Smart Focus - Franchising a Sustainable Approach for School Eye Health in China

Boy with glasses in rural China, provided by social enterprise Smart Vision and REAP.

In the June 2016 publication of the EYElliance and World Economic Forum report, "Eyeglasses for Global Development: Bridging the Visual Divide," a case study for REAP's Smart Focus social enterprise was published on page 21. Read the entire report here.

The Rural Education Action Program (REAP), an impact-evaluation organization, aims to inform sound education, health and nutrition policy in China. Since 2011, REAP’s five randomized controlled trials have shown that quality vision care is the most cost-effective intervention for improving child welfare, and leads to large and sustainable increases in learning and school performance, along with positive spillovers to children who don’t have poor vision.

REAP is now establishing a network of for-profit vision centres based at county hospitals through an initiative called Smart Focus. Those centres partner with schools to deliver high-quality vision care. Optometrists administer six hours of training for classroom teachers, enabling the latter to conduct initial vision screenings and refer students needing more advanced care through a highly structured referral system. The teachers are provided free mobile-phone time as an incentive, and the vision centres earn revenue from urban consumers in a cross-subsidization scheme that supports providing care for poorer rural consumers whose unmet need is greatest. To date, REAP has provided access to free or affordable glasses for over 30,000 primary school students and screened an additional 120,000 children.

In addition to screening children and supervising their wearing glasses, teachers play a vital role in communicating with parents. Once a teacher’s screening indicates a child needs glasses, the teacher often spends significant time convincing parents that (a) the child’s condition requires attention, (b) the problem is correctable, and (c) taking the child to the vision centre to get glasses is highly advisable.

Vision centres dispense “first pair free” or very low-cost glasses to rural elementary- and middle-school students, while providing part of the urban market with refraction and eyewear on a fee-for-service basis. Giving away the first pair of glasses is not “just charity”; rather, it provides access to the huge untapped rural market. To build confidence, vision centres unconditionally guarantee the frames for three months and lenses for six months, something that no private optician does. (A noteworthy challenge arises, however, with parents who believe that low-cost or free services must also be of low quality; usage rates and eyeglass prices have been shown to rise in tandem.)

Smart Focus provides county hospitals with management, retail expertise, training and equipment. Critically, the programme assigns a Smart Focus staff member at

each vision centre to coordinate construction and staff training, and to manage operations and logistics, including relationship-building with schools, hospitals and optical suppliers. To date, REAP has built four vision centres with full approval from the county education and health bureaus. As revenues rise, Smart Focus is committed to expanding the network of vision centres to new counties that lack appropriate care.

In addition, and in collaboration with Zhongshan Ophthalmic Center, Smart Focus arranges training in optometry and vision-centre management for three staff members from each centre. Smart Focus also trains nurses as optometrists through classroom instruction and an in-the-field training and mentoring programme. By the end of their training, nurses are certified to refract patients and make glasses, as well as identify more complex but common eye disorders for referral to ophthalmology departments. Further, Smart Focus pays vision centre staff salaries for the first six months during training and mentoring, and facilitates the centres’ purchasing of frames and lenses. Across China, 2,000 county hospitals each serve 400,000 people annually.

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