Eyes are often referred to as the windows to the soul, but are unfortunately also the gateway to a growing crisis that is casting a shadow over Africa's future.
Millions of people across the continent suffer from a range of eye conditions, which often go undiagnosed and untreated, leading to severe consequences. Eye health is a critical issue on the continent that has received insufficient attention despite its far-reaching impact.
According to the World Health Organization (WHO), approximately 39 million people worldwide are blind, with 90% of these individuals living in low- and middle-income countries. In Africa, this figure is particularly high as the situation is dire in rural areas, where access to eye care services is limited, and poverty rates are high. The majority of those living with such impaired vision or total blindness are older than 50. However, vision loss can affect people of all ages.
It's estimated that 80% of the population suffers from unaddressed near vision impairment, which can be corrected through the use of spectacles or surgery, reports WHO. The most common causes of blindness in Africa are cataracts, trachoma, glaucoma, diabetic retinopathy, age-related macular degeneration and uncorrected refractive errors, all of which can be prevented or treated if detected early.
Cataracts are most common among older people and affects over 94 million people worldwide, according to WHO. Glaucoma can affect people of any age and is experienced by 7.7 million people globally, while at least 4.2 million people suffer from corneal opacities, which cause scarring of the cornea. Diabetic retinopathy, a condition resulting in damage to blood vessels in the retina due to diabetes, is experienced by more than 3.9 million people.
A shortage of skilled ophthalmologists, optometrists, and other healthcare professionals in many African countries poses a significant challenge to delivering comprehensive eye care services, coupled with the high cost of eye care services, it presents a barrier for many Africans, particularly those living in poverty.
Sumrana Yasmin, Deputy Technical Director at Eye Health and URE at Sightsavers, discussed the challenges in addressing eye health in Africa with allAfrica's Melody Chironda, touching on social determinants of health in shaping eye health outcomes, and the importance of global support in preventing a national eye health crisis.
What are the key challenges in addressing eye health in Africa and how can they be mitigated to prevent a national eye health crisis?
There are many challenges to contend with when it comes to tackling avoidable blindness and vision impairment in Africa. In 2020, there were an estimated 111 million people across Sub-Saharan Africa with vision loss. And this number will only increase due to population growth, ageing, urbanisation, and other factors.
Eye health is often forgotten about and underfunded, and many countries have limited resources in terms of ophthalmologists, optometrists, and other eye health professionals. In Malawi, there are only fourteen ophthalmologists (0.5 per million people), 20 in Mozambique (1 per million people), and 69 in Tanzania (0.8 per million). This is much lower than the World Health Organization's minimum recommendation of 4 ophthalmologists per million people.
Supporting training of more eye health professionals, or indeed upskilling and continuing professional development for those already in such roles, will provide easier access and hopefully a better geographical spread of eye health workers across urban and rural areas.
There are also often barriers to accessing health care for certain groups of people, such as people with disabilities, women and girls, other marginalised groups, and remote communities. That may include physical barriers such as inaccessible buildings, financial challenges, long distances to health facilities, cultural traditions regarding the status of women, stigma and discrimination, and so on.
Awareness of the importance of good eye health varies across countries and communities and this poses challenges to people getting the support they need. People may not be aware of the symptoms of health issues, or the availability of eye health services, or there may be myths and misconceptions about the treatments available. I have heard many times of people being unsure about undergoing cataract surgery. They have been told that it is not going to make much difference so there is no need to go through a surgical procedure.
Almost everyone will experience impaired vision or an eye condition during their lifetime and require eye care services. These are all challenging issues, but ones that can be mitigated through increased funding, collaboration, and sustained focus on these areas. Eye health is so ingrained in most aspects of life, from wider health to education, livelihoods, and independence, that investment in it makes sense. It will have a much wider ripple effect than just improving eye health.
What strategies do you recommend for promoting sustainable eye health interventions in Africa to prevent an eye health crisis in the long term?
