Access to basic education: A literature review of challenges facing children living with visual impairment in Sub-Saharan Africa

Abstract

Visual impairment is a serious public health challenge that impacts on the social, economic, and educational opportunities of affected children, particularly those in Sub-Saharan Africa (SSA). Most countries in SSA fail to address education barriers emanating from poorly formulated education policies and implementation that directly or indirectly discriminate against children living with visual disabilities, particularly those from rural backgrounds. Therefore reviewing education policies and legislative laws about their pertinence and execution appears paramount. An extensive literature search was conducted using PubMed, Cochrane, Medline, and EBSCOhost databases as well as official websites including technical reports, policy documents and/or frameworks. The literature search used the following keywords in various combinations ‘access to basic education’, ‘challenges to accessing basic education’, and ‘visual impairment among children in Sub-Saharan Africa’. The literature reviewed geographically covers a SSA perspective on the following aspects: (1) visual impairment among children in SSA, (2) the lack of access to basic education for visually impaired children, (3) shortage of specialised skills in basic education for visually impaired children, (4) violations of good practice and discrimination in accessing basic education, and (5) possible solutions to the challenges experienced by children with visual impairments in SSA. Visually impaired children need to be recognised as part of their communities and should have the same rights to education as other citizens. All necessary measures should be made available for them to have fulfilling lives, including appropriate educational facilities.

Keywords

Access basic education children Sub-Saharan Africa visual impairment

Introduction

Access to basic education by visual impaired children is far from being achieved in many Sub-Saharan Africa (SSA) countries despite the gains in enrolment related to ‘Education for All’ movement led by the United Nations Educational, Scientific and Cultural Organisation (UNESCO) (Global Education Monitoring Report Team, 2020). Improving access to education at the rate and level required is hampered by the lack of resources, with education being a joint venture between funders, government, and the community, therefore requiring partnerships to succeed (Global Education Monitoring Report Team, 2020; Hayes & Bulat, 2017; Nielsen, 2006). Lewin and Little (2011) emphasised that even if an expanded definition of ‘access’ is adopted to include progression at appropriate age, achievement consistent with national attainment targets and successful completion of basic education cycle, many children remain out of school or in school but ‘silently excluded’. According to the United Nations Convention on the Rights of Persons with Disabilities, all children with disabilities are entitled to a non-negotiable right to an inclusive, free and quality basic education within the ‘general education system’ (Hayes & Bulat, 2017; United Nations, 2016). This legal framework provides a paradigm shift towards meeting the fundamental education rights of visually impaired children and receiving the support needed to succeed (Hayes & Bulat, 2017).

Visual impairment is defined according to the degree of loss of vision and can be either moderate or severe; according to World Health Organisation ‘VISION 2020’, both are generally referred to as ‘low vision’ (Hussain et al., 2011; Kapur, 2017; Vaishali & Vijayalakshmi, 2020). Children rely on visual interaction with their world and learn through observation and imitation of others; as a result, visual impairment can have severe socioeconomic and educational implications (Conroy, 2005; Vaishali & Vijayalakshmi, 2020). Irrespective of age, any individual with visual impairment or blindness, experiences both physical and psychological difficulties, which may include orientation, mobility, and/or prejudice (Conroy, 2005; Kapur, 2017; Muhit, 2007; Wodon et al., 2019).

