© World Health Organization 20132 i i 20142019 Introduction The global eye health action plan...

WHO Library Cataloguing-in-Publication Data

Universal eye health: a global action plan 2014-2019.

1.Eye diseases – prevention and control. 2.Vision disorders. 3.Blindness. 4.Health planning. I.World Health Organization.

ISBN 978 92 4 150656 4 (NLM classification: WW 140)

© World Health Organization 2013

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A global action plan 2014–2019

Universal eye health

ii

Universal eye health: a global action plan 2014–2019

ContentsForeword. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Resolution of the Sixty-sixth World Health Assembly: WHA66.4 – Towards universal eye health: a global action plan 2014–2019 . . . . . . . . 4

Universal eye health: a global action plan 2014–2019World Health Assembly document A66/11 (28 March 2013) . . . . . . . . . . . . . . . . 5

Appendix 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Appendix 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Appendix 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Appendix 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

1


ForewordThe most recent WHO estimates on the global magnitude and causes of visual impairments confirm a major opportunity for change in the lives of millions of people: 80% of all causes of visual impairment are preventable or curable. WHO estimates that in 2010 there were 285 million people visually impaired, of which 39 million were blind. If just the two major causes of visual impairment were considered priorities and control measures were implemented consistently across the world, by providing refractive services and offering cataract surgery to the people in need, two thirds of the visually impaired people could recover good sight. This scenario appears to be fairly easy to realize, but for multiple reasons both the aforementioned eye diseases remain major items on the unfinished agenda of public eye care.

Provision of effective and accessible eye care services is key for effectively controlling visual impairment including blindness. The preference is given to strengthening eye care services through their integration into the health system rather than through their provision in the vertical programme approach. There is ample evidence that comprehensive eye care services need to become an integral part of primary health care and health systems development. While it is critical, as an example, for preventing visual impairment from diabetes and premature birth, it is true for the prevention and management of almost all causes of avoidable visual impairment. In the international work in the health sector in the last few years there has been an ever-increasing focus on health system development and increasing attention to the benefits that come from integrating competencies and specialities of the health sector. There is the potential to streamline health promotion for eye care alongside general health promotion initiatives. There are a number of proven risk factors for some major causes of blindness

supported by evidence (e.g. diabetes mellitus, smoking, premature birth, rubella, vitamin A deficiency) which need to be addressed where appropriate through a health sector-wide approach. A major opportunity will be in incorporating the prevention of visual impairment and rehabilitation agenda into wider health policies and strategies, including post-Millennium Development Goals global actions. Multisectoral action is also crucial for preventing a range of chronic eye conditions. This becomes increasingly critical as chronic eye diseases, the incidence of which increases with age, are the major cause of visual impairment and in the future it is anticipated that, along with the global ageing of the world population, their relevance and magnitude will grow.

The adoption of the global eye health action plan by the Sixty-sixth World Health Assembly opens a new opportunity for Member States to progress with their efforts to prevent visual impairment and strengthen rehabilitation of the blind in their communities. All stakeholders are requested to join in this renewed effort to translate the vision of the global eye health action plan which is a world in which nobody is needlessly visually impaired, where those with unavoidable vision loss can achieve their full potential, and where there is universal access to comprehensive eye care services.

Dr Oleg ChestnovAssistant Director-GeneralNoncommunicable Diseases and Mental HealthWorld Health Organization

2


IntroductionThe global eye health action plan 2014–2019 aims to reduce avoidable visual impairment as a global public health problem and to secure access to rehabilitation services for the visually impaired. This should be achieved by expanding current efforts by Member States, the WHO Secretariat and international partners, improved coordination, efficient monitoring, focusing the use of resources towards the most cost-effective interventions, and developing innovative approaches to prevent and cure eye diseases.

Following the request of Member States at the Sixty-fifth World Health Assembly in 2011, the Secretariat, in close consultation with Member States and international partners, developed a draft action plan for the prevention of avoidable visual impairment for the period 2014–2019. The content and structure of the action plan was built on experiences in prevention of avoidable visual impairment gained through major international partnerships and alliances along with lessons learnt in implementing comprehensive eye health interventions at district and national levels. A major effort was made in engaging all stakeholders in the development of the action plan and stimulating their feedback on the draft through web-based consultations and consultative meetings convened by the Secretariat. The Sixty-sixth World Health Assembly endorsed the action plan by adopting resolution WHA66.4 entitled Towards universal eye health: a global action plan 2014–2019.

Actions for Member States, international partners and the Secretariat are structured around three objectives:

• objective 1 addresses the need for generating evidence on the magnitude and causes of visual impairment and eye care services and using it to monitor progress, identify priorities and advocate for greater political and financial commitment by Member States to eye health;

• objective 2 encourages the development and implementation of integrated national eye health policies, plans and programmes

to enhance universal eye health with activities in line with WHO’s framework for action for strengthening health systems to improve health outcomes;

• objective 3 addresses multisectoral engagement and effective partnerships to strengthen eye health.

The global eye health action plan is based on five principles and approaches which underpin the plan: universal access and equity, human rights, evidence-based practice, a life course approach, and empowerment of people with visual impairment. As there have been significant shifts in the pattern of causes of visual impairment, the action plan is structured to particularly address the global trend towards an increasing incidence of chronic eye diseases related to ageing. These are expected to be the most prevalent causes of avoidable visual impairment in the next decades.

The global eye health action plan is built using the health system approach, which encompasses the integration of eye care programmes into the wider health care system at all levels (primary, secondary, and tertiary).

Effective international partnerships and alliances remain instrumental in delivering effective public health responses and in strengthening the prevention of visual impairment. The reduction of avoidable visual impairment depends also on progress in other health and development agendas, such as the development of comprehensive health systems, human resources for health development, improvements in the area of maternal, child and reproductive health, and the provision of safe water and basic sanitation. Eye health needs to be included in broader noncommunicable and communicable disease frameworks, and can substantially contribute in those global initiatives addressing ageing, marginalized and vulnerable groups.

By setting a global target for the action plan, Member States have agreed to jointly work towards the reduction in prevalence

3


of avoidable visual impairment by 25% by 2019 from the baseline established by WHO in 2010. The global eye health action plan provides Member States with a set of activities to strengthen their health systems in the area

of eye care. Member States are invited, in collaboration with international partners, to identify and implement those actions most appropriate to their own circumstances and needs.

4


Resolution of the Sixty-sixth World Health Assembly:

WHA66.4 Towards universal eye health: a global action plan 2014–2019The Sixty-sixth World Health Assembly,

Having considered the report and draft global action plan 2014–2019 on universal eye health;1

Recalling resolutions WHA56.26 on elimination of avoidable blindness and WHA62.1 and WHA59.25 on prevention of avoidable blindness and visual impairment;

Recognizing that the global action plan 2014–2019 on universal eye health builds upon the action plan for the prevention of avoidable blindness and visual impairment for the period 2009–2013;

Recognizing that globally, 80% of all visual impairment can be prevented or cured and that about 90% of the world’s visually impaired live in developing countries;

Recognizing the linkages between some areas of the global action plan 2014–2019 on universal eye health and efforts to address noncommunicable diseases and neglected tropical diseases,

1. ENDORSES the global action plan 2014–2019 on universal eye health;

2. URGES Member States:

(1) to strengthen national efforts to prevent avoidable visual impairment including blindness through, inter alia, better integration of eye health into national health plans and health service delivery, as appropriate;

(2) to implement the proposed actions in the global action plan 2014–2019 on universal eye health in accordance with national priorities, including universal and equitable access to services;

1 Document A66/11.

(3) to continue to implement the actions agreed by the World Health Assembly in resolution WHA62.1 on prevention of blindness and visual impairment and the action plan for the prevention of blindness and visual impairment for the period 2009–2013;

(4) to continue to support the work of the Secretariat to implement the current action plan to the end of 2013;

(5) to consider the programme and budget implications related to implementation of this resolution within the context of the broader programme budget;

3. REQUESTS the Director-General:

(1) to provide technical support to Member States for the implementation of the proposed actions in the global action plan 2014–2019 on universal eye health in accordance with national priorities;

(2) to further develop the global action plan 2014–2019 on universal eye health, in particular with regard to the inclusion of universal and equitable access to services;

(3) to continue to give priority to the prevention of avoidable visual impairment, including blindness, and to consider allocating resources for the implementation of the global action plan 2014–2019 on universal eye health;

(4) to report, through the Executive Board, to the Seventieth World Health Assembly in 2017, and the Seventy-third World Health Assembly in 2020, on progress in implementing the action plan.

(Eighth plenary meeting, 24 May 2013 – Committee A, second report)

5



World Health Assembly document A66/11 (28 March 2013)1. In January 2012 the Executive Board

reviewed progress made in implementing the action plan for the prevention of avoidable blindness and visual impairment for the period 2009–2013. It decided that work should commence immediately on a follow-up plan for the period 2014–2019, and requested the Director-General to develop a draft action plan for the prevention of avoidable blindness and visual impairment for the period 2014–2019 in close consultation with Member States and international partners, for submission to the World Health Assembly through the Executive Board.3 The following global action plan was drafted after consultations with Member States, international partners and organizations in the United Nations system.

Visual impairment in the world today2. For 2010, WHO estimated that globally 285

million people were visually impaired, of whom 39 million were blind.

3. According to the data for 2010, 80% of visual impairment including blindness is avoidable. The two main causes of visual impairment in the world are uncorrected refractive errors (42%) and cataract (33%). Cost-effective interventions to reduce the burden of both conditions exist in all countries.

4. Visual impairment is more frequent among older age groups. In 2010, 82% of those blind and 65% of those with moderate and

2 See resolution WHA66.4.

3 See decision EB130(1).

severe blindness were older than 50 years of age. Poorer populations are more affected by visual impairment including blindness.

Building on the past5. In recent resolutions, the Health Assembly

has highlighted the importance of eliminating avoidable blindness as a public health problem. In 2009, the World Health Assembly adopted resolution WHA62.1, which endorsed the action plan for the prevention of avoidable blindness and visual impairment. In 2012, a report noted by the Sixty-fifth World Health Assembly and a discussion paper described lessons learnt from implementing the action plan for 2009–2013. The results of those findings and the responses received to the discussion paper were important elements in the development of this action plan. Some of the lessons learnt are set out below.

(a) In all countries it is crucial to assess the magnitude and causes of visual impairment and the effectiveness of services. It is important to ensure that systems are in place for monitoring prevalence and causes of visual impairment, including changes over time, and the effectiveness of eye care and rehabilitation services as part of the overall health system. Monitoring and evaluating eye care services and epidemiological trends in eye disease should be integrated into national health information systems. Information from monitoring and evaluation should be used to guide the planning of services and resource allocation.

(b) Developing and implementing national policies and plans for the prevention of avoidable visual impairment remain the cornerstone of strategic action. Some programmes against eye diseases have had considerable success in developing and implementing policies

6


and plans, however, the need remains to integrate eye disease control programmes into wider health care delivery systems, and at all levels of the health care system. This is particularly so for human resource development, financial and fiscal allocations, effective engagement with the private sector and social entrepreneurship, and care for the most vulnerable communities. In increasing numbers, countries are acquiring experience in developing and implementing effective eye health services and embedding them into the wider health system. These experiences need to be better documented and disseminated so that all countries can benefit from them.

(c) Governments and their partners need to invest in reducing avoidable visual impairment through cost-effective interventions and in supporting those with irreversible visual impairment to overcome the barriers that they face in accessing health care, rehabilitation, support and assistance, their environments, education and employment. There are competing priorities for investing in health care, nevertheless, the commonly used interventions to operate on cataracts and correct refractive errors – the two major causes of avoidable visual impairment – are highly cost effective. There are many examples where eye care has been successfully provided through vertical initiatives, especially in low-income settings. It is important that these are fully integrated into the delivery of a comprehensive eye care service within the context of wider health services and systems. The mobilization of adequate, predictable and sustained financial resources can be enhanced by including the prevention of avoidable visual impairment in broader development cooperative agendas and initiatives. Over the past few years, raising additional resources for health through innovative financing has been increasingly discussed but investments in the reduction of the most prevalent eye diseases have been relatively absent

from the innovative financing debate and from major financial investments in health. Further work on a cost–benefit analysis of prevention of avoidable visual impairment and rehabilitation is needed to maximize the use of resources that are already available.

(d) International partnerships and alliances are instrumental in developing and strengthening effective public health responses for the prevention of visual impairment. Sustained, coordinated international action with adequate funding has resulted in impressive achievements, as demonstrated by the former Onchocerciasis Control Programme, the African Programme for Onchocerciasis Control and the WHO Alliance for the Global Elimination of Trachoma by the year 2020. VISION 2020: The Right to Sight, the joint global initiative for the elimination of avoidable blindness of WHO and the International Agency for the Prevention of Blindness, has been important in increasing awareness of avoidable blindness and has resulted in the establishment of regional and national entities that facilitate a broad range of activities. The challenge now is to strengthen global and regional partnerships, ensure they support building strong and sustainable health systems, and make partnerships ever more effective.

