Regional Director’s Golden Jubilee Oration – “Towards Universal Eye Care: From strategy to results”

Dr R P Centre Golden Jubilee Ophthalmology Congress

Jawaharlal Nehru Auditorium, All India Institute of Medical Sciences

11 March 2017, New Delhi, India

Distinguished guests, ladies and gentlemen,

It is a privilege to be here today to celebrate the golden jubilee of this august institution, which is among the finest in the world.

For 50 years the Rajendra Prasad Centre for Ophthalmic Sciences has been at the vanguard of eye health teaching, research and care.

It is an institution that has stood tall as a center of excellence, and one that has made vital contributions to understanding the biomedical and biosocial components of eye health.

I am most pleased to count this institution among WHO’s collaborating centers, and to have the opportunity to work with you on prevention of visual impairment – a most important public health issue.

Indeed, despite dramatic public health gains in recent decades, the incidence and prevalence of visual impairment remains a pressing issue.

At the global level, approximately 285 million people are visually impaired. Of these cases, around 39 million are blind. Of significant import is the fact that 80% of visual impairment is avoidable – that is, it can be prevented or cured. 90% of cases occur in developing countries.

The South-East Asia Region, which is comprised of low- and middle income-countries, is particularly affected. There are around 90 million visually impaired persons in the Region, of which 12 million are blind. Again, 80% of cases could have been prevented. As you are no doubt aware, around eight million – or two thirds – of the Region’s blind persons are in India.

Across South-East Asia, and with it, India, the causes of visual impairment are relatively well known. Together cataract and uncorrected refractive errors account for more than three-quarters of visual impairment. At the same time, cataract accounts for more than 50% of blindness. The rest is primarily caused by glaucoma, trachoma and childhood blindness.

We are now, however, seeing new causes come to the fore. Eye problems related to noncommunicable diseases, including diabetic retinopathy and hypertensive retinopathy, are increasing in number as diabetes and hypertension rates climb. In similar fashion, macular disorders associated with ageing are becoming increasingly common as the Region’s population grows older.

The message is clear. The need to invest in eye health and accelerate progress against visual impairment cannot be over-emphasized.

Nevertheless, accelerating progress and achieving results is a question of strategy as much as it is one of commitment and resources. As such, it is worth looking at the policy realm in which we are operating, both as it relates to eye care specifically, as well as health and development more broadly.

Ladies and gentlemen,

The Vision 2020 Global Initiative, which was launched at the turn of the millennium, has provided much of the framework through which eye health has been conceptualized and approached. The Initiative envisaged a world in which ‘nobody is needlessly visually impaired’, and where ‘those with unavoidable vision loss can achieve their full potential’. It aimed to intensify and accelerate prevention of blindness activities so as to achieve the goal of eliminating avoidable blindness by 2020.

The Initiative’s scope has been expanded and built upon. A 2006 Action Plan enlarged its mandate to include visual impairment, not just blindness. This was followed by a 2009-2013 Action Plan drafted to complement global efforts aimed at combatting noncommunicable diseases. World Health Assembly resolutions adopted in 2003, 2006, and 2009 meanwhile served to keep eye health on the international agenda and uppermost in the minds of health ministers.

Nevertheless, as the mandate of the 2009-2013 Action Plan ended, an important evolution in the discourse on international development was occurring. In contrast to the vertical approach of the MDGs, a more holistic and integrated strategy was being promoted for a range of development issues, from energy consumption to poverty reduction. The Sustainable Development Goals, which came into effect in 2015, were the outcome of this shift in thinking. It was a shift with profound implications for public health.

Sustainable Development Goal 3, the health goal, for example, urges governments to ‘Ensure healthy lives and promote wellbeing for all at all ages’, and to leave no one behind in this quest. Primary health care and the attainment of universal health coverage is of fundamental importance within this approach. Indeed, it is the means by which ‘wellbeing for all’ can be achieved.

This renewed emphasis on primary health care has been reflected in recent eye health programming. The 2014-2019 global action plan for eye health, for example, makes clear that the goal of any effective and result-oriented programme must be the attainment of universal eye health care. To do so it urges Member States to integrate eye health into national health plans and health service delivery. The plan also recognizes the links between eye health and efforts to address noncommunicable and neglected tropical diseases.

