South Africa runs the risk of an added barrier to achieving its national goals if it continues to close its eyes to the increasing number of people who are avoidably blind. Cataracts and uncorrected refractive errors continue to be an under-reported barrier to education, employment, and health.
In 2020 the International Agency for the Prevention of Blindness (IAPB) estimated that 11 million people in South Africa were living with vision loss. Of these 370, 000 were blind. South Africa remains one of the most unequal countries in the world, with gender inequity having a far-reaching impact, extending to eye health service delivery. Approximately 58% of people living with vision loss are females. South Africa has been a signatory to sight-saving programmes like Vision 2020, amongst others, intended to reduce avoidable blindness through cataracts and uncorrected refractive error.
While efforts through policy amendments have been made to address the inequitable access to services and advance efforts for gender equality within health service access, eye health services in the public sector are inconsistent and not uniformly accessible across the various levels of care. South Africa runs the risk of missing developmental goals if its eyes remain closed to an increasing number of avoidably blind people.
Avoidably blind people compromised
This leaves people with avoidable blindness unfairly compromised due to low access to skilled professionals, surgical interventions, medications, and visual aids. Further, eye health awareness amongst impoverished communities remains low.
The backlogs in cataract surgery added to the already low cataract surgery rate per million people is a cause for concern. Cataracts, if left unaddressed, result in blindness in the elderly, diabetics, and children born with them. It is further associated with risks to safety and independence and has a corresponding impact on the economic stability of affected individuals and their households.
For young people living with uncorrected refractive error, there are risks of poor academic performance at school, low chance of employment and associated dangers of depression and early mortality. The socio-economic impact of an uncorrected refractive error in a country with an already high poverty rate requires intentional and strategic intervention from political and governance structures.
Whilst the cost to offer eye health solutions are notably high, the opportunity for multisectoral collaboration to resolve the eye health service delivery shows promise. In recent years, cooperation between the public, private and civil society sectors have reduced cataract surgery backlogs in various parts of the country. Efforts in KwaZulu-Natal, as an example, have seen significant contributions to cataract surgery and spectacle delivery services by collaborations between the Department of Health and organisations such as Al-Imdaad, and Active Citizens Movement, amongst others.
Universal eye health coverage a cure for avoidable blindness
Within the uMgungundlovu District, the collaboration between the Department of Health, private hospitals and civil society organisations led to more than 150 cataract surgeries delivered in honour of Mandela Day between 2018 and 2019.
Despite such gains, reporting remains low, and there are no standardised solutions to guide public-private engagements of this nature. Further, people-centred approaches such as community groups for people with eye health conditions and blindness are not accessible in underserved communities. Such formations allow for the exchange of information, advocate for treatment adherence and can contribute to solutions to advance safety and independence for this community.
Universal eye health coverage is necessary for inclusive and equitable access to eye health. There needs to be an intentional investment in eye health service delivery politically and through best practices for governance and resource allocation. Eye health is a long-term investment in the economy due to the link between eye health and achieving the Sustainable Development Goals 2030.