Capacity building of 7 Country Directors on Human Resources for Eye Health Development of Eastern and Southern Africa . Country directors or representants of South Sudan, Malawi, Kenya, Uganda, Zambia, Zimbabwe and Mozambique. RMT

1. HREH SESSION
Adidja AMANI, MD MPH
HReH focal person at Sightsavers

2. The Outline of the HReH session?
 where we have come from
where we are right now
where we want to go

3. Expectations of CDs…
ZAMBIA MOZAMB. UGANDA S. SUDAN KENYA MALAWI
Learning on how
other countries are
ensuring that the
staff trained are
retained in the
programme areas
Know better the
work in progress
An update on where
we are with the
implementation of
the HReH strategy Have more insight
into the support for
Training
Learn more on the
organizational
strategy for HRD
Detailed HReH plan
for Sightsavers
learning of
possibilities of
bonding the staff
from MOH on the
training
programmes
Find synergies to
continue to develop
HR in Mozambique
Funding
opportunities for
HReH, especially the
more costly
infrastructure
development for
training institutions.
Information on
Training institution
for orthopist
training
institutions, the
minimal
requirements for
entry and the
tuition fees
Learn from the
experience of others
how they have dealt
with some of the
problems facing
HReH in Kenya
Detailed advocacy
strategy for
government support
towards HReH
Development
learning from
others in general
Advocacy
component – what
is the level of
influence HReH
Priorities on the way
forward.
Information on
optometrist
training
institutions, the
minimal
requirements for
entry and the
Funding opportunities
for HReH
ADVOCACY
Update on the
HReH strategy
FUNDING/
support for
training
Learning from
others

4. At the end of this session, CDs will be able to:
1. Be at ease with the various tools
2. take forward its own unique
strategy to address the HReH crisis
3. design a framework plan for HReH
section of the new CSP
4. give constructive feedback on the
toolkit

5. “Silver bullet” question
Where would you aim if you had only one
bullet? And why?

6. THE EYE HEALTH WORKFORCE
CRISIS IN AFRICA: A SYSTEMIC ISSUE
Adidja AMANI, MD MPH
HReH focal person at Sightsavers

7. OUTLINE
 The health worker in the health system
What is the Current situation of HReH in ECSA?
 Why is the (eye) health workforce in crisis?

8. Who are the health workers?
 health workers : all people engaged in actions whose
primary intent is to enhance health (WHO, 2006)
www.who.int/whr/2006/06_chap1_en.pdf‎
 health workers : all people engaged in the promotion,
protection or improvement of the health of the
population (Adams et al., 2003: 276; Diallo et al., 2003)

9. Why are eye health workers equally important?
 Outreach services, hospitals are only as good as the people who staff them
 Eye health is overwhelmingly worker-dependent
 The only route to reach better eye health is through eye health workers. They are no
shortcuts
 Medical equipment, supplies, facilities, and medication will be wasted, without a
trained workforce
 HReH are the ultimate resource in health because they manage and
synchronize all other health resources, including financing, technology,
information, etc.
 Eye health workforce crisis must be addressed to achieve
 stronger health systems,
 universal access to health services, and
 greater improvements in actual health outcomes.

10. It is the health worker who glues these inputs together into a
functioning health system
 the health worker,
the most neglected
yet most essential
building block of
effective health
systems

11. increase in the density of qualified health workers has a positive impact on health
outcomes. However, most African countries that have a high disease burden continue
to face severe shortages of health workers
The power of the health worker

12. The eye health workforce crisis in Africa – WHY?
 Africa has the most severe health workforce shortage in the world.
 Of the 57 countries identified as facing HRH crisis (health workforce density ratio
below 2.3 per 1000 population), 36 are in the African Region (The World Health Report 2006 )
ROOT CAUSES:
 Two decades of health sector ‘mis-reforms’ treated health workers as a cost burden,
not an asset: structural adjustment policies, health reforms imposed ceilings on staff
numbers and salaries while capping investment in higher education and training.
 most donor projects shy away from investing in people for the long term
 Tendency to finance technical assistance and short-term training
 the workforce, commanding the largest share of the budget, is the least strategically
planned and managed resource of most health systems.

