Seven out of 10 people with vision problems in Africa do not have access to glasses.

Kenyan Jane Waithera (39, Chinga) saw her life change the day a mobile clinic from Kikuyu Hospital came to her village and prescribed her first pair of glasses, free of charge. It was 1996, she was 10 years old, and her vision was so poor that she wasn't performing well in school. “I couldn't read what the teachers were writing on the blackboard. I held books too close to my face to see anything, and people made fun of me. Of course, I failed exams, but not because I didn't know anything, but because no one ever considered there was a problem with my eyesight,” she recounts via video interview from Nairobi. Waithera has albinism , a genetic disorder that not only causes her body to produce little or no melanin but also causes vision problems.

However, no one had diagnosed her until that mobile clinic came to her village in 1996. “An eye therapist examined me and told my grandmother that I had a visual impairment. They prescribed me glasses for high myopia and explained that these wouldn't correct the damage already done, but they would allow me to see better,” Waithera recalls. She adds: “That day was decisive. If the mobile clinic hadn't arrived, I probably would have continued to be punished at school and dropped out.” “But I went from being the girl who was teased, to being at the top of the class, the one my classmates asked how to do things,” says the woman who is now the director of the Advisory Unit for the Inclusion of People with Disabilities in Kenya for the NGO Light for the World , which works to improve access to eye care services in Africa .

Waithera warns that many children on the continent are at risk of not having the same luck. This fear is not unfounded. A study published in May in The Lancet Global Health warns that in sub-Saharan Africa, Effective Refractive Error Coverage (eREC), or access to glasses or other optical solutions, is only 28% for people over 50 years of age. This is low considering that the global average coverage is 65%, and that in high-income countries it reaches 84%, according to figures from the same study. There isn't much data on children, as acknowledged by Stuart Keel, Technical Officer for the Vision and Eye Care Program at the World Health Organization (WHO) and co-author of the study. What is known, adds Keel, is that one in three children worldwide is nearsighted, and that this affects their school performance with potential consequences for their productivity and life plans.

The fact that some people have more access to eyeglasses and medical care than others—depending on the country in which they were born—opens gaps. “When they are adults, it drastically affects their ability to maintain decent employment and support their families. It is estimated that uncorrected vision loss can lead to annual productivity losses worldwide of around $400 billion (€351.391 billion),” explains Keel, a doctor in ophthalmic epidemiology.

Waithera, for her part, warns that the impact on productivity is even more acute in a context like Africa. “How many people can't afford even an eye exam and basic care? The longer you go without glasses, the worse your vision becomes. The less you participate, the less productive you are, and you miss out on opportunities. Investing in access to eye care and eyewear unlocks opportunities,” insists the ambassador for SPECS 2030 , a WHO campaign calling for global coordination to improve coverage of eye care services and eyewear.

In Kenya, for example, an estimated 3.8 million people suffer from eye conditions—ranging from mild to severe blindness—and this costs the country an estimated $262 million in productivity annually, according to data compiled by the International Agency for the Prevention of Blindness’ Vision Atlas platform . Overall, sub-Saharan Africa has the second highest prevalence of sight loss in the world (18.25%), behind only South Asia (22.2%).

Few services and very expensive

One of the reasons for the low rate of care for vision problems in sub-Saharan Africa and, in general, in low-income countries, according to Keel, the WHO technical officer, is that the few eye care services and eyeglasses are located in urban areas, creating a gap with rural populations. “The other problem is affordability: most eyeglasses are provided by the private sector, and the final cost is very high for the patient,” Keel adds. To top it all off, he says, there aren't enough health workers to examine, detect, and prescribe glasses or contact lenses, nor the capacity to dispense them properly.

Although the study published in The Lancet Global Health acknowledges that attention to vision problems has increased worldwide since 2000—in sub-Saharan Africa, in particular, coverage has risen by 60%—it also warns that, at the current pace, universal access will not be achieved until the end of the century. In Kenya, Waithera adds, progress is much slower.

“Perhaps what has improved today is awareness,” she says. “People know how to recognize when something is wrong with their children's vision, but they still don't have enough resources to access services.” She came to this conclusion after noticing that her 15-month-old daughter might have a vision problem. She took her to Kikuyu Hospital, the same one that treated her through the clinic when she was a child. Upon meeting with pediatricians and ophthalmologists, she learned that the mobile clinic no longer operates due to lack of resources. Her daughter was able to access a diagnosis because she was in Nairobi; but other children, Waithera laments, aren't so lucky.

People know how to recognize that something is wrong with their children's vision, but they still do not have sufficient resources to access services.

Jane Waithera, Director of the Disability Inclusion Advisory Unit at Light for the World

“In Kenya, it's very difficult to get a good diagnosis. And even if you do get one and get a prescription for glasses, it's very expensive,” she adds. She, for example, currently has a prescription of -14 in her right eye and -13 in her left eye and regularly requires new glasses. But Nigeria's public health system doesn't cover eye care, and although Waithera has private insurance through her job, she still has to pay for every optical product she needs. “I was supposed to replace my glasses in April. And it's June, and I haven't done it because I have to save a little to buy them,” she says. “Very little has changed in terms of accessibility and affordability.”

Keel, the WHO technical officer, emphasizes that there is no quick fix for regions like sub-Saharan Africa. “First, governments need to increase investment,” he says. “Checkups and glasses need to be included in health service packages and insurance plans offered to the public, especially children and the elderly, who are at-risk groups.”

However, this injection of money is no small feat. Spain, for example, announced at the end of May that it will provide public assistance of €100 to children under 16 who require glasses or contact lenses. Until now, optical products were not included in public coverage, and providing them will require an initial investment of €48 million.

For this reason, for Kee, it's key to attract the attention of international cooperation and philanthropic organizations. "Furthermore," she adds, "the private sector has an important role to play, as it's the main manufacturer and supplier of eyewear. Active collaboration with them is necessary." And, she concludes, it's also key to generate solutions that reach patients' homes. Waithera, from Kenya, calls this the "last mile" solution. "We must ensure that people [in rural areas] don't have to travel to big cities to access information and services," she says, recalling, once again, the mobile clinic that changed her life.