VISION 2020 and Me: Gullapalli N Rao

What does VISION 2020 mean to you?

We started the L V Prasad Eye Institute in 1987 in Hyderabad, India and my ambition then was solely to build a world-class eye centre in India. We were focused on clinical care, education and research, and a few years later, we added rehabilitation services. After the first 5 years, we were concerned about the complications coming to us from rural areas. We began thinking about a model to provide high-quality, comprehensive services there. Over several conversations, P G Michael (the then head of CBM in India) encouraged me to step into rural eye care – but I had no idea what was needed to be done. Then Mr. Nagarajan (Head of Sightsavers) also joined him. Nearly a decade after throwing open the gates of our tertiary centre in Hyderabad, we opened our first rural secondary centre with their support in a remote and under-developed region.

We drew attention to improved cataract surgical outcomes, while the cost of surgery steadily came down. We focused on re-training ophthalmologists to improve outcomes and better pre- and post-operative care. As we worked systematically on each of these issues, we also began to collect high-quality data. LVPEI’s APEDS study, for example, gave a clearer picture of the disease burden by showing that the prevalence of cataract was 50% and not 80% as was previously thought.

In 1994, on my way to that year’s annual American Academy meeting, I stopped over at IAPB’s Berlin General Assembly to understand what that was all about. A couple of weeks later, I had a letter from the new President, Dr. Pararajasegaram (Para) that I was elected as IAPB’s Regional Chair for South East Asia – I had no idea! In the next couple of years, I slowly began to get involved in the conversations in IAPB around a global campaign for the prevention of blindness. Allen Foster informed me of IAPB’s intention of nominating me as Secretary-General to help with the launch of a global initiative and then with the General Assembly in Beijing. After giving it some thought, in early 1998, I accepted that position.

Come 1999, and VISION 2020 had two launches, the formal one in Geneva by Dr Gro Harlem Brundtland, the Director General of the World Health Organization (WHO), and the next at the Beijing GA. This global initiative was championed by Bjorn Thylefors at WHO along with Para and Serge Resnikoff. From IAPB, the campaign had the backing of the ‘task force’ of CBM and Sightsavers which was later joined by Helen Keller International. Allen Foster played a pivotal role. This group was keen on accelerating action around avoidable blindness. With a marketing agency’s support, Allen Foster came up with the name ‘VISION 2020: The Right to Sight’.

For me, VISION 2020’s launch brought these two key themes of my work together.

One of VISION 2020’s key role was to bring eye care to the attention of policy holders – can you think of one or two key politicians from the region who began to take eye care seriously thanks to our advocacy?

A key aspect of VISION 2020’s accelerated action was to advocate for support with policymakers at the highest levels in governments like ministers of health or above. The Beijing GA was under the auspices of China’s then Minister of Health. The next was the launch of the initiative in India in partnership with National Programme for Control of Blindness (NPCB). Some of us had similar success with the planning commission and ministry of health in India. Right off the bat, VISION 2020 had begun where there was the highest burden of avoidable blindness.

By 2003-4, we began ramping up our Advocacy efforts and one goal was  to get Prevention of Blindness included in the WHO’s priority list. This received a big leap when HRH Prince Abdulaziz Al Saud of Saudi Arabia, our Regional Chair for EMR, helped us reach out to and convince a number of ministries of health in that region. There was a lot of leg-work initially. We picked up the phone and spoke to ophthalmology and optometry leaders around the world. Soon, the initiative captured the imagination of professional societies also – both ophthalmology and optometry. Brien Holden lead the effort from the optometry side initially.

Another big focus for us then was resource mobilisation. In 1999, we believed the total income for all eye care international NGOs was USD100 million – our ‘ambition’ was to double it by 2020! And to think that Seeing is Believing (with credit to Dick Porter for bringing in the Standard Chartered Bank) alone committed USD 100 million dollars over the next decade. Innovative programmes like “Optometry Giving Sight” and “Eye Fund” with the Deutsche Bank were launched. IAPB and VISION 2020 also saw active support from all major ophthalmic corporations from their highest levels of leadership.

What key aspects of VISION 2020 helped bring diverse stakeholders together?

VISION 2020 focused attention on several key issues within the sector. We were keen to tackle gender equity, both by disaggregating patient data and by welcoming more women into the public health eye care sector. VISION 2020 opened the doors for ideas and leaders from developing countries. IAPB leadership had participation from developing countries, including ophthalmic professionals along with INGOs, bringing both policy makers and implementers under a common cause. This led to new productive partnerships.

While VISION 2020 began with international NGOs, the initiative found support from universities and other key sources of eye care ideation. And from its very beginning, VISION 2020 encouraged ministries of health to work with the eye care community. This unlocked a lot of goodwill and snow-balled into a worldwide support for the initiative.

What do you think was VISION 2020’s biggest achievement?

VISION 2020 put eye care on everyone’s radar. It is hard to imagine how small and siloed we were as a sector back before its launch. VISION 2020 also helped the world see that eye care interventions were cost-effective, and that blindness was truly avoidable. VISION 2020’s lasting legacy would be that it managed to bring a systems approach to the sector and fused it with the need for sustained, high-level advocacy. The fact that we have equitable models of care is a lesson many health systems can learn from us. No other area of health care had anything equal to VISION 2020: The Right to Sight, a true coalition of all stakeholders.