Africa carries a disproportionate responsibility in terms of blindness and visual impairment. With approximately 10 per cent of the world's population, Africa has 19 per cent of the world's blindness. It is no surprise that this reality also mirrors the situation in terms of the burden of world poverty. There is an increasing recognition of the need to highlight the link between poverty, development and health care. Blindness, disabling visual impairment and the overall lack of eye-care services are too often the result of social, economic and developmental challenges of the developing world. The state of eye care in Africa stands in alarming contrast to that in the rest of the world. Poor practitioner-to-patient ratios, absence of eye-care personnel, inadequate facilities, poor state funding and a lack of educational programs are the hallmarks of eye care in Africa, with preventable and treatable conditions being the leading cause of blindness. Eye diseases causing preventable blindness are often the result of a combination of factors such as poverty, lack of education and inadequate health-care services. The challenge that Vision 2020 has set itself in Africa is enormous. Africa is not a homogenous entity, the inter- and intra-country differences in economic development, prevalence of disease, delivery infrastructure and human resources amplify the challenges of meeting eye-care needs. The successful implementation of Vision 2020 programs will be hindered without the development of a comprehensive, co-ordinated strategy that is cognisant of the differences that exist and the need for comprehensive solutions that are rooted in the economic and political realities of the continent as well as the individual countries and regions within countries. This strategy should recognise the need for economic growth that results in greater state funded eye-care services that focus on health promotion to ensure the prevention of eye disease, the development of eye clinics in hospitals and health clinics, and the training of the appropriate human resources.