Dr Ivo Kocur, WHO Prevention of Blindness and Deafness
Given that more than half of all hearing and visual impairment cases are preventable, it is clear that appropriate action can have a major impact on global health. Dr Ivo Kocur discusses these issues and the WHO strategy to address them
To further develop comprehensive eye and hearing health programmes at national and subnational levels, WHO has dedicated a small team of experts to support its Member States in their efforts. We work with an impressive range of international partners to provide technical assistance in needs assessments, formulations of national and subnational eye health and hearing health plans, their implementation and monitoring.
Seeking to identify the needs of its Member States, WHO works to provide technical support for the implementation of appropriate cost-effective health strategies. WHO has been very active in building international partnerships and alliances, such as the VISION 2020 Global Initiative; GET2020 – WHO Alliance for Global Elimination of Trachoma by 2020; African Programme for Onchocerciasis Control; and a collaborative agenda to prevent childhood blindness with the Lions Club International Foundation.
The VISION 2020 Global Initiative was launched in 1999 as a major global collaborative effort of the WHO and the International Agency for the Prevention of Blindness. The Initiative has promoted the development of national eye health plans based on needs assessments and a selection of the most appropriate interventions. VISION 2020 has also been a major advocacy effort which resulted in increased global awareness of the opportunities for preserving vision and controlling avoidable causes of visual impairment. Along this line, the World Health Assembly adopted a resolution on prevention of blindness in 2003 and 2006. Consequently, the World Health Assembly endorsed the Action plan for the prevention of avoidable blindness and visual impairment 2009-13.
A five-year plan
The eye health agenda has been repeatedly discussed by World Health Assemblies. In 2008, the WHO secretariat drafted an action plan for preventing avoidable visual impairment. WHO has worked on this comprehensive document with Member States and international partners, resulting in an action plan with five key objectives:
• Eye health advocacy for decision and policy makers
• Development of national eye health plans and policies
• Enhancement of research activities
• Improved coordination between partnerships and stakeholders at national and international level
• Improved standardised monitoring mechanisms
This five-year action plan was endorsed by the World Health Assembly in 2009. The plan aims to intensify and coordinate existing prevention of visual impairment activities, especially in low- and middle-income countries.
While reporting on the implementation of the current action plan to the WHO Executive Board in January 2012, the Board members decided that the political support which has been given to eye health should be continued. As a result, the secretariat drafted a new action plan for 2014-19. This was a major stimulus for learning about experiences of Member States and our partners with the current action plan. During the early months of 2012, we repeatedly interacted with the public through our website with discussion papers and surveys in order to collect critical feedback while working on the new action plan. Messages sent by Member States and a large range of partners confirmed that we have been working as one global team.
While this has been very encouraging for those directly involved in the development of the new action plan, a couple of key issues were revealed when implementing the current plan. Firstly, there is an increasing need to offer more evidence on the causes of visual impairment and their trends so that Member States can develop sufficiently detailed and specific intervention plans to fit their requirements. There is a need for operation research and adequate efforts to identify cost-effective interventions that suit the target community. This allows for successful evidence-based advocacy for eye health enhanced by measurable results of appropriate eye care interventions. As no one can and should operate in isolation through time-limited vertical programmes, it was repeatedly reported that effective integration of eye care services in health systems and effective partnerships are needed to make the best possible use of the existing resources.
Building on the experiences of Member States with the current action plan, the new global action plan is based on three core objectives, each with a set of actions for Member States, international partners and the secretariat:
• Address the need for generating evidence on the magnitude and causes of visual impairment and eye care services and use this information to advocate greater political and financial commitment by Member States to eye health
• Encourage 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
• Address multi-sectoral engagement and effective partnerships to strengthen eye health
Each of the three objectives has a set of metrics to chart progress. The major difference with the current action plan is seen in the effort to align WHO’s activities with national health systems and broader health agendas. It is now for the WHO Executive Board and the World Health Assembly to consider the action plan.
Improving quality of life
There have been many exciting research developments in recent years to help reduce the number of people with visual impairment or blindness. The WHO works with experts in various fields of eye and hearing health and convenes meetings to address specific issues. The result of those meetings are technical reports summarising experiences which are then offered to Member States as a technical tool they may use in the development of public health policies and strategies. Medical science is evolving very fast and eye and hearing care have experienced major technological development. While earlier most of the advanced techniques were not affordable for low- and middle-income countries, this is now changing. The use of communication technologies has dramatically changed the way people can access information, gain new knowledge, learn from experts. Education in healthcare has never been more accessible and the opportunities are growing.
It is hoped that WHO’s efforts will successfully contribute to improved quality of life in a world in which nobody is needlessly visually and hearing impaired, where those with unavoidable vision and hearing loss can achieve their full potential, and where there is universal access to comprehensive eye and hearing care services.