13. The impetus….
We have to work together to
ensure access to a motivated,
skilled, and supported health
worker by every person in
every village everywhere.”
LEE Jong-wook , November 2005

14. 02468
Seychelles(2005)
Gabon(2005)
SouthAfrica(2005)
Mauritius(2005)
Namibia(2005)
Botswana(2005)
SaoTomeandPrincipe(2008)
Zambia(2005)
CapeVerde(2008)
Nigeria(2008)
Swaziland(2009)
Kenya(2007)
Angola(2005)
Sudan(2007)
Mauritania(2009)
Ghana(2008)
Congo(2008)
Zimbabwe(2008)
Benin(2008)
DRC(2009)
EquatorialGuinea(2005)
Eritrea(2008)
Uganda(2007)
BurkinaFaso(2008)
Comoros(2008)
Rwanda(2007)
Guinea(2005)
Guinea-Bissau(2009)
Lesotho(2005)
Gambia(2008)
Madagascar(2005)
Cameroon(2009)
Mali(2008)
Coted'Ivoire(2008)
Senegal(2008)
Mozambique(2007)
Togo(2008)
Tanzania(2007)
CentralAfricanRepublic(2009)
Ethiopia(2008)
Liberia(2009)
Malawi(2008)
Chad(2009)
Burundi(2005)
Somalia(2006)
SierraLeone(2009)
Niger(2009)
Source: WHO/Global Atlas

15. Severe shortage of eye health workers – Linguistics zones …
POP.
MILLIONS
OPHTHALMOLOGISTS RATIO ArHPs Ratio
ANGLOPHONE 432 1,137 1/380,000 2,751 1/157,000
FRANCOPHONE 262 492 1/532,000 1,745 1/150,000
HORN OF AFRICA 100 118 1/847,000 188 1/627,000
LUSOPHONE 46 35 1/1,275,000 88 1/522,727
TOTAL 841 1,786 1/470,000 4,772 1/176,000

16. © Sightsavers
How many exactly? Health pyramid
LEVEL TYPE DESIRED RATIO
(Default targets)
NEEDS CURRENT
ESTIMATE
GAP
TERTIARY OPHTHALMOLOGIST 1/250,000 4,000 1,786 2,214
SECONDARY ALLIED EYE HEALTH
PROFESSIONALS
1/100,000 10,000 5,000 5,000
PRIMARY PEC 1/10,000 100,000 10,000 90,000

17. If densities of doctors across urban and rural areas were similar, the
points (one point represents one country) would all be close to the
“equality line”. Densities are much higher in urban areas,
explaining why all points are above the “equality line”.
Guinea
Mauritania
Chad
Mali
DRC
Ethiopia
Mozambique
Sudan
Uganda
Senegal
Niger
Rwanda
Kenya
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
0 0.5 1 1.5 2 2.5
Numberofdoctorsfor10,000persons(URBANarea
Number of doctors for 10,000 persons (RURAL areas)

18. Many reasons for crumbling eye health system…
 Policy dialogue among line ministries, stakeholders and partners remains limited
 Investment in HReH in most countries is generally inadequate
 The resources mobilized internally are not enough for production and employment
 Few countries have developed or implemented policies and strategies for retention
and good performance of available health workers
 The current output of HReH does not meet the requirements for delivering quality
eye health
 The capacity to generate, analyse and use HReH data for policy-making is still
inadequate
 Data on the exact numbers and skill mix remains fragmented
 skewed geographical distribution rural/urban areas
 inappropriate skill mix and migration of skilled eye health workers.

19. Many reasons for crumbling eye health systems…
• No agreement on cadres: job, registration
• Too few applicants for some cadres, V2020 targets not met e.g:
Uganda
• Career paths lacking e.g: Malawi
• Unsuitable placements after graduation
• No funding, eye health not a MoH priority e.g: Mozambique
• Areas without training institutions e.g: South Sudan
• Equipment supply and repair e.g: Zambia
• No link between ophthalmology training programmes and mid-level
eye care training programmes (thus, disconnect between HR
availability and needs in the field)

20. By cadres..
Ophthalmologists – All-rounders or sub-specialists – or both ?
Optometrists – Public or private – or both. Role of OTs ?
Cat. Surgeons – Most heavily contested
ONs – Degree or competency based ?
OCOs – Backbone ?– task sharing ?
OMAs – Is it worth continuing with them ?
PEC – Health seeking behaviour or outreach ?
CEHWs – Vertical or integrated ?

