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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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Printed in Spain.
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
Universal eye health: a global action plan 2014–2019
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
Universal eye health: a global action plan 2014–2019
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
Universal eye health: a global action plan 2014–2019
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
Universal eye health: a global action plan 2014–2019
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
Universal eye health: a global action plan 2014–2019
Universal eye health: a global action plan 2014–20192
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
Universal eye health: a global action plan 2014–2019
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
Universal eye health: a global action plan 2014–2019
(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
Universal eye health: a global action plan 2014–2019
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
Universal eye health: a global action plan 2014–2019
APPE
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10
Universal eye health: a global action plan 2014–2019
APPE
NDIX
2
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spec
ts o
f life
11
Universal eye health: a global action plan 2014–2019
APPE
NDIX
3
Obje
ctiv
es a
nd a
ctio
nsO
bje
ctiv
e 1
Mea
sura
ble
ind
icat
ors
Mea
ns
of
veri
fica
tio
nIm
po
rtan
t as
sum
pti
on
s
Evi
denc
e ge
nera
ted
and
used
to a
dvoc
ate
incr
ease
d po
litic
al a
nd
finan
cial
com
mitm
ent o
f M
embe
r S
tate
s fo
r ey
e he
alth
Num
ber
of M
embe
r S
tate
s th
at h
ave
unde
rtak
en a
nd p
ublis
hed
prev
alen
ce
surv
eys
durin
g th
e pa
st fi
ve y
ears
by
2019
Num
ber
of M
embe
r S
tate
s th
at h
ave
com
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
Universal eye health: a global action plan 2014–2019
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
Universal eye health: a global action plan 2014–2019
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
Universal eye health: a global action plan 2014–2019
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
Universal eye health: a global action plan 2014–2019
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
Universal eye health: a global action plan 2014–2019
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
Universal eye health: a global action plan 2014–2019
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
Universal eye health: a global action plan 2014–2019
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
Universal eye health: a global action plan 2014–2019
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
Preferred methods of data collection
Registers of national professional and regulatory bodies
20
Universal eye health: a global action plan 2014–2019
Unit of measurement Number of ophthalmologists per one million population
Frequency of data collection
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
Preferred methods of data collection
Registers of national professional and regulatory bodies
Unit of measurement Number of optometrists per one million population
Frequency of data collection
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
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
21
Universal eye health: a global action plan 2014–2019
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
Preferred methods of data collection
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
Frequency of data collection
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
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
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
Preferred methods of data collection
Government health information records, surveys
22
Universal eye health: a global action plan 2014–2019
Unit of measurement Number of cataract operations performed per one million population
Frequency of data collection
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)
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
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)
Preferred methods of data collection
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
Frequency of data collection
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
Source of information Health ministry or national prevention of blindness/eye health coordinator/committee
Dissemination of data The Secretariat periodically issues updates
Recommended