Global Blindness: Action for the next decade in eye care
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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 presentation we look at the plans to scale up global eye care through Universal Eye Health and the eye health systems approach. © 2016 International Centre for Eye Health, London School of Hygiene & Tropical Medicine. This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International license. Taken from the free online course: Global Blindness: Planning and Managing Eye Care Services. We encourage the use and adaptation of this resource for teaching and learning. Find more Open Educational Resources for eye care on our website at http://iceh.lshtm.ac.uk/oer
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Global Blindness: Action for the next decade in eye care
- 1. Global Blindness: Planning and managing eye care services Action for the next decade in eye care
- 2. What next for eye care? Build on lessons learnt and achievements Scale up momentum of action
- 3. Learning outcomes Understand the principles and goals of universal eye health Familiarize with key concepts in health systems
- 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
- 7. South Africa has 5 eye doctors per million population
- 8. Parts of Francophone & Lusophone Africa have 1 eye doctor per million population
- 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
- 13. Break down barriers Accessible services Affordable services Challenges of Universal Eye Care
- 14. Outreach methods Increase cataract output Reach rural and ageing populations Challenges of Universal Eye Care
- 15. Emerging diseases Glaucoma Diabetes Challenges of Universal Eye Care
- 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 i i i i i i i
- 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 ----- ----- ----- i ----- ----- ----- i ----- ----- ----- i
- 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. ? ? ?
- 24. Health systems approach Governance Service delivery Information systems Medicines, technology Health financing Health personnel
- 25. To summarise Universal Eye Health builds on the achievements of VISION 2020 More government responsibility Equity is key to all activities
- 26. Written by Dr Daksha Patel © 2016 International Centre for Eye Health, London School of Hygiene & Tropical Medicine. This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International license. Taken from the free online course: Global Blindness: Planning and Managing Eye Care Services. We encourage the use and adaptation of this resource for teaching and learning. Find more Open Educational Resources for eye care on our website at http://iceh.lshtm.ac.uk/oer
Editor's Notes
- 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
- To summarise: 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. Equity is the key to all universal eye health activities. Written by Dr Daksha Patel © 2015 London School of Hygiene & Tropical Medicine. This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International license