Vision for a Nation
Phase One
3/8/2009
Executive Summary
In the United Kingdom, where vision correction is freely available through the national health
scheme, 70% of people wear eyeglasses or contact lenses. This is the not the case for people living in
low and middle-income countries globally. For instance, in Africa, 95% of people who need
eyeglasses do not own a pair.
Visual impairment due to uncorrected refractive error has the potential to significantly affect a
person’s education, employment and quality of life, and has recently been estimated to cost at least
US$121.4 billion per annum globally in lost productivity. For these reasons it is a significant barrier to
the attainment of Education for All (EFA) and the Millennium Development Goals and is a priority of
Vision2020 – the Right to Sight, an initiative of the World Health Organisation and the International
Agency for the Prevention of Blindness (IAPB).
Adaptive Eyewear is a not-for-profit organization with the aim of providing low-cost, vision
correction solutions to underserved populations living in low and middle income countries globally.
Adaptive Eyewear is utilizing revolutionary, lens technology to overcome the significant shortage of
eye specialists and the lack of vision infrastructure in these countries. Self-adjustable eyeglasses
correct up to 90% of refractive errors and can be distributed by trained laypersons rather than eye
specialists allowing for the mass scale-up of vision correction. Vision for a Nation is a programme
designed to assess the vision of an entire country and offer eyeglasses to all who need them.
Rwanda has been identified as the best African country in which to provide proof-of-concept to
Vision for a Nation; despite a severe shortage of eye specialists, the Government of Rwanda is
committed to universal eyeglasses coverage by 2013 under its National Plan for Eliminating Needless
Blindness. Vision for a Nation will be implemented in 3 phases. Phase One aims to validate the
distribution mechanism of self-adjustable eyeglasses and will involve screening approximately 4,000
Rwandans living in Gicumbi district. Upon successful completion of Phase One and in agreement
with Rwanda’s Ministry of Health, Phase Two will be implemented. During Phase Two, vision
screening will be scaled-up to cover an entire administrative district, approximately 300,000 people.
It is estimated that 30,000 pairs of low-cost eyeglasses will be distributed during Phase Two over a 6
month period. Phase Three of Vision for a Nation will be a national rollout.
Under the Vision for a Nation programme, Adaptive Eyewear, in consultation with Ministry of
Health, will commission a number of independent, academic studies to evaluate the impact and
cost-effectiveness of the intervention.
The cost of Vision for a Nation is estimated at US$24 million. Adaptive Eyewear will work closely with
the Government of Rwanda to raise these funds in order to fulfil the goals of the country’s national
eye care plan. In doing so, Vision for a Nation aims to have a positive and measurable impact on the
education, employment and quality of life of all Rwandan beneficiaries, so contributing to Rwanda’s
Vision 2020 and Economic Development and Poverty Reduction Strategy.
Background
Between 50 and 70% of people living in high-income countries benefit from vision correction in the
form of prescription eyewear and ready-made reading glasses. By comparison, in Africa, where eye
care services and products are not readily accessible, 95% of people who need eyeglasses do not
own a pair. Given that uncorrected refractive error has an adverse impact on education,
employment and productivity it is a significant barrier to the attainment of Education for All and the
Millennium Development Goals. Recognizing the magnitude of this problem, correcting refractive
error is a priority of Vision2020 – the Right to Sight, an initiative of the World Health Organisation
and the International Agency for the Prevention of Blindness (IAPB).
Demographic context
The population of Rwanda is approximately 10 million. With only 8 ophthalmologists and 4
registered optometrists, there is a severe shortage of eye care professionals to serve the nation’s
vision needs. Nearly 85% of the population live in rural areas where eye care services and their
corresponding infrastructure are particularly limited. Further to this, approximately 60% of
Rwandans are living in poverty, making eyeglasses a luxury most cannot afford. The Government of
Rwanda has estimated that 1.2 million Rwandans require eyeglasses.
