The global mapping of low vision services

© 2009 Dr. Peggy Pei-Chia ChiangLow vision impacts on Quality of Life (QoL). Thus, low vision services are essential to enhance the QoL of people with functional low vision. However, of the estimated 70 out of the 124 million people with low vision who require services, approximately 5-10% has access to services. The demands for low vision services will continue to grow due to the emerging global trends in ageing populations and changes in the epidemiology of vision impairment. While critical data and information are available for other forms of vision impairment, there is a paucity of information on the distribution, needs, and priorities for improving low vision service delivery at the national, regional, and global levels. This thesis addressed the problem by first developing and distributing a survey to Vision 2020 contacts, government, and non government organisations in 195 countries during 2006-2008 to assess the current situation of low vision services globally. The survey was first pilot tested leading to improvements in the length, layout, and content of its form. Specifically, the survey topics included: epidemiology, policies, human resources, service provision, barriers, equipment, and monitoring and evaluation. The Classification Analysis and Regression Tree (CART), logistic regression methodology and grounded theory analysis were used to present the findings and identify the critical success factors of low vision service coverage. The qualitative component consisted of case studies in three countries (India, Ghana, and Cameroon) during November 2007 and 2008. A total of 101 interviews were carried out. The case studies provided an overview and historical perspective of services, effectiveness, cost, efficiency, acceptability, access, equity, sustainability, and ideal situations as recommended by interviewees. Qualitative findings from the case studies were produced with the assistance of the NVivo software. The primary results are that the majority (80%) of countries have poor (≤10%) coverage. Key issues pertinent to the current situation of service coverage are: human resources (number and combination of disciplines), funding (sustainability and arrangements), type of services provided (comprehensive and multidisciplinary) and its locations (NGOs or government facilities), and the sociodemographic and economic barriers (costs, awareness, and rural areas) to accessing services. The critical success factors found in this research are represented by the ‘FRAME’: Funding (sustainable source, public and private mix), Rehabilitation workers (e.g., adequate numbers of multidisciplinary personnel), Access to low vision devices, Multidisciplinary services; and External contextual influences in which low vision services operate in. The case studies identified seven major themes that further build on the FRAME: sustainability, governance, advocacy, human resources, access, awareness, and service delivery. The conclusion of the thesis is that a global picture of the current situation of low vision services was acquired and it is now known which countries have poor (≤10%) and better (>10%) coverage. It also found the critical success factors that will assist the WHO Low Vision Working Group and Vision 2020 to improve the current models of service delivery, future planning, training curriculum development, and priorities setting. Specifically, these need to be achieved through three areas of action: human resources development, sustainability, and advocacy