International Eye Foundation : seeing 2000 program -- expansion of clinical and surgical eye care services for children through support for NGOs worldwide : final evaluation

IEF met all three primary project objectives. There were aggregate increases of 63% in eye surgery for children (5,741 operations) and 978% in eye exams for children (509,017 exams). The capacity building (training) objective was generally met; overall, 92 doctors and 121 other health providers were reported trained in the program. Since most of IEF's grantee partners were strong eye care organizations already, individual grantees' performance on primary objectives was generally very high. Also, in the seven institutions visited by the evaluation team, the quality of surgical service was judged by the team to be generally high. However, results in numerical terms were skewed to regions where the underlying disease burden is greatest; data were not disaggregated by type of surgery, age, or diagnosis (all of which have implications for visual outcome); also, follow-up to determine quality of post-operative vision was not reported on. IEF's tripling of its surgery objective and 20- fold rise in eye exams suggests those service objectives were too modest, as is one person trained per organization as a training target. Finally, Seeing 2000's contribution to overall childhood blindness prevention is small. The small grants program was an innovative, cost- effective, and successful way to increase surgical services for childhood blindness. A great deal of activity at many partner institutions was generated by a relatively small infusion of IEF funds. A number of the grant partners are true centers of excellence. IEF fashioned a wide geographic network of committed, capable service organizations (e.g., WHO, the International Agency for the Prevention of Blindness [IAPB]), which at international policy/program levels raised the profile of childhood blindness as a separate entity requiring separate services. The small grant program was successful for a number of reasons. The network was self-selected, so that "good" organizations, like cream, rose to the top in the Request for Applications (RFA) process. IEF was also able to foster South- South transfer of capability by partnering more nascent NGOs with more robust ones. At the same time, larger grants to fewer organizations, if carefully targeted and designed, can potentially bring greater results in the long run in terms of strengthening an institution's program management and financial sustainability. Seeing 2000 was highly participatory and there was no micro-management from IEF, which was seen as a reliable and helpful partner, without any conflicting agendas of its own. All seven local partners visited by the evaluation team expressed high levels of satisfaction with the partnership with IEF, with the timeliness and utility of the IEF assistance given, and with what they, the grantees, accomplished with the grant funds. They all remarked that the Seeing 2000 grant enabled them to focus their institution on the needs of children, and to maintain that focus post-grant. Aravind, which manufactures intraocular lenses and suture material of high quality at low prices, has also become IEF's business partner. Post-grant capacity and programmatic and financial sustainability were not addressed systematically by IEF or its grantees, but the evaluation team had the sense that prospects were good at many grantee institutions. On the down side, monitoring and evaluation and results reporting were generally weak, and IEF seems thinly staffed for the TA mission it has embraced. Lessons learned were as follows: (1) A relatively modest level of funding to a PVO (in the $300-400,000/yr range) can be very effective and can result in measurable, meaningful achievements. (2) Cost-recovery for affordable and accessible curative surgery can be achieved. In situations involving high caseloads and empowered, committed organizations, cross- subsidization of services for children and the poor is quite feasible. Nonetheless, the right set of circumstances are needed, including: a high prevalence of a condition (such as blindness), clients' general willingness to pay, strong organizational commitment and ability to deliver good quality services, and high aggregate national wealth. (3) South-South assistance can be real, significant, and sustainable. In fact, South-North assistance can take place and meaningfully strengthen a grantor PVO's own programs.