Kovin Naidoo is revolutionizing access to eye care and eyeglasses for South Africa’s rural poor through a new economic model that provides benefits to all participants. Providing ultra low-cost eye services and eyeglasses to the rural poor, it also creates a system of sustainable and replicable training and employment of eye care providers and lens manufacturers.
The New Idea
Determined to bring eye care and blindness prevention to the poor, Kovin has developed a comprehensive, sustainable, and horizontal economic service delivery model for poor rural communities in South Africa. His model shifts the primary responsibility for refractive services and blindness prevention from private sector professionals to cadres of community eye and health care workers. Using a horizontal model which develops a value chain encompassing educationalists, educators, practitioners, clinics, hospitals, suppliers and the community, Kovin has intricately knit together a model for providing eye care, making it both affordable and accessible by the rural poor. His model comprehensively utilizes each component of the value chain, from education and training of eye care practitioners to establishment of examination sites, technical equipment and support, and manufacturing of lenses and frames. Additionally, Kovin has constructed incentives and configured relationships that ensure a win-win situation for all stakeholders involved in the model, which has elicited buy-in for his program and has made it sustainable.
The World Health Organization estimates that refractive errors contribute to 10 percent of world blindness. In South Africa, 80 percent of adults over the age of 40 and 10 percent of children are in need of refractive services and correction. Private optometry in South Africa reaches only about 25 percent of this population, and even then mostly in urban areas. Optometry and ophthalmology services are expensive to obtain and, until just a few years ago, were almost exclusively the domain of the private sector. Since the majority of South Africa’s poor live in rural areas, they are thus unable to access any eye care services. Children in particular suffer a great deal as vision problems have a detrimental affect on their learning process and ability to generate a livelihood. If refractive errors in children are not detected and treated early in life, they are at a high risk of developing amblyopia (lazy eye) which can lead to permanent squinting or loss of vision. These children are also often misidentified as having learning disabilities and are therefore placed into inappropriate classes, resulting in a misinformed approach to their learning.The disadvantage of vision impairment for all is exacerbated by poverty and lack of services. In addition to the lack of adequate and accessible services, the current cost of eyeglasses makes them unobtainable by the poor. Furthermore, beyond being able to afford them, actually being able to obtain eyeglasses is an even larger problem due to the near lack of eyeglass technicians, manufacturers, and sellers in the rural areas.There are isolated cases of initiatives by other citizen sector organizations to provide care, services, and eyeglasses to the rural poor in South Africa. However, they are usually charity-based, do not address the underlying socio-economic and political issues and only provide temporary and sporadic solutions to the problem.
Kovin has developed an economic service delivery model which makes use of a diverse set of interventions. Kovin's model reconstructs the entire value chain for eye care and reconfigures most components, resulting in a well thought out, comprehensive, and sustainable model for providing eye care. A unique feature of this multi-layered model is that it grows as more problems and challenges are encountered.Kovin's work is located within the International Center for Eye Care Education (ICEE), which is headquartered in Australia and works around the world to provide eye care services to the poor. Kovin’s affiliation with ICEE provides an institutional base for his work and also brings in funds from the head office. Kovin realized that the high cost of education and training in eye care provision made it inaccessible to many. Kovin’s first response was to establish a train-the-trainer program, which increased outreach, capacity, and skill of community-based heath care workers. Working in conjunction with civil society organizations, suitable candidates (ophthalmic nurses or primary care nurses) are identified and recruited. These candidates partake in a training course which trains them to undertake simple basic eye care examinations and make recommendations for eyeglasses or referrals to others for more complex and complicated cases. They are also assisted in setting up their own programs for training once back in their communities and provided with post-training support and education which keeps their training up-to-date. This ensures that the initial training is maintained and that the spread of the initiative continues. At the end of the training, the participants are awarded with a certification. Once trained and certified, these practitioners are supplied with a toolkit which has all the equipment needed for the services that they provide. This approach allows for more local people to be trained and to take eye care services into their own communities.Kovin is also working with local health clinics and hospitals to ensure the widest access possible. Part of the requirement of training is an internship component: students must have completed a fixed set of hours in optometric practice before they qualify for certification. Because the demand for these internships outweighs the supply of such positions, Kovin approached a local hospital which did not have an optometric service. He was successful in negotiating an intake of interested students to the hospital. In return, he helped the hospital set up an optometric clinic, where private