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The VISION 2020 initiative aims to eliminate avoidable blindness by the year 2020. Cataract, the main cause of blindness and other visual impairment, is a main focus of this effort. In India, the Aravind Eye Care System provides an impressive model demonstrating how high quality eye care, including cataract surgery, can be delivered to large numbers and made affordable to all. Similarly, financially self-supporting systems have not been developed at this point in sub-Saharan Africa. This paper explores the factors that lead to success at Aravind, and compares and contrasts the conditions in India with those found in much of sub-Saharan Africa. [ABSTRACT FROM AUTHOR]