There isn't much to do in Nampula. Lying idly to the north of the Mozambique capital of Maputo, this dusty city is a typical portrait of poverty stricken Africa, where ramshackle buildings line unpaved dirt roads that wash away in the rainy season.

There are the familiar scenes of strolling women with water drums balanced on their heads, wild animals crossing the roads among swerving, honking trucks carrying standing passengers, and children bathing in dirty water next to flaking Coca-Cola murals. There isn't much to do in Nampula but there is a sense of a lot going on. Eighteen years since the country was brutalised by the kind of civil war that has strangled so much African development, Mozambique is a country that seems to be lifting itself slowly to a new era.

Guidebooks boast of street safety, the local sense of humour and miles of undisturbed coastline. Economically, the tourist industry is growing – South Africans in particular travelling north for holidays. The economy is performing, poverty is on the wane (although half the country's population survives on less than $1 a day), foreign investors are sniffing around prospects in the mineral resource industry and the political system is stable. But problems remain. The police have a reputation for harassing foreigners, a laid-back attitude to life prevails where hotels forget bookings, people disregard appointments and nobody has change; where officials are known to extort bribes or issue financial penalties for virtually any infraction. "It is getting worse. They will fine you for anything now," says a white businessman based in the country for the last 15 years.

Turbulent histories, however, shape dysfunctional societies and it is in that context that aid programmes to the developing world have evolved, focusing belatedly on implementing sustainable structures where, in the past, dumping piles of cash in ill-equipped systems has produced few results.

Irish Aid has been firmly directed towards Mozambique for some time, focusing on the devastating conditions of a country (the life expectancy here is 38, among the worst in the world) that the vast majority of Irish taxpayers will never see.

Against the now unavoidable backdrop of domestic banking scandals and financial austerity, it is refreshing to see the sense of purpose and responsibility with which relatively small amounts of money are put to use.

The University Lurio in Nampula, whose concrete buildings once housed psychiatric patients, is one of its focal points. Irish Aid, through the work of Dublin Institute of Technology (DIT), the International Centre for Eyecare Education (ICEE) and the University of Ulster, is in the midst of providing the country with its first eyecare specialists – crucially its own eyecare specialists – in a country where, staggeringly, there are no qualified Mozambiquen optometrists among a population of nearly 23 million people.

For a five-year period, Irish Aid and DIT will have contributed about €2m towards research and sustainable development. In this case, the provision of eyecare facilities and the reduction of blindness and disease associated with refractive errors by the year 2020. The programme is already well on its way, with 42 students currently in training to be the nation's first optometrists by 2013 and a further 30 or so due to start in February. Their training will allow them to diagnose disorders, prescribe glasses and refer patients to opthalmologists. This is benevolent spending at its finest – classrooms have equipment and teachers are partially funded by the Irish state and DIT. It is an example of why in a world of budget slashing and spending guilt, foreign aid will always remain crucial.

And yet there are difficulties. Programmes like this are an example of the vast amounts of small details that hamper and distract efforts to improve conditions.

Just as money alone was never going to work, even dedication and intent can fall foul of local or cultural impediments. Those working at University Lurio, or 'Unilurio' as it is known locally, have spent the past year navigating a system pervaded by problems, dealing with systemic and individual practices not in keeping with western approaches to education or improvement. In a country like Mozambique, poverty of course plays its role even when the actual programme is fully-funded with dedicated staff.

"Sometimes when you walk around the campus you see state of the art laptops and then there are those that can't afford to eat in the morning. The difference is huge," says 26-year-old project manager Stephen Thompson, a development worker who has witnessed the influence of economic desperation in various African nations.

"When I came here I rather naively asked them all for their emails and some of them had never even seen an email."

But, of course, the significance of the problem is far more profound than laptops and emails. One eight-year-old girl helping students demonstrate their skills with an examination was found to be entirely blind in one eye. Asked by a lecturer to count the fingers held up in front of her face, she timidly reached forward and grabbed them in her hand, desperate to give the right answer if even by touch rather than sight. It is a sign of the future that a Mozambiquen optometrist found her problem; it is a sign of the present that she is unlikely to get a pair of glasses any time soon. They are too expensive and the programme is not yet fully equipped to provide them.

"Most people don't have enough money to buy a pair of glasses," says Vivien Ocampo, the Colombian senior optometrist who runs the course.

"That is one of the things that is difficult that we have to deal with. We can find the problem [with the student] okay but in this kind of population we need to find out how to have a low cost for them."

There are options and many of these are being examined by other DIT-funded research. In the meantime, the clinic in Nampula has equipment and should be able to begin providing glasses by next summer once it surmounts problems surrounding the construction of its new clinic, delayed in its completion by the usual local nonchalance.

