Eye care remains one of the most pressing global health challenges, and in Ethiopia, the impact is particularly profound, affecting millions of lives annually. Data from the recent National Survey on Blindness, Low Vision, and Trachoma underscores the gravity of the situation indicating that 1.6 percent of the population is living with blindness, while another 3.7 percent suffers from low vision.
According to the survey, an estimated 5.4 million people across the country also are currently grappling with either blindness or significant vision loss, highlighting a critical need for intervention.
In an effort to reverse these trends, Orbis Ethiopia works alongside the Ministry of Health and various partners to strengthen the nation’s eye care infrastructure. The organization focuses on human resource development—training a specialized workforce of doctors, nurses, and community health workers to establish a resilient and efficient health system.
Since its inception in 1998 as Orbis International’s first global program office, the Ethiopian branch has grown into a cornerstone of the organization’s mission that manages the largest eye care programs in the country.
Over the years, it has fundamentally transformed the nation’s eye care landscape by conducting nearly six million screenings and scaling annual cataract surgeries from 5,000 to more than 90,000. Beyond clinical treatment, it also has fortified the healthcare infrastructure by establishing over 300 primary and specialized eye care units.
In addition to delivering a monumental 100 millionth dose of azithromycin, Orbis Ethiopia has successfully transitioned an estimated 12 million people into a trachoma-free status across 73 woredas in the country.
Kathleen Sherwin was appointed CEO of Orbis International last month, bringing over 25 years of leadership in global health and sustainable development. Her career has been defined by a commitment to advancing health equity and gender equality, specifically focusing on expanding healthcare access for communities facing the steepest barriers to opportunity.
Alemayehu Sisay (MD, an ophthalmologist and public health expert, has overseen operations for over a decade as country director for Orbis Ethiopia.
The Reporter’s Abraham Tekle sat down with Sherwin and Alemayehu to get a better understanding of eye care in Ethiopia, particularly in relation to trachoma, and their organization’s long history in the country. EXCERPTS:
The Reporter: Your career has been defined by championing the rights of women and girls at organizations like Plan International and Planned Parenthood. Now, as CEO of Orbis International, what can you tell us about how the organization tailors its eye care programs to reach women and girls, who often face the steepest barriers to accessing healthcare in rural Ethiopia?
Kathleen Sherwin: As the ultimate gender champion, much of my career has been dedicated to gender equality and ensuring equitable access to health systems. Currently, 55 percent of those impacted by avoidable blindness are women and girls. Because of this, Orbis integrates a specific gender lens into our programming. While our goal is to serve everyone affected by avoidable blindness, “serving everyone” does not mean treating everyone the same. Women and girls, particularly in rural communities, face unique and formidable barriers. If a girl loses her sight, she is often unable to attend school; furthermore, because women are frequently the primary caregivers, entire families are impacted when their vision fails.
These barriers are multifaceted, including economic and logistic challenges, cultural expectations and requirements for parental or spousal consent, including a shortage of female healthcare workers to provide culturally appropriate support.
At Orbis, our approach to sustainable development involves intentionally breaking down these barriers. We train female eye care workers, provide transportation in remote areas, and conduct community-based outreach. We also collaborate with teachers, elders, and local officials to help them understand the healthcare burden and develop collective solutions. By working on the ground with local program staff, we ensure all our programming maintains a strong gender emphasis—serving everyone while providing the specialized attention necessary to meet the unique needs of women and girls.
Orbis recently celebrated a monumental milestone: delivering its 125 millionth dose of azithromycin in Ethiopia. Can you take us behind the scenes of what it takes to manage a logistics operation of that scale, and how this achievement brings us closer to the global goal of eliminating trachoma as a public health problem?
Kathleen Sherwin: In over 27 years of partnership with the Ministry of Health, Ethiopia has become Orbis’s first and largest investment, achieving a 74 percent reduction in trachoma and delivering 125 million doses of medication. Through the iconic Flying Eye Hospital and the establishment of 300 eye care centers, the collaboration has facilitated six million screenings and 90,000 surgeries. This success highlights a commitment to capacity building and specialty training, driven by a proud, unified effort between the government and INGO partners to transform the nation’s eye care infrastructure addressing all age spectrum of eye care.
Globally, Orbis has provided treatment to over 23 million people and conducted hundreds of thousands of training programs. In recent times, the organization has adopted high-tech interventions like AI-supported screenings. Does Orbis plan to adopt the same strategic model in Ethiopia and digitalize the sector?
Kathleen Sherwin: In its next global strategy, Orbis will prioritize country-level work through partnerships with governments. The organization uses tools including CyberSight, its AI platform; the Flying Eye Hospital for clinical training; hospital-based specialty training; and long-term community programs to build local capacity. The patient remains central, as 90 percent of blindness is treatable or avoidable. The strategy emphasizes integrating these resources into comprehensive, context-specific services determined jointly by country teams, governments, and communities, while deepening country presence and expanding to new areas.
The strategy will also increase focus on policy advocacy to ensure eye health remains integrated into primary health care amid reduced global health financing. Efforts will link eye health to education, climate, and livelihood outcomes. In countries including Ethiopia, Orbis works with consortium partners, combining areas of specialty to deliver coordinated services. Global, regional, and country partnerships will be strengthened to address financing gaps through collaboration and shared efficiency.
Ethiopia remains one of the most challenging environments for eye health globally, with 5.4 million people living with vision loss. Orbis has focused heavily on the southern part of the country. Has there been any strategic plan to address other parts of the country impacted with the same problem? How is that taken into account in your next phase of addressing the issue?
