I am a co-founder of Kopernik (kopernik.info), the technology marketplace for the developing world. I enjoyed reading this insightful article, and wanted to share my thoughts on the role of the government to scale up eyeglass distribution in the developing world.
In my previous roles working for the UN, I worked with many governments in developing countries, and in most cases, they face major funding shortfalls and lack the necessary human resources and structure to manage and implement basic government services,. Typically the poorer the country is, the weaker its government is.
In such situations, betting on developing country governments to develop a policy to subsidize the cost of eyeglasses, allocate funds, set up the distribution mechanism is simply too much to ask for. There are chronic shortages of basic health facilities and health personnel in the first place. Life-threatening issues, such as HIV/Malaria/TB and vaccine programs are given priority, and even these areas do not get sufficient attention and funding. It would be difficult to imagine that a government in this situation would even consider allocating funds to distribute eyeglasses on a national scale. This doesn’t even happen in most developed countries.
Another thing to consider is that as many developing countries, especially the poorest ones, rely heavily on external aid, and often the big donors have a say in the government decisions. From my experience, such agencies would be hesitant to fund emerging solutions on a large scale, given their natural tendency to avoid risk.
Having said that, I have seen eyeglasses distributed by the government to victims of natural disaster, so it can happen, though it is rare. The point is that while government can play a role, it is unlikely to be a major player in the distribution of eyeglasses in developing countries, and thus unlikely to solve the scalability issue.
As you say, business is a critical player, but typically focused on more lucrative markets - not the poorest, more remote areas. The solution in reaching the last mile population therefore lies in the approach that is referred to in your article. Using philanthropic funding, non-profits can take risks and trial innovative approaches, and prove the positive impact on the people’s life. Non-profits need to be persistent, invent cost-effective distribution mechanism to the last mile using creative partnership with local NGO and microfinance institutions, demonstrate its impact with data, and continue to engage the government, aid community, and businesses, with patience. Non-profit in this scenario plays more active role in serving the unreached.