Advocacy is an organized attempted change of policy, practice, and/or attitudes by presenting evidence and arguments for how and why change should happen.
Advocacy is needed in eye health because it can help to draw attention to patients’ needs and lead to provision of better health services. Advocacy also helps to raise public awareness about eye health problems and their impact on individuals, communities and the nation by putting pressure on policy makers and authorities to allocate adequate financial resources to eye health.
Mubende Comprehensive Eye health Project (MCEHP) is supporting the Government of Uganda implement comprehensive eye health services through a four year project. The project had four objectives to implement and also link them to the 4th country’s National Eye Care Strategic plan and Vision 2020 priorities.
Improve access to high quality comprehensive eye care services that are integrated into the national health systems.
Build capacity of the Ministry of Health (MOH) to effectively and efficiently deliver comprehensive eye health services to adults and children in four districts that comprise Mubende Health Region (MHR)
Advocate for the recognition of avoidable blindness as a public health problem and for Ministry of Health to develop national eye health policies, plans and programs for enhancing universal eye health
Improve the evidence base for comprehensive eye care in the country
Outputs of objective 3 would not be possible without an advocacy strategy in place that provided a road map. In Uganda through support of the previously completed SIB East Africa Child Eye Health project the MOH Collaborative Advocacy strategy was developed and adapted by the Ministry of Health. This strategy guided implementation of this objective under Mubende Comprehensive Eye health Project (MCEHP).
The advocacy strategy provides a road map for implementation of advocacy interventions at national, district, health facility and community level. It provides a guided vision and direction to the Government of Uganda, development partners, and all stakeholders concerned. Its key objective states that by the end of 2020, the Health, Education and Gender, Labour and Social Development government ministries will facilitate development and implementation of policies that support eye health systems and increase budget allocation for eye health care interventions at national and local government level by 10%.
The strategy is based on Vision 2020 Global Initiative objectives and core strategies whose mission is to eliminate all causes of preventable and treatable blindness as a public health issue by the year 2020.
The goal of the strategy is to guide government sectors and other key stakeholders in eye health to lobby for the mainstreaming of eye health so that it is increasingly embedded in the policies, systems, action plans and budgets in order to attract an increase in the relevant sector budgets of the ministries of Health, Education, and Sports and Gender, Labour & Social Development as key major partner ministries in eye health.
Project Objective 3. Advocate for the recognition of avoidable blindness as a public health problem and for Ministry of Health to develop national eye health policies, plans and programs for enhancing universal eye health
The outputs of this objective was dependant on Ministry of Health with guidance from the Technical committee of the National Prevention of Blindness. They utilised the MOH Collaborative Advocacy strategy and the 4th National Eye Health Plan which is also aligned with the National Development Plan. The MOH took lead in implementing all advocacy activities and monitored how these activities were implemented at district level.
The MOH Collaborative Advocacy strategy work plan (2016-2020) was used as the main driving tool and several technical planning meetings took place to determine key areas to roll out of the strategy that are in line with the project objective. The Collaborative Advocacy strategy work plan provides strategic direction for implementation of eye health interventions anchored on the following key pillars:
Building institutional capacity through training service providers in eye health in all sectors
Strengthening partnerships/alliances among stakeholders for wider participation in eye health interventions;
Involvement of political, professional, civic leaders and development partners to mobilise financial and material resources and support initiatives aimed at improving eye health in the country
During planning meetings, major eye health priorities were identified as key advocacy issues for the Ministry of Health sector to start with and these included:-
Eye health human resource development:
According to the 4th National Eye health plan that has all detailed information, the eye health workers in Uganda are few and do not meet the national and international distribution standards. The country lacks several sub-specialists especially in childhood cancer, retinal and corneal surgery etc. Full scholarships in ophthalmology are not enough for the number that is applying. The narrow career path and low remuneration has led to attrition especially of mid-level eye workers such as Ophthalmic Clinical Officers (OCO). Optometry is not a recognized eye health cadre in the country and there are only two Ophthalmic Nurses serving in the country.
Advocacy plan is to lobby for more positions of Senior Ophthalmologists to be established in the public service sector as well as an increase in the sub specialisation. Ophthalmic Clinical Officers (OCO) to have increased positions at senior level and their salary scale. Optometrist position to be established in the Public service structure of the country and nursing sector is lobbied to establish more positions of ophthalmic nurses.
Supplies of essential eye medicine by the National Medical Stores:
Lobby for expansion of the list of eye care medicine to match the skills at district and Regional Referral Hospitals
Funding for Eye health:
Lobby for increased funding for eye health at all levels of decision making.
Establish the country cataract surgical rate.
