Blindness is a major public health problem globally. The first estimate of global blindness by the World Health Organization (WHO) in 1972 provided a figure of 10 to 15 million, which was considered an underestimate [1].
In 1999, an extraordinary coming together of different national and international organisations and individuals with the common focus of tackling the problem of needless blindness resulted in the creation of a global movement called ‘VISION 2020: The Right to Sight’. Launched on 18 February 1999, VISION 2020 draws together the strengths and resources of the governments of the world, represented by the WHO; non-governmental organisations (NGOs) represented by the International Agency for the Prevention of Blindness (IAPB); individuals and foundations engaged in blindness prevention and eye care. The partnership provides guidance, technical and resource support to countries that have adopted its agenda [2].
The goal was simple: to eliminate the main causes of preventable and treatable blindness as a public health issue by the year 2020, in order to give all people in the world the ‘Right to Sight’. The three essential elements of the global plan are – disease control, human resource development, and infrastructure and technology development. The major strategies to achieve these goals were: advocacy, resource mobilisation and programme facilitation and implementation [1].
Several achievements can be credited to VISION 2020, both direct and indirect, during the last two decades. Some added newer initiatives while others helped in either enhancing or sustaining ongoing programmes.
A. Advocacy
When reviewing the achievements of VISION 2020, advocacy stands out as one of the major areas. Multiple successes were achieved at global and national levels.
Global
- The multiple World Health Assembly (WHA) resolutions in favour of prevention of blindness and eye care, and placing blindness on the health care agenda of WHO and its 193 Member States, was the major achievement. This also resulted in many countries making budgetary allocations for eye care. The last two resolutions in 2009 and 2013 were accompanied by WHO Action Plans, which provided more details on achieving the objectives and also refined implementation approaches [3,4]. The Chair of the Eastern Mediterranean Region (EMR), HRH Prince Abdulaziz bin Ahmed bin Abdulaziz Al-Saud, played a leadership role, and many leaders of ophthalmology and optometry in different countries contributed significantly to this effort.
- World Sight Day: World Sight Day, an annual event gazetted by the United Nations, is observed on the second Thursday of October. Created to focus world attention on the problem of global blindness, it became an official VISION 2020: The Right to Sight event in 2000. It is now the major international public relations and advocacy event in the annual calendar of national entities and eye care organisations throughout the world [5].
- The State of the World’s Sight report: The launch of the VISION 2020 report ‘The State of the World’s Sight’ provided a key focus for the World Sight Day of 2005. This has been a powerful advocacy tool with many governments.
- Global Ambassadors: A number of influential leaders like the former British Prime Minister, Sir John Major; HRH Countess of Wessex; and Former President of India, Dr APJ Abdul Kalam, are some of the Global Ambassadors who promote this cause.
- VISION 2020 sessions in international and supranational professional society meetings helped to disseminate the knowledge about the problem of blindness and efforts being made through VISION 2020.
Overall, WHA resolutions were a powerful advocacy tool with the policymakers, World Sight Day with the public, and VISION 2020 sessions with the professionals.
National
- Formation of National VISION 2020 entities with government partnership: India and China were the first countries to sign the VISION 2020 declaration.
- World Sight Day activities.
- National and state level professional societies organising VISION 2020 sessions; through these significant awareness was created among health professionals.
B. Resource mobilisation
When VISION 2020 was launched, the aspiration was to double the funding base generated at that time by all the NGOs. During the last two decades, funding for prevention of blindness and eye care multiplied several times, both through governmental and non-governmental sources.
Global
1. Governmental
Several governments around the world have either enhanced or initiated funding for prevention of blindness and eye care programmes. Many developed nations supported developing countries through a variety of programmes [6]. These include:
- The Australian Agency for International Development (now Australian Aid) provided large grants for programmes in South East Asia and sub-Saharan Africa. Fred Hollows Foundation (FHF), Christoffel Blindenmission (CBM) and Brien Holden Vision Institute Foundation (BHVIF) were the NGO partners.
- The United States Agency for International Development (USAID) continued to fund several activities throughout the world either directly or through US-based NGOs, including the control programmes for onchocerciasis.
- The Department for International Development (DFID) of the UK government is a major supporter of a number of programmes, including trachoma control either directly or through UK-based NGOs.
