Provision of Low Vision Services in Kenya: A Chrsitoffel Blindenmission Initiative

Focus: School Years

Topic: Low Vision

Peter Ndichu Mburu

Head, Visually Impaired Section

Special Education Division

Kenya Institute of Education

P.O. Box 30231

Nairobi

Kenya

ndichu63@yahoo.com

Introduction

Low vision services are those services that are provided to persons with visual impairments, to help them access information through the use of sight. According to WHO about 75% of persons with visual impairments have a degree of useful sight and only about 25% are totally blind. In Kenya about 68% of children attending schools/programmes for the visually impaired have low vision.

Provision of low vision services worldwide dates back from the mid 1970s. Recognition of low vision services has increased over the years such that there are many organizations in the world supporting research, development and provision of the services. The provision of these services in Kenya is spearheaded by international NGOs such as Christoffel Blindenmission (CBM) and Sight Savers International (SSI) in collaboration with the relevant government departments.

In Kenya majority of persons with low vision are under 20 years. These persons are in need of special education for the visually impaired. Therefore, the provision of low vision services has been focused on supporting learners with low vision to reap maximum benefit from education provision. These services include:

Training of teachers to support children with low vision.
Provision of appropriate equipment and materials.
Training learners to use their impaired vision to the maximum.
Provision of optical and/or ophthalmic interventions.
Holistic intervention in habilitation and rehabilitation.

Inadequate provision of low vision services usually leads to:

Most learners with the low vision being educated through techniques, methodologies and resources meant for totally blind, yet they have useful vision.
Learners with low vision becoming more dependant on their immediate associates in and after school.
Slowed development of integration of learners with low vision into regular schools.
Reduced access and participation of learners with low vision to education provision thus defeating the Education For All (EFA) goals of 2015.

It is therefore important to provides quality and adequate low vision services to all those who require them, especially those of school going age.

Historical Development of Low Vision Services in Kenya

The provision of low vision services in Kenya started in the early 1980s. It was and has been provided by the Ministry of Education Science and Technology (MOEST) in collaboration with various NGOs and religious organizations. Among these organizations, CBM has played a major role. Before 1980 all learners with visual impairments were educated as blind irrespective of their degree of vision loss.

In early 1980 the MOEST in collaboration with CBM conducted a survey in six (6) schools for the blind, on the need for low vision services. The survey revealed (among others) that there was a need for:

Optical and medical services.
Encouragement of children with low vision to use their sight since they were using techniques for the blind.
Training Special Education Teachers on supporting children with low vision in the classroom.

In addition to the above, the survey found out that 15 - 25 % of learners in the schools for the blind did not require special educational services at all. The report of the survey recommended that the training of special education teachers should be initiated as a matter of priority. In 1980 MOEST in collaboration with CBM initiated the training of teachers of visually impaired learners at Highridge Teachers College. One of the main aims of the training was to equip teachers with knowledge, skills and attitudes in order to start the provision of low vision services at the schools for the blind.

In 1982, immediately after the first graduates were posted to schools, CBM supported the provision of low vision services in the following aspects.

Adaptation and modification of classrooms in the schools for the blind to suit the needs of learners with low vision.
Provision of equipment and education support materials.
Production and supply of optical low vision devices to schools.
Development of integrated education programme for the visually impaired.

Introduction of the provision of the low vision services faced a number of challenges. One of them was the misconception that the use of sight by children with low vision would make the (little) sight diminish. Further to this there were fears that if children with low vision were removed from special schools and educated in regular school under an integrated set-up, the schools for the blind would not attract donor funding and hence close down. This has led to children with low vision being encouraged to use braille though reading it visually. In 1984, MOEST in collaboration with CBM conducted a follow up survey. The survey found out that there were some improvements but not all recommendations of the previous survey were implemented.

Since the MOEST was convinced that children with low vision could benefit from integrated programmes with low vision services support, a circular letter to this effect was issued. The circular underscored the need for the provision of quality low vision services to children in the schools and integrated programmes.

