Kenya is advancing the fight against visual impairment and uncorrected refractive errors (URE) through innovative social enterprise strategies aimed at transforming its eye health system. A recent study developed a comprehensive framework for integrating refractive error services, highlighting the pivotal role of social enterprises and advanced technologies like telemedicine.
Globally, URE remains the leading cause of visual impairment, particularly burdening populations at the base of the economic pyramid, particularly within developing countries. It is estimated around 90% of individuals with URE live in low to middle-income nations, yet correcting these errors often requires merely access to affordable spectacles. Despite this, Kenya struggles with significant barriers to eye care services, especially due to the limited number of eye care professionals and general public unawareness.
Research indicates approximately 1,091 eye care professionals serve over 47.5 million Kenyans, resulting in gross geographical disparities, underscoring the need for social enterprises to adopt innovative strategies like telemedicine to deliver services efficiently. The Ministry of Health recognized telemedicine as valuable during emergencies, such as the COVID-19 pandemic. Despite its potential, traditional commercial practices dominate the optical industry, focusing chiefly on profit over accessibility.
Through scoping reviews and expert opinions, key opinion leaders identified various components necessary for providing contextual refractive error services, including skills development, technology integration, vision centers, cross-subsidization, and collaborative partnerships. The study's framework anticipates integration and prioritization of these elements to revolutionize service delivery.
Key opinion leaders unanimously (100%) agreed on the urgent need to recognize social enterprises as instrumental for cost-effective service delivery addressing URE. They emphasized the significance of partnerships between eye care professionals and public/private sectors to effectively advocate for these initiatives. A notable insight shared was: "The model for integrating refractive error services should first prioritize partnership - Opinion leader #08.”
Community involvement is likewise fundamental, as it's the local populace who truly understand the challenges faced by those needing care. This perspective was reflected when one leader remarked, “The only people who understand the groups in dire need of refractive error services are the eye care professionals, as they should be involved - Opinion leader #06.” This reveals not only the potential for eye care experts to shepherd initiatives but also the importance of tailoring solutions to local contexts.
The proposed framework integrates technological solutions to streamline service provision across Kenya's diverse settings, ensuring wide-ranging availability and accessibility for all economic strata. Vision centers funded and managed by social enterprises can facilitate eyecare delivery, particularly if they leverage telemedicine and the skills of community health workers trained to assist with basic refractive error assessments and dispensing eyeglasses.
Through training community members as primary vision technicians, local economies stand to benefit, with citizens empowered through skills development yielding self-sufficiency. Such community-driven efforts, if effectively coordinated with various stakeholders, could bridge the gaps currently hindering eye health accessibility. Current scaling of practices like cross-subsidization is particularly relevant, as it enables service delivery to lower-income individuals who typically can't afford premium-priced spectacles.
The framework underlines the necessity of structured advocacy and policy changes to facilitate comprehensive service access, demonstrating the potential of social enterprises as catalysts for change. Through the implementation of this model, Kenya could not only resolve the existing challenges associated with its eye health ecosystem but also align with the Sustainable Development Goals (SDGs) aimed at reducing inequalities, promoting economic growth, and enhancing quality of life through improved vision care.
With key opinion leaders' insights, the framework promises not merely to address the pressing need for refractive error services but also empower communities by positioning social enterprises at the heart of Kenya’s eye health transformation.