The conditions that many visually impaired children in SSA live under, such as poverty and poor eye health services, contribute to education barriers, resulting in a decline in school attendance. The focus should not only be limited to getting children to school, when threats to their participation or attendance and quality of education are being disregarded (Davies & Macdowall, 2006; Global Education Monitoring Report Team, 2020). Learners living with visual impairment remain the most marginalised group despite efforts to integrate the special needs training of teachers as a result of learning material not being adapted to accommodate their special needs. The access and quality of education are interlinked, and policymakers need to identify factors contributing to the high dropout rates and non-enrolment of visually impaired children in schools (Davies & Macdowall, 2006; Global Education Monitoring Report Team, 2020; Kapur, 2017; Wodon et al., 2018). To adequately address the challenges of accessing education, participation by all relevant stakeholders is necessary. To this end, a review of available literature on the elements impacting visually impaired children accessing education is necessary; inclusive of relevant frameworks emanating from international, regional, and national organisations, legislative laws, and policies in education. The literature reviewed geographically covers a SSA perspective on visual impairment among children in SSA, lack of access to basic education for visually impaired children, shortage of specialised skills in basic education, violations of good practice and discrimination in accessing basic education and possible solutions to the challenges experienced by children with visual impairments in SSA.

Methods

A literature search using PubMed, Cochrane, Medline and EBSCOhost databases as well official websites including technical reports, policy documents and/or frameworks was conducted. The following keywords were used in various combinations to search for the literature: ‘access to basic education, challenges to accessing basic education, and visual impairment among children in Sub-Saharan Africa’. Studies and/or reports detailing the elements impacting visually impaired children accessing basic education inclusive of relevant frameworks, legislative laws, and policies in education in SSA were screened and selected using abstracts and/or titles published in English. Thereafter, data was extracted from full text articles and reports of both qualitative and quantitative studies that satisfied the selection criteria.

Visual impairment among children in SSA

The SSA region is reported to have the highest burden of visual impairment and blindness in the world and also has many of the world’s poorest countries (Bourne et al., 2013; Sacharowitz, 2005). Hussain et al. (2011) reported that there were approximately 1.4 million blind children below 15 years of age globally, of whom 320,000 lived in SSA, representing 0.96% of the global prevalence of blindness. This region has the largest burden of childhood blindness worldwide, with 1.24 children per 1000 being affected compared to 0.3 per 1000 in Europe and 0.8 per 1000 in India (Gilbert & Ellwein, 2008; Gilbert et al., 2008). Regardless of these alarming numbers that continue to increase in SSA, little attention is paid towards addressing the challenges of accessing basic education. For instance, the Millennium Declaration by the United Nations in 2011 on key global development initiatives does not make any reference to the population with disabilities (Morelle & Tabane, 2019). In addition, the Millennium Development Goals (MGDs) omitted targets and indicators concerning disability issues, therefore, they can never be achieved without addressing the rights of people with disabilities including access to basic education (Morelle & Tabane, 2019). Therefore, providing an analytical framework aimed at identifying visually impaired children, particularly those living in societies with poorly conceived public health and education policies, is essential.

Lack of access to basic education for visually impaired children

Visual impairment is a greater predictor of failure to enrol in school than rural residence, household economic status or gender (Gooding, 2006). The absence of programmes to identify children living with visual impairment and blindness for them to be examined, treated, referred, or rehabilitated at an early age in communities and schools adds to the burden on their parents, guardians, and caregivers. Furthermore, identifying the causes of blindness can be challenging for physicians in clinical settings, while teachers face uncertainties in dealing with these children (Hoyt & Good, 2001). The WHO and UNICEF (2008) indicated that in SSA, moderate and severe visual impairment are high in poor countries, where poverty and restricted access to basic health facilities are contributing factors.

