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- A solvable global problem: addressing access to eye care around the world
Industry profile
A solvable global problem: addressing access to eye care around the world
Peter Holland, chief executive for the International Agency for the Prevention of Blindness, on the ambition to raise the profile of eye health beyond World Sight Day
Peter Holland
05 October 2022
One billion
people worldwide have sight loss
In the month running up to World Sight Day we want everybody to make a pledge to have their sight tested. We had a target of a million last year and got over three and a half million pledges. This year we want to go even bigger and have a target of five million. But we’re also bringing this home to decision makers, holding a series of sight screenings in parliaments and assemblies around the world, including at the UK Parliament.
We also want to communicate that this is a problem that is solvable
Our Love Your Eyes global campaign has launched this year. It encompasses our objectives, starting from the individual and loving your eyes, but also recognising that this is a global problem. As a campaign it’s quite adaptable to different contexts. In the UK we think in the context of High Street opticians, but in many environments you don’t have that. Indeed, there is often quite a lot of stigma associated with simply wearing a pair of glasses. The feedback and experience we’ve had is that it provides quite a helpful way of challenging some of those issues as well. Having a positive message about caring for your own eye health allows people to use it in contexts where it is less straightforward.
You need effective policy advocacy to influence decision makers. But ultimately, politicians listen to voters and their communities. If they are getting messages that people think this matters, then they are more likely to listen to us, and our members, about how important it is to invest in eye care. That is what is critical for the billion people who need investment in services.
We are within reach of eliminating trachoma as a public health issue across the world. A small country, Vanuatu, has just declared that it has managed to eliminate trachoma. But you have to keep investment in that. Like any of these public health problems, if you let up, even as you get very close, then the problem comes back. It’s crucial that we keep going. Of course, it is that last mile that is always the most difficult.
We’ve introduced 2030 In Sight as a new strategy. The sector strategy has three elements to it: elevate, integrate and activate. It is based on the principle that this is a solvable problem. A crucial message of the strategy is that this isn’t just a health issue, but a developmental, economic and social issue as well.
The three strands of 2030 In Sight:
Elevate: raising the issue with decision makers, drawing out links to the wider impacts and making the case for proper investment in eye care, but also that there are cross-cutting issues and relationships needed with schools and business
Integration: ensuring that eye care is properly integrated as part of mainstream health services
Activate: recognising that many people get much of their eye care through private providers, and so we need the market to work properly, encouraging demand.
Having good eye health means you can improve your education, stay in work, or just participate in daily life. The evidence is there that in education eye care is probably the single most effective intervention for improving children’s access. Research from China [Ma et al, Effect of providing free glasses on children’s educational outcomes in China: cluster randomised controlled trial] suggests it might be equivalent to as much as half a semester’s additional learning. In work and productivity, the Lancet Global Health Commission, published last year, estimated conservatively that globally the world loses US$411 billion (approx. £386 billion) a year in lost productivity due to vision impairment. They said that the figure was likely many multiples higher.
The world loses US$411 billion a year
in lost productivity due to vision impairment
To optometrists I would say: pledge your eye tests for World Sight Day. Optometrists could also write or speak to local MPs and highlight the global, solvable problem.
The importance of collaboration
Collaboration is one of the areas we highlight in 2030 In Sight as being crucial. I think we can talk about partnership and collaboration in a number of different ways.There are partnerships across the sector. The non-governmental organisation (NGO) sector as a whole is not always the most collaborative – people are competing for funds – but increasingly, we see people coming together to partner, recognising that they can’t do everything individually.
As an example, recently we’ve backed the founding of the Coalition for Clear Vision. This is a group of NGO and private sector partners who work in problems around refractive error. The focus is how we scale up solutions to reach the almost one billion people who need access to glasses. This recognises that any individual organisation in the coalition can’t do it themselves.
This points to the second area, which is increasingly partnerships between NGOs, governments and the private sector. I think that cuts to one of the things that is fairly unique about eye health – the private sector has a really important role. In many other areas of healthcare it is a public provision, but in eye care, particularly because of access to glasses, the private sector plays a fundamental role.
The third area, and probably a newer one for the sector and more challenging, is that we need to work outside of the sector. I went to the Commonwealth Education Ministers meeting earlier in the year to talk to them about eye health. You need education ministers, not just health ministers, to be interested in this. Another example is businesses. Building those partnerships, not just within the sector but outside of it, will make a real difference.
A crucial message for us is about integrating eye care as part of mainstream health systems
The pandemic impact
The flipside of that has been that in eye care there has been quite a lot of innovation around its delivery, using technologies like smart phones to consult, screen and connect with patients. We’ve seen this both in higher income countries but also in low and middle income countries too.
We’ve seen examples of this in India, using the technologies in rural areas to consult with patients effectively in their own homes, and screen them so that they go to the clinics only when it is certain that they have a condition requiring that. Similarly, these technologies are used in Southern Africa, where health workers have been screening patients and can then connect to specialist ophthalmologists almost anywhere who can offer advice on treatments or determine whether people need a referral.
These weren’t new in the pandemic, but undoubtedly the pandemic accelerated the use of those.
However, it has probably been no more than a dent in the backlog and difficulties for access that people had. Given that we know the problem for one billion people is access to eye care, I think this has identified the ways you can begin to use technology to reach populations who don’t have access – it is one of the pathways for the future.
A crucial message for us is about integrating eye care as part of mainstream health systems. One of the fundamental problems is that there are never going to be enough specialist eye care workers: optometrists and ophthalmologists. Part of this will involve training, particularly in primary care, to be able to identify and treat problems as close to the source as possible, but I think using technology in ways that mean you only reach out to the specialist when you really need that input, is going to be one way to deliver that eye care.
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