Inequities in eye care in South Asia

article distributed under the Creative Commons Attribution Non-Commercial License. Inequities are often discovered and discussed around prevalence studies, which produces data relating to various types of inequities. It sits in the space of periodic assessment and continues to remain predominantly in the knowledge rather than action realm. Therefore there is a need for a paradigm shift in how we think about and approach inequities in service. The goal of “VISION 2020 The Right to Sight” and that of many organizations and governments engaged in eye care is around “eliminating avoidable blindness”. This implicitly means that there are people who are blind, but don’t need to be. This is true since proven interventions exist to treat or prevent the major causes of blindness or visual impairment. Globally, it is reported that 39 million people are blind and a further 246 million have moderate or severe visual impairment.1 A significant number of people with avoidable visual loss are not being reached and served by the current eye care delivery system for a variety of reasons including patient awareness and access to services. Thus, we need to recognize that inequity in the eye care delivery system is a significant cause of the remaining problem of avoidable blindness. Therefore it is relevant to look at how we currently provide eye care and redesign it with an explicit focus on the goal of eliminating inequities. Such a health system design should have inbuilt, on-going monitoring and processes for continuously identifying and correcting inequities as they occur, similar to what is done in clinical audit and care process for reducing complications, infections, etc. It is time that this paradigm shift occurs in the design of eye care services both at institutional and national level. In order to consider the redesign of eye care delivery, it is important to have an understanding of the origin of these inequities. Overall, inequity or those not served fall into a few broad categories: