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SIXTY-SIXTH WORLD HEALTH ASSEMBLY WHA66.4

Agenda item 13.4 24 May 2013

Towards universal eye health: a global action plan

20142019

The Sixty-sixth World Health Assembly,

Having considered the report and draft global action plan 20142019 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 20142019 on universal eye health builds upon theaction plan for the prevention of avoidable blindness and visual impairment for the period 20092013;

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

Recognizing the linkages between some areas of the global action plan 20142019 on universaleye health and efforts to address noncommunicable diseases and neglected tropical diseases;

1. ENDORSES the global action plan 20142019 on universal eye health;

2. URGES Member States:

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

(2) to implement the proposed actions in the global action plan 20142019 on universal eyehealth in accordance with national priorities, including universal and equitable access toservices;

(3) to continue to implement the actions agreed by the World Health Assembly in resolutionWHA62.1 on prevention of blindness and visual impairment and the action plan for theprevention of blindness and visual impairment for the period 20092013;

(4) to continue to support the work of the WHO Secretariat to implement the current actionplan up to 2013;

1Document A66/11.

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- 68 -

ANNEX 2

Universal eye health: a global action plan 201420191

[A66/11 28 March 2013]

1. In January 2012 the Executive Board reviewed progress made in implementing the action planfor the prevention of avoidable blindness and visual impairment for the period 20092013. It decidedthat work should commence immediately on a follow-up plan for the period 20142019, and requestedthe Director-General to develop a draft action plan for the prevention of avoidable blindness andvisual impairment for the period 20142019 in close consultation with Member States andinternational partners, for submission to the World Health Assembly through the Executive Board.2The 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 TODAY

2. For 2010, WHO estimated that globally 285 million people were visually impaired, of whom39 million were blind.

3. According to the data for 2010, 80% of visual impairment including blindness is avoidable. Thetwo 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 blindand 65% of those with moderate and severe blindness were older than 50 years of age. Poorerpopulations are more affected by visual impairment including blindness.

BUILDING ON THE PAST

5. In recent resolutions, the Health Assembly has highlighted the importance of eliminatingavoidable blindness as a public health problem. In 2009, the World Health Assembly adoptedresolution WHA62.1, which endorsed the action plan for the prevention of avoidable blindness andvisual impairment. In 2012, a report noted by the Sixty-fifth World Health Assembly and a discussionpaper described lessons learnt from implementing the action plan for 20092013. The results of thosefindings 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 crucia l to assess the magnitude and causes of visual impa irment andthe effectiveness of services.It is important to ensure that systems are in place for monitoringprevalence 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

1See resolution WHA66.4.

2See decision EB130(1).

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ANNEX 2 69

evaluating eye care services and epidemiological trends in eye disease should be integrated intonational 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 eyediseases have had considerable success in developing and implementing policies 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 humanresource development, financial and fiscal allocations, effective engagement with the privatesector 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 bebetter documented and disseminated so that all countries can benefit from them.

(c) Governments and their par tners need to invest in reducing avoidable visual impair mentthrough 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 forinvesting 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 highlycost effective. There are many examples where eye care has been successfully provided throughvertical initiatives, especially in low-income settings. It is important that these are fullyintegrated 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 inbroader development cooperative agendas and initiatives. Over the past few years, raising

additional resources for health through innovative financing has been increasingly discussed butinvestments in the reduction of the most prevalent eye diseases have been relatively absent fromthe innovative financing debate and from major financial investments in health. Further work on

a costbenefit 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 andstrengthening 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 AfricanProgramme 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 theelimination 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 resultedin 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, humanresources for health development, improvements in the area of maternal, child and reproductivehealth, 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 thoseaddressing 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 becontinuously addressed through multisectoral interventions.

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ANNEX 2 71

9. There are three indicators at the goal and purpose levels to measure progress at the nationallevel, 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

surgery. Further details are provided in Appendix 4.

Prevalence and causes of visual impairment.It is important to understand the magnitudeand 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 indetermining 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 surgeriesperformed per year, per million population) and cataract surgical coverage (number ofindividuals with bilateral cataract causing visual impairment, who have received cataractsurgery on one or both eyes). Knowledge of the surgery rate is important for monitoringsurgical 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 onthe 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 theimpact of the action plan. As a global target, the reduction in prevalence of avoidable visua l

impairment by 25% by 2019 from the baseline of 2010 has been selected for this action plan.

1

Inmeeting this target, the expectation is that greatest gains will come through the reduction in theprevalence of avoidable visual impairment in that portion of the population representing those who areover the age of 50 years. As described above, cataract and uncorrected refractive errors are the twoprincipal 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 willbe among those aged 50 years or more. Expanding comprehensive integrated eye care services thatrespond 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 thedraft action plan for the prevention and control of noncommunicable diseases 2013 2020, and globalefforts 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.2

1The global prevalence of avoidable visual impairment in 2010 was 3.18%. A 25% reduction means that the

prevalence by 2019 would be 2.37%.

2According to the International Monetary Fund, by 2019 the average gross domestic p roduct per capita based on

purchasing power parity will grow by 24% in low-income and lower-middle-income countries, by 22% in upp er-middle-

income countries, and by 14% in high-income countries.