(e) Elimination of avoidable blindness depends on progress in other global health and development agendas, such as the development of comprehensive health systems, human resources for health development, improvements in the area of maternal, child and reproductive health, and the provision of safe drinking-water and basic sanitation. Eye health should be included in broader noncommunicable and communicable disease frameworks, as well as those addressing ageing populations. The proven risk factors for some causes of blindness (e.g. diabetes mellitus, smoking, premature birth, rubella and vitamin A deficiency) need to be continuously addressed through multisectoral interventions.

7


(f) Research is important and needs to be funded. Biomedical research is important in developing new and more cost-effective interventions, especially those that are applicable in low-income and middle-income countries. Operational research will provide evidence on ways to overcome barriers in service provision and uptake, and improvements in appropriate cost-effective strategies and approaches for meeting ever-growing public health needs for improving and preserving eye health in communities.

(g) Global targets and national indicators are important. A global target provides clarity on the overall direction of the plan and focuses the efforts of partners. It is also important for advocacy purposes and evaluating the overall impact of the action plan. National indicators help Member States and their partners to evaluate progress and plan future investments.

Global action plan 2014–20196. The vision of the global action plan is a

world in which nobody is needlessly visually impaired, where those with unavoidable vision loss can achieve their full potential, and where there is universal access to comprehensive eye care services.

7. The global action plan 2014–2019 aims to sustain and expand efforts by Member States, the Secretariat and international partners to further improve eye health and to work towards attaining the vision just described. Its goal is to reduce avoidable visual impairment4 as a global public health problem and to secure access

to rehabilitation services for the visually impaired. The purpose of the action plan is to achieve this goal by improving access to comprehensive eye care services that are integrated into health systems. Further details are provided in Appendix 1. Five principles and approaches underpin the plan: universal access and equity, human rights, evidence-based practice, a life course approach, and empowerment of people with visual impairment. Further details are provided in Appendix 2.

8. Proposed actions for Member States, international partners and the Secretariat are structured around three objectives (see Appendix 3):

– objective 1 addresses the need for generating evidence on the magnitude and causes of visual impairment and eye care services and using it to advocate greater political and financial commitment by Member States to eye health;

– objective 2 encourages the development and implementation of integrated national eye health policies, plans and programmes to enhance universal eye health with activities in line with WHO’s framework for action for strengthening health systems to improve health outcomes;5

– objective 3 addresses multisectoral engagement and effective partnerships to strengthen eye health.

Each of the three objectives has a set of metrics to chart progress.

9. There are three indicators at the goal and purpose levels to measure progress at the national level, although many Member States will wish to collect more. The three indicators comprise: (i) the prevalence and causes of visual impairment; (ii) the number of eye care personnel; and (iii) cataract

4 The term “visual impairment” includes moderate and severe visual impairment as well as blindness. “Blindness” is defined as a presenting visual acuity of worse than 3/60 or a corresponding visual field loss to less than 10° in the better eye. “Severe visual impairment” is defined as a presenting visual acuity of worse than 6/60 and equal to or better than 3/60. “Moderate visual impairment” is defined as a presenting visual acuity in the range from worse than 6/18 to 6/60 (Definition of visual impairment and blindness. Geneva: World Health Organization; 2012). The action plan uses the term “visual impairment”. Also, see the ICD update and revision platform “Change the definition of blindness” .

5 Everybody’s business: strengthening health systems to improve health outcomes: WHO’s framework for action. World Health Organization. Geneva, 2007.

8


surgery. Further details are provided in Appendix 4.

• Prevalence and causes of visual impairment. It is important to understand the magnitude and causes of visual impairment and trends over time. This information is crucial for resource allocation, planning, and developing synergies with other programmes.

• Number of eye care personnel, broken down by cadre. This parameter is important in determining the availability of the eye health workforce. Gaps can be identified and human resource plans adjusted accordingly.

• Cataract surgical service delivery. Cataract surgical rate (number of cataract surgeries performed per year, per million population) and cataract surgical coverage (number of individuals with bilateral cataract causing visual impairment, who have received cataract surgery on one or both eyes). Knowledge of the surgery rate is important for monitoring surgical services for one of the leading causes of blindness globally, and the rate also provides a valuable proxy indicator for eye care service provision. Where Member States have data on the prevalence and causes of visual impairment, coverage for cataract surgery can be calculated; it is an important measure that provides information on the degree to which cataract surgical services are meeting needs.

10. For the first of these indicators there is a global target. It will provide an overall measure of the impact of the action plan. As a global target, the reduction in prevalence of avoidable visual impairment by 25% by 2019 from the baseline of 2010 has been selected for this action plan.6 In meeting this target, the expectation is that greatest gains will come through the reduction in the prevalence of avoidable visual impairment in that portion of the population representing those who are over the age of 50 years. As described above, cataract and uncorrected refractive errors are the two principal causes of avoidable visual impairment, representing 75% of all visual impairment, and are more frequent among older age groups. By 2019, it is estimated that 84% of all visual impairment will be among those aged 50 years or more. Expanding comprehensive integrated eye care services that respond to the major causes of visual impairment, alongside the health improvement that can be expected to come from implementing wider development initiatives including strategies such as the draft action plan for the prevention and control of noncommunicable diseases 2013–2020, and global efforts to eliminate trachoma suggest the target, albeit ambitious, is achievable. In addition, wider health gains coming from the expected increase in the gross domestic product in low-income and middle-income countries will have the effect of reducing visual impairment.7

6 The global prevalence of avoidable visual impairment in 2010 was 3.18%. A 25% reduction means that the preva-lence by 2019 would be 2.37%.

7 According to the International Monetary Fund, by 2019 the average gross domestic product per capita based on purchasing power parity will grow by 24% in low-income and lower-middle-income countries, by 22% in upper- middle-income countries, and by 14% in high-income countries.