optometrists manage and supervise these students on a part-time basis. The students now have a regular site for their internships and the hospital now has an optometric arm. This model has been so successful that Kovin is now being approached by other hospitals and local health authorities for replication of this model and it has led to the development of the National Refractive Error Program whereby private optometrists conduct sessions in the public hospitals as part of a formal program coordinated by ICEE. The program provides the rules, guidelines and administration for the clinics, while the optometrists provides his/her services in terms of eye exams. Spectacles are sold at a common exit price at all such clinics and a cost recovery component ensures that the clinic is viable and sustainable. Examination sites are attached to clinics or community health centers. The more complex ocular and eye care problems are referred to optometrists or ophthalmologists. For these complex issues that are also located in distant areas, a program has been set up with the Red Cross Air Mercy Services, which flies optometrists and ophthalmologists out to these sites on a regular basis. The bulk of the costs associated with providing glasses is the technical aspect of producing the lenses. In order to make the examination sites sustainable, affordable means of supplying eyeglasses had to be found. Therefore, Kovin asked a former neighbor from his childhood home who imports goods from China to scout around for affordable eyeglasses. Also wanting to generate employment for young people in his community, Kovin struck a deal with the laboratory that manufactured eyeglass lenses for his partner’s practice (she is a practicing optometrist): he would use the lab as a supplier for uncut lenses for all the growing examination sites, if the lab outsourced their fitting of lenses to these young people. ICEE trains the young people in the technique of cutting lenses to fit the frames using the labs as a training site. At the same time, he was able to source a supplier in China through his friend for a nominal amount per frame and nominal importation fees. This deal has slashed the price of eyeglasses from approximately US$80 each to an amazing $2.00 for ready made and $5 to $10 for made-to-order spectacles, making spectacles affordable for most South Africans. This purchase price includes the frames, lenses, shipping, and minor administration costs (from which the ICEE recovers the costs). The small profits made on the sale of eyeglasses are used to cross-subsidize other aspects of care, such as the treatment of ocular disease. Kovin’s strategy is also to position the ICEE as a generator of knowledge of refractive services and related eye care issues. Utilizing his links and position at the University of Kwa-Zulu Natal, South Africa, he has initiated a research facility that, while still in its early stages, will be used to generate knowledge in this area. This will be used to revise and improve current programs and provide strategic support to the sector.Kovin has proven quick results with the installation of eye care sites across South Africa. Kovin's model has great implication for the provision of broader health care and has a conceptual framework which can be replicated across other health care fields in South Africa. In addition, other African countries are looking to adopt this approach as it is responsive to different socio-economic and cultural needs and simple and easy to develop and implement. Funding has been secured to implement a model program and evaluate it so that duplication of the model will be effective for other areas.
Born to an entrepreneurial mother and sports-orientated father, both with strong morals and family values, Kovin was exposed at an early age to doing the right thing in making life choices. His mother, clearly a dominant influence in his life and a positive role model for many in the community, enforced strict rules for Kovin and his siblings to ensure that they stay focused on their education and personal development, yet explore their own creativity and interests. When his mother passed away when he was 14 years old, he found that, more than ever, he strived to live and internalize the values espoused by his mother: to live with integrity, fight for what you believe, and give back to the community no matter how little you have. From his father he learned about accountability and credibility. His father managed a local soccer club and used his scrupulous recording and reporting operations as a basis to teach his children how to be accountable to and credible within the community. From an early age, Kovin displayed signs of being a leader. He excelled at sports, earning provincial colors for karate, a sport which he believes contributed to instilling in him a strong sense of discipline which has contributed to the many successes and achievements evident in his life. He was a strong student and anti-apartheid activist beginning with his involvement with the youth movement, Helping Hands, an organization which mobilized and assisted the community with various community issues and the accessing of basic services. At the University of Westville-Durban, he was elected to the Student Representative Council and initiated many interventions to assist and develop other students. He led major campaigns against apartheid for which he was detained for eight months. After his release he was house arrested and banned. Between 1989 and 2002, Kovin was awarded various awards and scholarships, including a Fulbright. He has pursued avenues to develop solutions to the eye care system in South Africa, which led to the development of various programs under ICEE. This has created a platform for him to develop innovative means of accessing quality and sustainable means for provision of refractive services and blindness prevention to the poor not only in South Africa, but to over 15 countries in Africa as well.