Liat Clark from Wired writes about REAP's vision care social enterprise, Smart Focus Vision, winning the Clearly Vision Prize for startups that bring low-cost vision care to rural communities around the world. Read the original article here.

Smart Focus Vision

Stanford, CA

The US-based startup has partnered with eyewear company Luxottica OneSight to help scale eye care to ten million people in China that do not have access to affordable services. According to research conducted by Stanford University, only one out of six rural children in China has a set of glasses and most rural students have never had an eye exam. The for-profit ran a pilot operation in conjunction with the Chinese Academy of Sciences before launching in the provinces of Shaanxi and Gansu, where it distributes low-cost glasses, trains doctors and teachers, and constructs clinics. Teachers can test vision directly in classrooms and use mobile phones to automate patient referrals and prescriptions. Smart Focus argues the nonprofit route would never have been a sustainable or scalable way of helping the number of children that need eye care.

As well as a share of the prize money, the winners will have access to mentoring and be invited to a series of one-day events - Clearly Labs - around the globe where they can meet optometrists and other entrepreneurs. The campaign has a number of high-profile advisers onboard, including cofounder of Warby Parker, Neil Blumenthal and founder of Shanghai Tang, David Tang, who commented: "Access to good sight should not be a luxury. Yet, 2.5 billion people are still forced to go without clear vision. Radical new thinking is necessary to rectify this.”

Malfrid Braut-Hegghammer, a former CISAC Stanton nuclear junior faculty fellow and Stanford MacArthur Visiting Scholar, wrote a Washington Post op-ed about why some dictators are more likely to get nuclear weapons. Below are the opening paragraphs:

Many dictators have sought nuclear weapons; some succeeded, some came close, others failed spectacularly. A careful examination of two such regimes illuminates why. Today, many dictatorships are becoming personalist, in which leaders dominate decision-making at the expense of formal state institutions. According to recent research, personalist dictators are more likely to pursue nuclear weapons and are less likely to get them, but they can become increasingly dangerous and unrestrained if they succeed.

In my recent book, Unclear Physics: Why Iraq and Libya failed to build nuclear weapons, I revisit the unsuccessful attempts in those two countries. Libya failed badly at its nuclear-weapons program, whereas Iraq came dangerously close to a major breakthrough when its program was interrupted by the 1991 Gulf War cease-fire.

Using documents and interviews with scientists, doctors, journalists, academics, military officers and ex-officials, I reconstruct the history of both countries’ nuclear programs. The stories that emerge challenge key assumptions in the conventional wisdom about these projects and regimes. At the same time, this account brings important differences between the two cases to light.

Personalist leaders weaken their states to concentrate power in their own hands, but they do so in different ways. Saddam Hussein fragmented Iraq’s state apparatus, whereas Moammar Gaddafi dismantled Libya’s state institutions. Such strategies weaken states in distinct ways, which affect their capacity to build nuclear weapons. Gaddafi’s efforts to create a “stateless state” were particularly damaging. Personalist dictators use different strategies to manage their nuclear programs. But they share some common challenges, as weak state institutions make micromanagement very costly and oversight difficult. Read more.

Braut-Hegghammer is now an associate professor of political science at the University of Oslo.

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.)