Public Policy Advocacy Strategy for Eye Health in Paraguay: Public policy from civil society

Background and Settings  

Located in the southern region of Latin America, the Republic of Paraguay faces critical public health challenges, exacerbated by the lack of a universal health system and a health coverage that does not exceed 30% of the population (in the public health system). This results in the systematic exclusion of thousands of people from essential ophthalmological services, relegating the population to depend on private provision in the field of ophthalmology. However, this is often beyond the reach of large sectors of society due to economic and geographical obstacles. In this scenario, there is an urgent need to articulate public policies in the field of eye health that promote equitable access. This challenge entails the urgent task of designing and implementing comprehensive strategies to ensure universal and equitable access to ophthalmological services for the entire Paraguayan population. The challenge is to build a public policy capable of organising civil society and the state to reduce the systematic gaps in access and to strengthen and improve comprehensive eye health services for the population. 

Goals and objectives 

Strengthen public policy on access to comprehensive eye health in the Republic of Paraguay through the articulation of key actors and the implementation of targeted strategies.   

1.     Create a civil committee to develop evidence and plans on blindness prevention. 
2.     Strengthen the capacity of the Ministry of Health in eye health policy. 
3.     Reduce preventable blindness through high quality cataract surgery. 

Main implementation strategies 

The primary initiative was the formation of the National Eye Health Committee, preceded by a training and discussion open to key civil society actors. This forum initially aimed to gather evidence on eye health in Paraguay and lay the groundwork for a collaborative committee. The subsequent inclusion of the Ministry of Health in the committee strengthened public policy in this sector. 

As a significant achievement, the committee developed the National Eye Health Plan, the first public policy focused on universal eye health in Paraguay. Today, the committee is still active, with plans to update the programmed and strengthen state capacity in public eye policy. 

To this extent, the main strategies in this work process were the articulation through talks and open forums, the publication of reports and status reports, and the work on plans that articulated civil society.  

Stakeholder involvement   

Fundación Visión and its allies played a crucial role in analyzing the public policy landscape in Paraguay, a country with a small state and limited technical capacity to implement health policies. At this juncture, Fundación Visión recognized that, although a public policy to prevent blindness was needed at the national level, initial leadership would not necessarily emanate from the Ministry of Health. In this context, the foundation took on a coordinating role, bringing together different actors to discuss and coordinate training strategies. It also financed advocacy processes and focused its strategies on blindness prevention to the exclusion of any other particular interest. 

Impact  

• The Vision 2020 National Committee acted as a catalyst in the formulation of public policies in the field of eye health in Paraguay. 
•  The establishment of the National Eye Health Plan for the Prevention of Blindness in Paraguay materialized thanks to the proactivity and initiative emanating from this committee. 

•  A national referral and counter-referral system for clinical case management in the eye health domain was implemented. 

Lessons learned and recommendations   

Advocacy has emerged as a crucial element in eye health policy making. Political science is not merely an add-on, but an essential tool that civil society must use constructively to strengthen state capacities and respond to the needs of the population. The strategy adopted was based on three essential pillars. Some of the lessons learned are: 

• Generating empirical evidence for setting national eye health policy priorities. 
• The effective articulation of the committee, for which individuals were specifically designated to coordinate inter-organizational efforts. 
• The development of strategic plans at national level to enhance the capacity of the National Eye Health System to respond to patients’ needs. 
• The implementation of action units within the organization facilitated the implementation of evidence-based projects and the articulation of collaborative efforts. 

•  It was recognized that the effectiveness of these initiatives is a long-term exercise, requiring patience and sustained commitment from managers and authorities to achieve optimal results.