The key priority of all SSA countries is the ratification of the African Charter on Children’s Rights and Welfare (Jones, 2000; UNESCO, 1998, 2010). Being able to live a productive and independent life is often difficult, even in developed countries where educational approaches are designed to assist children living with visual impairment and blindness. The United Nations General Assembly in 1996 reported that children with disabilities remain unreached by education, with over 50% being excluded either due to laws excluding or enabling this and with only 1% receiving instruction in some countries. Similarly, UNICEF in 2014 reported an estimate of 90% of children with disabilities including those with visual impairment that have not received any form of education. Wodon et al. (2018) reported that only a small proportion of children with visual impairment were enrolled, particularly girls, ranging from 46.4% in Senegal to 31.5% in Zambia, and a significant number of them do not translate from primary to secondary education. In 2000, Apple et al. (2000) reported a rate of 90% of children with visual impairment in low-income countries being deprived of access to education. Gilbert and Ellwein (2008) indicate that only 5% to 10% of the children with visual impairment in developing countries receive some form of education. Those who are afforded the opportunity to attend school are likely to drop out and often fail to reach the secondary school level. This negatively impacts the family when siblings are required to drop out of school to look after the visually impaired children. The majority of mainstream schools lack appropriate facilities, resources, and materials to train and teach visually impaired children, as they are primarily accustomed to educating children with normal sight (Gooding, 2006). A conclusion can be deduced that visual impairment does not receive adequate attention and will continue to be a significant barrier to accessing basic education in SSA countries.

In the Republic of South Africa, basic education is compulsory for children aged between 7 and 15 years. However, Donohue and Borman (2014) report that the majority (70%) of those living with visual impairment and falling between this age range were out of school. Of those who attended school, many were still in special schools for learners with visual impairment. The concern at the time of release of this report was that not a single provincial Department of Basic Education produced accurate estimates of visually impaired children who were out of school (Department of Social Development (DSD) et al., 2012]. Visual and hearing impairments were the most commonly cited by the 2011 census, recording approximately 64,927 children with severe visual impairment (DSD et al., 2012). Furthermore, a Basic Education report from South Africa indicated approximately 2483 children were partially sighted, with only 1184 enrolled in special schools for the visually impaired (Department of Basic Education [DBE], 2014]. There is therefore a need for those in leadership positions to advocate for more schools with facilities to cater for the needs of visually impaired children.

Perceptions, attitudes and beliefs of parents and teachers affect the inclusion of visually impaired children in schools (Gooding, 2006; Jones, 2000; Kupar, 2017). A Ugandan study listed some barriers contributing to the lack of enrolment of visually impaired children, including poor peer behaviour such as bullying and teasing, higher fees for special needs schools, a sense of shame from parents and stereotyping children into particular vocational skills (Gooding, 2006; Jones, 2000). Agesa (2014) in Trans-Nzoia, Kenya, identified ‘being dependent’ as negatively perceived and impacting on social relationships. Thus, most children lack motivation, and learning is hindered as a result of being overprotected by parents, guardians, and caregivers.

Visually impaired children attending mainstream schools find themselves in a strange environment among their sighted peers who, in most cases, lack knowledge and awareness about visual impairment. In addition, these children rely mostly on their hearing and occasionally touch senses, while they are sometimes neglected by the overburdened teachers who fail to make sense of their explanations (Agesa, 2014; Kapur, 2017). Advocating for health promotion can help reduce the differences in health status between normally sighted and visually impaired children to ensure that the latter achieve their full potential with equal opportunities and resources at their exposal. Investing more resources on eye health education and awareness campaigns through the media, with a particular focus on rural and remote areas, will have a positive impact on society at large in understanding the plight of children living with visual impairment.

Other reasons that prevent visually impaired children from attending school are identified in school reports in South Africa. These include the continued societal stigma shared by parents, fear for children’s safety, a lack of knowledge about the existence of special schools for the visually impaired or blind, distance between schools and parents’ homes, high cost of enrolment, hostel, and transport fees, as well as the expectation from parents for children to contribute to the household. In addition, diseases causing visual impairment may be progressive, and the parents’ tendency to be in denial even after the problem has been identified further exacerbates the situation of keeping these children out of school (DBE, 2015; DSD et al., 2012). A clear indication from reports is that the number of children not schooling will exceed those on waiting lists to enrol at available schools for the blind, as the number of schools, and the children they can take, are limited (DBE, 2015; DSD et al., 2012; Human Rights Watch, 2015).