21. Challenges in HReH Development identified by CDs
ZAMBIA MOZAMBIQUE UGANDA S. SUDAN KENYA MALAWI Addressed?/6
Shortage of Human
Resource
training of Ophthalmic HR
Inadequate
numbers and skill
mix.
No Training institutions for
Ophthalmologist
Interesting middle level
medical personnel in taking
up eye-health as an area of
specialization;
Government funding for
training of eye health
professionals
5
Inadequate
infrastructure for eye
health
leakage of existent
Ophthalmic HR to private
sector and NGO’s
Urban-rural
disparities
Few ophthalmologists
Increasing the numbers of
different cadres of eye-
health workers
Inadequate capacity of
training institutions, e.g.
Malawi College of Health
Sciences
3
Very Inadequate
consumables
right composition of the
Ophthalmic Team (new
cadres)
Insufficient training
capacity or lack of
it for some cadres
No sub-specialist in
Ophthalmologist
Inadequate numbers of Eye
health workers versus V2020
requirements
3
Delayed
implementation of
eye health structure
by the government
V2020 National Plan
Low attraction and
retention of health
workers with the
right skill mix
The mid-level cadres within the
country have not yet been
included into the Public
Services remuneration grading
system
Equitable distribution of
eye-health workers
countrywide Unclear career path for eye
care cadres
3
Inadequate transport
MoH budget line for
ophthalmology
Unpopularity of
ophthalmologists
among graduate
The infrastructure for eye care
services inadequate
Lack of basic eye health
equipment in district hospitals
1

22. Half full
Half
empty

23. The extent to which Eyehealth is mentioned in National Health &HRH Plans
Not Mentioned Limited Moderate Eye-Health is a listed focus area
Health HRH Health HRH Health HRH Health HRH
Gambia
Kenya
Moz.
Kenya
Gambia
Mali
Moz
Nigeria
Tanzania
Uganda
Zambia
Malawi
Nigeria
Zambia
Sierra Leone
Sth Africa
Benin
Burkina
Sierra Leone
Sth Africa
Zimbabwe
Cameroon
Malawi
Cameroon
Ghana
Liberia
Mali
Sierra Leone
Tanzania
Uganda
Zimbabwe
It is important to note that limited or no mention of eye-care in the National Plan is not necessarily
reflective of countries level of engagement with the Ministry of Health

24. Eye-health mentioned in National Health and HRH plans
0
1
2
3
4
5
6
7
8
9
Not Known No Mention
in Plan
Limited
mention in
Plan
Moderate
mention in
Plan
Focus Area in
Plan
Health Plan
HRH plan

25. Key messages:
 a production challenge
 an underutilization
challenge
 a distributional
challenge:the rural-urban dimension,
region, income, sector (public/private for-
profit/ private not-for-profit or a mix of
these)
 a performance challenge,
refers to the fact that the quality of the
work performed by health care
professionals
 a financing challenge

26. Don’t forget….
patient
Adequate HR:
Numbers
Skills
Competencies
Minimum
Infrastructure
Services
Delivery
Regular &
Adequate
Supply of
Essential
Medicines &
Supplies
National &
Nation-wide
Strategy
Guidelines &
Protocols
Service
 Status
 Salary
Satisfaction
 Stability
 Security

27. Adidja AMANI, MD MPH
HRH focal person, SIGHTSAVERS
SIGHTSAVERS’ STRATEGIC RESPONSE
to the Human Resources for Eye Health Crisis in
Africa

28. Strategic alignment externally…..

29. Strategic alignment Internally…
Nigel Crisp,
the inspirer
Caroline
Harper,
The Commissioner
Ronnie Graham,
HRH Director
10-Year Strategy to respond
to the HReH Crisis in Africa

30. RECAP….

31. Eye health is on a unique journey in Africa…
 From sight restoration through prevention of blindness
to eye health
 From vertical/parallel approaches to HSS
 From disease control to comprehensive eye health
 From top-down to bottom-up
 From INGO led to government led
the process of strengthening the eye health work force from a
specific historical situation, characterised by:
 Fragmentation
 Weak evidence base
 Donor dependence
 Disease specific focus
 Dominance of tertiary/curative thinking

