Zero Draft “Universal Access to Eye Health: A Global Action plan 2014-2019” Consultation – 8 October 2012
Mr Chairman, distinguished participants and colleagues:
I am speaking on behalf of the International Agency for the Prevention of Blindness (IAPB). IAPB is the global peak body for eye health representing more than 100 non government, research and training organisations. IAPB and the WHO are partners in VISION 2020: The Right To Sight, a global initiative to prevent avoidable blindness.
IAPB would like to thank WHO for arranging this consultation on the Zero Draft “Universal Access to Eye Health: A Global Action Plan 2014-2019”.
IAPB has also submitted a written response to the Zero Draft. In the interest of time, I would like to only highlight a few points.
We believe that the Zero Draft represents a significant improvement on the current action plan. It reflects lessons learned through VISION 2020 and through the current action plan. The Zero Draft also includes many of the suggestions made in previous consultations.
Vision, Goals and Objectives
IAPB broadly agrees with the vision, goal, and objectives as included in the zero draft but has made the following suggestions to improve clarity:
- The proposed goal in the Zero Draft is to reduce blindness and visual impairment as a global health problem. It needs to be clear that it is about reducing avoidable blindness and visual impairment as a global health problem.
- The ‘Purpose’ of the action plan in the Zero Draft is to ‘improve eye health through comprehensive eye care services integrated in health systems’. Eye health is important to improving broader health outcomes, and needs to be better integrated into health systems. This is what the new action plan is trying to achieve. The purpose of the action plan should therefore be ‘to improve health through comprehensive eye care services integrated in health systems’.
Targets and indicators for the action plan
IAPB welcomes the inclusion in the Zero Draft of options for global and national targets and indicators to monitor progress in meeting the goal and objectives of the new action plan. This is a significant step forward on the current action plan.
IAPB believes that it is critical to have agreed global targets for avoidable blindness and visual impairment that are evidence based. It is also important that the specific targets are agreed as part of reaching agreement on the action plan.
IAPB recommends that WHO consider the inclusion of a key target: that ‘avoidable blindness should be less than an x% (an agreed percentage) of overall global blindness’ (defined as vision less than 3/60).
The definition of avoidable blindness should include Cataract, Diabetic retinopathy, Onchocerciasis, Trachoma, and uncorrected refractive errors. The set percentage should be based on recent epidemiological data on avoidable blindness and visual impairment in high income countries. This would provide a best practice scenario and an effective practical global target that would be relevant at the country level.
This approach is proposed because it is evidence based, rather than the linear trend based target proposed under Option A in the Zero Draft, and because it is a realistic way for countries to assess and set their own national targets based on national data.
We recommend that WHO apply the same methodology for setting a percentage based target for moderate and severe visual impairment (defined as vision less than 6/18).
IAPB would welcome WHO establishing a small time limited working group to analyse existing data to determine the proportion of avoidable blindness in high income countries, and use that to determine the actual percentage set as the threshold or target. It will be important for this work to be completed in time for submission to the WHO Executive Board in January 2013 so that the draft action plan and the proposed targets can be considered and agreed at the same time.
IAPB welcomes the inclusion of indicators to monitor progress in achieving the goal and objectives of the action plan. This represents a significant improvement on the current action plan and with proper implementation will allow measurement of measure national, regional and global progress towards the ultimate goal of eliminating avoidable blindness and visual impairment.
We appreciate that further refinement will be needed on the indicators to be used, including on the relevant methodology, mechanisms and timeframes for collection and dissemination of the data. IAPB would recommend the inclusion of one additional indicator on Cataract coverage disaggregated at sub-national or province level, gender, and age in selected countries. This will be important for understanding the prevalence of cataract which is the single largest cause of avoidable blindness.
IAPB looks forward to continuing to working collaboratively with WHO and member states to finalise the action plan.