REGIONAL COMMITTEE Fifty-third Session
Provisional Agenda item 13 SEA/RC53/3 (Rev.1) 24 July 2000
REGIONAL STRATEGY ON VISION 2020: THE RIGHT TO SIGHT
WHO and its Member States have long been involved in prevention of blindness (PBL) programmes. As a result, there has been a decline in blindness resulting from infective causes, such as trachoma and onchocerciasis, as well as due to nutritional deficiencies such as xerophthalmia. However, because of the rapid increase in the ageing population, the number of blind in the world has increased. It is estimated that this number will double from the current 45 million to 80 million by 2020. One-third of the world’ s 45 million blind people live in the countries of South-East Asia. WHO has intensified its efforts to meet this challenge of increasing blindness by launching a new global initiative for the elimination of avoidable blindness. This new initiative, called Vision 2020: The Right to Sight, was launched by the Director-General of WHO on 18 February 1999. The Regional Director for South-East Asia launched the Regional Vision 2020 on 30 September 1999. The three key strategies identified for successful implementation of Vision 2020 in the Region are: (1) Advocacy, (2) Partnership development and networking, and (3) Integrated approach to reduction of disease burden through coordinated development of human resources and infrastructure. Problems and constraints in the implementation of Vision 2020 include: inadequate human resources and insufficient infrastructure, poor managerial capacity and dwindling resources. A series of recommendations directed to the countries and to the Regional Director have been developed. In view of the magnitude of the problem, its effect on the perpetuation of poverty and in causing early death, countries are urged to accord high priority to PBL programmes. Available evidence has firmly established that PBL programmes are at least as cost effective as immunization. Priority actions recommended for the countries include the establishment/ strengthening of national programmes with national coordinating bodies and designation of programme managers with appropriate allocation of resources. The Regional Director is requested to enhance support to the countries in programme development and monitoring by strengthening the technical unit in the Regional Office with staffing and budget.
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CONTENTS Page
1. 2. 2.1 2.2. 2.3
BACKGROUND .....................................................................................................................1 REGIONAL STRATEGY.........................................................................................................1 Advocacy ...........................................................................................................................1 Partnership Development and Networking...........................................................................2 Integrated Approach to Reduction of Disease Burden through Coordinated Development of Human Resources and Infrastructure ........................................................3 CURRENT STATUS OF BLINDNESS IN SOUTH-EAST ASIA .................................................3 SUMMARY OF PRIORITY ACTIVITIES..................................................................................4 ISSUES AND CONCERNS.....................................................................................................5
3. 4. 5.
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1. BACKGROUND Vision 2020:The Right to Sight is a new Initiative launched by WHO in collaboration with its partners, the countries, the International Agency for Prevention of Blindness (IAPB) and the supporting Nongovernment Development Organizations for Elimination of Avoidable Blindness from the world by the year 2020. Global Vision 2020 was officially launched by the DirectorGeneral of WHO on 18 February 1999. South-East Asia Vision 2020 was launched by the Regional Director on 30 September 1999. This working paper outlines the strategy for the elimination of avoidable blindness in South-East Asia.
2. REGIONAL STRATEGY The Regional strategy has been developed through a process of consultations with WHO headquarters and in partnership with the countries, other UN agencies, financial institutions, IAPB and Nongovernment Development Organizations (NGOs). The following are the essential elements of the strategy: (1) Advocacy efforts to increase awareness of blindness as a major public health problem by strengthening the information base for health functionaries at various levels for the formulation of policies and strategies in support of Vision 2020: The Right to Sight. (2) Establishing partnership with countries, collaborating centres, professional organizations, financial institutions, and nongovernmental organizations. This will enable all concerned in combating blindness to work in a focused and coordinated way to achieve the common goal of eliminating avoidable blindness. (3) The third element of the strategy consists of the development of an integrated approach for disease control, human resource development as well as infrastructure and technology development at various levels of health systems, and the strengthening of primary prevention and primary eye care through community involvement.