Although this largely resulted in outputs of objective 4 of the project, but will later be used as an advocacy tool to guide evidence based eye health planning at the MOH
Development of Information, Education and Communication (IEC) materials:
To support the advocacy process by holistically addressing the public health awareness, prevention and rehabilitation components effectively
Advocacy engagements were planned to be implemented at two levels i.e. the centre and district levels depending on best entry level as some of the issues required bottom up planning and general consensus given the fact that Uganda is implementing a decentralized system of governance.
At the centre (National) level, key decision makers to be met in a one day advocacy meeting included:-Officials from Ministries of Health, Education, Labour, Gender and Social Development, Finance, Public Service, Health Service Committee, Parliamentary committees, Training institutions (Makerere University and Jinja OCO training institution) and other key eye health partners.
After wide consultations, this was later scaled down to engaging Human Resource experts from Ministries of Health and Public service, training institutions (Makerere University and Jinja OCO training institution), Professional councils and Associations with guidance from available official documents to address the issue of Eye Human resource through developing Schemes of service for Ophthalmologists, Optometrists and Ophthalmic Clinical Officers. Other experts and key partners identified would then participate in the decision making of the development process at other levels of development.
At the district level, 15-20 key decision makers were met in a one day meeting at the District headquarters:-
Chairpersons Local Council V, Resident District Commissioners (RDC), Chairpersons, District Service Commission, Secretaries of the District Service Commission, Chief Administrative Officers, Assistant Chief Administrative Officers in charge of Health, Secretaries for Health, District Health Officers, Human Resource Officers, 2 Councilors of People with disabilities (PWDs) 1-2 Ophthalmic Clinical Officers, NGOs involved in Eye health, Disability Prevention Organisations (DPO) e.g. Uganda National Association of the Blind (UNAB)
Logistics, budgets, messages with evidence and supportive information e.g. job descriptions as well as teams, agenda and implementation programme for both national and district meetings were availed.
District level advocacy activities
Advocacy workshops were held in all implementing districts through engagement of the district administrators who highlighted the district eye health situation and challenges. This was followed by a joint presentation from the National Eye Health Coordinator of the Ministry of Health and the Senior Consultant Ophthalmologist.
MOH made highlights of the global and country situation in the area of blindness and visual impairment and the consequences as a result. Discussions were made based on the selected advocacy issues to work on from the Collaborative Eye health strategy work plan and the country eye health service delivery as guided by the MOH 4th Eye health plan (2016-2020), whose Vision is aligned to that of the Global action plan.
Expected outputs included: – Increased financial allocation and human resource placement in all relevant sectors for eye health, having in place adequate institutional structures to scale up eye health interventions e.g. staffing, reporting and supervision, a wide social movement of stakeholders to rally support for eye health services among the public sector and civil society organisations/NGOs/ and Community Based Organisations, strengthened coordination among sectors and other stakeholders and harmonization of messages on eye health and an enabling policy environment that supports eye health interventions in various sectors of development such as health, education and rehabilitation.
Districts thereafter came up with a costed work plan to be incorporated into the district plans and budgets to address issues in the following thematic areas: – human resources for health, advocacy and lobbying, service delivery, health financing, HMIS and data use, medicine. Supplies and equipment, coordination, governance and oversight. Follow-up monitoring meetings were later conducted and findings were that districts had complied with about 90% of their commitments.
District level advocacy meeting led by the National Eye Health Coordinator – MOH
National level advocacy activities
Technical expert teams from MOH with support from the project, led the process of developing, printing and distribution of Information, Education and Communication (IEC) Eye health materials and was well completed. These materials in form of 5 posters and 7 fact sheets with key eye health information are owned by MOH. They also supported the district advocacy meetings and enriched MOH with Eye health IEC materials that were not available before.
Development process of the schemes of service for Ophthalmologists, Optometrists and Ophthalmic Clinical Officers underwent all the required development processes with support from the project and is awaiting top management of the Ministries of Health and Public service to be adapted for implementation.
This project has also supported the MOH to conduct a survey to establish the national Cataract Surgical Rate (CSR) of the country. Results will be used as an advocacy tool to guide evidence-based eye health planning for the next Eye Health Plan.
Final decision to undertake implementation of these activities was done through a joint stakeholder’s planning meeting called by the Ministry of Health with support from the project.
National level advocacy meeting led by the
National Eye Health Coordinator – MOH
All these activities were also endorsed and reviewed periodically by the Project Steering Committee meetings that comprised of key partner Ministries of Health, Education & Sports, Gender Labour & Social Development, Standard Chartered Bank, National Prevention of Blindness Committee and Brien Holden Vision Institute – Uganda office.
Through joint project eye health planning and monitoring meetings conducted on quarterly rotational basis with support from the project, partnership between the Ministries of Health, Education, Gender , Labour and Social Development was easily strengthened resulting into achieving the desired project ownership, sustain ship and outputs of the project indicators.