- The German government’s support through CBM and Lions International has always been substantial and has helped in building eye care infrastructure and training programmes throughout the world.
- In Canada, Operation Eye Sight Universal worked with the Canadian government and mobilised additional funding for programmes in many countries.
- The French government provided funding through the Organisation pour la Prévention de la Cécité (OPC) for programmes in Francophone countries.
- The Danish government supported programmes through the Danish International Development Agency (DANIDA).
In addition, certain countries and regional health programmes benefitted from multi-lateral organisations like the World Bank. Together, the availability of all these sources of governmental funding helped in creating the necessary infrastructure, training of human resources, and setting up and implementing programmes.
2. Non-governmental
Prevention of blindness and the eye care field has benefitted from the support of vibrant NGOs and corporations from different countries. Through the efforts of IAPB and VISION 2020, additional support was mobilised from a number of other sources [5].
- Standard Chartered Bank (SCB) – Seeing is Believing programme: SCB partnered with IAPB to support the development of eye care programmes in countries where the bank operated. This massive $100 million donation is the biggest ever corporate cash gift to prevention of blindness and eye care.
- Queen Elizabeth Diamond Jubilee Trust: In celebration of the diamond jubilee of HM Queen Elizabeth II, the Trust was formed with a major focus on prevention of blindness, providing funding of £100 million. This accelerated work on the elimination of trachoma, control of diabetic retinopathy and retinopathy of prematurity (ROP), together with human resource development and eye care research in Commonwealth countries.
- Corporate giving: Through corporate membership of IAPB, several ophthalmic corporations supported VISION 2020 activities. These include Merck Inc, Bausch & Lomb, Carl Zeiss, Alcon and Pfizer. In addition, Barclays Bank has also contributed to VISION 2020.
- Champalimaud Foundation: This Portuguese foundation has provided significant funding for the programmes over the last few years. This includes the ‘Annual Vision Prize’ of one million euros given in alternate years to an outstanding eye care research breakthrough and to an outstanding contribution to the relief of blindness in developing countries. Several IAPB member organisations have received this prize.
3. Alternative sources of funding
When the IAPB and VISION 2020 group was exploring alternative avenues of resource mobilisation, two ideas emerged and were implemented.
- Eye Fund: This is in partnership with Deutsche Bank, in the form of a low interest loan to organisations to help them scale up their activity in an accelerated way. Four organisations have benefitted from this.
- Optometry Giving Sight (OGS): This is a partnership between IAPB, World Council of Optometry (WCO) and International Centre for Eye Care Education (currently Brien Holden Vision Institute Foundation) to mobilise contributions from optometrists around the world to support programmes to control uncorrected refractive error and optometry education. Several programmes benefitted from this initiative.
4. Gifts in kind
Donation of medicines by Merck (Mectizan – ivermectin) and Pfizer (Zithromax – azithromycin) worth hundreds of millions of dollars for the elimination of onchocerciasis and trachoma respectively have been massive ‘in kind’ contributions. The gift of “as many doses as required for as long as required to eliminate the disease” made elimination of onchocerciasis a possibility. Trachoma has been eliminated in many countries with a distinct possibility of total elimination of blindness from trachoma in the next decade.
National
Several national and some state-level governments have given a big boost to funding eye care programmes around the world. These included:
India: The Indian government has always provided significant funding to prevention of blindness programmes through their National Programme for the Control of Blindness (NPCB) established in 1976. During the last two decades, this national funding quadrupled and has reshaped the way eye care is delivered in the country, resulting in a positive impact on millions of lives. The biggest success story is the rapid escalation of cataract surgical volume. The South Indian states of Telangana and Andhra Pradesh, and the Eastern state of Odisha, have committed substantial funding for eye care; and a few other states have increased their allocation.
Bangladesh: Primary and secondary eye care was provided to over a million forcibly displaced Myanmar nationals in Bangladesh through fixed primary health care facilities and vision centres, and referrals to secondary level eye care facilities [7].
Pakistan: With District programmes being sustainable, Pakistan recently released a report on the cataract surgical rate (CSR) showing that it now exceeds 5000.
Latin America: Several countries including Argentina, Brazil, Chile, Mexico, Paraguay and Uruguay have given support for cataract surgery.
In addition to the governmental funding in countries like India, significant local philanthropy, both individual and corporate, has been making a significant difference.