32. SHIFT….
Eye health strategy meeting-21-23 November2012
From: To:
× Focusing on blindness and disease control  Focusing on comprehensive eye health
× Building capacity for individual projects  Building capacity to meet national needs
× Being a fragmented eye health sector  Being a united and collaborative eye health
sector
× Having programmes led by INGOs  Having programmes led and owned by
governments
× Emphasising programme implementation  Emphasising advocacy – to change the systemic
barriers to effective HReH
× Working in isolation from other health sectors  Working beyond the ‘usual suspects’ to engage
with wider health and HRH initiatives.
× Taking a ‘vertical’ approach, with  Taking comprehensive approach, with attention to

33. The Vision
Vision:
All people in Sub-Saharan Africa experience good
health and reduced morbidity – through access to a
comprehensive, high quality and sustainable eye health
workforce as part of strong national health systems.

34. Vision:
All people in Sub-Saharan Africa experience good health and reduced morbidity
– through access to a comprehensive, high quality and sustainable eye health
workforce as part of strong national health systems.
Goal:
To contribute to achieving a comprehensive, high quality and sustainable
eye health workforce in Sightsavers-supported countries
and more widely in Sub-Saharan Africa by 2022.
Objective 1:
The right number
Objective 2:
The right quality
Objective 3:
The right training
Objective 4:
The right balance
To support 24
countries in Sub-
Saharan Africa to
achieve their
national targets
for the eye health
workforce by 2022
- as an integral
part of strong
national systems
for human
resources for
health.
To support
countries where
Sightsavers works
to address the key
challenges that
limit the provision
of appropriate,
accessible and
high quality
services by the
eye health
workforce.
To strengthen
national and
regional training
institutions and
systems to ensure
the appropriate
scale, quality and
responsiveness of
the eye health
workforce.
To accelerate
investment in
Francophone and
Lusaphone
countries –
addressing their
specific needs and
shortages and
contributing to
significant
progress towards
their national
targets for the eye
health workforce.

35. Objective 1: To support 24 countries in Sub-Saharan Africa to achieve their national targets for the eye
health workforce - as an integral part of strong national systems for HRH
 In each of the 16 countries where Sightsavers works:
1. national situation analysis on HReH to identify key gaps in the eye health workforce and
interventions to address them.
2. Contribute to the Development of a costed national HReH plan to address the key gaps in the eye
health workforce
3. integration of the national HReH plan into the HRD through the CCF
4. advocacy to the government and other key national stakeholders to fully resource and implement the
national HReH plan.
 At regional and global levels:
 advocacy and resource mobilisation among donors and other key stakeholders to secure fund to
implement national HReH plans.

36. © Sightsavers
Priority 1: The number of the eye health workforce
address existing shortfalls in number of eye health workers at all levels
include the scaling-up and strengthening of:
–Ophthalmologists and sub-specialists.
–Optometrists.
–Allied Eye Health Professionals.
–Primary and Community-Level Eye Health Workers.
Priority 2: The quality of the eye health workforce
to address the range of issues that affect the quality and impact of the eye health workforce–
task-sharing, incentives and accreditation – are made within the context of overall national strategies for
HRH and HSS

37. Objective 2: To support countries where Sightsavers works to address the key challenges that limit
the provision of appropriate, accessible and high quality services by the eye health workers
– national situation analysis to identify and prioritise the key limits affecting the eye
health workforce
– Advocacy to the government and other key national stakeholders to address the
key limitations wider national HRH plans.
At regional and global levels:
– Conduct and compilation of research of ‘what works’
– regional and global advocacy to multi-lateral and bi-lateral stakeholders to
integrate HReH issues within broader HRH strategies
– partnership with all relevant stakeholders

38. Objective 3: To strengthen national and regional training institutions and systems to ensure the
appropriate scale, quality and responsiveness of the eye health workforce.
Strengthening specialist training institutions and systems for HReH
 Situation analysis to identify and prioritise gaps in specialist training institutions and
systems for eye health workers;
 mapping of institutions, stakeholders, policies and facilities.
 Development of a national plan to respond to the priority gaps in specialist training
institutions and systems for eye health workers
 Advocacy to the government and other key national stakeholders to address the
priority gaps
Mainstreaming eye health into training systems for other health workers
:
– focusing on identifying and addressing gaps in relation to the integration of
eye health into general HRH training institutions and systems

