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.)

CDDRL Mosbacher Director Francis Fukuyama participated the screening of the Children of Men, the 2006 film adaptation of PD James’ dystopian novel, at the event organized by the Future Tense - “My Favorite Movie” series, in which thought leaders host screenings and discussions on their favorite movies with science and technology themes. Children of Men is set in the year 2027, 18 years after the last child was born, due to worldwide infertility. In the video at the top of this post, filmed Sept. 21, Fukuyama expanded on the thoughts he shared at the screening. Watch here. 

The consequences of state collapse anywhere in the world can be devastating and destabilizing for neighboring and even distant countries.

The complexity of each situation demands a tailored response, according to Stanford scholars embarking on a new American Academy Arts & Sciences project to identify the best policy responses to failing states embroiled in civil wars.

A failed state is that whose political or economic system has become so weak that the government is no longer in control. Such instability has already threatened or affected Syria, Libya, Yemen and other polities.

The project, Civil Wars, Violence and International Responses, is led by Stanford’s Karl Eikenberry and Stephen Krasner. Eikenberry is a faculty affiliate at Stanford’s Center for International Security and Cooperation (CISAC) and the former U.S. ambassador to Afghanistan. Krasner is a faculty member in the political science department and a senior fellow at the Freeman Spogli Institute for International Relations and Hoover Institution.

Other Stanford scholars involved include Francis Fukuyama and Steve Stedman of the Center on Democracy, Development, and the Rule of Law; CISAC's Martha Crenshaw, political scientist James Fearon; Paul Wise of the Center for Health Policy and the Center for Health Policy and the Center for Primary Care and Outcomes Research; and Michele Barry, the senior associate dean for global health at the medical school.

The effort will culminate in a two-volume issue in AAAS’s journal Dædalus. On Nov. 2-4, the academy will hold an authors’ workshop in Cambridge, Mass., to discuss journal content.

Different approaches

In an interview, Eikenberry said the problematic U.S. interventions in Iraq and Afghanistan make it clear that different approaches must be used for different countries.

“The robust counterinsurgency campaign that the U.S. employed for periods of time in both Afghanistan and Iraq was premised on the viability of the standard development model that aims to put countries on the path to economic well-being and consolidated democracy,” he said.

However, such an approach assumes that decision makers in those states have the same objectives as the intervening states, which typically seek to improve the lives of people in those countries, said Eikenbery. Prior to serving as the U.S. ambassador to Afghanistan from 2009 until 2011, Eikenberry had a 35-year career in the U.S. Army, retiring in 2009 with the rank of lieutenant general.

As Krasner points out, when intervention occurs, the hope is that improvements in one area – such as the quality of elections, rule of law, economic growth, or military recognition of civilian authority – would lead to improvements in other areas, according to Eikenberry.

But opposition and a constrained sense of “limited opportunities” can arise to thwart a well-meaning intervention, Eikenberry said.

He added, “Information asymmetries and the absence of mutually compatible interests between national and external elites, make it impossible to put target countries on a rapid path to prosperity and consolidated democracy. External actors must have much more modest goals.”

Syrian consequences

As for the case of Syria, Eikenberry noted that such civil wars can actually become more lethal and dangerous to global order than inter-state conflicts.

These types of conflicts like that in Syria tend to escalate into high levels of violence because of the costs that the losing parties believe they will incur, he said.

“This in turn leads to state fragmentation and the possibility of transnational groups with international ambitions getting involved,” he said. “Civil wars can result in an enormous number of civilian casualties, which generates large scale refugee flows” and puts huge pressure on neighboring states.

Eikenberry said Syria is being “internationalized by entangling regional and great powers in proxy wars,” which is exacerbating that conflict beyond Syria and throughout the greater Middle East. As for the immediate, direct threat to the U.S., that debate still continues, he added. 

On that note, one project goal is to assess risks to other countries that may emanate from civil wars and protracted intrastate violence like that in Syria, Eikenberry said. He and his colleagues will examine the effects of  international terrorism, massive displacements of people, proxy wars that escalate to interstate warfare, criminal organizations that displace governments, and pandemics. 

Policy implications

Eikenberry is hopeful the project influences policy and practice toward countries experiencing civil war and violence.

“Facilitating dialogue among a variety of constituencies with knowledge on the dynamics and impact of civil wars that might not normally or directly interact, including government and military officials, human rights organizations, academic and scholarly experts, and the media, will be one outcome of the project,” he said.

The idea is to allow “new ideas to emerge” regarding how to handle such states, as well as methods of applying such findings, he said.

“Exploring ways to create stability and more lasting peace, taking into consideration voices from academic and practical fields, should prove valuable to the policy community,” Eikenberry said.

Following publication of the volumes, the project will convene international workshops aimed at developing better regional perspectives. Such outreach activities will provide the feedback for the publication of another AAAS paper aimed at informing U.S. and international policy and research on the subject. A series of roundtable discussions in Washington is also planned.