 Afrika is a huge continent with varied challenges from setting to settings, from country to country, but I would like to start by saying that the major challenge now would be the lack of data, lack of data on refractive services, so it makes planning and implementation and even assessment of implementations very difficult. Another challenge would be the varied human resources providing refractive services. We have some that have been trained for a few weeks to those who have been trained for six years and so the skills in some parts the skills are almost not there and then you have the super skilled ones. Even those who are now trained as optometrists, for instance in some countries where you have a adequate number of optometrists, there is an issue of mal distribution so you have very well trained personnel but they are all crowded in the city areas. And why is this so? Because it is private sector driven and of course because it is private sector driven these optometrists set up their own clinics so that they can make money and we end up having a vertical program more or less. So refractive error hasn't really been embedded in the comprehensive eye care system as it should be. In some countries where for instance in Nigeria and in Ghana where a little bit of refractive error is going on in the public hospitals we still do not have the provision of spectacles. So these are some of the challenges that we have in refractive errors here in Africa. That leads me on to the next part which is you've raised the point of human resources. What have been the progress that has been made in terms of human resource development in Africa? One of the key developments I would say is the existence now of training schools in Africa. So training schools are available now for the French speaking. They are also available for English speaking so there are four year BSE programs in Malawi and there's another one in Uganda that's coming up and Eritrea actually has started graduating students. So this is a very important development and we also have a school in Mozambique for the Portuguese speaking. So this has opened up access to all Africans who intend to study optometry. So this is actually a good development for optometry. It's great to see the development that's being made in terms of human resource training. In your experience and in the Nigerian setting then what would you say is the acceptance of spectacles? How are they received in the community? They are not well received in the communities. Now in the cities and amongst those who are educated yes, spectacles are accepted but quite a large number of people still reject spectacles as a means of treatment. There's quite a lot that needs to be done. There's quite a lot of investment that needs to be done to change these beliefs, their cultural beliefs, sometimes it's the cost, sometimes it's peer pressure, sometimes it could be as a result of not feeling the need to have spectacles on and we also find that some have actually developed kupin skills. So even with large uncleatery factors they are able to carry on life at least to some extent and the thing that is fine. So we still have a lot to do. I would say no. Spectacles are not accepted to a large degree. And thank you for summarising such a huge and vast topic of uncorrective refractive errors. The points that you've raised, the challenges, the barriers they can not just be seen in Africa, we see them globally. So if there were three key messages that you would say are necessary in terms of prioritising refractive error services that are more local, district level, what would you say those are? Nigeria is ready to deploy optometries at the primary IK level. So if I have three take home messages I would mention one that qualified skilled personnel should be at all the levels of care including the primary IK level. Now the second would be to invest in health education and promotion, targeting the barriers that have stood against the optic of spectacles. And then the third would be to recognise that the government and everyone needs to recognise that refractive error is a disability that can be treated and therefore should be part of the national insurance scheme. Thank you Ann for summarising that for us. It's been very informative and it's helped to raise some key points that are needed in terms of overcoming the correction of refractive errors. It's my pleasure.