39. © Sightsavers
 severe shortages in eye health training institutions which are under-
funded ,under-subscribed, short-staffed, lack of equipment, etc
 a need to work with the education sector more broadly to ensure that
HReH training and planning is systems-based.
 will also require the strengthening of eye health training within the
training of general health workers.
 CPD remain largely uncoordinated, partial and under-resourced
The training of the eye health workers

40. Objective 4: To accelerate investment in Francophone and Lusophone countries – addressing their
specific needs and shortages and contributing to significant progress towards their national
targets for the eye health workforce
 Francophone or Lusophone region or group of countries:
 Situation analysis to identify and prioritise the specific challenges affecting the investment
imbalance in the eye health workforce= Francophone strategic plan available
 Development of an action plan to address the specific challenges.
 Building of strategic regional alliances and build awareness and action on the imbalance.
 Building of capacity of Sightsavers own country offices, on strategic advocacy
 At the regional and global levels:
 Implementation of intensive advocacy within regional institutions (such as AP/HRH, RHA,
AFDB, AU ,WHO and GHWA to address the investment imbalance
 Acceleration of resource mobilisation from international donors

41. How can we achieve these 4 objectives ?
 By cadre – work with WHO, professional bodies,
 By country – CCF process, HAF, HSS, country strategies
 By institution – engage, evaluate, invest
 Through advocacy – Influencing different domains
 GLOBAL: GHWA, WHO, IHP+, G8 etc
 REGIONAL: WHO-Afro, AP/HRH, AfDB, RHAs
 NATIONAL: HRH Departments, MoH, MoE, MoF
 With partners – strengthen our work with HRH Departments, civil
society

42. © Sightsavers
Levels
Sightsavers strategic approaches
District
Country
Regional
Global
 Demonstrate scalable cost-effective approaches. The HR of eye health-specific projects to
providing models and action to address the national HReH crisis within the context of wider
action on HRH and health systems strengthening.
 Ensure high quality programmes based on evidence
 Develop effective partnerships. By collaborating with stakeholders in both the eye health and
mainstream health sectors at all levels: GHWA, HRD/MOH AP/HRH
 Develop effective and joined-up advocacy by emphasising strategic advocacy to ensure pro-
HReH policies within the context of action on wider HRH and health systems strengthening.
 Establish strong strategic networks and alliances by taking a leadership role, mobilising
coalitions and ensuring synergies with other like-minded stakeholders from all sectors.
 Gather and disseminate sound research and evidence by collaborating with others and
maximise our own evaluations to identify and share evidence of ‘what works’ in HReH.
 Mobilise significant additional resources
 Use resources strategically and efficiently. emphasise financial sustainability

43. Our added-value….
 organisational strategy and priority. Sightsavers frames its attention to HReH within a
comprehensive organisational strategy that emphasises HSS and the building of national,
government-d responses
 A progressive approach. moved ‘out of the blindness box’ to address comprehensive eye
health and HReH within the context of wider strategies for HRH and HSS
 Emphasis on scalability and cost-efficiency. Sightsavers emphasises the identification of
models and approaches to address the HReH crisis that can be scaled-up
 A ‘seat at the table’. Sightsavers is actively involved with key mechanisms and
advocacy opportunities to address the overall HRH and HReH crisis CCF at
country level
 Research, innovation and good practice through research and learning from
recent evaluations
 Working in partnership. strategic partnerships with key stakeholders at the global level
(such as WHO, IAPB and the GHWA), at regional level (AP/HRH, the WHO Afro, African
Health Observatory) and at national level with MOH/e

44. © Sightsavers
 Strategy needs to be country specific, rooted into a critical analysis of
the real constraints rather than in generic advocacy
 Ensure that support truly contributes to sustain national efforts to
develop an adequate health workforce
 Align our work with national government plans rather than developing
parallel systems- not silo programs
 Partner with MOH and MOE in all the countries
 Make better investment decisions
 Expand our research work, so we are confident that we speak not just
with conviction but on the basis of hard evidence

45. The toolkit
FROM SYSTEMIC PROBLEMS
TO SYSTEMIC SOLUTIONS

46. Target audience
 Target audience: CD, PM,Pos.. Other stakeholders
(NGO community, Ministries of Health and
Education
 Country Directors are in a unique position to make
THE DIFFERENCE

