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.
Policymakers are constantly seeking ways to improve the well-being of their citizens to reduce poverty and stimulate their economies and it is well recognised that healthcare is vital for well-functioning economies and cohesive societies. Yet in developing countries, where resources are scarce, tough choices constantly have to be made among competing social priorities.
Proving the value of curing avoidable blindness to these policymakers was one of the reasons that my Tej Kohli Cornea Institute made so many interventions into poor communities in India between 2015 and 2019. During that period we welcomed 223,404 outpatients and delivered 43,255 surgical procedures to cure and alleviate blindness. But that is still a small proportion of the 12 million people in India who are currently blind.
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. This is particularly the case in countries where people with blindness or visual impairment do not enjoy the benefits of a wider healthcare infrastructure.
Payback is quick when restoring sight
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.
The Investing in Vision study, commissioned by The Fred Hollows Foundation and undertaken by PricewaterhouseCoopers, has helped to quantify this. 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.
Incalculable extra benefits
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. Additional benefits, such as increased education, gender equality, reduced child mortality, improved self-esteem, health costs averted from reduced mental illness and expanded social networks, could not be included.
However, such broad benefit-to-cost estimates can be somewhat uncoupled from the practicalities of in-country policymaking. 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 with ‘low human development, the estimated economic return for each dollar invested in building a sustainable primary and secondary eye health system and 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 who got treated, and their carers, were employed at the same rate as the national average, then the potential productivity boost to the economy would be tremendous.
Big gains in China and Pakistan
In China, where the immense population means that individual provinces are often as large as nations, the analysis focused on the southwest 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 was 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, every dollar spent on eye health 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 they are elsewhere.
Unlocking all human potential
The Investing in Vision study provides powerful evidence that by unlocking human potential, any 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 developing economies.
It is also notable that 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.
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.