The circular emphasized the following:

All children attending schools/programmes for the visually impaired should have optical and ophthalmic medical intervention.
All children recommended for print work to commence immediately.
All children recommended to join regular schools to leave the schools for the blind immediately.
Every class to be divided into two, one for those with low vision and the other for educationally blind at lower primary school level.

After 1984, there was enough evidence that children with visual impairments can be educated successfully in regular schools when provided with appropriate supporting in form of specialized equipment and materials, specialized teachers and related services. In 1986 MOEST in collaboration with CBM and SSI initiated the Nairobi Education Integrated Programme (NIEP) for the Visually Impaired. By this time the provision of low vision services was getting acceptance and appreciation in the schools and programmes for the visually impaired. After successful experience of Nairobi Integrated Education Programme for the Visually Impaired, SSI with MOEST initiated the Kenya Integrated Education Programme (KIEP) for the Visually Impaired in 1989 in 19 districts. These 19 integrated programmes are very successful up to today. In addition, there are twenty-six other integrated programmes initiated through local efforts.

In 1991, there was a serious drawback on the provision of low vision services to children in the schools for the blind. A letter from the only high school for the blind in the country informed the six primary schools for the blind that all those who would be admitted to the secondary school have to be proficient in braille reading and writing irrespective of their level of vision loss. This impacted negatively on the provision of low vision services. However, this problem has been addressed through in-service training of teachers, sensitization and provision of appropriate equipment and materials.

The 1994 Study

In early 1990’s there was worldwide new initiative on modern strategies and approaches to low vision service practices. The new initiate involves multidisciplinary participation of various professionals such as special educationalists, eye care personnel, therapists, etc. In view of this CBM embraced the modern approach. The modern approach could not be implemented without a local comprehensive study of the situation on the ground. This led MOEST in collaboration with CBM to conduct a study in six schools for the blind and two model integrated programmes for the visually impaired in 1994.

The survey was conducted to establish the composition of learners with visual impairments and the level of support services provided in the schools and programmes for visually impaired. A total of 1083 children were assessed and the following were results of the survey.

17% of the children were found to be totally blind.
68% of the children were found to be low vision.
15% of the children were found not to be visually impaired.
Materials and equipments were provided without corresponding training to the teacher and learners on their use.
There was inadequate coordination in the provision of services.

The study also revealed that 55% of the children with visual impairments in the schools and programmes for the blind could read and write regular print with or without magnification. About 25% of all children assessed required optical low vision devices to read and write print and about 30% could read regular print without magnification if trained on special reading and writing techniques. However, only about 20% of all children assessed knew some print and most of them were not considered to be visually impaired.

In some schools for the blind, there was hardly any attempt to carry out low vision work. In these schools almost all the children learned through braille. In such schools low vision work had to be started from an initial stage, while other schools and integrated programmes had already taken first steps towards low vision work such that braille was not the major learning medium. Most of the children with low vision had knowledge of print.

The study recommended the following:

1.About 33% of all the children at the schools and integrated programmes needed to be trained to use print from an initial stage.

2.About 14% of the children assessed were reading and writing using braille but almost half of them required some additional low vision therapy in visual stimulation and functional vision training so that they can use their reduced vision for functional purposes.

3.25% of the children required optical low vision devices to enable them to read and write regular print. They required to be trained to use these devices to enable them read and write efficiently without too much effort and inconveniences.

4.30% of the children were able to read and write regular print without magnification. This group of children required help to read and write print in the most comfortable position e.g. with special head posture, close distances and special reading methods.The most appropriate placement for these children in classroom, the contrast of reading and writing materials and the lighting conditions are very important.

5.15% of the children did not need to be in special schools or programmes. They were not visually impaired. However, 28.5% of them were taught through braille. They required special instruction and training sessions in print before they leave the schools for the blind to fit in the regular schools.

6.Teachers needed to be in-serviced in the field of low vision.