To provide proper eye health for everyone we need to create a resilient health system which has trained workers, a solid infrastructure, reliable supplies of medicine and equipment, and adequate funding.
To achieve this, we partner with national and local governments, including Ministries of Health and Education, and other organisations across the continent to improve eye health services, facilities, outreach, inclusion of people with disabilities and other marginalised groups, and so on. We look at what areas of a country's health system need strengthening, where eye health service gaps are, and who is being left behind, and tailor projects accordingly.
For example, in Nigeria, we have identified that we need to focus on child eye health. In Malawi and Uganda we have inclusive eye health initiatives and in Tanzania the recent Boresha Macho inclusive eye health project, funded by the UK government through UK Aid Match.
In Zambia, we are addressing unaddressed refractive errors, such as long- and short-sightedness, and supporting the government in the development of an assistive technology strategy.
We cannot do this alone. To avoid an eye health crisis in Africa, governments, non-government organisations, donors and stakeholders need to work together and prioritise eye health as a development issue. This includes long-term planning, policy influencing, continued funding, appropriate resources, and commitments to integrate eye health into wider health, education, employment, and development systems.
What role do social determinants of health play in shaping eye health outcomes in Africa?
Good eye health and vision care play a significant role in reducing health disparities. It can also positively influence many other social challenges, including poverty, other health inequities, and healthcare costs. Based on learnings from our projects we know that, in addition to access to eye health services, effective eye care delivery depends on understanding and addressing community social needs. Through engaging communities and assessing existing healthcare resources to understand how well they meet their needs, health systems can then be enhanced to promote eye health and vision care for all.
Advocacy for the right policies and resources is also critical to help communities meet their eye care and social needs. Engaging communities in advocacy initiatives so that they can speak up for their right to access health services will help ensure equity of services, in terms of access and availability for vulnerable populations.
How can technology and innovation be leveraged?
The COVID-19 pandemic showed the world how fragile global and national health systems are. And that we do not have enough resources to meet the needs of a growing and ageing population, now or in the future. It also highlighted the need to find innovative ways and technology-based solutions to expand coverage of eye care services and reach those who need them most.
New technological developments in eye health screening and diagnostics, telemedicine, artificial intelligence, digital health, and other areas have helped increase access to eye care for all. Technology and innovation can also contribute in other areas, such as educating patients about eye health, text message reminders for check-ups and taking medication.
However, innovating in a resource-constrained setting can be challenging. A long-term sustained plan needs to be put in place to build an effective health innovation ecosystem in Africa, that is aligned with national health priorities and development plans.
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How important is global support and collaboration?
Extremely important - as the statistics show. Globally, 1.1 billion people have an untreated or preventable visual impairment. And without concerted effort, an estimated 61 million people could be blind by 2050 due to global population growth and ageing.
More than 90% of people who are blind and more than 85% of people with visual impairment live in low- and middle-income countries. And women account for more than half of global blindness and visual impairment prevalence.
But a global eye health crisis is not inevitable. We can stop it if we come together to act now - which is where global support and collaboration come in. Last October, Sightsavers launched our Eye Health Equals campaign, calling for eye health to be made a global priority and highlighting that eye health equals opportunity, allowing children to learn and adults to earn.
It is vital that governments, organisations, donors, and communities collaborate and support each other to make ambitious but achievable changes to reduce the global eye health burden. This includes recognising the importance of eye health, integrating eye health into global and national health programmes, and investing in inclusive eye health services. Prioritising eye health plays an important part in creating a ripple effect across education, well-being, economics, and health outcomes. Which ultimately helps reduce poverty and allows individuals, communities, and the nation, to thrive.
We are in the midst of a great momentum to ensure universal eye health coverage for all, particularly in the context of building back better and equality. Simple, cost-effective, and innovative solutions already exist. We need to focus on how we can harness the potential of eye care. This means greater alignment between national governments, international and national organisations, and communities to ramp up resources, invest in systems strengthening, cross-sectoral collaboration, and a wholehearted commitment at all levels to address this global crisis.
