Blindness encompasses several degrees of inability to see, ranging from the simple impairments in seeing objects, to a total lack of sight.
Blindness is no respecter of race, age or gender, as long as anybody has eyes, he is at risk of blindness from several causes, and this is the universality of blindness!
Basic causes of blindness include: Congenital (i.e. developmental defect before birth); Acquired (disorders that develop after birth). In the second group; Infections, Injuries, Non-Communicable disorders, Ageing, are some of the known causes.
In 1999, in response to the observed trend in blindness data available the World Health Organisation (WHO) and International Agency for Prevention of Blindness (IAPB), which showed that unless active action is taken, a total 75million persons (based on projections from available blindness prevention data) would be blind worldwide by the year 2020, a movement called VISION2020:
The Right To Sight was launched, and annually on the second Thursday of every month of October, an advocacy day for this movement is observed.
By the year 2010, that is, 10 years down the lane, the impact of the activities mounted up had revealed a 10 to 13 percent reduction in visual impairment across board. Put simply, the initiative and all it entails has proven to be “effective”!
The Burden Of Blindness In The Land
According to the published reports of the recently conducted (between 2005-2007) first National Survey on Blindness in Nigeria, at least 4 Nigerians out of a hundred (4.2 percent) are blind, and even after issuing spectacles for best correction, the rate still remains as high as not less than 3 of 100!
It also revealed that in every 100 blind Nigerians, Catarract was accountable for 43 of them, while Glaucoma accounted for another 17, Corneal Scars due to the triad of Vitamin A Deficiency+Measles+Use Of Traditional Eyemedicines accounted for another 8, while the remaining 32 would be due to Uncorrected Refractive Error, Aphakia, Trachoma, and several Non-communicable Disoders.
Furthermore, the study implied that at least 1 million Nigerians are blind, and another 3 million are visually impaired!
Similar findings were true of such surveys by India (2005), and Pakistan (2003).
In fact, the International Agency for Prevention of Blindness (IAPB) in collaboration with World Health Organization (WHO) embarked on the activities of VISION2020: The Right To Sight in view such data.
And till date, 90 percent of all visually impaired worldwide live in developing countries, 65 percent of them are aged above 50 years, 19 million children are visually impaired, but the earth-shaking reality is: 80-90 percent Of Visual Impairement Is Avoidable Or
Ammenable To Control!
Why Such A Burden?
The 3 Cardinal resources in any system are Manpower, Material and Money, and a proper application of all these has always held the promise of achieving whatever goals set by such a system.
A look at our total Health Care Sector, within which the eye care system can be found, has a lot to say about such a burden as ours.
1. Manpower For Eye Health:
The survey revealed a human resource for eye health that is inadequate, ineffective and mal-distributed. Not less than 80 percent of the total population of ophthalmologists are based in the urban areas, while 70 percent Nigerians live in rural areas!
There is a further geopolitically inequitable distribution of manpower as there could be up to 4times the number of health workers in one zone as compared to another!
There is also manpower underutilization leading to low productivity of ophthalmologist, and other eye care team members.
Ignorance of available services, fear due to poor information on eye health issues, and poverty which is responsible for inability to make out-of-pocket payments for care services, as well as a misplaced value system continues to enhance the gloomy statistics above.
2. Material Resources For Eye Health:
There is a minimum level of infrastructure needed to achieve the onerous task of VISION2020: The Right To Sight by any national government and what we have on ground suffers from quality as well as quantity. Eye care is one field that is highly dependent on technology, with the rate of equipment engineering and procedural innovations on the international scene so rapid that even the average ophthalmologist is kept on his/her toes just to keep abreast of the changes. The lack of optimal enabling environment for this is a major cause of low productivity.
The services available at our centres may not be acceptable to the people due to socio-cultural issues, and it may be the reason that the survey detected that only about 47 out of 100 eyes treated for straight forward cataract had formal cataract surgery, while another 43 eyes had the traditional cataract surgery (couching!) which is usually of poor outcome, and the rest 10 eyes had complicated cataracts necessitating the choice for formal care often times.
We have outdated equipments sitting down in many of our secondary and tertiary centres, thus making training of eye care HR an arduous task for the trainers; retention strategies are poorly elucidated, giving room for continuous brain drain, and unending attrition, hence the rich venture often into Health Tourism Schemes in foreign lands, to sort out their needs, while the 80 percent continue to languish in darkness and ‘pain’
If the suggestions above are accepted, it will soon be clear to our INGOs who are getting donor-fatigued gradually, that a new dawn has come to our National Prevention of Blindness efforts, and the whole sub-Saharan Africa shall indeed have hope that before the year 2020, avoidable blindness shall no more be burdensome.
3. Funding For Eye Health:
Health Financing: At the national level the estimated per capita expenditure on health is $131 which fall very much short of the global average of $863. At the state level, where most secondary and primary care is provided, the health per capita spending is hardly up to $4.
In 2010, federal budget allocation to health was 3.4 percent, and eyecare received less than 0.005 percent of that. The results of such underfunding can only be a weak health care system, run by poorly motivated HR, helplessly watching the worsening trend in blindness.
4. Elimination of avoidable blindness is beneficial to all:
From whichever angle we may approach the benefits of eliminating this scourge, we will realise too quickly how much benefits we all stand to gain.
Developmental economists have shown that the global cost of visual impairment is up to $3 trillion, and the 6th largest cause of DAILY loss is attributable to avoidable blindness. The implication is that by investing more in eye care, governments get returns by reducing the economic burden of blindness on all concerned, and get to make savings as the rate of past economic losses reduce.
In a family, where one member who often would be a bread winner suffers from blindness, the whole family gets drawn into poverty, a child would have to drop from school to serve as a guide and provide personal support to that family member, others may also have to become emergency employees so as to earn funds to cater for such a family. As cataract is the commonest cause of such situation, treatment leads to eventual restoration to economic activities and the freeing of other family members to pursue their goals. This is why it is often said that cataract surgery is one of the most effective health care interventions known.
Considering the MDG goals, the achievement of health thematic aspects will be accelerated if only eye health could become of utmost importance at state and local government levels of healthcare, and primary health would then have “eyes that see” and propel the vision of a globe free of all inequalities, marginalisation, non-equitable distribution of resources, etc.
YES WE CAN!
In view of all we have been sharing, and despite the challenging realities, we strongly believe that “WE CAN” change the current trends and restore the dignity of humanity, by supporting the basic right of all to sight.
All stakeholders have to come together, the Federal Government through the auspices of the currently re-packaged NATIONAL EYE HEALTH PROGRAMME serving as an active clearing house for the activities of all organizations in a public-private mix; elucidation of action plans and programmes that address long-term needs, close working with the terms, goals, and strategies of VISION2020: THE RIGHT TO SIGHT INITIATIVE, and strengthening the health information systems to accommodate eye care data management, robust monitoring and evaluation of programmes and encouragement of research activities to ensure sustainability of such programmes through re-programming as the case may be.
We need massive campaigns that will cut across all media systems and tools, to re-educate the masses, and reap the benefits of behaviour change communications; Corporate bodies need to do more in the area of CSR, and support organisations running programmes and projects that give leverage to prevention of blindness activities in underserved communities; Local NGOs have to seek partnerships with several state governments yet to elucidate clear vision2020 strategies and activities, with an aim of jointly developing sustainable and working systems of primary and secondary care in those localities.
Innovations centering on health insurance schemes may be a great way of dealing with the dilemma of lack of ability for out-of pocket payment for care.
All hands have to be on deck as the year 2020 is less than 8 years away!
