Eye health essential for achieving Sustainable Development Goals
EvEry second Thursday of October is World Sight Day. This year Zimbabwe commemorated World Sight Day under the theme “Love your Eyes”, with the aim of emphasising the importance of eye care. The International Agency for the Prevention of Blindness which is an alliance for the eye care sector leading the World Sight Day has launched several tools to support the provision of quality eye care services. Eye care services have not been prioritised unlike other non-communicable diseases such as cancer and diabetes because eye conditions are not considered as life threatening. We cannot be ignorant of the fact that poor eye health leads to increased risk of mental health disorders and other non-communicable diseases. With the increasing health emergencies such as Covid-19, this makes eyecare services less of a priority, and yet the global need for eyecare services is projected to increase mainly because of the changes in demographics and lifestyle.
WHO world report on vision
vision is the most dominant of our senses and has a great impact on independence and quality of life. vision impairment occurs when an eye condition affects the visual system and vision function. In some cases other eye conditions can lead to blindness. vision influences the ability of an individual’s mobility, communication, and can have consequences on childhood development, quality of education and employment opportunities. Eye health is generally characterised by an ageing population and an increase in unhealthy lifestyles and more often eye conditions or visual impairment goes untreated. A person can undergo surgery, wear spectacles or use other assistive devices to increase their vision.
The WHO World report on vision (2019) provides evidence that shows the importance of eyecare, globally estimating 2,2 billion people to have vision impairment and yet almost half is avoidable or yet to be addressed. This data can also be an underestimation as data on children with vision impairment is limited. Untreated cataracts and uncorrected refractive error are the major causes of vision impairment or avoidable blindness for both adults and children. The burden of visual impairment is not equally borne and rests heavily on low-to-medium income countries.
The World report on vision estimated the gap for untreated cataracts and uncorrected refractive error globally at US$24,8 billion with the Lancet Global Health Commission estimating US$411 billion loss of productivity. Further, the report emphasises the need to promote Integrated People Centred Eye Care (IPEC) which takes into account promotion, prevention, treatment and rehabilitation interventions in the health system.
2030 insight strategy
Building on the efforts of v2020, the 2030 Insight Strategy focuses on the need to end avoidable sight loss through elevating eye health issues, integrating eye health in the primary health system and activating the demand for services. Despite the fact that at some point everyone will need eyecare services, there has been lack of awareness on the eye conditions influencing the demand for services. Lack of data and awareness has influenced commitment by governments to provide funding across the globe.
In order to unlock the political will and financing there is need for evidence to prove the impact that poor vision will have on economies. Embedding vision as a fundamental socio-economic development issue, integrating eye health in the primary health system and activating demand through empowering people becomes a necessity to enhance access to eye health services.
National Eye Health Strategy
Efforts by the government of Zimbabwe through the Ministry of Health and Child Care (MoHCC) have yielded some success. The MoHCC adopted and aligned the National Eye Health Strategy to the priorities of the World report on vision and 2030 Insight Strategy. Prior to the 2030 Insight Strategy the MoHCC and its partners made progress in addressing the priorities of vision 2020 through refurbishment of infrastructure, capacity building of eye health personnel, equipping of eye units, procurement of drugs and consumables to ensure the provision of quality eye care services.
Based on the local data that has been generated through the rapid Assessment of Avoidable Blindness (rAAB), there is a need to scale up services and enhance access. Efforts have been made to integrate primary eye care into the primary health system. The first eye health survey in Zimbabwe, rapid Assessment of Avoidable Blindness was conducted in Manicaland Province in 2016 to determine the prevalence and causes of blindness. In the past Zimbabwe was using the WHO estimate of 1% prevalence. The rAAB is conducted on people aged 50 years and above because the majority of people who experience visual impairment are above 50 years. The 2016 rAAB revealed a prevalence of 3,9%; 67% untreated cataracts, 53% uncorrected refractive error. Further the survey revealed that a number of people were not accessing eye care services because of the cost and unavailability of services, use of harmful practices and lack of awareness on eye conditions. Subsequent rAABs conducted in Masvingo and Matabeleland South Provinces have revealed almost the same prevalence.
Challenges
The progress in providing eye care services in Zimbabwe is not matching the population needs and this is a result of lack of eye health data in the health information system. Availability of the services, acceptability, accessibility and affordability have been major elements affecting access. The cost of services which includes out-ofpocket payments such as transport and accommodation has heavily put a strain on the patient and reduced the number of people accessing eyecare services. Using the goat index, how many goats does one have to sell in order to access eye care services? The brain drain has not spared the provision of eye health services, leaving a huge gap and need for specialized eye care personnel.
Other socio economic factors such as gender, cultural practice, disability have also hindered access to eye care services. Lack of knowledge about eye conditions and the services available has affected access, with some patients presenting late for interventions leading to blindness. Acceptance to wear spectacles or undergo surgery has been cited a major barrier, making the need to demystify myths and addressing harmful cultural practices in eye care imperative.
Way forward
Leaders should consider affordable, accessible and inclusive eye care services at all levels of care. Understanding the burden of eye conditions and magnitude of the eye care needs is important for planning eye care services. There is an urgent need to increase awareness on eye conditions and services available in order to strengthen eye care and increase uptake. Planning and providing cost effective eye care services according to the needs of the communities will enhance the delivery of comprehensive health care.
Eye health is essential for achieving over half of the sustainable development goals and should be prioritised as a development issue. For example there are direct linkages between achieving quality education (SDG 4), decent work and economic growth (SDG8) and no poverty (SDG1), poor vision can affect the quality of education and influence access to opportunities leading to poverty. A multi sectoral approach therefore becomes necessary to achieve quality eye health services for all.
tigere is a development practitioner and writes in her personal capacity. These New Horizon articles published in the
are coordinated by Lovemore Kadenge, an independent consultant, past president of the Zimbabwe economics Society and past president of the chartered Governance & Accountancy (cGI Zim). — kadenge.zes@gmail. com or mobile +263 772 382 852