9


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plet

ed a

nd p

ublis

hed

an e

ye c

are

serv

ice

asse

ssm

ent o

ver

the

last

five

ye

ars

in 2

019

Obs

erva

tion

of W

orld

Sig

ht D

ay

repo

rted

by

Mem

ber

Sta

tes

Epi

dem

iolo

gica

l and

eco

nom

ic

asse

ssm

ent o

n th

e pr

eval

ence

an

d ca

uses

of v

isua

l im

pair

men

t re

port

ed to

the

Sec

reta

riat b

y M

embe

r S

tate

s

Eye

car

e se

rvic

e as

sess

men

t an

d co

st–e

ffect

iven

ess

rese

arch

re

sults

use

d to

form

ulat

e na

tiona

l an

d su

bnat

iona

l pol

icie

s an

d pl

ans

for

eye

heal

th

Rep

orts

of n

atio

nal,

regi

onal

and

gl

obal

adv

ocac

y an

d aw

aren

ess-

rais

ing

even

ts

Adv

ocac

y su

cces

sful

in

incr

easi

ng in

vest

men

t in

eye

heal

th d

espi

te th

e cu

rren

t glo

bal

finan

cial

env

ironm

ent a

nd

com

petin

g ag

enda

s

Act

ion

s fo

r O

bje

ctiv

e 1

Pro

po

sed

inp

uts

fro

m M

emb

er S

tate

sIn

pu

ts f

rom

th

e S

ecre

tari

at

Pro

po

sed

inp

uts

fro

m

inte

rnat

ion

al p

artn

ers

1.1

Und

erta

ke p

opul

atio

n-ba

sed

surv

eys

on

prev

alen

ce o

f vis

ual

impa

irm

ent a

nd it

s ca

uses

Und

erta

ke s

urve

ys in

col

labo

ratio

n w

ith p

artn

ers,

allo

catin

g re

sour

ces

as

requ

ired

Pub

lish

and

diss

emin

ate

surv

ey r

esul

ts,

and

send

them

to th

e S

ecre

taria

t

Pro

vide

Mem

ber

Sta

tes

with

tool

s fo

r su

rvey

s an

d te

chni

cal a

dvic

e

Pro

vide

est

imat

es o

f pre

vale

nce

at r

egio

nal a

nd g

loba

l lev

els

Adv

ocat

e th

e ne

ed fo

r su

rvey

s

Iden

tify

and

supp

ly a

dditi

onal

re

sour

ces

to c

ompl

emen

t go

vern

men

ts’ i

nves

tmen

ts in

su

rvey

s

12


Act

ion

s fo

r O

bje

ctiv

e 1

Pro

po

sed

inp

uts

fro

m M

emb

er S

tate

sIn

pu

ts f

rom

th

e S

ecre

tari

at

Pro

po

sed

inp

uts

fro

m

inte

rnat

ion

al p

artn

ers

1.2

Ass

ess

the

capa

city

of

Mem

ber

Sta

tes

to p

rovi

de

com

preh

ensi

ve e

ye

care

ser

vice

s an

d id

entif

y ga

ps

Ass

ess

eye

care

ser

vice

del

iver

y,

allo

catin

g re

sour

ces

as r

equi

red.