Trachoma is among a number of neglected tropical diseases that WHO is working with Member States to eliminate by 2020. Within the Region, Myanmar and Nepal are already reported to have eliminated trachoma, and will undergo validation next year. On this note, I appreciate India’s recent initiatives to tackle the problem, and I commend the RP Center’s support to these efforts.

Ladies and gentlemen,

As I have outlined, our global action plan is both well-defined and comprehensive in scope. But to go from strategy to results, and to achieve universal eye health, there are a few approaches that I wish to emphasize as being particularly useful.

The first is ensuring quality information. As with almost everything we do in public health, information remains vital to policy, strategy and outcomes. In India, as across the Region, we continue to lack high-quality data on many aspects of visual impairment. Due to the nature of the problem and its association with marginalized populations, good data will help target interventions and thereby improve results. Systems must be devised to monitor visual impairment prevalence among the population generally, and key high-prevalence groups such as older persons specifically. The effectiveness of existing eye care and rehabilitation services should likewise be monitored closely, with information integrated into national epidemiological data.

The second is developing a clear matrix of priorities based on scientific evidence and good practice. Though integrating eye health into primary health care services is essential, and must be our end-goal, we can also find other innovative ways to reach out and provide services. These must be developed into priority order, with adequate funding secured. ‘Best buys’ include investing in cataract surgical coverage and correcting refractive errors. Implementing school vision care programs is another great way to reach people, and is already being pursued across the country. Wherever possible, advances in technology and IT should be harnessed to serve these and other initiatives.

The third is strengthening health systems to facilitate implementation of eye health policies. This can be done by creating a national eye health or blindness committee that can guide progress. It can be done by including eye care in national lists of essential medicines, or allocating specific human resources towards eye care within national planning. And it can also be done by adopting a set of national indicators and targets to contextualize and make sense of data. The key to utilizing this approach is achieving system-wide uniformity. After all, a national policy can only be as strong as the weakest link implementing it.

The fourth – and one we must always work on – is establishing and maintaining close multisectoral partnerships. The education, finance, welfare and development sectors are all integral to tackling visual impairment and blindness. Their role in doing so should be clear, with the buy-in of all stakeholders established. At the same time, partnerships among the NGO and INGO sectors should be aligned with national priorities, policies and programmes, ensuring synchronicity and unity of purpose. Stronger partnerships will also promote effective use of resources.

On this note, it’s worth reflecting on the partnership between our respective organizations, and how best we can leverage it for further gains.

In recent times the RP center has been remarkably active. It has been instrumental in carrying out a national blindness survey, a diabetic retinopathy survey, and a national trachoma survey. It is taking a lead role in strengthening primary eye care, and is developing models of service integration that can be rolled out nationwide. And, as I understand, it will also be at the forefront of efforts to train health care workers in eye care at primary, secondary and tertiary levels. These activities are commendable, and each one will help accelerate towards achieving universal eye coverage.

As you go about these endeavors, I want to stress WHO’s ongoing support. WHO, like you, is committed to creating 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. Our shared history, if appropriately harnessed, can help us make further progress.

We can, for example, work alongside you to collect and analyze data. That could mean devising surveys and other epidemiological tools, collating and disseminating reports that can help inform future interventions, and assessing existing eye care services and their cost-effectiveness.

We can help develop innovative solutions to problems that may be impeding progress. That could include providing examples of best practices from other Member States, or helping to develop innovative policies that can overcome persistent barriers.

And we can engage partners and help coordinate efforts. That could mean arranging key meetings and workshops aimed at achieving greater working efficiency, or engaging the wider development community to support and complement eye care initiatives.

Distinguished guests, ladies and gentlemen,

We have much to do. I am nevertheless convinced that through the strength of our partnership and the clarity of our vision we can achieve our goals.

I once again congratulate the Rajendra Prasad Centre for Ophthalmic Sciences on its long and decorated history, and look very much forward to accelerating joint efforts to end preventable visual impairment, to secure access to rehabilitation services for all, and to achieve universal eye health coverage.

Thank you very much.