Shortage of specialised skills in basic education

Children living with visual impairment, or any other disability, face barriers to education from the lowest to the highest academic levels. They are highly unlikely to achieve education qualifications, as less expectations and demands are placed on them, or they face limited opportunities that take their impairments into account (Gooding, 2006; Lwanga-Ntale, 2003). In addition, without qualified teachers who are equipped to deal with their special needs, the poor quality of their education will affect their ability to succeed. ‘Achieving Education for All’ therefore remains an immense challenge due to a number of factors, including the shortage of qualified teachers in SSA. This places children who are in special needs schools in dire need of training opportunities to improve the little education they receive (Lewin, 2009; Lewin & Little, 2011; Lewin & Sabates, 2012; Kapur, 2017; UNICEF, 2009). The lack of curriculum innovations, and the slow changes in education which are to do with visually disabled children, are contributed to by poor planning or implementation that may emanate from inappropriate or outdated education policies.

The shortage of specialised skills at schools, such as orientation and mobility specialists restrict these children’s access to the specialised skills that are essential for their activities of daily living. This problem is worse in developing countries, particularly in rural areas, where most of the critical skills, such as braille, travel skills, and effective use of their remaining vision, are being taught by people who are not appropriately qualified (Jones, 2000; Muhit, 2007). In support, the Global Education Monitoring Report Team (2020) raised concerns regarding the availability, skewed distribution and level of access to specialist support for visually impaired children after analysing data from 11 countries in SSA. Out of the 11 countries, only Uganda indicated having adequate specialist teachers, however, the quality of training provided required improvement. Unsurprisingly, in countries such as Cameroon, Senegal, and Zambia, teachers are often reported to have never received any basic orientation on education for children with visual impairment. This highlights the need to invest in improvements in both quantity and quality of specialist teachers as well as continuous professional development in the region in order to ameliorate access to basic education by visually impaired children.

Another detrimental issue that needs to be addressed is that most schools for the visually impaired are too costly and are not affordable for those who need them. This results in the visually impaired children being educated in the normal classroom environment with little or no access to specialised tuition to enable them to acquire a set of skills enabling them to contribute to the economy of their respective countries (Jones, 2000; Muhit, 2007). Hence, the consequences are considerable for the visually impaired child, as they will be expected to perform like normal sighted children without the teacher understanding the difficulties they face in adapting while being educated (Jones, 2000; Save the Children/UK, 1999). In trying to address these concerns, South Africa has established a system of District-based Support Teams aimed at providing support to schools that have enrolled children with disabilities including visual impairment (Global Education Monitoring Report Team, 2020). Morelle and Tabane(2019) emphasised that the successful inclusion of visually impaired children in mainstream schools depends largely on teacher’s knowledge of different eye conditions, training, and quality of support as well as their confidence in teaching children with visual disability. Unfortunately, the lack of specialised skills necessary to recognise and address vision loss leaves most affected children with undiagnosed ocular diseases throughout their schooling experience. In the absence of knowing the nature and extent of the vision loss of school children, the specialised resources and personnel required to meet their needs cannot be identified and allocated (Muhit, 2007). Providing screening services ensures that children develop appropriately and have equal opportunities and a balanced social life (Muhit, 2007). In addition, vision screening can generate data on the causes and frequency of visual impairment and blindness, which help to identify those in need of eye health services such as educational, clinical or rehabilitative needs (Muhit, 2007). It is critical that these screening programmes are accompanied by eye health education to spread information in the communities in which schools are located. In doing so, those children who are excluded from the education system can also benefit through the improvement of eye health behaviour by their parents.

