The rationale for shifting from a voluntary clinical approach to a public health approach in addressing refractive errors

Abstract

Millions of people need eyeglasses and do not have them. Assuming that the average pair of eyeglasses has an effective life span of two to five years, an additional 60 to 150 million spectacles would be needed each year for the estimated 303 million individuals who currently need correction. Optometrists are engaged in a variety of capacities in an attempt to address the significant public health problem of uncorrected refractive error. One popular method used by many voluntary optometry‐led organisations is to provide direct clinical services to individual patients in developing countries. Considerable manpower, materials, money and logistical resources are used in conducting these short‐term missions, yet scarce evidence exists regarding their cost effectiveness or the efficacy and long‐term impact of these interventions. The provision of direct clinical services by most foreign volunteers does not directly build local capacity and may hinder development of sustainable local services. Adopting public health approaches will enable volunteer provider organisations to dramatically increase their program effectiveness and output, while developing local capacities in a sustainable way. These approaches should include: Following the national strategy for blindness prevention as determined by the Ministry of Health and forming partnerships with relevant local, national and international organisations. Using need‐based criteria to target programs more efficiently. Developing sustainable services via local capacity building. Monitoring, evaluating and using evidence to guide programs. By using these approaches, a larger contribution will be made by the volunteer organisations in addressing the unmet need for refractive correction.

Potential lost productivity resulting from the global burden of uncorrected refractive error

“…Eyeglasses are a low-cost intervention and, if we assume they are replaced at the rate of one pair every 3 years, an additional 53 million eyeglasses would be needed annually to address the current burden of URE -a figure comparable to previous estimates. 14 The direct cost of a vision test and pair of eyeglasses in the United b GDP under the assumption of economic productivity, adjusted for population-weighted regional labour force participation rate and population-weighted regional employment rate. c 2.39 = Total cases across all regions as a percentage of total world population.…”

The World Burden of Refractive Blindness

“…Assuming that the average life span of spectacles is 2 to 5 years, 11 repair and maintenance services should also be available. There may be a loss of capture if indigent patients need to seek out these services.…”

The role of short-term volunteers in a global health capacity building effort: the Project HOPE-GEMC experience

“…Further, the provision of direct clinical services by foreign volunteers does not directly build local capacity and is counterproductive to the development of sustainable health services. Considering that many countries and communities continue to repeatedly attract medical tourist visits points to a lack of local capacity building [6]. …”