VISION 2020 and Me: R D Thulsiraj

What does VISION 2020 mean to you?
VISION 2020, the global intiative has at its heart, the idea that eye care needs to go beyond the four walls of a hospital. I was playing a very active role in IAPB just as VISION 2020 was coming into being in the mid-90s. VISION 2020 had a clear, defined goal. It had a set of key strategies – human resource development, infrastructure development, disease control – that were broad enough to work in a variety of contexts around the world. With my background in management, these principles and their clarity really appealed to me.

This flexibility of setting clear goals but allowing for regional and local specifics also worked very well for me. I held a series of responsibilities in IAPB, including the regional chair for a period, and saw clear parallels with Aravind Eye Care System’s own focus at that period.

A key example for this symmetry would be Aravind’s very popular Programme Manager training workshops. At the height of the VISION 2020 programme, even governments would actively participate in these workshop courses, sending their staff for training. The VISION 2020 framework offered a blueprint, and also legitimacy, for these workshops and their curricula. The International Centre for Eye Health (ICEH) anchored these workshops around the world with Robin Percy managing them and Aravind ran many of these workshops in India and globally.

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?
VISION 2020 encouraged the establishment of chapters in individual countries and India was among the first countries to have its own national chapter. Some of the groundwork for the establishment of the national chapter was on the basis of some policy outreach a small group of us were working on. In the mid-90s, I had, as part of the Aravind Eye Care System, worked on a World Bank funded project to tackle cataract blindness in seven Indian states. The project increased India’s annual spend on cataract from around 10 crores (100 million rupees) to nearly 80-100 crores annually.

This project was a big success. While it focused on cataract, it also laid the groundwork for training, infrastructure and NGO collaboration. When VISION 2020 India was formed, we helped draft the strategy plan and also advocated for a four-fold increase in India’s spending on blindness prevention. Our collective efforts with Mr Montek Singh Ahluwalia (the Chair of India’s 11th Planning Commission) and our results backed by these previous successes, set the stage for the current phase of relations between NGOs and the Indian government.

What key aspects of VISION 2020 helped bring diverse stakeholders together?
India had a generation of impactful eye care leaders who were keenly committed to community eye health, based on the best of knowledge and experience of their times. By the time VISION 2020 came about, it brought together a whole new generation and a new set of ideas to community eye care within the Indian approach. As the founders of this initiative, we could show the sector the benefits of presenting a united voice to governments – after all, governments present to us with a unified vision too. This unity, coupled with continued stakeholder relevance has been key to VISION 2020’s longevity and success in the Indian sub-continent. VISION 2020 still has a lot to offer, including an environment of cooperation and collaboration for eye hospitals and organisations operating in this sector. It has also streamlined the dialogue with the government in India, which is hard for individual organisations to achieve on their own.

All this has led to a situation where a significant portion of eye care in India currently happens through the VISION 2020 India membership today.

What do you think was VISION 2020’s biggest achievement?
VISION 2020’s biggest achievement is harder to pin down. Its original goals have shifted over the two decades of its existence. Ultimately, I believe its biggest value was in the broad platform it established for eye care. Going into the future, we need to build on this aspect of VISION 2020 as we set our sights on the many hard challenges ahead of us. We need to re-draw our emphasis from global to regional and local strategies. We need to focus on countries where the Cataract Surgical Rate (CSR) is less than 1000, as CSR continues to be a good proxy for the availability of secondary care.

In spite of the tremendous progress made, I would say, hold off on celebrating VISION 2020 as a success – there is still a lot more that needs to be done. The notion of success could inadvertently slow us down. Do take stock for sure, as VISION 2020 showed us where we stand and the strategies we need to pursue for the future.