Eye

The Global Initiative for the Elimination of Avoidable Blindness (Vision 2020: The Right to Sight) sets a major challenge requiring a significant increase in the provision and uptake of eye care services. If the increasing trend in blindness is to be reversed, then access to eye care services needs to be made more widely available. One of the most significant barriers to accessing these services is affordability. The shrinking economies of many of the world’s poorest countries is placing increasing pressure on health care budgets that are already severely over stretched. Competing demands from life threatening diseases such as AIDS, malaria, and TB are pushing eye health services further down the agenda list of public health priorities. Simultaneously, the increasing cost of health care is forcing many governments to reform the structure of their health delivery systems. Many are choosing to introduce cost recovery mechanisms, as a means of controlling the overall rising costs of providing health care services. Articles in this issue focus primarily on the supply issues of service delivery, looking particularly at how increasing operational and manufacturing efficiencies can reduce costs to an affordable level. But to place affordability within the reach of ordinary people, their families and the communities in which they live, we also need to understand the demand issues which place additional cost burdens that do not allow access to eye care. The costs are many and complex and the intention of this article is to explore what these might be (direct and indirect), and to offer some suggestions as to what might be done in order to make eye care more affordable to those who can least afford it.