 65 Solidarity Assistance Program  www.pension65.gob.pe which has a national enrollment of over 540,000 users over the age of 65. Ninety-five percent of those over the age of 65 suffer from presbyopia and 100% need to reduce UV radiation damage.

To date PENSION 65 and MSH-Peru have distributed 25,000 reading glasses and 20,000 sunglasses. We proposed to expand the “Que Bien Te Veo Peru” program and to distribute 100,000 reading and sunglasses under the formal agreement established with PENSION 65. 

Ophthalmological services in Peru are extremely limited. With a population of 32 million inhabitants, Peru has only 1,079 ophthalmologists and only 11% of the rural population in the Amazonian jungle and the Andean mountain regions have access to professional eyecare services—98% of ophthalmology services are concentrated in the coastal cities, such as Lima.

While Peru has been ranked by the World Health Organization as the country with the world’s highest index of solar radiation, the Ministry of Health has no program to counteract the dangers of ultraviolet radiation on eyesight.

The human eye is most susceptible to damage induced by UV radiation and produces pathologies such as pterygium (raised tissue of the cornea), photokeratitis (ultraviolet keratitis), and cataracts. A study conducted in northern Peru found that only a quarter of people who needed cataract surgery were treated. The prevention of ocular diseases with sunglasses is of vital importance. Likewisse providing reading glasses to improve near vision will improve the quality of live of thousands of peruvians in situacions of poverty and vulnerability.

The sunglasses and readers will be acquired from RestoringVision www.restoringvision.org in the USA, then transported to Peru and cleared through customs in Lima. MSH-Peru will coordinate distribution campaigns with PENSION 65 as per their priorities and selection of those in the greatest need.

MSH-Peru staff will conduct training, supervision, quality control of the measurement and distribution of lenses in the campaigns. The PENSION 65 team will facilitate coordination with local authorities and support the logistical aspects available to them.

The project will benefit 100,000 users over 65 living in vulnerable situations and extreme poverty thus enabling them to age with dignity and healthiness.

The areas where the beneficiaries are located are marginal rural and urban regions of the coastal, mountain and jungle regions of Peru. Campaigns are promoted through the media and the support of authorities, communal leaders, and municipal and regional officials.

It is striking that this population is uninformed of the problems of presbyopia and the damage caused by UV radiation. The results are immediate and testimonies exclaim "I will re-read my newspaper", "I will knit again", "I will work again”, among others.

“Ageing with Dignity” is one of the central objectives of the MSH-Peru and PENSION 65 agreement. The provision of reading glasses not only addresses poor eye health, it enables the beneficiaries to take advantage of educational, economic, technological activities previously unimaginable at these ages. Addressing and solving these problems motivates the population, their leaders, and authorities and creates bonds of solidarity between the population and their authorities. 

During the implementation of different projects in poverty stricken rural areas I realized that poor eye health and exposure to UV rays was a forgotten issue and not included in any health or economic development projects. The simple solution of providing readers and sunglasses was rarely considered.

Therefore we began to investigate solutions and found a group in the United States (Restoring Vision www.restoringvision.org that provides lenses and a validated methodology for the measurement and delivery. With Restoring Vision’s initial support, we adapted the methodology for Peru. See video https://www.facebook.com/mshperu/videos/2115456175399021

To date over 100 campaigns have been conducted and 26,772 reading lenses and 12,560 sunglasses have been delivered. 

First of all, what motivates and impassions me about this project is the immediate impact it has on the beneficiaries. Suddenly people can see correctly; the change is immediate and exhilarating to the beneficiary.

Secondly, I am passionate that we have created a sustainable program within the Government of Peru (PENSION 65) with a target population of 540,000 indigent elderly. Their national scope and 600 employees are here to stay.

Finally, I am excited that the Que bien to Veo Peru program has generated stronger relationships with the national, regional, and local governments.

During my professional experience I have designed, directed, and implemented numerous projects focusing on poverty reduction. I developed the “Que Bien Te Veo Peru” program to address a need often forgotten or rarely foreseen as a key element to improve the lives and health of the poor.

My knowledge of Peruvian reality, its culture, areas of poverty and vulnerability prompted this innovative solution to improve eye health.

The opinion of the officials of PENSION 65 is very favorable and their desire to continue implementing the campaigns is a special motivation. Contributing to their vision of Aging with Dignity is extremely rewarding. We are confident that this project and its expansion with PENSION 65 will contribute to the development of Public Policies to ensure respect for the rights to Ageing with Dignity.

During the development of the "Que Bien Te Veo Perú" program, we have had several problems finding local sponsors to finance the campaigns. The first place we looked was to private companies and international aid organizations. With little luck, we turned to local municipal governments who have responded enthusiastically.

The participation of local governments has forced us to be creative and develop administrative and logistical mechanisms to ensure quality and accountability. While the impact of COVID 19 caused the campaigns to be halted temporarily, with the gradual reopening in rural areas, mayors and local officials have been requesting a renewing of the program.

2005 found me in a national NGO developing a unique and potentially game-changing community development model. It happened that the donor moved the contract to Management Sciences for Health, a large US non-profit with one ‘request’… “no slippage, keep the program going”.

