pwc.com.au Investing in Vision Comparing the costs and benefits of eliminating avoidable blindness and visual impairment Brian Doolan The Fred Hollows Foundation September 2012 IAPB 9 th General Assembly

Shifting Paradigms in Health Care The Economic Case to achieve VISION2020 goals Too often the costs of poor health are borne by society – eye health is no different Often the monetary hurdles have been viewed as overly high PwC and The Fred Hollows Foundation Investments are therefore both cost effective and sustainable. Indeed, when combined with the broader social benefits, eliminating avoidable blindness is the genuine unpicked low-lying fruit of development policy In pure monetary terms the economic case for achieving the VISION 2020 goals is compelling, the Benefits: Costs Ratio = 4:1 is productivity enhancing Our work sets out to shift this paradigm. 2

Globally, the benefits of eliminating avoidable blindness and visual impairment outweigh the costs by a multiple of Total benefits are estimated to be at least US$522.6 billion from 2011 to 2020, outweighing the additional investment required (US$127.4 billion).... In developing countries......which is equal to a benefit cost ratio of PwC and The Fred Hollows Foundation 3

The series of reports by PwC addressing the costs and benefits of VISION 2020: * Developed in partnership with Three Rivers Consulting The global initiative for the elimination of avoidable blindness The Price of Sight Estimates the global cost of eliminating avoidable blindness and visual impairment* Total investment of $378.9 billion required ($127.4 billion in developing countries) A benefits framework for eliminating avoidable blindness and visual impairment The Value of Sight Estimates the value of benefits associated with the effort to eliminate avoidable blindness and visual impairment* Benefit value of $1,115.4 billion ($522.6 billion in developing countries) Investing in Vision Compares the cost to eliminate avoidable blindness with the corresponding benefits. Benefit cost ratio of 2.8 and 4.1 in developing countries IAPB Conference Presentation of Investing in Vision PwC and The Fred Hollows Foundation 4 We would like to acknowledge the contribution to various phases of this work by key individuals and from the following NGOs:

The benefits of eliminating avoidable blindness and visual impairment far exceed the investment required PwC and The Fred Hollows Foundation 5 Benefits $8.9 per capita (in developing countries) Costs $2.2 per capita (in developing countries) Economic benefits Health benefits Social Investment in primary and secondary health care systems Investment to treat the backlog

Social benefits are weighted towards developing countries Benefits not quantified in monetary terms Reduced Child Morality Increased Primary Education Improved Independence, Self-esteem, & social networks Improved quality of life Reduced extreme poverty Increased gender equality Social benefits will be realised predominantly in developing countries  $ PwC and The Fred Hollows Foundation 6

Future research will help to overcome the data limitations encountered, strengthening the analysis of costs and benefits Key areas for future research that would help to refine future estimates of both the costs and benefits include: Despite the data limitations, sensitivity analysis shows that the benefits of eliminating avoidable blindness and visual impairment substantially outweigh the costs Prevalence yrs Average income and employment for blind & visually impaired in developing world Impact of caring on productivity Current expenditure on eye health services by country Current workforce in respect to eye health and primary care by country PwC and The Fred Hollows Foundation 7

An innovative financing mechanism There is therefore likely to be a key role for donors: For the poorest nations donors can fund the entire package For less poor donors can provide initial financing, with the positive pay-off from reforms being gradually used to offset donor funding Making this Possible Initial Donor support transitioning into self financed Donor financed Self - financed $ $ $ $ PwC and The Fred Hollows Foundation 8 Investment in eliminating avoidable blindness is both cost effective and sustainable. For the world’s poorest countries finding the requisite funds will be a challenge, and for others still it will likely be insurmountable. The only existing barriers are political.

The Fred Hollows Foundation is hosting a Breakfast session Wednesday, 19 September, am Hall A Presentation of the methodology used for the Price of Sight report and the Benefits Framework report, The Fred Hollows Foundation Mr Jeremy Thorpe, Partner, PwC Australia and Mr Marty Jovic, Director, PwC Australia PwC and The Fred Hollows Foundation 9

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