Leveraging health systems strengthening: a focus on improving eye health

The problem
Poor eye health is one of the most common health problems facing people in developing countries. WHO estimates that one adult goes blind every second, and one child becomes blind every minute. Globally, an estimated 314 million people are visually impaired, including 45 million people who are blind and 269 million have low vision. Beyond blindness, conditions such as presbyopia and conjunctivitis are also widespread; overall, up to 25-30 per cent of the population may be affected by eye disease or visual impairment at any one time.  The rise of conditions such as HIV/AIDS, hypertension and diabetes, which can cause blinding diseases, together with an ageing population, means an ever-increasing number of people are at risk of visual impairment.

Not only are eye diseases very common, they affect the poorest most. Poorer people are often more exposed to risk factors (such as poor sanitation and nutritional deficiencies) and less able to access services. There are also important gender variations: globally, two-thirds of people who are blind are women.

While eye care has improved in some regions, in most developing countries, and particularly in poor rural districts, there is a dramatic lack of eye-care services. Massive shortages of eye health personnel, drugs and equipment, and a low priority given to eye care in national and donor health plans and  budgets, mean that across Africa, less than 30 per cent of those in need have access to eye care services. In many countries, the figure is less than 10 per cent.

The impact
Eye health has a profound impact on the achievement of the Millennium Development Goals. Even minor eye complaints can create social and economic problems, and blinding conditions can have a devastating impact on individuals, families and communities. Numerous studies show that visual impairment affects income and livelihoods, nutrition and food security, infant mortality, social status, and access to education and healthcare. Blindness also has a huge public cost for countries. The annual global economic impact of blindness and low vision was estimated at US$42 billion in 2000. If the prevalence of visual impairment does not decrease, this figure is projected to rise to US$110 billion per year by 2020, with a regional cost of 0.5 per cent of GDP in Sub-Saharan Africa and India.

What needs to happen?
The good news is that with today’s knowledge and technology, up to 80 per cent of global blindness is preventable or treatable. Many eye problems can be tackled easily and efficiently, often at primary care level. Strategies to prevent blindness are feasible, proven and cost-effective. As recognised by the World Health Assembly, “the treatments available [for blindness] are among the most successful and cost-effective of all health interventions”. For example, cataract surgery generates increased economic productivity in the first year equivalent to 1500 per cent of the cost of the intervention.

Services at primary level are the foundation for effective eye health. An estimated 80 per cent of eye problems could be tackled at this level and a primary health approach is both more efficient and effective.

Working on a primary health foundation, eye care can be integrated within all components of the health system – policy, finance, human resources, medical supplies, information systems and service management. This means:
• Including eye health within overall health plans and budgets, to provide direction and funding;
• Making eye health a core element of general primary healthcare training, and investing in mid-level eye care personnel (for example, ophthalmic nurses and cataract surgeons);
• Including eye care drugs and equipment in lists of essential medicines and medical supplies, and ensuring they are available;
• Measuring eye conditions through the national health management information system, to understand their magnitude and enable planning for effective services; and
• Ensuring effective service delivery structures and systems for eye health. This includes strong teamwork, good referral systems and effective supervisory and support structures.

Conclusion
We need to recognise eye health as an essential component of a strong health system. We know eye health affects poverty, education and national development, and we know there are highly cost-effective interventions and feasible, proven strategies. Sightsavers looks forward to continued partnership with Commonwealth governments to tackle avoidable blindness and strengthen national health systems.

For more details please contact:

Sightsavers
Grosvenor Hall
Bolnore Road
Haywards Heath
West Sussex
RH16 4BX

Tel: +44 1444 446600
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