Alemayehu Sisay (MD): Everything is related to the way we partner with other organizations. Through strategic partnerships and shared responsibilities with other development organizations, eyecare initiatives have expanded into regions such as Amhara and Tigray. In the southern part of the country, these efforts have achieved a 100 percent reach in tackling trachoma, liberating more than 12 million people from the disease.
This progress represents a significant 76 percent reduction compared to the baseline from 20 years ago. While the program’s reach is now widespread, the country continues to face ongoing challenges in the health sector that require continued intervention.
How can the local adoption and alignment with the WHO’s SAFE strategy ensure that elimination reach thresholds are met while maintaining sustainable progress?
Alemayehu Sisay (MD): The WHO’s SAFE strategy is an integrated, multi-faceted platform designed to eliminate trachoma by addressing the entire society rather than just individuals. The acronym represents four key components that must be implemented together: Surgery for trichiasis, Antibiotics for active infections, Facial cleanliness to reduce transmission, and Environmental improvement. Because trachoma is a disease of poverty, some experts expand the “E” component to include education and the economy, emphasizing that the disease can only be eradicated by addressing these underlying social conditions.
The “F” and “E” components—facial cleanliness and environmental sanitation—are particularly critical for long-term elimination, as they require clean water, behavioral change, and the management of human waste to disrupt fly-borne transmission. Implementing only surgery and antibiotics is insufficient, as the infection will recur without these preventative measures. Consequently, extensive resource investment and partnerships with WASH organizations are essential to ensure the SAFE strategy is executed as a cohesive, sustainable intervention.
To what level the problems are addressed in Ethiopia in line with the WHO’s SAFE strategy?
Alemayehu Sisay (MD): Significantly, I would say compared to the baseline. The World Trade Organization’s Tropical Data System provides a survey tool for every district to design interventions based on baseline data. According to the 2013-14 Global Trachoma Mapping Project, the national average prevalence of active infection was nearly 29 percent, but it has since dropped to less than ten percent. This progress means over 33 million Ethiopian children now live in trachoma-free environments. Specifically, in Orbis intervention areas, active infections have been reduced by 76 percent, while cases of blinding trachoma have decreased by 53-54 percent, signaling significant momentum toward elimination.
The remaining hurdle is the “last mile challenge,” which involves the difficult task of identifying and treating the few remaining cases. This phase requires substantial resources, infrastructure, community participation, and continued collaboration. Once these final cases are managed and impact assessments confirm no further intervention is needed, elimination can be officially declared. However, securing the necessary support to overcome these final logistical barriers remains the primary obstacle to reaching that goal.
Could you provide recent data regarding prevalence rates specifically within the country’s conflict-affected areas? How do you secure and mobilize resources to reach populations suffering from these conditions in such high-risk regions?
Alemayehu Sisay (MD): Pinpointing the most significant progress by district is difficult, but the burden of trachoma remains highest in conflict-affected regions like Oromia, Amhara, and Tigray. As a neutral development partner with no religious or political affiliations, our mission is strictly humanitarian. This independence is crucial; it allows us to gain the necessary permission from various groups to operate in conflict zones, ensuring that we can provide essential services to the communities in need without becoming entangled in political dimensions.
By maintaining this apolitical stance, we have successfully conducted Mass Drug Administrations (MDAs) and surgeries in areas of active conflict. This progress would be impossible without a shared understanding that our work is purely for the benefit of the population. While significant challenges persist and the situation on the ground is complex, our commitment to operating in a neutral environment remains the primary reason we continue to move toward trachoma elimination.
Orbis helped establish the Eye Bank of Ethiopia, the only one of its kind in sub-Saharan Africa outside of South Africa. How central is this facility to your regional strategy for treating corneal blindness, and are there plans to replicate this ‘hub’ model in other parts of the continent?
Alemayehu Sisay (MD): The eye bank is the brain child of Orbis. I’m delighted with it, because when it was established, the number of people affected with corneal blindness in Ethiopia was more than 250,000. Corneal transplant was the only way to restore vision. Its establishment required infrastructure, specialized machines, and equipment to preserve corneas beyond 24 hours. In the beginning, corneas were imported due to the absence of local donors, but advocacy and awareness programs later encouraged cornea donation.
Infrastructure, trained professionals, and a cornea retrieval system are now in place, allowing collection and distribution beyond to cities including transport corneas to surgeons, enabling transplant procedures the next day. Corneal transplant services are now available in multiple regions, reflecting expanded access compared to 15 years ago. So, today, we have corneal transplant services in Hawassa, in Mekelle, in Bahir Dar as well as in Gondar. But, in terms of improving the access, we are trying our best.
How aware would you say the general public is about corneal transplants and donation?
Alemayehu Sisay (MD): This needs a lot of advocacy in the future, as it is not enough. Awareness requires continued advocacy, as current levels remain limited compared to a population of nearly 130 million in Ethiopia. Only about 15,000 to 20,000 people have pledged to donate their cornea after death, which reflects a small number of committed donors. The media has a responsibility to share information, while religious and cultural barriers need to be addressed through education and awareness programs over time.
The eye bank has conducted more than 37,000 corneal transplants to date, reflecting expanded service delivery. However, many people remain blind due to corneal conditions and require transplant procedures. Increasing corneal donation, strengthening awareness, and ensuring infrastructure to support donor registration remain necessary to expand access to treatment.
