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The Future of Vision Care in Latin America: An Interview with Dr. Juan Carlos Silva


In 2018, the Vision Impact Institute adopted a regional advocacy approach, as part of our work to prioritize good vision, which included a focus on Latin America. Through our partner-centric approach, we have built relationships with a variety of local and regional experts who are driving the topic of good vision in their regions and specific countries where access to vision care is much needed. According to the IAPB, in 2020, in the Latin America and Caribbean Region, there were 78 million people with vision loss. Of these, 3.7 million were blind.


We are honored to know and collaborate alongside Dr. Juan Carlos Silva, former Regional Advisor of Vision and Hearing Care, PAHO. Dr. Silva served as the Eye Care Regional Adviser for Latin America and the Caribbean at the Pan American Health Organization (PAHO), regional office of the World Health Organization from 1991 to 2021.


We recently interviewed Dr. Silva to understand the state of vision care in Latin America and gain his perspective on what will be required of the next generation of vision advocates to ensure the region’s population can see well.


AS YOU SEE IT, WHAT ARE THE BARRIERS TO VISION CARE IN LATIN AMERICA?

JCS: Population-based surveys reveal that in low-income countries in the region, out-of-pocket payments and lack of knowledge about eye diseases and vision care are the main barriers to people seeking care. In addition, human resources focused on eye care are concentrated in the wealthy districts and neighborhoods, leaving the poorest areas with insufficient services. The barriers to spectacle uptake are also higher in the lowest socioeconomic strata.


HOW HAVE YOU MEASURED INEQUALITIES IN EYE HEALTH IN THE PAST?

JCS: We have measured inequities in cross-sectional eye health surveys in three categories: educational attainment, literacy, and wealth. We found that blindness and moderate visual impairment prevalence are concentrated among the most socially disadvantaged.


We also measured the distribution of ophthalmologists within each country using data on ophthalmologists affiliated with national professional societies and Human Development Index (HDI) estimates at the subnational level. Some countries in Latin America have substantial inequality in ophthalmologist distribution.


HOW CAN WE INTEGRATE EYE CARE INTO THE PUBLIC HEALTH SYSTEM?

JCS: In my opinion, cataract surgery and refractive errors are priority interventions that should be included within health benefit packages – reducing out-of-pocket payments and integrating them into primary health care, health education and promotion programs and referral pathways.


It’s best if eye health is included within national health plans and incorporated into relevant programs such as maternal and child health, school health, non-communicable diseases, and healthy aging. Vision screening can also be carried out through school health programs. In addition, it’s crucial to raise awareness of the importance of early identification of eye conditions and ways to access eye care services through primary health care.


WHAT MEASURES ARE NEEDED TO IMPROVE ACCESS TO VISION CARE FOR THE MOST VULNERABLE POPULATION IN LATIN AMERICA?

JCS: There are a number of ways to reach the most vulnerable with vision care, including:

  • Reducing or eliminating the out-of-pocket payment for interventions such as refractive error correction and creating incentives for better distribution and quality of eye care professionals.

  • Informing and motivating people to seek treatment and to reduce fear of treatment.

  • Strengthening service capacity through effective leadership, sharing tasks, training, appropriate equipment, and supplies.

  • Creating public-private partnerships and developing outreach programs.


HOW CAN WE IMPROVE THE DISTRIBUTION OF EYE CARE PROVIDERS IN THE REGION?

JCS: Building a supply of eye care providers in the region is key to meeting the needs of its people. In my experience, creating schools of ophthalmology, optometry, and allied health personnel has been shown to be successful. We also must prioritize underserved areas by hiring and retaining eye care personnel through financial incentives, good working conditions, abundant equipment and supplies, continuous medical education, and good housing for family members. Quality of training also should be upgraded, with emphasis on competency with appropriate support, supervision, and equipment.


HOW CAN LOCAL AND REGIONAL VISION RESEARCH HELP TO BRING ABOUT THE IMPORTANT CHANGES NEEDED IN PUBLIC HEALTH?

JCS: Most of the evidence collected in Latin America is on how to identify vision problems and their impact on the population. There is a lack of research on how to turn evidence into policies and programs. We need evidence on the effectiveness of advocacy, health education, and communication programs and on interventions like low-cost spectacles and telemedicine to increase access in the public and nonprofit sectors.

HOW CAN VISION HEALTH POLICIES MOVE US FURTHER TOWARDS ACCOMPLISHING THE UN SUSTAINABLE DEVELOPMENT GOALS?

JCS: Eye health is necessary to achieve the Sustainable Development Goals by improving work productivity, mental health, and education and equity. Vision is particularly relevant to SDG 3 on good health and well-being, and to other SDGs, such as those on education, gender equality, work, and economic growth.


WHAT ADVICE WOULD YOU GIVE TO THE NEXT GENERATION OF VISION HEALTH ADVOCATES?

JCS: I’m excited to see the next generation take the work that my generation has done and elevate it to the next level. I would encourage them to:

  • Focus their advocacy on incorporating eye health into other disciplines and initiatives. It is particularly important to integrate eye care priorities such as poor vision correction and protection into other medical systems and services (e.g., neonatology, child health, school health, diabetes, healthy aging program) at primary, secondary, and tertiary levels to improve disease detection and referral pathways. This can be accomplished by advocating with international professional bodies, colleges, and non-governmental organizations. It’s not always limited to the eye care community.

  • Work on developing national protocols and legislation to guide and support the eye care interventions in the various health care disciplines at all life stages.

  • Reduce inequity in eye care and strengthen eye care services to marginalized or vulnerable groups (rural, poor communities, indigenous people, and ethnic minorities) through human resources, infrastructure, equipment, and supplies along with improving public and nonprofit services management.

  • Measure the impact of eye care delivery through population-based surveys and embed this information in national health information systems.

  • Conduct research on the impact of policies and interventions on health systems and services. This data would be necessary for future evidence-based policies and plans.

  • Provide health education and promotion for all life stages to make people aware that preserving or recovering sight is an asset for the long term.

Dr. Silva’s insights provide a helpful overview of what is still needed in Latin America – and in many other parts of the world – where good vision is yet to reach its rightful status in both the public health and international development conversation. We are grateful for Dr. Silva, and those like him, whose work has forged a path for all of us to follow.

 

About Dr. Juan Carlos Silva:

Dr. Silva was the Eye Care Regional Adviser for Latin America and the Caribbean Pan American Health Organization, World Health Organization from 1991 until his retirement in early 2021. He earned his Master’s in Public Health (MPH) from Johns Hopkins University, School of Public Health in May 2004 and his Doctor of Medicine degree from the Universidad del Rosario, School of Medicine – Bogota, Colombia. Dr. Silva was awarded the Pan American Health Organization, 2005 Annual Director’s Award on 2005 and was recognized with the Pan American Association of Ophthalmology “Francisco Contreras Prevention of Blindness Award” in 2019. He is also the author on a large collection of research.