Vision for a Nation
Adaptive Eyewear is a not-for-profit organization with the aim of providing low-cost, vision
correction solutions to underserved populations living in low and middle income countries globally.
In order to increase rapidly the coverage of affordable vision correction worldwide, Adaptive
Eyewear is utilizing revolutionary, self-adjustable eyeglasses, which can correct up to 90% of
refractive errors and can be distributed by trained laypersons rather than eye specialists. Selfadjustable eyeglasses have been proven for use in adults; the Ghanaian Ministry of Education, with
support from the World Bank and Department for International Development (DfID), have
successfully distributed over 11,000 self-adjustable eyeglasses through the non-formal education
sector by training adult literacy tutors to oversee the screening and refraction process. In total,
30,000 self-adjustable eyeglasses have been distributed by civilian and US military outreach
programmes operating in Africa, Eastern Europe and Asia.
Building on the success of past programmes, Adaptive Eyewear has developed the concept of Vision
for a Nation; a programme designed to assess the vision of an entire nation and offer eyeglasses to
all who need them. In view of the Government’s strong commitment to universal vision correction
as documented in the National Plan for Eliminating Needless Blindness in Rwanda, Adaptive Eyewear
has identified Rwanda as the best African country in which to launch the Vision for a Nation
programme. Adaptive Eyewear will work in partnership with the Government of Rwanda to
implement Vision for a Nation over a 5 year period in accordance with the national eye care plan.
The Vision for a Nation programme aims to have a positive and measurable impact on the
productivity levels, education and employment prospects of all Rwandan beneficiaries, so
contributing to Rwanda’s Vision 2020 and Economic Development and Poverty Reduction Strategy.
Given the impact of eyeglasses on education, Adaptive Eyewear is committed to covering the vision
correction needs of children. Currently, the only adjustable lens technology available for children is
not self-adjustable and requires supervision by an optometrist or ophthalmologist. Although studies
are underway to determine if children can correctly self-refract using adjustable eyeglasses under
appropriate supervision, Adaptive Eyewear will only pursue this intervention if it is shown to be safe
and ethical. For this reason, the d.o.b Foundation will provide an optometrist to supervise the
distribution of suitable eyeglasses to children during Phase One of Vision for a Nation. The results
from Phase One and the child self-refraction study will determine the child distribution model for
Phases Two and Three.
In addition to the distribution of eyeglasses, Adaptive Eyewear will commission independent
research to determine the impact of the intervention on education, economic productivity and road
safety, and to calculate the cost-effectiveness of the intervention. The cost of all eyeglasses will be
subsidized and set in agreement with the Government of Rwanda, reflecting people’s ability to pay.
Where appropriate, Adaptive Eyewear will make available competitively priced ready-made reading
glasses.
Significance
Rwanda Vision 2020 & EDPRS
In July 2000, the Government of Rwanda set an ambitious target of attaining middle-income country
status by the year 2020. The Government’s long-term plan to achieve this goal is outlined in the
document ‘Rwanda Vision 2020’ and Rwanda’s Economic Development and Poverty Reduction
Strategy (EDPRS) paper. Rwanda Vision 2020 and the EDPRS aim to guarantee the wellbeing of the
population by increasing production and reducing poverty.
Under Rwanda Vision 2020, private sector-led development is to become Rwanda’s principle
component for economic growth. The government has pledged to actively encourage
entrepreneurship and privatisation in order to reduce costs and broaden consumer choice. Vision
for a Nation aims to develop a sustained demand for eye care, in particular, vision correction and in
so doing, will assist in creating a market for eyewear and increase the use of other eye care services.
It is anticipated that over time, the private sector will meet the growing demand for these services
and products creating a sustainable industry from which Adaptive Eyewear can implement an exit
strategy.