2.1 Advocacy Strong emphasis will be laid on advocacy in the South-East Asia Region because the pressing nature of health problems and scarcity of resources have resulted in according low priority to prevention of blindness. Blindness has generally been viewed in the context of disability requiring the attention of a compassionate civil society, often as a service and sometimes as charity offered to the disabled community. The full societal implications of blindness as the second leading cause of disability (next only to osteoarthritis) with the consequences of profound economic loss and early death have been recognized only recently.
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PBL programmes are among the most cost-effective health interventions. This knowledge will be more widely disseminated and specifically targeted at policy-makers and financial controllers employing a variety of approaches. Some of these include: advocacy workshops, production of advocacy materials, observance of Regional Vision 2020 Day and World Sight Day, and national launches. The Regional Office will provide advocacy platforms to Vision 2020 using several fora available to it, such as the Consultative Committee on Programme Development and Management (CCPDM), Regional Committee (RC), Health Ministers and Health Secretaries meetings, meeting of Parliamentarians, meeting of WHO Representatives and the meeting of Advisory Committee on Health Research (ACHR). The eye health profession has shown varying responses to the issue of prevention of blindness. These have varied from overwhelming support to lukewarm response. Advocacy targeted at the professional group to align them to the values and goals of Vision 2020 will be part of the overall advocacy strategy to broaden the constituency of support.
2.2. Partnership Development and Networking Networking and partnership are the key to successful implementation of Vision 2020. This will be implemented at two levels. For micro-management of Vision 2020, networking within the Regional Office will allow sharing of knowledge and resources scattered in different units and departments within the Regional Office. Very often blindness is a result of factors outside the purview of the eye care programme. Nutrition, childhood, old age and injury are significant risk factors for blindness. Health promotion, effective health infrastructure and the available human resources for health are critical means to reach the target population. This networking will facilitate coordination between different technical units and senior public health specialists engaged in the health of the population at the technical level. This will be done by establishing a Task Force for Vision 2020, which will function as a think tank to advise the Regional Director on policy and programme matters. A Resource Directory of institutions and professionals engaged in eye care and prevention of blindness will be established to facilitate effective networking and partnership development. While the above will facilitate technical and professional networking for micromanagement of Vision 2020, systems for macro-management will also be put in place. A Regional Coordination Group with the participation of country representatives, representatives of IAPB and non-government development organizations, other UN agencies and WHO will be constituted. This will provide the structural framework for bringing together a variety of partners for integrated and coordinated service delivery for Elimination of Avoidable Blindness from South-East Asia. A Corporate Advisory Group will provide a forum for business, industry and corporate philanthropy to contribute to Vision 2020. While a vast number of the poor are blind and are therefore routinely classified as being unable to pay, their sheer number provides an opportunity for the hitherto unexplored market. Management experts are advocating the creation of a consumer market out of the poor. Therefore, a Corporate Advisory Group would provide an excellent opportunity to bring in the talents and resources of the corporate sector.
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2.3 Integrated Approach to Reduction of Disease Burden through Coordinated Development of Human Resources and Infrastructure About 90 per cent of the diseases causing blindness in this region are avoidable (i.e. either preventable or curable) with simple and cost-effective technology. Much of the knowledge and technology is already available; what is needed is the political will and professional support to apply this knowledge. Vision 2020 is dedicated to the elimination of those causes which can be dealt with inexpensively by the existing infrastructure. Cataract, trachoma, vitamin A deficiency, refractive errors, low vision and childhood blindness are the target conditions identified for elimination. Cataract and glaucoma-related blindness is seen all over the Region. Infective causes of blindness, such as trachoma (India, Myanmar, Nepal) and nutritional causes, such as vitamin A deficiency (Bangladesh, Indonesia, Myanmar and Nepal) are focally distributed. The Region is also witnessing increasing blindness related to improved socioeconomic conditions, such as diabetic retinopathy and age-related macular degeneration. There is a general shortage of all categories of eye care personnel in most countries of the Region. Their inadequate number is not the only concern. Inappropriate mix (the Region has 11 000 ophthalmologists and only 9 000 optometrists), inequitable distribution (80 per cent of human resources are concentrated in urban areas), low productivity (in some countries ophthalmologists perform two cataract operations or even less in a week) and the lack of public health skills are among other major HRH concerns. Education and training teams of eye health care workers in adequate numbers with appropriate category and skill mix oriented to public health ophthalmology aligned to the goals of Vision 2020 with need-based distribution will be adopted as the key strategy in HRH planning and management. In many countries, the available infrastructure is inadequate, while in others it is inadequately, and sometimes inappropriately, used. It has been observed that in many situations the output of the available infrastructure could be doubled without additional financial input. There are also issues related to inappropriate selection of technology. The regional strategy will consist of operations research to increase the productivity of the existing infrastructure with improvement in the quality of outcome, replication of currently available high-volume high-quality sustainable models, guidelines for acquiring good quality and cost-effective equipment, and the production of low-cost, high quality optical devices, including intra-ocular lenses.