In some countries, premiums are paid by the wealthy to fund the provision of glasses to the poor while, alternatively, some kind of 'certificate of poverty' could be considered in order to assist those who simply can't afford to pay. Thompson recalls the fate of NHS dependent children in his native England, once forced to sport cheap frames and bulbous lenses so grotesque and stigmatic "they would rather not wear them at all".

There are also issues surrounding trust. White doctors are trusted. They are seen as regulars of universities and hospitals here, but optometry is a stranger that provokes scepticism and bemusement.

"At the beginning [my friends] all said that it was a waste of time, that it wasn't a good cause," said 20-year-old Hermenegildo Tomo from Nampula, a shy man who smiles at the memory and is now in his second year. "But as time went, because they saw us in the schools, they understand now that this is a very important course and they changed their minds and encouraged me to carry on."

Others who don't have friends of family at Unilurio are slower to change, often opting for traditional healers or 'witchdoctors' instead. This brand of medicine has made something of a comeback in the vacuum of civil war as regions around Mozambique fell back into local control. Often its techniques are horrendous – one person describes the use of a stick to remove a cataract – and, at the very least, will destroy any prospect of future alternative treatment.

SITTING on the corner of a desk in front of a documentary camera in her small air-conditioned office, Ocampo lists off the global 'blind stats' she prepared for the interview, before erring with her English and beginning again. It is a difficult message to get across, not just for Ocampo, but for anyone.

Of the 250 million people with dysfunctional sight in the world, most of whom are in developing countries, as much as 190 million cases are avoidable with proper care. It is a statistic that advocates and charities often quote, not always cognisant of how fathomless a piece of information it is.

However, when small children, volunteers for an obscure and invasive eye examination of the kind they have never encountered, wait nervously in a classroom surrounded by mysterious equipment and white coats, it is easier to understand a vision for the future.

"In popular media in the west you would see people having their eyes tested. Like you might see it in Father Ted or something but here there is no relevance to it, not in the popular culture. It's a completely foreign concept," says Thompson.

The children here look at strange eye charts that seem, on first inspection, to be written in an obscure tribal dialect. The symbols are in fact all the letter 'E' turned in a variety of positions so that children, many of whom, are illiterate, can demonstrate their ability to see by indicating the direction in which the letter is facing. As part of their course, the students have designed more child-friendly charts featuring fish and school uniforms that will be correctly specified and set out on charts back in Dublin.

"It's about how people here relate to optometrists because many here can't read or write," says Thompson.

The students themselves also present a significant problem, not on an individual basis but because of one of the greatest cultural hurdles faced by the university's head optometrists Ocampo and Mariajo Lopez and their team. In Mozambique, unlike most western societies, punctuality and even responsibility are not always adhered to.

"If I say to them I need this for tomorrow it's not going to be tomorrow, it's going to be for whenever they want and this is frustrating," says Ocampo, as students slip in and out with overdue work. "It could take months or weeks or days because they think it's not a priority; that they can do it whenever they want and that is a big difficulty for me."

This is a common aspect of life here. In banks people skip queues, in business you are often forgotten as quickly as you say hello and appointments or any other pre-arranged agreements are never as certain as they may seem.

They have made some inroads though. Assignments are forgotten but the course's initial half-empty classrooms are now generally full and those who are not there have given prior warning.

It seems a trivial gripe, prompted by a western concern for good manners but it is actually crucial to the completion of an important degree class in the middle of a country in desperate need of its future spoils. Speaking about it, the students themselves see the significance.

"In general people encourage me because I belong to the first team. Particularly my mother and father and I got a lot of encouragement from him and he gave me the idea to go for further studies," said Janet Abdulali who aspires to becoming a specialist in paediatric optics. For an 18-year-old she has already had considerable experience examining children.

Her classmate Anjela Joana (20) adds: "There are many problems related to sight and eyes in Mozambique and there are no Mozambiquen optometrists so we will be the first to help here with the problems.

"We really need people to come here to actually see what we are doing. Most people don't know so we need as many guests as possible."

But for all the late assignments and missed classes, the message Ocampo and her staff are trying to communicate is that respect for a sustainable system is a respect for the future of their country. There is a lot to do in Nampula.

Ocampo fidgets in her seat and stresses with her arms what she battles to teach her students every day. "It's not for us, it's for you, for your future," she says. "You have to think big always and it's about the responsibility for your whole country."

Sunday Tribune reporter Mark Hilliard and photographer Feargal Ward visited Mozambique through the Simon Cumbers Media Challenge fund, established by Irish Aid in 2005 to promote the country's involvement in foreign humanitarian projects