A

sses

smen

ts s

houl

d co

ver

avai

labi

lity,

ac

cess

ibili

ty, a

fford

abili

ty, s

usta

inab

ility

, qu

ality

and

equ

ity o

f ser

vice

s pr

ovid

ed,

incl

udin

g co

st–e

ffect

iven

ess

anal

ysis

of

eye

heal

th p

rogr

amm

es

Col

lect

and

com

pile

dat

a at

nat

iona

l le

vel,

iden

tifyi

ng g

aps

in s

ervi

ce

prov

isio

n

Pub

lish

and

diss

emin

ate

surv

ey r

esul

ts,

and

repo

rt th

em to

the

Sec

reta

riat

Pro

vide

Mem

ber

Sta

tes

with

tool

s fo

r ey

e ca

re s

ervi

ce a

sses

smen

ts

and

tech

nica

l adv

ice

Pub

lish

and

diss

emin

ate

repo

rts

that

sum

mar

ize

data

pro

vide

d by

M

embe

r S

tate

s an

d in

tern

atio

nal

part

ners

Adv

ocat

e th

e ne

ed fo

r ey

e ca

re

serv

ice

asse

ssm

ents

Sup

port

Mem

ber

Sta

tes

in

colle

ctio

n an

d di

ssem

inat

ion

of

data

Iden

tify

and

supp

ly a

dditi

onal

re

sour

ces

to c

ompl

emen

t go

vern

men

ts’ i

nves

tmen

ts in

eye

ca

re s

ervi

ce a

sses

smen

ts

1.3

Doc

umen

t, an

d us

e fo

r ad

voca

cy, e

xam

ples

of

bes

t pra

ctic

e in

en

hanc

ing

univ

ersa

l ac

cess

to e

ye c

are

Iden

tify

and

docu

men

t suc

cess

ful

inte

rven

tions

and

less

ons

lear

nt

Pub

lish

resu

lts a

nd r

epor

t the

m to

the

Sec

reta

riat

Dev

elop

tool

s an

d pr

ovid

e th

em

to M

embe

r S

tate

s al

ong

with

te

chni

cal a

dvic

e

Col

late

and

dis

sem

inat

e re

port

s fr

om M

embe

r S

tate

s

Adv

ocat

e th

e ne

ed to

doc

umen

t be

st p

ract

ice

Sup

port

Mem

ber

Sta

tes

in

docu

men

ting

best

pra

ctic

e an

d di

ssem

inat

ing

resu

lts

Iden

tify

addi

tiona

l res

ourc

es

to c

ompl

emen

t gov

ernm

ents

’ in

vest

men

ts

13


Ob

ject

ive

2M

easu

rab

le in

dic

ato

rsM

ean

s o

f ve

rifi

cati

on

Imp

ort

ant

assu

mp

tio

ns

Nat

iona

l eye

hea

lth

polic

ies,

pla

ns a

nd

prog

ram

mes

for

enha

ncin

g un

iver

sal e

ye

heal

th d

evel

oped

and

/or

str

engt

hene

d an

d im

plem

ente

d in

line

with

W

HO

’s fr

amew

ork

for

actio

n fo

r st

reng

then

ing

heal

th s

yste

ms

in o

rder

to

impr

ove

heal

th o

utco

mes

Num

ber

of M

embe

r S

tate

s re

port

ing

the

impl

emen

tatio

n of

pol

icie

s, p

lans

and

pr

ogra

mm

es fo

r ey

e he

alth

Num

ber

of M

embe

r S

tate

s w

ith a

n ey

e he

alth

/pre

vent

ion

of b

lindn

ess

com

mitt

ee, a

nd/o

r a

natio

nal p

reve

ntio

n of

blin

dnes

s co

ordi

nato

r, or

equ

ival

ent

mec

hani

sm in

pla

ce

Num

ber

of M

embe

r S

tate

s th

at in

clud

e ey

e ca

re s

ectio

ns in

thei

r na

tiona

l lis

ts

of e

ssen

tial m

edic

ines

, dia

gnos

tics

and

heal

th te

chno

logi

es

Num

ber

of M

embe

r S

tate

s th

at r

epor

t th

e in

tegr

atio

n of

eye

hea

lth in

to

natio

nal h

ealth

pla

ns a

nd b

udge

ts

Num

ber

of M

embe

r S

tate

s th

at r

epor

t a

natio

nal p

lan

that

incl

udes

hum

an

reso

urce

s fo

r ey

e ca

re

Num

ber

of M

embe

r S

tate

s re

port

ing

evid

ence

of r

esea

rch

on th

e co

st–

effe

ctiv

enes

s of

eye

hea

lth p

rogr

amm

es

Rep

orts

that

sum

mar

ize

data

pr

ovid

ed b

y M

embe

r S

tate

s P

olic

ies,

pla

ns a

nd p

rogr

amm

es

have

suf

ficie

nt r

each

for

all

popu

latio

ns

Ser

vice

s ac

cess

ed b

y th

ose

in

need

14


Act

ion

s fo

r O

bje

ctiv

e 2

Pro

po

sed

inp

uts

fro

m M

emb

er S

tate

sIn

pu

ts f

rom

th

e S

ecre

tari

at

Pro

po

sed

inp

uts

fro

m

inte

rnat

ion

al p

artn

ers

2.1

Pro

vide

lead

ersh

ip

and

gove

rnan

ce fo

r de

velo

ping

/upd

atin

g,

impl

emen

ting

and

mon

itorin

g na

tiona

l/su

bnat

iona

l pol

icie

s an

d pl

ans

for

eye

heal

th

Dev

elop

/upd

ate

natio

nal/s

ubna

tiona

l po

licie

s, p

lans

and

pro

gram

mes

for

eye

heal

th a

nd p

reve

ntio

n of

vis

ual

impa

irm

ent,

incl

udin

g in

dica

tors

and

ta

rget

s, e

ngag

ing

key

stak

ehol

ders

Sec

ure

incl

usio

n of

prim

ary

eye

care

in

to p

rimar

y he

alth

car

e

Est

ablis

h ne

w a

nd/o

r m

aint

ain

the

exis

ting

coor

dina

ting

mec

hani

sms

(e.g

. nat

iona

l coo

rdin

ator

, eye

hea

lth/

prev

entio

n of

blin

dnes

s co

mm

ittee

, oth

er

natio

nal/s

ubna

tiona

l mec

hani

sms)

