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Keep it simple!

Interview with Professor Allen Foster about his experience of the impact of planning on the prevention of blindness.
DAKSHA PATEL: Professor Foster, you have been involved in eye care programmes for the last three decades. In your experience, what would you say has been the strength, the impact, of planning for prevention of blindness over the years.
ALLEN FOSTER: Thanks Daksha, I think to answer that question I have to kind of go back what impact it’s had on my life and to kind of explain that. So when I started, I was a young doctor, and I went to Tanzania and was an ophthalmologist. And for five years, I was working as an ophthalmologist, helping a lot of people, but basically doing clinics, doing theatre lists, routine day after day after day, without actually thinking about what difference is it making. And then, after five years, I came back to England. I was doing some more studies. And I was on a course and the question was asked, what do you want to achieve before you die.
And that question really hit home to me. Was I going to have a life that was just busy doing doing? Or did I actually want to achieve something and leave something behind, leave a legacy? So when I went back to Tanzania, I tried to put that thinking into action and began to think about, well, how do we want to plan the services at the hospital. How could we make them better? And how would they carry on when I left? And then, from that, I started working with the Tanzanian Ministry of Health and looking at eye services in Tanzania and how to plan those, so that they were more equitable for people and more available.
And then, subsequently, after I left Tanzania, I had the opportunity to work with CBM internationally, and to visit many countries, and start thinking about the problem of global blindness. And the fact of the matter is 75% of blindness is avoidable. And so planning starts with why are you doing it. And the why was blindness is avoidable. Therefore, we have to do something about it. And instead of just doing, doing, doing, it was to plan services either locally, or at a district level, or at a country level, or internationally, but in order to achieve overcoming the problem of avoidable blindness, and thereby leaving a legacy for those who come after us.
DAKSHA PATEL: What would be your key take-home messages for anyone who has done this course and is working at a district-level hospital?
ALLEN FOSTER: So key take-home message, I think one of the dangers is sometimes we over-complicate things. So there’s this idea of planning has to be a huge document and with objectives and strategies and all sorts of words and so on. So I think my key home message would be, first of all, keep it simple. Make it understandable. You identify a problem, and you want to see that problem addressed. You want to see change. And then, how are you going to do that? And then do it. You keep it simple. Second, step by step, do it bit by bit. Achieve the first step, and then the second step, and then the third step.
Don’t try and make any big five-year plan, where you’re kind of thinking about all the resources that you need. And you end up with a huge document, and then nothing happens afterwards. So identify the problem, identify the change, keep it simple, go step by step. Remember, it’s about people and not about paper. It’s about getting people to work with you on it, a team to address it. There’s a very famous African saying, which is “how do you eat an elephant?” So the problem is how to eat an elephant. And the answer is you do it mouthful by mouthful, bit by bit, step by step, but with your friends. You can’t do it alone. You have to have people with you.
So you have to share the vision, share the idea, and then work together to address it. Keep it simple, step by step, with your friends’ teamwork. Essence of planning.
In this step Daksha speaks with Professor Allen Foster, co-director of the International Centre for Eye Health at the London School of Hygiene & Tropical Medicine, about his personal experiences of the impact of planning for the prevention of blindness. Professor Foster also shares his key take home message for anyone involved in the delivery of eye care at the district level.
As you watch, think about planning and management for eye care in your own setting. Planning can be regarded as multi-staged and complicated. What could you do more simply to make a difference for blindness?

About Professor Allen Foster

Professor Allen Foster, originally from Lancashire in the UK, graduated with Honours in Medicine from the University of Birmingham in 1973. He was a general medical officer in Mvumi Hospital in Tanzania from 1975 to 1985.
During his time there Allen helped develop a national eye care plan, and with support from Dr Joseph Taylor and CBM, he established a clinical training program for doctors and ophthalmic assistants training over 200 people from all over Africa.
After 10 years in Tanzania, he returned to the United Kingdom to work for CBM as their International Medical Director, based at the Institute of Ophthalmology in London. His unique experience of an academic research and teaching base in London, combined with overseas exposure to eye care delivery on three continents facilitated the development of training courses in Community Eye Health, both in the UK and in low income countries. Allen was also closely involved in the development of the VISION 2020 strategy and global initiative.
Allen moved to the London School of Hygiene & Tropical Medicine in 1999. In 2006, Allen was appointed CBM President and CEO, positions he held until 2013. Today he continues his work as co-director of the International Centre for Eye Health at the School.
Allen maintains an interest in research, working on blinding eye diseases in children, ocular infections, and cataract services. He has numerous publications and several international awards, but is best known as a passionate advocate and teacher of VISION 2020.
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Global Blindness: Planning and Managing Eye Care Services

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