47. 1- Country Coordination and Facilitation
2- Rural and Remote areas Retention
3- The Onehealth tool
4- HRH Action Framework
5- Planning Checklist
6- Country Actions
47

48. Some homework to do beforehand …
48
 Does the country have a strategy or plan for HR? Is it updated?
 Does the country have a HRD or management unit within the MoH?
 Does the existing staff correspond to the target staffing levels?
 What kinds of tools/methods of planning are used by MOH?
 Does an established cycle exist for planning, implementation and
evaluation in the health sector?
 Which stakeholders should be involved in the development of the
HReH plan and which ones should be consulted?

49. HReH analysis of the situation
 aims to ensure that policy positions are informed by
concrete evidence gathered either from programme
work on the ground, or through reviews of literature
that is available
 A good test for determining whether you’ve identified
a truly systemic problem is to ask yourself “Why?” at
least five times. Such a series of questions forces you
to keep going until you reach the truly systemic cause.

51. CCF is documented in some countries…
51

52. Several published Case studies on CCF...
52
 Eritrea
 Indonesia
 Nepal
 Nigeria
 Pakistan
 Sudan
 Zambia,
 Zimbabwe
 etc

53. Stakeholder HRH Position Power
Governmental
Ministry of Health Increased HRH production, higher wages, more training High
Ministry of Health (sub-national level):
hospital/clinic managers
HRH stock, wage bill, tenure, training Medium
Ministry of Education Higher HRH production / some pre-service training Medium
Ministry of Finance; Ministry of Planning Limit wage bill for HRH High
Civil Service Agency Limit wage bill and restrict HRH to public sector rules High
Local governments HRH stock / wage bill and/or employment (sub-national) Low
Non-governmental
Professional associations / unions
(Physicians, nurses, pharmacists, etc.)
Limit HRH production, increase wage bill, restrict non-
professional roles
Medium to High
NGOs (national/international) HRH production, stock, wage bill, tenure, training Low
International institutions (donor, technical
assistance agencies)
Increase HRH production and wage bill, special interest in
HRH for specific disease programs
Medium to high
Media Report on conflict and poor performance; often ignore reform
proposals
Low to medium

54. EDUCATION
FINANCIAL
INCENTIVES
PROFESSIONAL
SUPPORT
• Supportive
supervision and
mentoring
•Implement
appropriate
outreach
activities
•
•Senior posts in
rural areas
54

56. Why Planning HReH?
 Planning means building a bridge from where you are now to where you want
to be when you have achieved the objective before you
 HWs are not fungible, optional, or immediately available on demand
 The function of planning meets the group’s need to accomplish its task by
answering the question how. But the ‘how’ question soon leads to ‘When does
this or that have to happen?’ and ‘Who does what?’
 Because of limited resources, it is important to accurately estimate the number
of health workers required to meet the eye health care needs, as this will help
governments and donors make prudent health systems spending decisions

57. HReH planning
57
 Clarify the purpose of the planning and how it contributes to the HReH strategy
 Plan the planning: external expertise needed? Which stakeholders involved?
 Agree on the methods for determining the numbers and types of staff
 Identify data required and collect from existing databases
 Analyses Supply: audit of the existing staff and anticipate flows in and out
 Identify tools for analysis
 Analyse the data and develop projections, Present findings to key stakeholders;
agree on targets and explore strategies for achieving it
 Establish indicators for monitoring and evaluation and reporting mechanisms
 Incorporate into the wider HR strategy

58. 6- ADVOCACY TOOL FOR HReH ?
 systems are unlikely to change to accommodate eye
health, So we need to change to be accommodated
by health systems
 Neglecting the workforce wastes all other resources
 In order to be effective, the advocacy will target the
right audiences, using appropriate forums and
relevant channels and delivery mechanisms
 HWs is one of the best investments, with considerable
returns on investments in the health, education, and
economic sectors.
Key advocacy messages

