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Action for the next decade in eye care

Action for the next decade in eye care
SPEAKER: What next for eye care? Building on the lessons learned and achievements of the first decade of VISION 2020, it is important that the momentum of action is scaled up. In this session, we will look at the proposed plans for the next decade in eye care. By the end of this session, you should be able to understand the principles and goals of universal eye health, know the key concepts in health systems, evaluate the global action plan 2014 to 2019, and apply global concepts at the local level, regional, national, and district. As the VISION 2020 initiative has moved forward it has become apparent that it faces some key issues.
Stronger service delivery is needed for the growing numbers of patients with diabetic retinopathy and glaucoma. More blindness prevention and early case detection is needed to reduce the number of blind years people experience, especially children. And more trained personnel in eye care are urgently needed at all levels, and especially in Africa. The VISION 2020 initiative set a target of four eye doctors per million population for Africa by 2010. But this has not been achieved in all regions. It is also very low compared to other areas. For example, India and China have between 10 and 20 eye doctors per million population.
Within Africa, the numbers of eye doctors vary from five per million population in South Africa to less than one per million in some Francophone and Lusophone countries. The distribution of eye doctors is also a challenge as most work within cities despite the bigger population and need being in the rural settings.
Following the World Health Organization’s directive on Universal Health Coverage, the International Agency for the Prevention of Blindness, the IAPB, has adopted the universal eye health approach. And this is defined as ensuring that all people have access to needed promotive, preventive, curative, and rehabilitative health services of sufficient quality to be effective whilst also ensuring that people do not suffer financial hardship when paying for those services. In other words, all people should enjoy access to the best quality eye care without risk of impoverishment. Applying the principles of universal eye health and eye care programmes means that services need to be made comprehensive for all eye diseases and vision impairments.
Services also need to be equitable, that is available to everyone, whether urban or rural, male or female, young or old, rich or poor, or whether they are isolated or disabled. Varied models of care are needed to achieve this. For example, outreach screening and referral, or surgical outreach, or telemedicine. The models of care used by any eye care programme must be in line with the existing health system. And this is to help ensure that the programme does not run as a separate vertical service, but is recognised as part of the health service delivery mechanism to prevent, treat, and rehabilitate with the best quality.
Financing of eye care varies within health systems, but it is important to ensure that services are affordable by everyone.
There are several challenges to delivering universal eye care at the local level. At a community level, it is essential to break down barriers and make services both accessible and affordable. Eye care providers need to consider methods of outreach to reach blind and visually impaired people in rural areas. This will cater for ageing populations and increase output for cataract surgical services. Eye care services also need to become aware of, and plan for, the growing challenge from emerging non-communicable diseases, such as diabetes and glaucoma.
To support the implementation of the universal eye health approach IAPB has developed a global action plan. This aims to reduce the prevalence of avoidable blindness worldwide by 25% between 2010 and 2019. And this target will be achieved through strong and equitable health systems. To strengthen health systems three key areas must be addressed. Local data is needed to identify needs and priorities, gaps and inequities at community level. This is done through rapid assessment surveys and local data collection. More eye health workers must be trained and the workforce must be distributed appropriately. Training must also be strengthened to ensure excellence in service delivery. And eye care services must become more comprehensive covering prevention, promotion, treatment, and rehabilitation services.
Three indicators will measure whether the action plan’s target is achieved. Evidence on the prevalence and causes of visual impairment, numbers of eye care workers and their distribution, and the outputs of service delivery. As cataract is the main cause of blindness, this indicator will be measured through cataract surgical rate and cataract surgical coverage. What is the health systems approach? Integrating health care activities into a health system is important. A health system is how people, resources, and their actions are organised to promote, to maintain, and restore health. A good health system provides for day-to-day use, but also has planning in place to anticipate and manage risks, such as a natural disaster, for example.
The World Health Organization’s model of a health system has six key blocks. Governance, ensuring key leadership and responsibility mapping, planning, and setting of targets. Health personnel, delivering appropriate numbers and distribution of health worker cadres. Health financing, financing and managing income and expenditure. Medicines and technology, providing adequate infrastructure and supplies. Information systems, ensuring good governance with good information. And finally, service delivery, providing equitable, excellent, and economically sound services. Monitoring these blocks provides insight into the overall quality of the health system. The six blocks can be seen as cogs in a wheel all working together to create a strong health system.
In summary, universal eye health has clear and specific goals, which build on the achievements of the VISION 2020 initiative. There is more responsibility at government level and the global action plan relies on health system strengthening to deliver a comprehensive eye care service. And finally, equity is the key to all universal eye health activities.

What’s next for eye care? It is important to build upon the achievements and lessons learnt in the first decade of VISION 2020: The Right to Sight, and increase momentum for further action.

In this step we look at the plans to scale up global eye care in the next decade through Universal Eye Health and the eye health systems approach.

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Global Blindness: Planning and Managing Eye Care Services

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