C. Programme planning and implementation
Several initiatives have helped in programme planning and implementation throughout the world.
Global, regional and country launches
The global launch of VISION 2020: The Right to Sight in 1999, followed by regional and country-level launches, provided opportunities for consultation between stakeholders and the development of local VISION 2020 targets for individual regions and countries.
VISION 2020 Committees and National Plans
Commitment to VISION 2020 was demonstrated by the establishment of national VISION 2020 committees and formulation of national VISION 2020 plans. In the first five years, 53 countries drafted VISION 2020 National Plans and 78 formed VISION 2020 National Committees.
VISION 2020 workshops
A series of VISION 2020 advocacy and planning workshops were convened in Member States, with local support and the participation of national and international faculty. These workshops were planned as a series, starting with advocacy, followed by development of national plans and detailed district plans.
Tool Kit (for Developing an Action Plan)
The Tool Kit “Developing an Action Plan” developed by IAPB and WHO in multiple languages provides invaluable information on developing, implementing and evaluating National Prevention of Blindness Plans [5].
Epidemiological studies
A large number of surveys, both intensive epidemiological as well as Rapid Assessment of Avoidable Blindness (RAAB) surveys were conducted during the last two decades.
Together, these provided better understanding of the magnitude, main causes, risk factors, regional differences and progress made. Some examples of studies conducted in different regions are:
Africa: Eye care data collection is more focused and efficient; in countries with strong NGO presence significant progress was made and statistics improved.
EMR: Most countries have conducted RAAB surveys providing data on magnitude of visual impairment.
Latin America: This region claims the largest number of papers on Rapid Assessment of Cataract Surgical Services (RACSS) and RAABs; all the countries in the region produced at least one community-based survey.
South-East Asian Region (SEAR): In the last decade several RAAB surveys have been conducted in countries in the region, either for the first time (Maldives, Sri Lanka and Timor Leste) or as a repeat study.
Impact
The Vision Loss Expert Group published its report in 2017 from the data of 2015. According to this report, 253 million in the world are visually impaired, of whom 36 million are blind. Despite the significant demographic shift in the past two decades, there is a decline in the prevalence of visual impairment from 4.58% in 1990 to 3.38% in 2015 [8]. Disparities due to socio-economic status, geography and gender remain. This is an indication that ‘equity’ in eye care still remains elusive.
Universal Eye Health providing comprehensive eye care equitably to everyone should be the focus for the immediate future. Through this, there is an opportunity for this sector to create a model for comprehensive ‘Universal Health Care’, an aspiration of many countries.
References
1. Global Initiative for the Elimination of Avoidable Blindness. WHO:
http://www.sbop.com.br/wp-content/
uploads/2018/12/2000-WHO-Prevention
-of-Infantil-Blindness.pdf
2. Rao GN, Raman U. Vision 2020: The Right to Sight. CRST 2005:
https://crstoday.com/articles/
2005-sep/crst1005_09-php-2
3. World Health Assembly, 62. Prevention of avoidable blindness and visual impairment. World Health Organization, 2009:
https://apps.who.int/iris/
handle/10665/2244
4. World Health Assembly 66, 2013. Towards universal eye health: a global action plan 2014–2019:
https://apps.who.int/iris/
handle/10665/150155
5. Rao GN. Vision 2020: Progress Report. CRST 2007:
https://crstoday.com/articles/
2007-feb/crst0207_05-php/
6. Rao GN. VISION 2020: Past, Present and Future. In Innovative Approaches in the Delivery of Primary and Secondary Eye Care. Eds: Khanna R, Rao G, Marmamula S. Springer; 2018.
7. Situational analysis of Rohingya refugees and host:
www.seva.org/site/DocServer/
Rohingya_Refugees_Analysis
_Seva_IAPB.pdf?docID=3441
8. Flaxman SR, Bourne RRA, Resnikoff S, et al. Global causes of blindness and distance vision impairment 1990-2020: a systematic review and meta-analysis. Lancet Glob Health 2017;5(12):e1221-e34.
(All links last accessed February 2020)
Acknowledgements:
Dr Babar Qureshi, Dr Taraprasad Das, Dr Daniel Etya’ale and Dr Kovin Naidoo provided information on progress in different regions.
COMMENTS ARE WELCOME
