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by Allen Foster FRCS, FRCOphth
Medical Director, Christoffel Blindenmission
Senior Lecturer, International Centre
for Eye Health

(Article originally published in the Newsletter of the International Agency for the Prevention of Blindness May 1999 and used with permission.)

During the last two years the World Health Organization, the International Agency for the Prevention of Blindness and a group of non-governmental development organizations involved in eye care have been working together to address the question ‘How to reduce the number of blind persons in the world to a minimum by the Year 2020′. The result of these discussions is the ‘Global Initiative to Eliminate Avoidable Blindness’ and the campaign to create awareness and new resources called ‘Vision 2020: The Right to Sight’.

This article will seek to address four questions: 1. Why do we need a programme against blindness? 2. What is the Global Initiative and Vision 2020? 3. How will the Global Initiative be implemented? 4. Who is involved?

Why do we need a programme against blindness? The available data suggests that by the year 2000 there will be approximately 50 million blind people in the world. The majority live in Asia and Africa. Approximately 8-10 million people become blind each year and it is estimated that around 6-8 million people who are blind die each year. The result is a net increase of 1-2 million blind persons per year. The increase in blindness is due to an increasing world population and increased life expectancy, with more people in the world living beyond the age of 60 years.

Of the 50 million blind people in the world, it is estimated that, approximately half is due to cataract, 15% due to trachoma, 4% due to blindness in children and 1% due to onchocerciasis. These four conditions make up 70% of the world’s blindness. The remaining causes are glaucoma (approx. 15%), diabetic retinopathy (5%) and a variety of other causes (10%).

Despite the efforts of UN agencies, national governments, and non-governmental] organizations, blindness is an increasing problem causing loss of quality of life to the individual; and an economic burden on the individual, family and society in general. A recent study from India estimated that the annual cost of blindness for every 1 million population is approximately $4 million per year.

With this background it was decided that a concerted effort should be made by all those involved in prevention of blindness and eye care delivery to address the major causes of blindness, with the aim of reducing the number of blind people in the world from an estimated 75 million in the year 2020, (if the present situation does not change), to a target of 25 million.

What is the Global Initiative and Vision 2020?

The Global Initiative to Eliminate Avoidable Blindness has identified four diseases for priority action in the first phase. These are:

  • cataract
  • trachoma
  • onchocerciasis
  • childhood blindness and visual loss.

Together with this disease orientated approach it is recognised that there is also need for:

  • human resource development (particularly in Africa)
  • infrastructure development (emphasizing appropriate technology).

a) Disease strategies

There are now well-defined strategies for cataract (cataract extraction with intraocular lens implantation); trachoma co (the SAFE strategy consisting of Surgery for trichiasis, Antibiotics for active infection, Facial cleanliness for reduction in transmission and Environmental improvement to remove risk factors); onchocerciasis (community directed distribution of Mectizan® on an annual basis), and vitamin A deficiency (consisting of short, mid and long-term strategies to promote vitamin A intake). There is still a need to develop specific strategies for other avoidable causes of visual loss in children, for which a workshop was held in India in April 1999.

b) Human resource development

Many governments and nongovernmental organizations are already emphasizing the importance of human resource development at the primary, secondary and tertiary levels of eye care. This is particularly true for sub-saharan Africa, where on average there. is only one ophthalmologist per million population. As well as training in the technical aspects of ophthalmology, there is a need for training in management skills and a community approach to eye care.

c) Infrastructure development

The last few years have seen major technological developments in ophthalmological practice in the industrialized world. These developments are often expensive but can improve the quality of eye care offered. Increasingly, these technological developments are being adapted for use in the developing world. High quality, affordable intraocular lenses and eye sutures are now available. Efforts have been made to produce low cost spectacles and eye drops. Several companies are involved in the production of affordable ophthalmological equipment and instruments.

Vision 2020: The Right to Sight

The Vision 2020: The Right to Sight campaign is a global effort to advocate the importance of preventing and treating blindness with the aim of mobilizing new resources from government, corporate and voluntary sectors of society for use in the Global Initiative programme.

How will the Global Initiative be implemented?

The Global Initiative programme and Vision 2020 campaign was officially launched in February 1999 at WHO in Geneva and will be further promoted and discussed at the Assembly of the International Agency for Prevention of Blindness to be held in Beijing in September. The Global Initiative programme consists of four five-year phases commencing in the year 2000.

The first phase will emphasize programmes for cataract, trachoma, onchocerciasis and visual loss in children together with human resource and infrastructure development. It is planned to create regional (six WHO/IAPB regions-see chart), and national initiatives against blindness in individual countries. In order to achieve the goal of the programme it will be important that governments, UN Agencies and NGDO’s work together in a coordinated way. Models for this type of collaboration have already been successful in the control of onchocerciasis and are beginning to be implemented in trachoma programmes. One of the key features in these programmes has been the creation of a small national Task Force which brings together the Ministry of Health, UN Agencies, and NGDO’s to plan, resource and implement eye care services.

Wherever possible the management and implementation unit should be kept reasonably small, targeting a population of 1-3 million people. – These small manageable ‘implementation units’ would appear to be important for a successful eye care service.

Undoubtedly, as the Global Initiative programme develops, so the priorities will change and phases 2, 3 and 4 of the 20-year programme are likely to have new emphases and directions.

Who is involved?

To be successful the Global Initiative programme, needs the involvement of eye care professionals, health policy makers and managers, and philanthropists (individual and corporate). That is, it requires those with technical professional skills, those involved in decision-making and having management skills and those who have access to the needed resources.

The International Agency for Prevention of Blindness is a forum which brings together eye care professionals, UN Agencies, non-government development organizations and national eye care programmes. The members of IAPB together with the WHO, therefore have a vital role to play in advocacy, planning and implementation of the Global Initiative programme.