Violations of good practise and discrimination in accessing basic education

Organisations such as UNICEF, UNESCO and WHO have collaborated to address and advocate for issues of childhood health and children’s rights, including those living with impairments (Jones, 2000). However, it cannot be assumed that these initiatives will automatically benefit those who need it, the most marginalised children. A high cost is incurred by countries due to childhood blindness in terms of lost productivity, as they become adults with no or little education and few employment opportunities (Hayes & Bulat, 2017). In high-income countries, despite the low prevalence of childhood blindness, considerable resources are spent in ensuring that visually impaired children receive appropriate education, while this is the opposite in most developing countries in the SSA (Global Education Monitoring Report Team, 2020; Wodon et al., 2018). Furthermore, many developing countries do not have the resources to initiate new programmes or projects to assist affected children and rely on international donors and non-governmental organisations (NGOs) (Hayes & Bulat, 2017). The direct costs of educating visually disabled children, providing rehabilitation services and loss of productivity, impact on families and communities, particularly in developing countries (Sacharowitz, 2005). Through emerging research, a range of strategies such as awareness campaigns have been suggested and have yielded positive results (Jones, 2000; Hayes & Bulat, 2017; Save the Children/UK, 1999).

Jones (2000) describes good practice as not absolute or fixed, referring to the fact that what may be considered as progress in one country may be perceived as regression in another. Ethiopia has shown considerable progress by availing resources to schools, following the exclusion of visually impaired children from being educated, while countries such as Swaziland and Zimbabwe are far behind in improving the situation for visually impaired children (Jones, 2000). A survey conducted in Zimbabwe in two poor communities revealed that education and health facilities for the general population were inadequate (Jones, 2000). The schools only allowed a few of the local visually impaired children to enrol due to inadequate teacher skills, thereby not only denying those who are not enrolled their education right but also the opportunity for integration into society (Jones, 2000; Save the Children/UK, 1999).

Many countries that have constitutions and policies that enshrine the rights of visually impaired children to access education have failed to translate them into practice. While some of their efforts can be applauded, children with disabilities tell a woeful tale of exclusion, with most coming from poor backgrounds and some being orphans (Gilbert et al., 2008; Jadoon et al., 2007; Jones, 2000). The families are required to pay for their medical and education expenses, despite having a right to free health care and basic education. The fact that a child is blind is a barrier to attending educational and health facilities. The Convention on the Rights of the Child (CRC) advocates for compulsory ‘Free for All’ primary education. However, the governments in SSA countries have struggled financially to reach that goal due to existing barriers to achieving optimal health and development for children. Other barriers may include the physical environment, a lack of access to existing ophthalmic services as well as the behaviour or attitudes of family and community members, which result in low self-esteem for the visually impaired child (Gilbert et al., 2008; Global Education Monitoring Report Team, 2020; Jadoon et al., 2007; Jones, 2000). A 2012 report from Swaziland highlighted that the government had ignored learners living with disabilities who require special education, as the learning material is not adapted to accommodate them. With a few specialised schools for the visually impaired, they remain the most marginalised group, despite efforts to integrate special needs training of teachers. The inclusive education policy goal relevant to mainstream instruction, which advocates for access regardless of any form of disability, gender, financial, and health status, remains inadequately and inefficiently translated into practice (Harmonization of Children’s Laws in Swaziland, 2012). Therefore, the inclusivity of stakeholders in education needs to take into account the existing and emerging factors affecting children when planning or reviewing policies to address barriers to learning. Informed decisions by policy developers, and proper implementation regarding access to basic education, can be enabled by conducting research on indicators in the respective ministries to curb the barriers and dropout numbers.

Possible solutions to the challenges experienced by children with visual impairments in SSA Worldwide; there has been a significant shift from having special education segregation to inclusive education, which is also the case in some SSA countries. However, there has been a general oversight in providing the necessary support for visually impaired children to enable their full participation in society (Hayes & Bulat, 2017; Polat, 2011). Hence, while systems need to be put in place, the responsibility rests with each individual to understand their impairment and be supportive at the same time. Hayes and Bulat (2017) identify the importance of having strong policies and legislation that is translated into practice at the school level as well as ensuring that programmes to support the transition from a segregated to inclusive education are well established.