The program we developed under the national NGO was a winner; its foundation was that every community has its leaders-female and male-who know what is needed. All they need are the empowering tools of management and leadership.

Most of the staff went over to MSH with the contract…and I did too, as the Director! An ‘uprooted’ staff, a new prestigious international NGO (MSH), and a mandate for “NO SLIPPAGE!”

And the following four years saw fantastic results.

• The methodology developed in our initial 550 communities was organically replicated in 1,200 rural communities.
• Based on its efficacy, the model was adopted by the Ministry of Health for national replication.
• The reputation of the program and its impactful development model empowered MSH to establish its first independent national affiliate—MSH-Peru, which I now proudly lead.

I do not claim to own these and the many other remarkable results. All I did was harness the empowering leadership philosophy we espoused.

MSH-Peru www.mshperu.org  is incorporated as a Peruvian organization, registered in public registers since 2014. I currently hold the position of Executive Director.

MSH-Peru  is affiliated with MSH Inc. www.msh.org headquartered in Medford, Massachusetts. The relationship between the two organizations is governed by an affiliation agreement.

The “Que Bien Te Veo Peru!” program has shown that it is possible to solve problems such as presbyopia and the prevention of UV damage through provision of reading and sunglasses in areas where there is no ophthalmological service.

The participation of different social actors (regional governments, municipalities, volunteers, community leaders, health workers, and government social programs) opens the opportunity to find new alternatives that by tradition have been limited exclusively to the health sector. The interest and motivation of policy makers is bringing about attention to areas which have been overlooked for decades.

1. PROBLEM AND/OR NEED

· Contribute to improving vision problems of those in extreme poverty and vulnerability who suffer presbyopia by providing access to reading lenses and prevent eye damage caused by exposure to UV solar radiation.

2. INPUTS AND ACTIVITIES

      * Inputs: Reading and sunglass lenses, campaign equipment, methodology and tools developed, trained personnel for the measurement and delivery of lenses, volunteers.

      * Activities:

             * Before the Campaign,

                   Coordination between PENSION 65 and municipalities

                   Dissemination of the Campaign and awareness-raising to the              population.

            * In the Campaign

                  Lens intake, measurement and delivery process

                      30% of users improve productivity.

                      30% of users improve education.

                      30% of users improve the use of information technologies.

3. OUTPUTS

        * Outputs

               Number of users who receive the measurement and delivery of reading lenses.

               Number of users receiving sunglasses and information on prevention measures to prevent damage from ultraviolet radiation.   

               No of volunteers participating in the campaigns.

        * Services

4. INTERMEDIATE RESULTS

              * No. days of the campaigns to deliver 100,000 lenses.

              * No. of municipalities involved and supporting the implementation of the campaigns

5. FINAL RESULTS

• Number of users of PENSION 65 who can live out the promise of Aging with Dignity and good health.

The program has served 39,332 people of whom 26,772 have received reading lenses and 12,560 have received sunglasses with UV protection.

In one year, we are planning to serve 100,000 affiliates of PENSION 65: 50,000 with reading glasses and 50,000 with sunglasses with UV protection.

In 5 years, the goal would be to serve the 540,000 affiliates of PENSION 65.

A) In the first year the following goals are

      1. 50,000 users over 65s have imporved close-up vision (presbyopia)

            * 30% of users improve productivity.

            * 30% of users improve education.

            * 30% of users improve the use of information technologies.

       2. 50,000 users of the PENSION 65 Program access to and use sunglasses with UV protection

           * 50,000 users have the knowledge, attitudes and practices for the prevention of UV radiation damage.

B) In the 5th year it is expected

    1. 400,000 users over 65s, improve close-up vision (presbyopia)

          30% of users improve productivity.

          30% of users improve access to education.

           30% of users improve the use of information technologies.

Barriers in the 1th year:

• Financial barriers; secure the financing of US$ 3.00 for each reading and sunglass lens, for the purchase, transportation from the United States, payment of taxes, storage, transportation to rural areas, staff and operating expenses of MSH-Peru.
• Technical barriers; accessibility and logistical aspects can be complicated in the rural areas where users live.
• Legal Barriers; None as MSH-Peru has all the permits that Peruvian legislation requires for the importation of lenses.
• Cultural Barriers; the population and the authorities have accepted the project for its immediate benefits; we have even worked with native and indigenous populations.
• Market barriers; the costs are lower than market costs and the lenses are of good quality.

Barriers in the 5th year:

• Financial barriers; to seek financing for 400,000 affiliates of PENSION 65.
• Technical barriers; rural areas where users are accessibility and logistical aspects can be complicated.
• Legal Barriers;. None, MSH Peru has all the permits that Peruvian law requires.
• Cultural Barriers; none, the population and the authorities have accepted the project for its immediate benefits.
• Market Barriers; none as there are no of other institutions implementing a similar and lower cost project.

We currently have as a strategic partner-PENSION 65-a Solidarity Assistance program of the Government of Peru. www.pension65.gob.pe

An Inter-Agency Cooperation Agreement has been signed for the implementation of campaigns and the search for sponsors and/or funders.

So far the campaigns have been coordinated and implemented in 58 Municipalities (in Peru we have 1678 municipalities).