Sub-Saharan Africa has the highest regional burden of blindness and visual impairment in the world (it has 11% of the world's population, but around 20% of the world's blindness). But simply putting in place more clinically trained manpower alone will not be sufficient to meet eye care needs, say Susan Lewallen (Kilimanjaro Centre for Community Ophthalmology, Good Samaritan Foundation, Moshi, Tanzania) and Amir Bedri Kello (Light for the World, Addis Ababa, Ethiopia). Dedicated managerial support will also be needed, they argue. "Management systems run by professional nonclinical personnel are needed to support clinical personnel so that they can be productive."