Eliminating avoidable blindness: a wise investment in developing countries

Lachlan McDonald - World Health Organization

GBM roundelPolicymakers constantly seek ways to improve the well-being of their citizens, reduce poverty and stimulate their economies. Yet in developing countries, where resources tend to be scarce, tough choices are constantly being made among competing social priorities. Against this backdrop it is imperative that prospective social investments – such as those required to build and maintain a sustainable eye health care sector in order to eliminate avoidable blindness and visual impairment – clearly demonstrate that they are effective and represent good value for money.

It is well recognised that healthcare is a vital input into well-functioning economies and cohesive societies .

Despite the clear links between health and prosperity, health systems in many developing countries (including eye health systems) remain chronically underfunded

It has often been claimed that eliminating avoidable blindness makes economic sense. Intuitively, restoring sight almost immediately transforms a person’s life, but being able to see also allows individuals, and their families, to be more economically productive than would otherwise have been the case. Such impacts are particularly the case in contexts where people with blindness or visual impairment do not enjoy the benefits of supportive infrastructure.

Preventing avoidable blindness; payback is quick

Restoring sight also unlocks people’s skills and abilities that might otherwise have been progressively lost. It frees up the time of their carers so they can work more hours or more productively. Evidence suggests that many of these benefits can be reaped in a relatively short timeframe .

There are also broader efficiency gains for the economy in the form of costs that are avoided. In particular, a burden of avoidable blindness and vision loss is the costs of injuries sustained from falls . These reduced health costs are considered a direct benefit from investments in vision.

Yet, until recently, the economic return from investments in sight has been difficult to quantify. The Investing in Vision study , commissioned by The Fred Hollows Foundation and partners and undertaken by PricewaterhouseCoopers, has helped address this key gap. Using an independently validated methodology, the research conservatively estimated that the additional income that would be earned as a result of building ‘gold standard’ sustainable eye health systems and by treating the existing backlogs of blindness and visual impairment would considerably outweigh the costs – by a factor of four to one in developing countries.

Intangible benefits are priceless

In reality, the true economic value of eliminating avoidable blindness is likely to be much greater. This is because the researchers limited their analysis to those benefits for which there was a reliable monetary value – productivity benefits to those affected by vision loss and their carers and costs averted from falls. Additional benefits, such as increased education, gender equity and reduced child mortality, along with improved self-esteem, health costs averted from reduced mental illness and expanded social networks could therefore not be included .

The research nonetheless makes it clear that money spent on improving vision is a sound investment: in people; and in communities

However, such broad benefit-to-cost estimates can be somewhat dislocated from the practicalities of in-country policy making. Three additional studies were undertaken in 2013 in order to validate these aggregate results as well as provide country-specific information for policymakers.

In Kenya, one of Africa’s largest countries and with ‘low human development’, the estimated economic return on each dollar invested in building a sustainable primary and secondary eye health system plus funding the services required to clear the untreated backlog of cases is $3.56 . If in the absence of avoidable blindness and visual impairment, those people treated, and their carers, were employed at the same rate as the national average then the potential productivity boost to the economy would be huge, as shown in table 1 below.

Big potential gains in China and Pakistan

In China, where the immense population means that individual provinces are as large as nations, the analysis focused on the south-west Yunnan Province, one of China’s poorest with nearly 1.3 million people blind and visually impaired. Each additional dollar invested in the efforts to eliminate avoidable blindness is estimated to yield $3.16 . Again, the potential productivity benefits would be considerable.

In Pakistan, a country with 180 million people and with the potential to be one of the world’s largest economies, the benefits are potentially huge, again as shown in table 1 below: every dollar spent on eye health in Pakistan has the potential to yield $6.00 . The considerably higher rate of return in Pakistan reflects the fact that it already has a relatively well-developed secondary health care system, so the costs required to strengthen this in relation to the benefits are lower than elsewhere.

Working in unity, stronger together

The Investing in Vision study brought together, for the first time, academics and practitioners across economics and eye health to examine the prospective financial benefit of eliminating avoidable blindness and vision impairment on a global scale. It provides powerful evidence that, by unlocking human potential, money spent on eliminating avoidable blindness is a wise investment: it increases people’s personal economic engagement and prosperity; and provides a boost to struggling economies.

Further, most of these benefits are likely to accrue directly to women and among the poor. Globally, women account for around 60% of all blindness and visual impairment – an imbalance that is reflected in every region of the world .

Poorest people will benefit the most

While poverty and blindness are tightly linked; the poorest countries and the poorest people within countries are more likely to suffer from vision loss . This means that the people who would benefit the most from these investments are also among those that need them the most.

Table 1: Economic value of eliminating avoidable blindness in three developing countries

Total between 2013-2020

*Includes the avoided efficiency costs that result from generating additional taxation revenue to fund heath care services to treat co-morbidities.

Submitted by: Erkan Kalenderli Caption: Eye screening Sub-theme: , , Eye screening, Eye care professionals

The additional income that would be earned as a result of building ‘gold standard’ sustainable eye health systems and by treating the existing backlogs of blindness and visual impairment would considerably outweigh the costs – by a factor of four to one in developing countries

Wise investment

Wise investment

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