Kangwa I. M. Muma1,2,4 and Willard Bwalya Mumbi3,4

1National Eye Health Coordination, Directorate of Clinical Care and Diagnostic Services, Ministry of Health, Lusaka Zambia

2Department of Ophthalmology, School of Medicine and Clinical Sciences, Levy Mwanawasa Medical University, Lusaka, Zambia

3Lusaka Eye Hospital, Lusaka, Zambia

4University teaching Hospitals-Eye Hospital, Lusaka, Zambia

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Since launching the Vision 2020, the Right to Sight in 2004, Zambia has developed and implemented two eye health strategic plans on various objectives and strategies to eliminate avoidable blindness and visual impairment. The current National Eye Health Strategic Plan (NEHSP) 2017-2021 is the third to be implemented and it provides a five-year strategic direction for eye health from 2017 to 2021, highlighting the goals, objectives in the elimination of avoidable blindness in Zambia. It further provides a path and framework to guide the planning, delivery, management and implementation of quality eye health services at community, district, provincial and national levels, in order to increase eye health coverage across the country to at least 90% by the year 2021. The NEHSP draws its aspirations from the National Health Strategic Plan (NHSP) 2017 – 2021, the 7th National Development Plan, Sustainable Development Goal (SDGs), the Vision 2030 and the legacy goals.

The Sustainable Development Goal 3 calls on stakeholders to ensure healthy lives and promote well-being for all individuals at all ages and recognising the important intersections between eye health and other goals including Goal 1 (reducing poverty through maintaining and restoring sight), Goal 4 (ensure inclusive and equitable quality education and promote lifelong learning opportunities for all), Goal 5 (achieve gender equality and empower all women and girls), Goal 8 (promote sustained, inclusive and sustainable economic growth, full and productive employment and decent work for all), and Goal 10 (reduced inequalities).

As part of the transformation agenda, the Ministry of Health equally calls for intersection between eye health and legacy goals 1 (reduce maternal and child illnesses and deaths by tackling conditions such as trachoma which tend to affect women and children largely), 3 (recruit 30,000 health workers by 2021 which also is critical for enhanced eye health service delivery), 4 (implement the National Health Insurance Scheme and increase coverage from 4% to 100% in order to increase eye health care financing as well), 8 (train 500 specialists by 2021 in order to have ophthalmologists distributed to all parts of the country among others) and 9 (halt and reduce the incidence of non-communicable diseases in order to prevent blindness from conditions such as cataract, glaucoma and diabetic retinopathy). The objectives and strategies in attaining these intersections are embedded in the NEHSP. The national eye health service coverage has increased to 81.5% in 2019 from 31.5% in 2011.

The prevalence of blindness in Zambia ranges from 2.2% to 4.4% which implies that there are 339,081 to 678,162 people who are either visually impaired or blind within a population of 16 954 051. The major causes of blindness include cataract (53.2%), glaucoma (19.0%), trachoma (5.7%), refractive errors (15.3%), corneal opacity (3.6%) and retinal disorders including diabetic eye diseases (3.2%). All these causes of vision impairment are preventable or addressable through early detection and timely management, and that cost-effective interventions covering promotion, prevention, treatment and rehabilitation. In line with the government policy of delivering health services through the primary health care approach, the majority of the eye health services are being delivered through the primary health care levels to address the needs associated with eye conditions and vision impairment. This is the more reason of taking eye health services to all the far-flung areas of the country by the year 2021.

Vision impairment has a negative impact on development, educational achievement, quality of life, social well-being and economic independence of individuals. In order to counter this, there has been an enhancement of availability and accessibility of eye health care services, such as cataract surgery, refraction services and provision of spectacles, including shortages of trained health personnel, socioeconomic and cultural factors, inequities, and costs of services. In line with the Vision 2020 Right to Sight strategy, there has been a deliberate effort to expand infrastructure, procure equipment and consumables, embrace new technological advances and human resources for eye health expansion. This progress has seen all eye health investigations and surgeries being performed within the country either at public or private facilities. It is envisaged that the foundation that has been laid down provides good prospects of the eye health public facilities to be the trend setters in the country and the SADC region. To this end, two indicators for health eye care are being used nationally which are effective coverage of refractive error and effective coverage of cataract surgery.

The fight against avoidable blindness requires commitment of purpose of all stakeholders through forging strong partnerships and collaborations. It is by doing such that we are going to attain the much-desired Universal Eye Health Coverage and integration across the continuum of eye health care.