7.There is need to start well functioning low vision resource centres in all schools and programmes for the visually impaired to support children with low vision use their vision efficiently.

The results of the study emphasised that low vision work should be implemented in all schools and integrated programmes for the visually impaired in Kenya. To convert children from using braille to print, individualised training has to be carried out by the teachers working in these schools.

Low Vision Project – (Pilot)

As a result of the 1994 study, MOEST in collaboration with the CBM started the pilot Low Vision Project. The aims of the pilot project are:

· To encourage and train as many children with low vision as possible to become efficient visual learners.

· To reinforce low vision services to become an essential element in the existing provision of the education for the visually impaired children in Kenya, so that persons with low vision are prepared to cope in the sighted world as independent as possible.

The pilot project main objectives are to:

Conduct low vision assessment to children.
Provide low vision devices to persons who require them.
Offer low vision therapy to children with low vision.
Train resource personnel to conduct low vision therapy
Conduct in-service training for teachers of children with low vision.

Monitoring and Evaluation

The provision of the low vision services in the country has continually been monitored and evaluated. This has led to identification of various achievements, constraints and challenges.

Achievements

So far the Project has achieved the following:

Thirty (30) teachers have undergone an in-service training programme in low vision.
Four (4) Low Vision Therapists have been trained. Seven (7) more are currently been trained.
Low vision screening and assessment kits have been developed.
Eleven (11) Low Vision Resource Centers have been established (at 6 residential schools for the visually impaired and five integrated programmes).
A Low Vision Clinic at PCEA Kikuyu Hospital has been established.
Two satellite Low Vision Clinics have been established at Kwale in the Coast and Sabatia in the Western part of the country.
The development of an in-service training curriculum for teachers in low vision work has been initiated and is at advanced stages of approval.
The development of a training curriculum for Vision Therapists is at advanced stages of approval.
Quality low vision services have been provided to children with low vision attending the six residential schools and five integrated programmes for the visually impaired.

Constraints

Inadequate supervision.
Inadequate resources to reach needy cases.
Frequent transfers and exodus of the specially trained teachers.
The schools learning environment are not low vision friendly.
Inadequate use of low vision devices.

Challenges

a) Expansion of low vision services to all those who require them.

b) Enhanced public awareness and understanding of low vision services in order to change attitudes and cultural beliefs.

c) Strengthening and harmonizing the current networking system and operation structures.

d) Development of a databank on special needs at MOEST.

e) Provision of appropriate training to all the teachers of children with low vision.

f) Development of appropriate standards and indicators for delivery of quality low vision services.

Recommendations

In order to address the constraints and challenges encountered in the provision of low vision services, the following recommendations have been made to the relevant government departments:

1. Management and administration of low vision work should be strengthened and integrated into the existing education system.

2. A training curriculum on low vision should be developed and approved for:

3. Teachers.

4. Low Vision Therapists (LVTs).

5. Provide appropriate facilities for effective implementation of training programmess and low vision service delivery.

6. Ensure improved capacity building for low vision service delivery at all levels.

7. Establish mechanisms for creation of public awareness.

8. Develop appropriate tools for data collection and management.

9. There is need to revamp the teaching of orientation and mobility, activities of daily living and special communication skills to ensure that they are an integral part of special education provision for children with special needs.

10. Provision of services to multi-handicapped children with low vision need to be reinforced.

Conclusion

With the implementation of the above recommendations, support from our friendly NGO’s, the donor community and local initiatives, the quality of low vision services is set to improve. The Low Vision Project (has now been turned into a permanent unit of PCEA Kikuyu Hospital) organized a series of meetings during the year 2001 with all the stakeholders and a draft policy on the provision of low vision services has been prepared and is awaiting the ministry of education approval. Implementation of this policy shall lead to the achievement of Vision 2020 aims and objectives (in Kenya). The provision of low vision services in Kenya can therefore be taken as a model for other third world countries. Quality provision of these services will ensure that persons with low vision can fully participate in all activities at school and community level, hence including them in the society.