3. CURRENT STATUS OF BLINDNESS IN SOUTH-EAST ASIA Ø Ø Ø One-third of the world's 45 million blind and half of the world's 1.5 million blind children live in this region. SEAR has a disproportionate burden of blindness with one quarter of the world’ s population and one-third of the world's blind. Every minute four persons in South-East Asia become blind. The number of blind persons will increase to 30 million at the current level of intervention.
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Blind persons in the Region are among the poorest in the world and among the poorest in the society; most of them are women, elderly and marginalized. Ninety per cent of the blindness in this region is avoidable. Blindness is estimated to cost the countries of the Region US$5.6 billion annually in lost productivity, special education and rehabilitation. Blindness not only causes human suffering, but is also economically devastating and is a cause of many early deaths. Mortality among the blind is one-third higher than that among their sighted peers. Preventing blindness is not only about relieving suffering. It is about prolonging life, addressing poverty, empowering women, and helping the marginalized and weaker sections of the society. The distribution of disease burden in the countries of South-East Asia is not uniform. Thailand has a low blindness prevalence rate of 0.3 per cent while at 1.5 per cent Indonesia has five times higher prevalence and, in fact, one of the highest in the world. Cataract is the leading cause of blindness in all countries. Trachoma and vitamin A deficiency are focally distributed. Glaucoma and diabetic retinopathy are emerging causes of blindness in many countries of the Region.
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4. SUMMARY OF PRIORITY ACTIVITIES (1) Advocacy • Political commitment • Professional alignment • Public (community) support (2) Partnership and networking • Networking for micro-management of Vision 2020 – Establishment of an in-house Taskforce for Vision 2020 – A resource directory of institutions and professionals in the Region • Networking for macro-management for Vision 2020 – Regional Coordination Group – Corporate Advisory Group (3) Reduction of disease burden, development of HRH and infrastructure • Priority for disease control (cataract, trachoma, vitamin A deficiency and childhood blinding diseases, refractive error and low vision, vitamin A deficiency). • Human resources development – Quality, mix, distribution, productivity. • Infrastructure development – Productivity, coverage, accessibility, affordability.
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5. ISSUES AND CONCERNS Issues and concerns centre primarily around budget and management, both in the Regional Office and in the Member States. Although the Regional Director has formally launched Vision 2020, funds have not been earmarked in the 2000-2001 Regional budget. In many countries, there is no WHO Regular budget allocation for Vision 2020 or for prevention of blindness. A serious effort is needed to mobilize funds to translate the political commitment and policy directions to technical implementation. The Regional Office itself lacks appropriate structural mechanisms and linkages for programme support at the regional level. Establishment of a post of Regional Adviser, an in-house task force, a Regional Coordination Group and a Corporate Advisory Group, is now in progress. Once established, they will facilitate the implementation of Vision 2020. The lack of dedicated budget remains a major concern. In many countries, sufficient funds are not available for PBL activities. The countries of South-East Asia show considerable variations in the development of PBL programmes. Some have well-developed programmes while others have virtually none. National programmes with effective national plans of action and identification of national programme managers (focal persons) are critical to ensure effective planning, implementation and monitoring at the country level. A national coordinating group to facilitate coordination between different partners at the country level is lacking in many countries.