Better Vision for the Poor18
If the NREGS case study illustrates how civil society can be an effective watchdog, the one that follows shows civil society acting as a catalyst. Many poor people with bad eyesight, unfortunately, do not have eyeglasses. The case describes different approaches to provide eyeglasses to the poor that have been attempted, and shows how an NGO, VisionSpring, is acting as a catalyst to solving the problem.
Approximately 517 million people in developing countries are considered visually impaired because they do not have access to eyeglasses.19 The Centre for Vision in the Developing World at Oxford University has a higher estimate: Over one billion people need but do not get vision correction.20 For the poor, eyeglasses often are either inaccessible or unaffordable. A variety of approaches have been tried to solve this problem: For-profit business model, innovative technology, and social entrepreneurship. Yet, to date, none have succeeded on a large enough scale.
Many challenges confront the provision of eyeglasses to the poor in developing countries. One study in India of poor people with presbyopia found that about 23 percent of the subjects were unaware of the problem, another 29 percent did not assign it a high priority or accepted poor eyesight as a “natural” process of aging, 18 percent did not have the money to afford treatment, and the rest said “other obligations” (such as need for travel and no escort) prevented an eye exam.21
Not only do the poor lack information about the importance of vision correction, but they also lack knowledge of how to go about getting eye care. A study in Tanzania found that although the subjects perceived eyeglasses to be useful and affordable, most did not know where to get them.22 In the developing world, eyeglasses are primarily available in high-priced urban optical shops. For the rural poor, a trip to buy glasses requires travel to an urban center to visit an eye doctor, which is often a day-long trip each way.
In the Tanzania study, 31 percent of the people surveyed were unable to afford eyeglasses at “a price that covered the cost and shipping of the spectacles.”23 A study in East Timor found that 49 percent of rural subjects were unwilling to pay even $1 for eyeglasses, and only 16 percent were willing to pay $3.24 A recent study in India provided eyeglasses free to the subjects. One month after using the eyeglasses, the subjects were asked how much they would be willing to pay for the eyeglasses; the median answer was about $4.25 (This is an overestimate of the true willingness to pay because in real markets consumers have to purchase eyeglasses prior to use.)
A major barrier to delivering vision correction is the lack of trained optometrists. Many developing countries have as few as one optometrist for every million people; the figure for the United Kingdom is one per 8,000 people; in Mali, the ratio is one per 8