Eye care delivery in developing nations: paradigms, paradoxes, and progress.

Only 5% of the world's population is found in the United States, yet we as a nation consume 40% of the world's resources. In stark contrast, two thirds of the world's population live in developing countries where 90% of all blindness occurs and where even the most basic resources for eye care delivery are scarce or absent. Using U.S. criteria defining blindness (less than 20/200 [6/60]), the World Health Organization estimated in 1984 that 42-52 million people were blind from all causes, an increase of more than 10% since 1978. High population growth rates in most developing countries coupled with the failure of governments to develop health services commensurate with needs are responsible for this trend. On economic grounds alone, the U.S. eye care delivery paradigm cannot be broadly replicated in the developing world. Instead, cost-effective creative strategies, many already in place, such as mass surgery camps in Asia and delivery of eye care by non-ophthalmologists in Africa, can be expanded and streamlined. The upgrading of sight restoration and preservation care depends upon mobilization of political will within the international health community; governments must prioritize eye care as a public health problem; health planners must mobilize financial resources and work closely with technical assistance organizations, and ministries of health must cease to emulate expensive high-technology eye care models.