59. Possible advocacy research priorities….
TOPIC PURPOSE
Determine economic evaluation of eyecare
interventions in comparison to other competing
health burdens: cataract – age related , refractive
errors , childhood cataract , trachoma (i.e. 60-
70% of global blindness; all ages & both
genders)
To provide data for advocacy through demonstrating the economic
& social rationale for increasing resources to strengthening national
eyecare programmes
Determine total costs & benefits of investing in
eyecare, i.e. positive economic rates of return
To demonstrate that investing in eyecare is a good investment from
a national development perspective
Determine the benefits of eyecare To provide government & donors reassurance that their investment
has positively changed lives & impacted the MDGs
Document examples of sustainable eyecare To demonstrate to donors & governments that eyecare programmes
have the potential to be sustainable
Document examples of successful programmes To demonstrate to donors & governments that eyecare programmes
have the potential to be successful in terms of the attributes of
health systems
59

60. Step 1:
Analysis
of the
situation
Step 2:
Planning
Step 3 :
Integratio
n and
resource
mobilizati
on
Step 4:
Implement
ation
Step:
M&E
6- COUNTRIES ACTIONS
HRH 10 Year strategy meeting, Nairobi October 2012
60

61. In Saudi Arabia, sentences are read from right to left and not from left
to right so people read the advert in the opposite direction.
Lesson – No matter how smart an idea may be, it must take into
consideration the context of the culture and understanding of the
target audience
.
• Sale of Coke was dwindling in a Saudi Arabian Town
• Weeks later, sales became worse as everyone started avoiding coke

62. KEY MESSAGES….
 We have these support documents- We must follow through.
 We must maintain clear communication with Human
Resources Director in MoH,
 The more we stay in our comfort zone the less confident we
are about stepping out of it
 Convincing policymakers to take action requires evidence-
based information, strategic thinking, strong advocacy
skills, and persistence

63. “That is tedious, I am just going to do it my way,
because that way lay confusion, chaos and inefficiency”
63
It is important to have sound processes!
“Changing Gear - A
time of Challenge”
“The processes are there for
a reason and we need to
follow them”

64. PUTTING EYE HEALTH WORKERS FIRST
“BUSINESS AS USUAL” WILL NOT DO
Adidja Amani, MD MPH

65. Every country, should have a workforce plan shaped to
its situation and crafted to address its health needs
 the response must be inclusive, engaging all relevant
stakeholders, including non health and nongovernmental
groups.
 Strengthening the health workforce is a shared
challenge that demands commonly developed
solutions—a mutual responsibility of all.
 Crafting a workforce to meet national health needs
requires sustained efforts over time—it cannot be a
fleeting fad.

66. Country-based and country-led strategies constitute the
primary engine for driving workforce development.
 No country is an island in workforce development
 The cost of inaction is unmistakable
 the response must be country-based and country-led—
because all global initiatives must be implemented, planned,
and owned in specific national settings
 Technical approaches alone will not do, because adequate
financing, strong leadership, and political commitment are
necessary.
 the principal lever for strategic action is national

67. Eye health Workforce development demands building a
strong action coalition across all stakeholders
 Health workers must be at the center
 collaboration must reach beyond the health sector to finance,
education, and other ministries and beyond government to
academic leaders, professional associations, labour unions,
educational institutions, and nongovernmental
 All must be involved in setting national goals, designing
strategies, drawing up plans, and implementing policies and
programs
 Good data, invariably scarce where needed most, are
essential to inform and guide such efforts

68. Will have to restock the shelves….
 All countries should develop national eye health
workforce strategic plans fully integrated in
National HRH plans to guide enhanced investments
in HReH as the core component of strengthening
national eye health systems

69.  Each country develops its country plan through local consultation, a
participatory process which includes consultation with all stakeholders
 Ensure availability of credible evidence and strategic intelligence on HReH
availability and flow
 Beyond quantitative targets, geographic distribution, gender composition,
minimum standards, competency frameworks and other aspects related to
wider management practices
 Develop effective and joined-up advocacy
 Focus policy actions and investment decisions where they are most required
 Strengthen HReH coordination mechanisms to facilitate policy dialogue
 Develop and implement costed HRH strategies and plans as an integral
component of national health strategies;
 Attainable and realistic objectives considering the financial constraints
faced by low-income countries
SOME ASPECTS THAT SHOULD BE
REFLECTED IN THE CSP

70. “SILVER BULLET” QUESTION: WHERE WOULD YOU AIM IN
HREH DEVELOPMENT IF YOU HAD ONLY ONE BULLET?