The Government of Rwanda has committed substantial resources to improving the health and
education of its citizens in order to fulfil its goal of building a productive and efficient workforce and
becoming a knowledge-based and technology-led economy. Visual impairment due to uncorrected
refractive error has the potential to significantly affect a person’s productivity, their livelihood and
quality of life, and has recently been estimated to cost at least US$121.4 billion per annum globally
in lost productivity. Without the provision of eyeglasses, Rwanda’s increased investment in health
and education for human resource development is likely to be undermined.
Rwanda’s Health Sector Policy
The mission of the Ministry of Health (MoH) is ‘to ensure and promote the health status of the
population of Rwanda’. Vision for a Nation will underscore several of the major policy objectives of
the MoH as follows:
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To improve the availability of drugs, vaccines and consumables. Vision for a Nation will improve
the availability of eyeglasses by sourcing low-cost adjustable eyeglasses and by approaching
donors to fund their purchase.
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To expand geographical accessibility to health services. Vision for a Nation will improve
accessibility to eye care services by training Community Health Workers (CHWs) to identify
refractive error and basic eye disease at the village level.
Financial accessibility of health services: Vision for a Nation will improve financial accessibility of
eyeglasses by sourcing products that do not require the services of an eye care specialist,
thereby reducing the cost of their distribution in communities. Vision for a Nation will also seek
donor funding to subsidise the purchase and distribution costs for eyeglasses. The Rwandan
government will assist by waiving all taxes and duties on the low cost eyeglasses to be sold for
the duration of this programme.
To improve the quality of and demand for health services in the control of diseases: Vision for a
Nation will improve the quality and demand for eye care in three ways. First, Rwandans in need
of eyeglasses will have the opportunity to achieve clear vision in situ thus being able to observe
the immediate benefit of vision correction. Second, during screening, basic eye disease will be
identified and the individual referred for further diagnosis and treatment. Third, Vision for a
Nation will work with the Government of Rwanda to raise awareness and educate the
community in eye care. As the public’s knowledge of vision care increases so too will their
demand for quality services and products.
Rwanda’s Education Sector Policy
The mission of the Ministry of Education, Science, Technology and Scientific Research (MoE) is ‘to
combat ignorance and illiteracy and to provide human resources useful for the socio-economic
development of Rwanda through the education system’.
Literacy is the foundation for effective learning. By tackling barriers to literacy Vision for a Nation
will indirectly support the attainment of several policy objectives of the Education Sector Plan.
Rwanda’s commitment to literacy will promote an atmosphere of lifelong learning that will
ultimately lead to an increase in the economic productivity of disenfranchised adults, promote
gender equality in rural and urban communities and enhance the quality and sustainability of
education among children.
Reading and writing are visually demanding tasks. While it is readily accepted that poor vision can
have a dramatic impact on learning capability and educational potential, there are a great many
people in low and middle income countries who are unaware that their vision is poor or that it can
improved by eyeglasses. Vision for a Nation will underscore the policy objectives of the MoE by
raising awareness of the impact of poor vision on educational potential through the national
screening programme and providing an immediate solution to its correction.
National Eye Care Plan
The Government of Rwanda is a signatory to the global initiative of Vision2020 – the Right to Sight.
Accordingly, it has developed a National Plan for Eliminating Needless Blindness which was officially
endorsed by the Ministry of Health on the 28th of April 2009. Under this 5 year plan, the
Government aims to provide eyeglasses at a rate of 400,000 per annum by 2012 and distribute 1.2
million eyeglasses by 2013. In order to achieve this ambitious goal, the plan states the need to
reduce the cost to procure lenses and frames and the need to utilise optimally the limited human
resources available. Vision for a Nation will facilitate Rwanda’s national eye care plan through the
provision of subsidised, low-cost eyeglasses which can be delivered by trained laypersons.
The Government of Rwanda has endorsed the distribution of adaptive eyeglasses for the
implementation of its national eye care plan. In partnership with Adaptive Eyewear, the MoH will
evaluate two innovative models for their distribution during Phase One of the Vision for a Nation
programme. The outcomes of Phase One will inform how best to achieve universal eyeglasses
coverage by 2013.