to

over

see

impl

emen

tatio

n an

d m

onito

ring/

eval

uatin

g th

e po

licie

s, p

lans

and

pr

ogra

mm

es

Pro

vide

gui

danc

e to

Mem

ber

Sta

tes

on h

ow to

dev

elop

an

d im

plem

ent n

atio

nal a

nd

subn

atio

nal p

olic

ies,

pla

ns a

nd

prog

ram

mes

in li

ne w

ith th

e gl

obal

act

ion

plan

Pro

vide

Mem

ber

Sta

tes

with

tool

s an

d te

chni

cal a

dvic

e on

prim

ary

eye

care

, and

evi

denc

e on

goo

d le

ader

ship

and

gov

erna

nce

prac

tices

in d

evel

opin

g,

impl

emen

ting,

mon

itorin

g an

d ev

alua

ting

com

preh

ensi

ve a

nd

inte

grat

ed e

ye c

are

serv

ices

Est

ablis

h/m

aint

ain

glob

al a

nd

regi

onal

sta

ff w

ith r

espo

nsib

ility

fo

r ey

e he

alth

/pre

vent

ion

of

visu

al im

pair

men

t

Est

ablis

h co

untr

y po

sitio

ns fo

r ey

e he

alth

/pre

vent

ion

of v

isua

l im

pair

men

t whe

re s

trat

egic

ally

re

leva

nt a

nd r

esou

rces

allo

w

Adv

ocat

e na

tiona

l/sub

natio

nal

lead

ersh

ip fo

r de

velo

ping

pol

icie

s,

plan

s an

d pr

ogra

mm

es

Sup

port

nat

iona

l lea

ders

hip

in id

entif

ying

the

finan

cial

and

te

chni

cal r

esou

rces

req

uire

d fo

r im

plem

entin

g th

e po

licie

s/pl

ans

and

incl

usio

n of

prim

ary

eye

care

in

prim

ary

heal

th c

are

Sec

ure

fund

ing

for

key

posi

tions

in th

e S

ecre

taria

t at

head

quar

ters

, reg

iona

l and

co

untr

y le

vels

15


Act

ion

s fo

r O

bje

ctiv

e 2

Pro

po

sed

inp

uts

fro

m M

emb

er S

tate

sIn

pu

ts f

rom

th

e S

ecre

tari

at

Pro

po

sed

inp

uts

fro

m

inte

rnat

ion

al p

artn

ers

2.2

Sec

ure

adeq

uate

fin

anci

al r

esou

rces

to

impr

ove

eye

heal

th a

nd p

rovi

de

com

preh

ensi

ve

eye

care

ser

vice

s in

tegr

ated

into

hea

lth

syst

ems

thro

ugh

natio

nal p

olic

ies,

pla

ns

and

prog

ram

mes

Ens

ure

fund

ing

for

eye

heal

th w

ithin

a

com

preh

ensi

ve in

tegr

ated

hea

lth c

are

serv

ice

Per

form

cos

t–be

nefit

ana

lysi

s of

pr

even

tion

of a

void

able

vis

ual

impa

irm

ent a

nd r

ehab

ilita

tion

serv

ices

an

d co

nduc

t res

earc

h on

the

cost

–ef

fect

iven

ess

of e

ye h

ealth

pro

gram

mes

to

opt

imiz

e th

e us

e of

ava

ilabl

e re

sour

ces

Pro

vide

tool

s an

d te

chni

cal

supp

ort t

o M

embe

r S

tate

s in

iden

tifyi

ng c

ost–

effe

ctiv

e in

terv

entio

ns a

nd s

ecur

e th

e fin

anci

al r

esou

rces

nee

ded

Adv

ocat

e at

nat

iona

l and

in

tern

atio

nal l

evel

s fo

r ad

equa

te

fund

s an

d th

eir

effe

ctiv

e us

e to

im

plem

ent n

atio

nal/s

ubna

tiona

l po

licie

s, p

lans

and

pro

gram

mes

Iden

tify

sour

ces

of fu

nds

to

com

plem

ent n

atio

nal i

nves

tmen

t in

eye

car

e se

rvic

es a

nd c

ost–

bene

fit a

naly

ses

2.3

Dev

elop

and

mai

ntai

n a

sust

aina

ble

wor

kfor

ce fo

r th

e pr

ovis

ion

of

com

preh

ensi

ve e

ye

care

ser

vice

s as

par

t of

the

broa

der

hum

an

reso

urce

s fo

r he

alth

w

orkf

orce

Und

erta

ke p

lann

ing

of h

uman

res

ourc

es

for

eye

care

as

part

of w

ider

hum

an

reso

urce

s fo

r he

alth

pla

nnin

g, a

nd

hum

an r

esou

rces

for

eye

heal

th

plan

ning

in o

ther

rel

evan

t sec

tors

Pro

vide

trai

ning

and

car

eer

deve

lopm

ent

for

eye

heal

th p

rofe

ssio

nals

Ens

ure

rete

ntio

n st

rate

gies

for

eye

heal

th s

taff

are

in p

lace

and

bei

ng

impl

emen

ted

Iden

tify,

doc

umen

t and

dis

sem

inat

e be

st p

ract

ice

to th

e S

ecre

taria

t and

ot

her

part

ners

with

reg

ard

to h

uman

re

sour

ces

in e

ye h

ealth

Pro

vide

tech

nica

l ass

ista

nce

as

requ

ired

Col

late

and

pub

lish

exam

ples

of

best

pra

ctic

e

Adv

ocat

e th

e im

port

ance

of a

su

stai

nabl

e ey

e he

alth

wor

kfor

ce

Sup

port

trai

ning

and

pro

fess

iona

l de

velo

pmen

t thr

ough

nat

iona

l co

ordi

natio

n m

echa

nism

s

Pro

vide

sup

port

to M

embe

r S

tate

s in

col

lect

ion

and

diss

emin

atio

n of

dat

a

16


Act

ion

s fo

r O

bje

ctiv

e 2

Pro

po

sed

inp

uts

fro

m M

emb

er S

tate

sIn

pu

ts f

rom

th

e S

ecre

tari

at

Pro

po

sed

inp

uts

fro

m

inte

rnat

ion

al p

artn

ers

2.4

Pro

vide

co

mpr

ehen

sive

and

eq

uita

ble

eye

care

se

rvic

es a

t prim

ary,

se

cond

ary

and

tert

iary

le

vels

, inc

orpo

ratin

g na

tiona

l tra

chom

a an

d on

choc

erci

asis

el

imin

atio

n ac

tiviti

es

Pro

vide

and

/or

coor

dina

te u

nive

rsal

ac

cess

to c

ompr

ehen

sive

and

equ

itabl

e ey

e ca

re s

ervi

ces,

with

em

phas

is o

n vu

lner

able

gro

ups

such

as

child

ren

and

the

elde

rly

Str

engt

hen

refe

rral

mec

hani

sms,

and

re

habi

litat

ion

serv

ices

for

the

visu

ally

im

paire

d

Est

ablis

h qu

ality

sta

ndar

ds a

nd n

orm

s fo

r ey

e ca

re

Pro

vide

WH

O’s

exi

stin

g to

ols

and

tech

nica

l sup

port

to M

embe

r S

tate

s

Adv

ocat

e th

e im

port

ance

of

com

preh

ensi

ve a

nd e

quita

ble

eye

care

ser

vice

s

Sup

port

loca

l cap

acity

bui

ldin

g fo

r pr

ovis

ion

of e

ye c

are

serv

ices

, in

clud

ing

reha

bilit

atio

n se

rvic

es

in li

ne w

ith p

olic

ies,

pla

ns a

nd

prog

ram

mes

thro

ugh

natio

nal

coor

dina

tion

mec

hani

sms

Mon

itor,

eval

uate

and

rep

ort o

n se

rvic

es p

rovi

ded

in li

ne w

ith

natio

nal p

olic

ies,

pla

ns a

nd

prog

ram

mes

thro

ugh

natio

nal

coor

dina

tion

mec

hani

sms

2.5

Mak

