VISION 2020 will address five major causes of blindness in francophone Africa: cataract, trachoma, glaucoma, onchocerciasis and childhood blinding disorders, particularly those leading to corneal scarring. The World Health Organization (WHO), the governments concerned and nongovernmental development organizations (NGDOs) will work together to increase the number of adequately trained national cadres and improve their distribution between large cities and rural areas; assist in the transfer of appropriate sight-saving technologies to developing countries; as well as help these countries implement cost-effective strategies for blindness prevention.

"Sub-Saharan Africa together with China and India account for an estimated 60% of the world's blind. However, figures alone can neither depict the economic plight of blind people and those with serious visual impairment, nor express the untold suffering and humiliation they experience," WHO's Regional Director for Africa told reporters at a press conference that followed the signing ceremony. The burden of blindness in French-speaking Africa, Dr Samba emphasised, was not only a public health but also an important economic issue. "The burden of blindness in Africa is increasing and will at least double by 2020 if urgent preventive measures are not taken," Dr Samba warned. As major reasons for such an increase, he mentioned rapid population growth and ageing, appalling living conditions, the severe shortage of adequately trained ophthalmologists, and the limited supply of essential eye drugs and modern technologies to prevent and treat blindness.

According to WHO, cataract is responsible for up to 60% of the blind in the sub-region, or some 1.2 million people, with an estimated 300 000 new cases of blinding cataracts each year. "The cataract surgery rate (CSR) in the sub-region is still among the lowest in the world -- only between 200 and 400 per 1 million of the general population compared to 3500–5000 in the developed countries," said Dr Alain Auzemery, Director of IOTA -- a WHO collaborating Centre in Africa. "In other words, only 20% of new cases are operated while the backlog of unoperated cataracts is steadily on the rise. However, in Mali the situation is somewhat better. IOTA performs around 4000 operations a year. Almost 80% of them are cataract operations"

There are an estimated 100 000 blind children (aged 0 – 15) in French-speaking African countries. Absolute numbers in childhood blindness, however, do not reflect the full scale of the tragedy associated with it. Approximately half of the blind children die within one or two years of becoming blind. When related to the total number of years lived with disability, the burden of childhood blindness in Africa is second only to cataract. The main causes of childhood blindness are corneal scarring (from measles, vitamin A deficiency, conjunctivitis of the newborn, etc.), congenital cataract, and hereditary disorders.

Onchocerciasis is endemic in 15 French-speaking African countries. In many of these countries, It still constitutes a serious obstacle to socio-economic development. Thanks to the outstanding success of the Onchocerciasis Control Programme (OCP) over the past 25 years in most of West Africa, some 11 million children have been protected against onchocerciasis, and approximately 500 000 people have been saved from blindness. OCP will come to an end in 2002, even though disease surveillance activities will continue. Further efforts to eliminate avoidable blindness due to onchocerciasis will be pursued mainly within the African Programme for Onchocerciasis Control (APOC) launched in 1995. APOC is based on a full partnership between affected communities, the participating governments, a consortium of international NGDOs and bilateral agencies. Control of the disease throughout the continent is expected to be achieved by the year 2010 if present efforts in endemic countries are successfully completed.

Trachoma – a disease common in areas of the world that are socio-economically deprived of basic needs in housing, health, water and sanitation – is endemic in most French-speaking African countries. A strategy referred to as "SAFE" (Surgery, Antibiotic, Facial Cleanliness and Environmental Improvement) has been developed and is being applied in affected areas. It is expected that through the use of the SAFE strategy it will be possible to eliminate trachoma as a blinding disease by the year 2020.

"The development of a reliable epidemiological database on blindness and visual impairment is an important objective of VISION 2020 in Africa," stressed Dr Serge Resnikoff, Coordinator of WHO's Prevention of Blindness and Deafness programme in Geneva. "For example, WHO estimated that in French-speaking Africa close to 400 000 people are either blind or severely visually impaired from trachoma. However, the ongoing epidemiological mapping of the disease in the sub-region suggests that this is an underestimation."

Dr Resnikoff also stressed the increasingly important role played by NGDOs in blindness prevention in Africa. At present, there are around 10 NGDOs collaborating with WHO in Africa. Among these, are (in alphabetical order): Christoffel-Blindenmission (Christian Blind Mission International – CBM); Helen Keller Worldwide; International Federation of Ophthalmological Societies ; Lions Clubs International Foundation; Operation Eyesight Universal ; Orbis International ; OPC (Organisation pour la Prévention de la Cécité); Sight Savers International; The Carter Center and The Fred Hollows Foundation.

"The right to sight is a basic human right. Nevertheless, it is an unaffordable luxury for almost 45 million people in the world, 6 million of whom live in Africa. The elimination of avoidable blindness by 2020 is a lofty goal and a tall target. VISION 2020 provides a unique opportunity for African Governments, international organizations and NGDOs working with WHO, to jointly reach this target," stressed Christian Garms, CBM's Executive Director and Chairman of the VISION 2020 Task Force.

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