4. Learning outcomes
Evaluate the Global Action Plan
2014-2019
Identify the relevance and
application of global concepts to a
local level
5. Key issues facing VISION 2020
Stronger
service
delivery
for diabetic
retinopathy,
glaucoma
More
prevention
and early
case
detection
More
trained
personnel
at all levels,
particularly
in Africa
6. VISION 2020 target for Africa:
4 eye doctors per million
population by 2010
9. “Universal Health
Coverage: the single
most powerful
concept that public
health has to offer”
WHO Director-General Margaret Chan
10. "Ensuring that all people have access to
promotive, preventive, curative and rehabilitative
health services, of sufficient
quality to be effective, while
also ensuring that people do
not suffer financial hardship
when paying for these
services."
11. Principles of Universal Eye Health
Services must be
comprehensive
Services must
be available to
everyone
12. Principles of Universal Eye Health
Models of care
must be in line
with the existing
health system
Services must
be affordable
16. Global Action Plan 2014 - 2019
Reduce blindness and visual
impairment by 25% by 2019
Through strong and equitable
eye health systems
25%
17. Global Action Plan 2014 - 2019
Strengthen health services
•Local data collection
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18. Global Action Plan 2014 - 2019
Strengthen health services
•Local data collection
•More eye health workers
19. Global Action Plan 2014 - 2019
Strengthen health services
•Local data collection
•More eye health workers
•Comprehensive services
20. Global Action Plan 2014 - 2019
Health systems indicators
1. Evidence of prevalence and
causes of visual impairment
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21. Global Action Plan 2014 - 2019
Health systems indicators
1.Evidence of prevalence and
causes of visual impairment
2.Number and distribution of
eye health workers
22. Global Action Plan 2014 - 2019
Health systems indicators
1.Evidence of prevalence and
causes of visual impairment
2.Number and distribution of
eye health workers
3.Outputs of service delivery
23. What is the health systems
approach?
How people, resources and their
actions are organised to
promote, maintain and
restore health.
?
? ?
What next for eye care? Building on the lessons learnt and achievements of the first decade of VISION 2020: The Right to Sight 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 presentation you should be able to
Know the key concepts in health systems
Understand the principles and goals of universal eye health
Evaluate the Global Action Plan 2014-2019
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
More trained personnel in eye care are urgently needed at all levels, particularly in Africa.
The VISION 2020 initiative set a target of 4 eye doctors per million population for Africa by 2010. 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 5 per million population in South Africa ….
…to less than 1 per million in some Francophone and Lusaphone 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, …
Image: Remy Steinegger/World Economic Forum CC BY-SA 2.0 flic.kr/p/9dVj1e
…the International Agency for the Prevention of Blindness (the IAPB) has adopted the Universal Eye Health approach. 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, while also ensuring that people do not suffer financial hardship when paying for these 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 in eye care programmes means that services need to be made comprehensive for all eye disease and visual impairments.
Services also need to be equitable, available to everyone, whether urban or rural, male or female, young or old, rich or poor, or isolated or disabled.
Varied models of care are needed to ensure 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. 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 services are affordable by everyone.
There are several challenges to delivering universal eye care at a local level:
At a community level, it is essential to break down barriers and make services accessible and affordable.
Eye care providers need to consider methods of outreach to reach the blind and visually impaired people in rural areas. This will cater for aging 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 which aims to reduce the prevalence of avoidable blindness worldwide by 25% between 2010 and 2019. This target will be achieved through strong and equitable health systems.
To strengthen health systems 3 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.
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 :
1. Evidence on the prevalence and causes of visual impairment
2. Numbers of eye care workers and their distribution
3. 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, 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.
The World Health Organization’s model of a health system has 6 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, technology – providing adequate infrastructure and supplies
Information systems – ensuring good governance with good information
Service delivery – providing equitable, excellent and economically sound services
Monitoring these blocks provides insight into the overall quality of the health system. The 6 blocks can be seen as cogs in a wheel, all working together to create a strong health system