Academic journal article Bulletin of the World Health Organization

Improving Eye Care in Rwanda

Academic journal article Bulletin of the World Health Organization

Improving Eye Care in Rwanda

Article excerpt

Ameliorer les soins oculaires au Rwanda

Mejorar la atencion oftalmica en Rwanda

Introduction

Visual impairment--both preventable and treatable--affects an estimated 285 million people globally. Most of the people affected (87%) live in low- and middle-income settings. (1,2) In Africa, an estimated 32 700 people per million are visually impaired. (3) A variety of eye disorders contribute to visual impairment, including cataract, glaucoma, trachoma and refractive error. (3) Nearly 80% of impairments are preventable or treatable. (4) Presbyopia--difficulty focusing on nearby objects--is a common feature of ageing, as the ocular lens loses elasticity. The ageing population and the lack of national plans to address the effect of visual impairment on peoples productivity and quality of life, will likely increase the burden of eye disease in many African countries. (5)

Providing eye care services to mitigate visual impairment is an important dimension of delivering comprehensive primary health care. It also contributes to economic growth and development by helping reduce injuries and by improving access to education and employment. (6) Investment in eye care services has a benefit-to-cost ratio of more than two to one. (4, 7)

While there is multilateral organizational support for integrating eye care services into health systems--including the launch of the VISION 2020 Right to Sight Initiative--there are barriers to progress, especially in low-income settings. (2) In many African countries, there is a shortage of eye care personnel, a lack of standardized training, inadequate coordination among eye care stakeholders and for those in need of eye care, the cost of equipment and treatment can be an obstacle. (4, 8) Challenges with data collection and measurement of the burden of visual impairment complicate efforts to generate support for effective health policy development. (8) Here we summarize ongoing efforts to overcome barriers to addressing the burden of visual impairment in Rwanda.

Setting

Rwanda has 10.5 million inhabitants. Over the past two decades, mortality caused by infectious diseases has dropped, for instance, mortality related to acquired immunodeficiency syndrome fell by 82% between 2000 and 2012. Consequently, life expectancy has nearly doubled since the 1990s and is now at 63 years of age. (9) In the population older than 49 years, in 2006, the overall prevalence of visual impairment was 5.3% (not including presbyopia) and the prevalence of blindness was 1.8%.10 In 2006, more than 80% of the eye conditions were considered preventable or treatable--including cataract, refractive error and trachoma. (10) Other estimates suggest that more than 65 000 people (0.6%) in Rwanda are blind in both eyes and 12% of the population--including those with presbyopia --have a correctable refractive error and are therefore in need of corrective lenses. (11)

While Rwanda has experienced substantial economic growth, nearly 50% of the population still lives below the poverty line, especially in rural areas. This means that most people are not able to afford private eye care services. (12) More over, most eye care resources are located in the capital of Kigali, a situation which has resulted in public-private partnerships aiming to ensure equity in access to eye care services.

Box 1. Summary of main lessons learnt

* Collaboration between stakeholders under a single national plan
has ensured that resources and efforts are complementary,
optimizing the ability to provide eye care.

* Improved access to primary eye care and provision of insurance
has increased demand for eye care services at secondary and
tertiary levels.

* A comprehensive strategy is needed; one that includes prevention
of eye disease and a supply chain for glasses and lenses.

Forming partnerships

In 2002, Rwanda signed the VISION 2020 initiative and created a national vision plan to end needless blindness. …

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