BLINDNESS, HIDDEN IN PLAIN SIGHT

  ADA AGHAJI argues the need to prioritise eye health as treating vision loss improves quality of life

Iya Basira, a 67-year-old hardworking businesswoman and grandmother from Ilesha has never seen her grandchildren because she is blind from cataracts. She can no longer move around freely, so she has abandoned her business. Her nine-year-old granddaughter has been forced to drop out of school to be her eyes in the community and guide her around her daily activities which includes begging for alms. Iya Basira thinks her blindness as just a part of growing old and is totally unaware that a 15-minute cataract surgical operation could restore her sight.

Ibrahim Pam, a 42-year-old accounts clerk in Jos lost his sight from Diabetic retinopathy and had to be laid off work. He had suffered diabetes for 20 years, but no one informed him that this could affect his eyes. Regular checking of his eyes would have detected the condition earlier and he would have been sent for preventive treatment.

Papa Okonkwo, a 57-year-old professional shoemaker retired to the village late last year, to depend on hand outs from his relatives. It had become progressively difficult for him to thread his needle and maintain his high standard of shoe repairs. He was totally unaware that a simple pair of near vision glasses would solve his condition.

These are a few examples of the one billion people globally with vision loss. In Africa, about 110 million people have vision loss and 24 million of them are Nigerians. Almost nine out of 10 of the causes of vision loss could have been prevented or treated.

Untreated vision loss is of public health concern, not just in Nigeria, but worldwide. The New York Times in 2018 published an article headlined – “Improving a billion lives”. It estimated that about a billion people globally had eye conditions that could be corrected with a simple pair of glasses. And wearing these glasses could dramatically increase the economic productivity of those affected. The article also suggested that the poor eyesight of truck drivers in Nigeria was responsible for the majority of road traffic accidents in our country!

So much has been written about the power of treating vision loss to drastically alter the developmental trajectory of people, communities and countries. The former US secretary of state Madeline Albright stated, “Lack of access to eye care prevents billions of people around the world from achieving their potential and is a major barrier to economic and human progress.” It has been estimated that untreated vision loss accounts for up to $400-billion in lost productivity annually.

Last week, the Director-General of the Kofi Anan Global Health Leadership programme, Dr Alex Coutinho, drew my attention to another article in the New York times. This was titled, “Glasses Improve Income, Not Just Eyesight.” The author seemed surprised that a simple pair of glasses could improve workers earnings by up to 33%.

These findings are not new. Almost 20  years ago, a blindness survey was conducted in Nigeria. One of the findings was that blindness was a cause and consequence of poverty in Nigeria. Poor people could not afford eye treatment and people with untreated vision loss lost jobs/income due to their condition. Double jeopardy.

Research has also shown that treating vision loss improves peoples’ quality of life, increases household incomes, reduces poverty and hunger, improves school enrolment- children with poor vision are more likely to drop out of school, reduces gender inequity, makes our cities safer. Eyecare programmes have been described as the golden thread connecting the sustainable development goals (SDGs). Reducing vision loss is a crucial enabler to achieving the SDGs.

So why haven’t we rushed to embrace this silver bullet that will catapult 110 million Africans and 24 million Nigerians into prosperity? There are several reasons for this.

One of these is the low political priority for eye health. With the continental burden of malaria, TB, HIV/AIDS, maternal mortality, vision loss has been hidden in plain sight.

In many African countries, eye health is not prioritised. Many African countries do not have national eye health policies and blindness is treated as a neglected tropical disease – a conundrum to be sorted out by non-governmental organizations (NGOs). Fortunately, Nigeria is ahead in that regard; we have a National Eye Health Policy, we have domesticated several WHO interventions to make eyecare more accessible, we have a National Eye Health Coordinator and a National Eye Health Committee. However, our eye health policies still need to be implemented.

Funding is crucial to implement our eye health policies. For far too long eye health has been funded by NGOs. The eye health security of 240 million Nigerians cannot be dependent on foreign aid and NGOs. However, the government cannot do it alone. It is a collective responsibility.

We need to explore domestic funding and other innovative financing mechanisms, such as health insurance schemes, community-based financing models, and social impact bonds, to mobilize additional funding for eye health programs. We need to partner with the private sector to fund eye health. This will involve advocacy, policy reform, and collaboration with key stakeholders. Last month, I was privileged to be part of an Africa CDC delegation to Morocco to understudy their health system. It was amazing what they have done with public private partnership (PPP) in terms of health service delivery and health commodity manufacturing. They have completely eradicated malaria and organized their eye health system so that even the nomadic population have access to eye health. Yes, they run a successful monarchy, but they leverage heavily on PPP. Can we do the same in Nigeria? Can we develop a PPP model to tackle avoidable blindness? Although funding is not the only challenge, it is a crucial one. There are several other challenges to delivering accessible, affordable, and sustainable eyecare services in Nigeria, but with the political will and appropriate financing, we will always make a way.

The International Agency for the Prevention of Blindness has set targets for countries to eliminate avoidable blindness by 2030. A similar target was set for 2020 but many countries, including Nigeria failed to achieve it.  Next month at the World Health Assembly, preventing vision loss will be discussed and a report will be made on member states’ progress towards achieving this set target. Nigeria, for socio-economic and political reasons, needs to lead the way in showing remarkable progress towards eliminating avoidable blindness. Not just for socio-economic improvement or bragging rights: but so that Iya Basira’s sight can be restored, and she can return to her business, her granddaughter can return to school, and Pa Okonkwo can return to his viable shoe repair business. 

 Aghaji is a Professor of Public Health Ophthalmology at the University of Nigeria and an Africa CDC Kofi Annan Global Health Leader