e av

aila

ble

and

acce

ssib

le

esse

ntia

l med

icin

es,

diag

nost

ics

and

heal

th te

chno

logi

es

of a

ssur

ed q

ualit

y w

ith p

artic

ular

focu

s on

vul

nera

ble

grou

ps

and

unde

rser

ved

com

mun

ities

, and

ex

plor

e m

echa

nism

s to

incr

ease

affo

rdab

ility

of

new

evi

denc

e-ba

sed

tech

nolo

gies

Ens

ure

exis

tenc

e of

a n

atio

nal l

ist o

f es

sent

ial m

edic

al p

rodu

cts,

nat

iona

l di

agno

stic

and

trea

tmen

t pro

toco

ls, a

nd

rele

vant

equ

ipm

ent

Ens

ure

the

avai

labi

lity

and

acce

ssib

ility

of

ess

entia

l med

icin

es, d

iagn

ostic

s an

d he

alth

tech

nolo

gies

Pro

vide

tech

nica

l ass

ista

nce

and

tool

s to

sup

port

Mem

ber

Sta

tes

Adv

ocat

e th

e im

port

ance

of

esse

ntia

l med

icin

es, d

iagn

ostic

s an

d he

alth

tech

nolo

gies

Pro

vide

ess

entia

l med

icin

es,

diag

nost

ics

and

heal

th

tech

nolo

gies

in li

ne w

ith n

atio

nal

polic

ies

17


Act

ion

s fo

r O

bje

ctiv

e 2

Pro

po

sed

inp

uts

fro

m M

emb

er S

tate

sIn

pu

ts f

rom

th

e S

ecre

tari

at

Pro

po

sed

inp

uts

fro

m

inte

rnat

ion

al p

artn

ers

2.6

Incl

ude

indi

cato

rs

for

the

mon

itorin

g of

pr

ovis

ion

of e

ye c

are

serv

ices

and

thei

r qu

ality

in n

atio

nal

info

rmat

ion

syst

ems

Ado

pt a

set

of n

atio

nal i

ndic

ator

s an

d ta

rget

s, in

clud

ing

thos

e on

reh

abili

tatio

n,

with

in th

e na

tiona

l inf

orm

atio

n sy

stem

s

Per

iodi

cally

col

lect

, ana

lyse

and

in

terp

ret d

ata

Rep

ort d

ata

to th

e S

ecre

taria

t

Pro

vide

tech

nica

l sup

port

to

Mem

ber

Sta

tes

by in

clud

ing

natio

nal i

ndic

ator

s an

d ta

rget

s in

na

tiona

l hea

lth s

yste

ms

Col

late

and

dis

sem

inat

e da

ta

repo

rted

by

Mem

ber

Sta

tes

annu

ally

Adv

ocat

e th

e im

port

ance

of

mon

itorin

g us

ing

natio

nally

ag

reed

indi

cato

rs

Pro

vide

fina

ncia

l and

tech

nica

l su

ppor

t for

col

lect

ion

and

anal

ysis

of

nat

iona

l and

sub

natio

nal d

ata

Ob

ject

ive

3M

easu

rab

le in

dic

ato

rsM

ean

s o

f ve

rifi

cati

on

Imp

ort

ant

assu

mp

tio

ns

Mul

tisec

tora

l eng

agem

ent

and

effe

ctiv

e pa

rtne

rshi

ps

for

impr

oved

eye

hea

lth

stre

ngth

ened

Num

ber

of M

embe

r S

tate

s th

at r

efer

to a

m

ultis

ecto

ral a

ppro

ach

in th

eir

natio

nal

eye

heal

th/p

reve

ntio

n of

blin

dnes

s po

licie

s, p

lans

and

pro

gram

mes

The

WH

O A

llian

ce fo

r th

e G

loba

l E

limin

atio

n of

Tra

chom

a by

the

Year

202

0, A

fric

an P

rogr

amm

e fo

r O

ncho

cerc

iasi

s C

ontr

ol, a

nd

Onc

hoce

rcia

sis

Elim

inat

ion

Pro

gram

for

the

Am

eric

as d

eliv

er a

ccor

ding

to th

eir

stra

tegi

c pl

ans

Num

ber

of M

embe

r S

tate

s th

at h

ave

eye

heal

th in

corp

orat

ed in

to r

elev

ant

pove

rty-

redu

ctio

n st

rate

gies

, ini

tiativ

es

and

wid

er s

ocio

econ

omic

pol

icie

s

Num

ber

of M

embe

r S

tate

s re

port

ing

eye

heal

th a

s a

part

of i

nter

sect

oral

co

llabo

ratio

n

Rep

orts

from

Mem

ber

Sta

tes

rece

ived

and

col

late

d by

the

Sec

reta

riat

Rec

eipt

of a

nnua

l rep

orts

and

pu

blic

atio

ns fr

om p

artn

ersh

ips

Non

-hea

lth s

ecto

rs in

vest

in w

ider

so

cioe

cono

mic

dev

elop

men

t

18


Act

ion

s fo

r O

bje

ctiv

e 3

Pro

po

sed

inp

uts

fro

m M

emb

er S

tate

sIn

pu

ts f

rom

th

e S

ecre

tari

at

Pro

po

sed

inp

uts

fro

m

inte

rnat

ion

al p

artn

ers

3.1

Eng

age

non-

heal

th

sect

ors

in d

evel

opin

g an

d im

plem

entin

g ey

e he

alth

/pre

vent

ion

of v

isua

l im

pair

men

t po

licie

s an

d pl

ans

Hea

lth m

inis

trie

s id

entif

y an

d en

gage

ot

her

sect

ors,

suc

h as

thos

e un

der

min

istr

ies

of e

duca

tion,

fina

nce,

wel

fare

an

d de

velo

pmen

t

Rep

ort e

xper

ienc

es to

the

Sec

reta

riat

Adv

ise

Mem

ber

Sta

tes

on

spec

ific

role

s of

non

-hea

lth

sect

ors

and

prov

ide

supp

ort i

n id

entif

ying

and

eng

agin

g no

n-he

alth

sec

tors

Col

late

and

pub

lish

Mem

ber

Sta

tes’

exp

erie

nces

Adv

ocat

e ac

ross

sec

tors

the

adde

d va

lue

of m

ultis

ecto

ral w

ork

Pro

vide

fina

ncia

l and

tech

nica

l ca

paci

ty to

mul

tisec

tora

l act

iviti

es

(e.g

. wat

er a

nd s

anita

tion)

Pro

vide

sup

port

to M

embe

r S

tate

s in

col

lect

ing

and

diss

emin

atin

g ex

perie

nces

3.2

Enh

ance

effe

ctiv

e in

tern

atio

nal a

nd

natio

nal p

artn

ersh

ips

and

allia

nces

Pro

mot

e ac

tive

enga

gem

ent i

n,

and

whe

re a

ppro

pria

te, e

stab

lish

part

ners

hips

and

alli

ance

s th

at

harm

oniz

e an

d ar

e al

igne

d w

ith

natio

nal p

riorit

ies,

pol

icie

s, p

lans

and

pr

ogra

mm

es

Iden

tify

and

prom

ote

suita

ble

mec

hani

sms

for

inte

rcou

ntry

co

llabo

ratio

n

Whe

re a

ppro

pria

te, p

artic

ipat

e in

and

lead

par

tner

ship

s an

d al

lianc

es, i

nclu

ding

eng

agin

g ot

her

Uni

ted

Nat

ions

ent

ities

, th

at s

uppo

rt, h

arm

oniz

e an

d ar

e al

igne

d w

ith M

embe

r S

tate

s’

prio

ritie

s, p

olic

ies,

pla

ns a

nd

prog

ram

mes

Faci

litat

e an

d su

ppor

t es

tabl

ishm

ent o

f int

erco

untr

y co

llabo

ratio

n

Pro

mot

e pa

rtic

ipat

ion

and

activ

ely

supp

ort p

artn

ersh

ips,

alli

ance

s an

d in

terc

ount

ry c

olla

bora

tion

that

har

mon

ize

and

are

alig

ned

with

Mem

ber

Sta

tes’

