Lesson 3: How are we doing?

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A good start

The VISION 2020 global initiative was launched in 1999 with the goal of eliminating avoidable blindness by the year 2020. The success of VISION 2020 should be judged against its impact and reduction of levels of avoidable blindness in the world. Recent data on the global prevalence of blindness and visual impairment suggests a decline of approximately 10% in the overall number of blind and visually impaired: nearly 29 million people.

The number of blind people has fallen from an estimated 45 million to 39.8 million. Over the same period, there has been an 18% increase in the population of those aged 50 years and older worldwide, so these figures, if confirmed, provide some cause for optimism.

Scaling up and adopting new strategies

However, much more needs to be done if we are to achieve our overall objective. The way forward will require us to build upon existing success, to ‘scale-up’ what we are already doing, by going from project level to full country-wide programmes, and to adopt new strategies where progress has been slower than hoped.

For VISION 2020, increasing the available financial resources to implement national plans and to bring good quality, equitable eye health services to the poorest communities is one very obvious area that requires our attention. This will require extensive advocacy work to influence
and change the minds of policymakers around the world, most of whom presently see blindness as a low priority.

But even if we were able to get more money, would countries have the capacity to absorb it and actually deliver the much-needed eye health services? Sadly, the answer is no in many countries because of the chronic shortage of eye health workers. Human resource development for eye health must receive even greater emphasis in the second decade of VISION 2020.

Training is an important aspect of this but only one part of a complex jigsaw that includes wider policy issues such as staff retention and motivation, deployment to rural areas, the ‘brain drain’ to high-income countries and/or private practice, and so on.

Another important area to consider is the creation of consumer demand for eye health services. Why do so many people still turn to traditional treatments rather than seek out the eye units that VISION 2020 has so busily promoted? Quality and access have to receive even greater attention than previously. For example, the quality of outcomes for cataract and trichiasis
surgery is unacceptable in many countries and standards of surgery have to be improved.

We also have to look for opportunities to promote VISION 2020 within the wider health development world, which will require us to make new partnerships that take us outside our traditional comfort zone within our own profession.

This may all seem rather daunting, but we must remember that there has been a huge amount of innovation and progress within VISION 2020. We have much to contribute to the world of health development and others can learn as much from us as we can from them.