The Tragedy of Preventable Blindness

According to the World Health Organization, some 314 million people are visually impaired worldwide, 45 million of them totally blind. The tragedy is that three-quarters of all blindness can be prevented or treated.

Avoidable blindness poses an enormous challenge to the global health care system, particularly in low- and middle- income countries. There are 9 million people in Africa alone with preventable blindness, 50-75 percent due to cataracts and 5 percent from glaucoma, says Keerti Bhusan Pradhan, who represents the NGO Right to Sight, and who is to present research he did in Africa at the Irish Forum for Global Health biennial conference Nov. 29 and 30.

And, while Pradhan’s work has centered on Africa, his research applies equally to Asia. There are 4 million blind in Pakistan, 1.3 million in Indonesia. There are 12 million blind in India, with eye-damaging diabetes increasing in what health authorities call epidemic proportions. Most visually impaired people are older and females are more at risk at every age, in every part of the world. About 87 percent of the world's visually impaired live in developing countries.

Although 50 to 75 percent of blindness is attributable to cataracts, the health response has been appalling. According to the WHO, cataract surgery is one of the most cost-effective treatments that can be offered in developing countries. It can allow people to increase their economic productivity by up to 1,500 percent of the cost of the surgery during the first post-operative year.

In Pakistan, for instance, it is a simple one-hour procedure that costs about US$30, but that figure is well beyond what many can afford in the developing world.

Besides cataract and glaucoma, other causes are age-related macular degeneration, corneal opacities, diabetic retinopathy, trachoma, and eye conditions in children including those caused by vitamin A deficiency. Age-related blindness is increasing throughout the world, as is blindness due to uncontrolled diabetes. The Netherlands-based IRC International Water and Sanitation Center reports that simple face washing and improved access to safe water and sanitation would play a major role in eliminating trachoma, which currently blinds more than 6 million people across the world, with 150 million at risk from infection.

NGO Right To Sight is dedicated to eradicating preventable blindness through the use of proven techniques in cost recovery, training and surgical practice. One of his major landmarks is his contribution to improving eye care and preventing avoidable blindness in India as well as many countries in Africa.

Investing in preventing avoidable blindness is not only a public health imperative but also a smart investment as it saves costs for countries and donors, Pradhan says. According to research by Frick and Foster, the estimated cost of global blindness and low vision was US$42 billion in 2000. Without a decrease in the prevalence of blindness and low vision, it is projected that the total annual costs will rise to US$110 billion by 2020. However, Pradhan says, if avoidable blindness were eliminated, the projected cost would be reduced to only US$57 billion in 2020.

There are many challenges to initiatives that aim to eliminate avoidable blindness and two major ones are inconsistent quality of care and shortage of healthcare workers. One of the novel approaches Right To Sight brings in Africa is using private public partnership to engage the private sector in public health. Most of health care in sub-Saharan Africa is in the public sector and Pradhan envisions a growing role of the private sector in meeting public health needs in the region. According to a research study, US$20 billion of additional investment is needed for health care in private sector to improve health outcomes in Africa.

Pradhan believes that operational ownership of eye hospitals by the private sector partners is vital. Right To Sight, a nonprofit, works in partnership with Shalina Laboratories, a pharmaceutical company in Democratic Republic of Congo (DRC). Shalina plans to expand Right To Sight's private-public model of eye care delivery to 18 African countries with six centers planned in the Congo in phases.

This pilot would provide a road map for many private partnerships to have eye care services in Africa, leading towards the goal of eliminating avoidable blindness by 2020, Pradhan says.

Preventing avoidable blindness mandates a stronger response at all levels and from all stakeholders. The biennial conference of the Irish Forum for Global Health could change the game for evoking a response to eliminate avoidable blindness.

Bobby Ramakant is a CNS Policy Adviser. He writes extensively on health and development for Citizen News Service. Email: bobby@citizen-news.org, website: www.citizen-news.org)