Rwanda is one African country poised to dramatically improve visual healthcare for its citizens. Since the 1990s, it has improved its mortality rate caused by infectious diseases, doubled its life expectancy and experienced significant economic development. Rwanda created a national vision plan in 2002 when it signed the World Health Organization’s  VISION 2020 initiative. The aim of the initiative is to eradicate preventable and treatable blindness by raising awareness, securing resources and facilitating the planning and implementation of the initiative.

Of the 285 million people in the world who are visually impaired, 87% live in low- and middle-income areas. With 32,700 per million people living with visual impairments, Africa is one of those areas. Still, almost 80% of visual impairments—that often lead to blindness if untreated, such as cataracts, glaucoma, trachoma as well as refractive error (myopia, hyperopia, presbyopia and astigmatism)—can be prevented or treated. If not, blindness throughout the world will double by 2020, and the developing countries will shoulder the burden, according to WHO.

Visual impairments reduce the quality of life and people’s productivity. Eye care is part of a comprehensive primary healthcare plan that helps to reduce injuries, and improve educational outcomes and access to employment opportunities. All these improvements contribute to economic growth and development.

Recently, WHO examined the national plan for eye care in Rwanda, focusing on progress made, as well as current and future needs. The result was a reflection of three lessons learned.

First Lesson: A single national plan optimizes the provision of eye care.

The Ministry of Health coordinates all partners’ efforts to align with the national vision plan. The Ministry makes certain that providers complement each other’s resources and strengths. International nonprofit partners coordinate with each other and private eye care clinics and hospitals to ensure accessibility to a variety of services across the country.

Some of the work that the nonprofit partners provide is funding for disease burden studies, building eye care clinics, supporting scholarships to train eye care specialists and standardizing the eye care curriculum for nurses.

Examples of coordination of services include:

• Vision for a Nation, a U.K. charity, provides low-cost or free eye glasses to those in need.
• The Fred Hollows Foundation, an Australian charity, began working in 2004 in the Western Province of Rwanda when the only other available eye care service was a mobile service.
• The Christoffel Blinden Mission, headquartered in Germany, locates their services in the Southern Province of Rwanda, and among other services, performs specialized pediatric surgery.

Second Lesson: Better access to primary eye care and vision insurance has increased the demand for more advanced eye care at the secondary and tertiary levels.

Most of the population is currently enrolled in the Rwanda Community Based Health Insurance Policy set up in 2010. This policy provides affordable eye care and reimbursement for consumable products.

As Rwandans benefit from accessible primary eye care through insurance, awareness of further eye care needs to grow. Now, there are more instances of cataract operations and treatment for glaucoma.

Treatment for eye diseases, such as trachoma, has risen dramatically in the last five years. In 2009, treatment for eye diseases was not among the top ten reasons for seeking eye care. In 2014, it was the second leading cause of treatment.

Third Lesson: A comprehensive strategy, one that includes prevention of eye disease and a supply chain of glasses and lenses, is still needed.

Rural areas are still underserved. Almost 50% of the population lives in rural areas of poverty and are unable to afford private eye care services. In any case, rural areas still do not have adequate eye care services as most eye care resources are situated in the capital of Kigali. Another startling fact is that for the 10.5 million people in Rwanda, there are only 18 ophthalmologists and most of them live in the capital.

Task shifting is one solution to the lack of trained professionals through the Rwandan three-year ophthalmic technician training course, but more trained eye care professionals will be needed.

The demand for eye care services may be increasing not only due to more awareness and accessibility to services but also due to an aging population, as the life expectancy doubled since the 1990s to age 63. Among the eye problems associated with age is presbyopia, which usually requires prescription lenses such as bifocals.

WHO feels confident that these lessons learned will provide a basis to overcome barriers to progress and continue to improve the planning, implementation and provision of services to meet the eye care needs of the people of Rwanda.

– Janet Quinn

Sources: WHO 1, WHO 2, WHO 3, Vision for a Nation, CBM, Hollows
Photo: The Fred Hollows Foundation