prio

ritie

s,

polic

ies,

pla

ns a

nd p

rogr

amm

es

3.3

Inte

grat

e ey

e he

alth

into

pov

erty

-re

duct

ion

stra

tegi

es,

initi

ativ

es a

nd w

ider

so

cioe

cono

mic

pol

icie

s

Iden

tify

and

inco

rpor

ate

eye

heal

th in

re

leva

nt p

over

ty-r

educ

tion

stra

tegi

es,

initi

ativ

es a

nd s

ocio

econ

omic

pol

icie

s

Ens

ure

that

peo

ple

with

avo

idab

le a

nd

unav

oida

ble

visu

al im

pair

men

t hav

e ac

cess

to e

duca

tiona

l opp

ortu

nitie

s, a

nd

that

dis

abili

ty in

clus

ion

prac

tices

are

de

velo

ped,

impl

emen

ted

and

eval

uate

d

Writ

e an

d di

ssem

inat

e ke

y m

essa

ges

for

polic

y-m

aker

s

Adv

ise

Mem

ber

Sta

tes

on w

ays

to in

clud

e ey

e he

alth

/pre

vent

ion

of v

isua

l im

pair

men

t in

pove

rty-

redu

ctio

n st

rate

gies

, ini

tiativ

es

and

soci

oeco

nom

ic p

olic

ies

Adv

ocat

e th

e in

tegr

atio

n of

eye

he

alth

into

pov

erty

-red

uctio

n st

rate

gies

, ini

tiativ

es a

nd

soci

oeco

nom

ic p

olic

ies

19


APPENDIX 4

National indicators for prevention of avoidable blindness and visual impairment1. Prevalence and causes of visual impairment

Purpose/rationale To measure the magnitude of visual impairment including blindness and monitor progress in eliminating avoidable blindness and in controlling avoidable visual impairment

Definition Prevalence of visual impairment, including blindness, and its causes, preferably disaggregated by age and gender

Preferred methods of data collection

Methodologically sound and representative surveys of prevalence provide the most reliable method. Additionally, the Rapid Assessment of Avoidable Blindness and the Rapid Assessment of Cataract Surgical Services are two standard methodologies for obtaining results for people in the age group with the highest prevalence of visual impairment, that is, those over 50 years of age

Unit of measurement Prevalence of visual impairment determined from population surveys

Frequency of data collection

At national level at least every five years

Source of data Health ministry or national prevention of blindness/eye health coordinator/committee

Dissemination of data The Secretariat periodically updates the global estimates on the prevalence and causes of visual impairment

2. Number of eye care personnel by cadre2.1 Ophthalmologists

Purpose/rationale To assess availability of the eye health workforce in order to formulate a capacity-development response for strengthening national health systems. Ophthalmologists are the primary cadre that deliver medical and surgical eye care interventions

Definition Number of medical doctors certified as ophthalmologists by national institutions based on government-approved certification criteria. Ophthalmologists are medical doctors who have been trained in ophthalmic medicine and/or surgery and who evaluate and treat diseases of the eye


Registers of national professional and regulatory bodies

20


Unit of measurement Number of ophthalmologists per one million population


Annually

Limitations The number does not reflect the proportion of ophthalmologists who are not surgically active; clinical output (e.g. subspecialists); performance; and quality of interventions. Unless disaggregated, the data do not reflect geographical distribution

Source of information Health ministry or national prevention of blindness/eye health coordinator/committee

Dissemination of data The Secretariat annually issues a global update based on the national data provided by Member States

2.2 Optometrists

Purpose/rationale To assess availability of the eye health workforce in order to formulate a capacity-development response for strengthening national health systems. In an increasing number of countries, optometrists are often the first point of contact for persons with eye diseases

Definition Number of optometrists certified by national institutions based on government-approved certification criteria


Registers of national professional and regulatory bodies

Unit of measurement Number of optometrists per one million population


Annually

Limitations The number does not denote performance, especially the quality of interventions to reduce avoidable blindness. There is a wide variability in knowledge and skill of optometrists from one nation to another because curricula are not standardized

Numbers do not reflect the proportion of ophthalmic clinical officers, refractionists and other such groups who in some countries perform the role of optometrists where this cadre is short staffed or does not exist



21


2.3 Allied ophthalmic personnel

Purpose/rationale To assess availability of the eye health workforce in order to formulate a capacity-development response for strengthening national health systems. Allied ophthalmic personnel may be characterized by different educational requirements, legislation and practice regulations, skills and scope of practice between countries and even within a given country. Typically, allied ophthalmic personnel comprise opticians, ophthalmic nurses, orthoptists, ophthalmic and optometric assistants, ophthalmic and optometric technicians, vision therapists, ocularists, ophthalmic photographer/imagers, and ophthalmic administrators

Definition Numbers of allied ophthalmic personnel comprising professional categories, which need to be specified by a reporting Member State


Compilation of national data from subnational (district) data from government, nongovernmental and private eye care service providers

Unit of measurement Number of allied ophthalmic personnel per one million population


Annually

Limitations The numbers do not denote performance, especially the quality of interventions to reduce avoidable blindness. There is a wide variability in knowledge and skill. These data are useful for monitoring of progress in countries over time but they cannot be reliably used for intercountry comparison because of variation in nomenclature



3. Cataract surgical service delivery3.1 Cataract surgical rate

Purpose/rationale The rate can be used to set national targets for cataract surgical service delivery. It is also often used as a proxy indicator for general eye care service delivery. Globally, cataract remains the leading cause of blindness. Visual impairment and blindness from cataracts are avoidable because an effective means of treatment (cataract extraction with implantation of an intraocular lens) is both safe and efficacious to restore sight. The cataract surgical rate is a quantifiable measure of cataract surgical service delivery

Definition The number of cataract operations performed per year per one million population


Government health information records, surveys

22


Unit of measurement Number of cataract operations performed per one million population


Annually at national level. In larger countries it is desirable to collate data at subnational level

Limitations This indicator is meaningful only when it includes all cataract surgeries performed in a country, that is, those performed within the government and nongovernmental sectors

Comments For calculations, use official sources of population data (United Nations)



3.2 Cataract surgical coverage

Purpose/rationale To assess the degree to which cataract surgical services are meeting the need

Definition Proportion of people with bilateral cataract eligible for cataract surgery who have received cataract surgery in one or both eyes (at 3/60 and 6/18 level)


Calculation using data from methodologically sound and representative prevalence surveys. Additionally, calculation using data from the Rapid Assessment of Avoidable Blindness and the Rapid Assessment of Cataract Surgical Services, which are two standard methodologies to obtain results for people in the age group with the highest prevalence of blindness and visual impairment due to cataract, that is, those over 50 years of age

Unit of measurement Proportion


Determined by the frequency of performing a national/district study on the prevalence of blindness and visual impairment and their causes

Limitations Requires population-based studies, which may be of limited generalization

Comments Preferably data are disaggregated by gender, age, and urban/rural location or district


Dissemination of data The Secretariat periodically issues updates

© World Health Organization 20132 i i 20142019 Introduction The global eye health action plan...

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