The factors that contribute to violating the rights of children with visual disabilities include a lack of knowledge, information and skills about how to support and work with them irrespective of their visual impairment (Hayes & Bulat, 2017; Polat, 2011). Priority needs to be placed on availing more education facilities in rural areas for visually disabled children to improve enrolment numbers and overcrowding of classrooms. These schools need to have well-trained teachers to serve as focal points for visual impairment or blindness and frequently provide outreach programmes to surrounding communities.

Visual impairment imposes limitations resulting in a child finding it difficult to move around and control their environment. A willingness to understand these limitations will therefore lead to identifying suitable methods in educating learners with visual impairment. Braille and other tool subjects have been obvious options in attempts to teach children with visual impairment while neglecting the other special provisions that take into account all the perceptual restrictions experienced (Agesa, 2014). Adjustments of the learning environment, such as lighting, using large print books, teaching aids, seating arrangements, classroom safety and management, are essential for productive learning among those who are visually impaired (Agesa, 2014; Hayes & Bulat, 2017).

Governments in the SSA region need to fully implement the declaration of the International CRC, which deals with the obligations to strive for children’s education rights. On the other hand, it is not always the case that parents intentionally ignore the rights of their visually impaired children, as some also need support, knowledge and education about the respective impairments affecting their children (Jones, 2000) by the respective government ministries entrusted with such responsibilities, for example, local Education, Health, Social Development offices, etc. Self-advocacy promotion is one of the best ways of combating ignorance, whereby children effectively communicate and convey their interests, problems and feelings about life. Addressing various challenges, such as complacency by those who have the means to make a difference, poor reasoning, and inept role players requires coordination and coherent decision making across all fields responsible for advancing educational equity. NGOs have a role to play in making sure that visually impaired children are not forgotten and remain visible in the community (Jones, 2000). Hence, there is no use in wasting money on buying canes and braille writers if the children show no enthusiasm for using them. Appropriate mechanisms of communication, such as stories and activities to demonstrate life with impairment, highlight the crucial role to be played by the availability of appropriately trained teachers (Jones, 2000; Save the Children/UK, 1999).

The differences in the patterns and prevalence of causes of visual loss compared to other impairments in children are relevant for policy development and amendments, as well as individual case management aimed at the early detection of vision defects. Furthermore, the promulgation of legislation is a prerequisite for long-term improvements in visually impaired children’s lives and for supporting and monitoring the practical implementation of their rights inclusive of accessing basic education. However, this is hindered by the misunderstanding or having insufficient comprehensive relevant policies, poorly disseminated with lack of budgetary provisions and effective monitoring mechanisms, a lack of commitment and willingness to adapt to new ideas, taking into account the impairment of the child (Glewwe, 2002; Hayes & Bulat, 2017; Jones, 2000; Morelle & Tabane, 2019). Good health and a sound education are required to underpin basic human capabilities, with governments having a crucial role to play in improving human living conditions, as well as providing access to services and infrastructure (Polat, 2011). In addition, a broader understanding of rehabilitation is essential, as this will not only focus on individual therapy but also prioritise eradicating poverty, promoting social welfare, and development of those living with visual impairment, as well as ensuring a long lifespan with the willingness of communities to participate in ensuring these goals are reached (DSD et al., 2012).

Conclusion

Visually impaired children are continually denied their basic right to access basic education with no special preference being made for them, and finding ways to meet their needs can be challenging for SSA countries with severely limited resources. The transition towards inclusive education systems supported by legislative frameworks is hampered by the persistent substantial gaps between policy and practice, as a result of the lack of adequate budgetary provisions and full participation of relevant stakeholders to improve educational equity in SSA countries. For successful educational reforms aimed at improving access to basic education by visually impaired children, governments in SSA need to commit inclusive education to guarantee all-inclusiveness and non-discrimination in the right to education.

Footnotes

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Velibanti Nhlanhla Sukati

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