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72

ANNEX2

APPENDIX 1

VISION, GOAL AND PURPOSE

VISION

A world in which nobod y is needlessly visually impaired, where those with un avoidable vision loss can achieve their full po te ntial, and where there is un iversal access to

comprehensive eye care services

Goal Measurable indicators1 Means of verifi cation Important assumptions

To reduce avoidable visual impairment as

a global public health problem and secure

access to rehabilitation services for the

visually impaired2

Prevalence and causes of visu al

impairment

Global targ et: reductio n in prevalence of

avoida ble visual impair ment by 25% by

2019 from the baseline of 2010

Collection of epidemiological data at national

and s ubnational levels and development o f

regional an d global estimates

Human rights conventions

implemented, equity acros s all

policies achieved, and people with

visual impairment fully empowered

Sustained investment achieved b y

the end of the action plan

Purpose

To improve access to comprehensive eye

care s ervices that are integrated into

health systems

Number of eye care personn el per million

population

Cataract surgical rate

Reports summarizing national data provided

by Member States

Services accessed fully and

equitably by all populations

1See also Appendix 4.

2

-term target being t o reduce national blindness rates t o less t han 0.5%, with no more t han 1% in individ

programmes for the p revention of blindness.Geneva, World Health Organization, 1990 (document WHO/PBL/90.18).

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73

APPENDIX 2

CROSS-CUTTING PRINCIPLES AND APPROACHES

Universal access and equity Human rig hts Evidence- base d practice Life course approach Empower ment of people with

blindness and visual

impairment

All people shou ld have equitable

access to health care and

opportunities to achieve or

recover the highes t attainable

standard of health, regardless of

age, gender or social position

Strategies an d interventions for

treatment, prevention and

promotion must be compliant

with international human rights

conventions and agreements

Strategies an d interventions for

treatment, prevention and

promotion need to be based on

scientific evidence and good

practice

Eye health and related policies,

plans and programmes need to

take account o f health and social

needs at all s tages of the life

course

People who are blind or who

have low v ision can participate

fully in the social, economic,

political and cultural aspects of

life

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74

SIXTY-SIXTHWORLDHEALT

HASSEMBLY

APPENDIX 3

OBJECTIVES AND ACTIONS

Objective 1 Measurable indicators Means of verification Important assumptions

Evidence generated and used to advocateincreased po litical an d financial

commitment of Member States for eye

health

Number of Member States that haveundertaken and p ublished prevalence

surveys during the past five years by

2019

Number of Member States that have

completed and published an eye care

service assess ment over last five yearsin 2019

Observation of World Sight Day reported

by Member States

Epidemiological and econo micasses sment on the prevalence and causes

of visual impairment rep orted to the

Secretariat by Member States

Eye care service asses sment and costeffectiveness research results us ed to

formulate national and sub nationalpolicies and plans for eye h ealth

Reports of national, regional and global

advocacy and awareness -raising event s

Advocacy s uccessful in increasinginvestment in eye health despite the

current global financial environment and

competing agendas

Actions for Objective 1 Proposed inputs from Member States Inputs from the Secretariat Proposed inputs from international

partners

1.1 Undertake population-based surveyson prevalence of visua l impairment and

its causes

Undertake surveys in collaboration withpartners, allocating resources as required

Publish and diss eminate survey results,

and s end them to th e Secretariat

Provide Member States with tools forsurveys and technical advice

Provide estimates of prevalence at

regional and global levels

Advocate the need for surveysIdentify and supp ly additional resources

in surveys

1.2 Asses s the capacity of Member

States to provide comprehensive eye careservices and identify gaps

Asses s eye care service d elivery,

allocating resources as required.Asses sments shou ld cover availability,

accessibility, affordability, sustainability,

quality and equity of services provided,including costeffectiveness analysis ofeye health programmes

Collect and compile data at nationallevel, identifying gaps in service

provision

Publish and diss eminate survey results,

Provide Member States with tools for eye

care service ass essments and technicaladvice

Publish an d disseminate reports that

summarize data provided by MemberStates and international partners

Advocate the need for eye care s ervice

assessments

Support Member States in collection and

dissemination of data

Identify and supply additional resources in eye care service assessments

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ANNEX2

75

and report them to the Secretariat

1.3 Document, and use for advocacy,

examples of best practice in enha ncing

universal access to eye care

Identify and document success ful

interventions and lessons learnt

Publish results and report them to th e

Secretariat

Develop tools and provide them to

Member State s along with techn ical

advice

Collate and diss eminate reports from

Member States

Advocate the need to document best

practice

Support Member States in do cumenting

best practice and diss eminating resu lts

Identify additional resources to

Objective 2 Measurable indicators Means of verification Important assumptions

National eye h ealth policies, plans and

programmes for enhan cing universal eye

health developed and/or strengthened and

framework for action for strengt hening

health sys tems in order t o improve health

outcomes

Number of Member States reporting the

implementation of policies, plans and

programmes for eye health

Number of Member States with an eye

health/prevention of blindness

committee, and/or a national prevention

of blindness coordinator, or equ ivalent

mechanism in place

Number of Member States that include

eye care sections in their national lists ofessential medicines, diagnostics and

health technologies

Number of Member States that report the

integration o f eye health into national

health plans and budgets

Number of Member States that report a

national plan that includes h uman

resources for eye care

Number of Member States reporting

evidence of research on the cost

effectiveness of eye health programmes

Reports that summarize data provided by

Member States

Policies, plans and programmes have

sufficient reach for all populations

Services accessed by thos e in need

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partners

2.1 Provide leadership and governance

for developing/updating, implementing

and monitoring national/subnational

policies and plans for eye health

Develop/upd ate national/subnational

policies, plans and programmes for eye

health and p revention of visual

impairment, includ ing indicators and

targets, engaging key stakeholders

Secure inclusion of primary eye care into

primary health care

Establish new and/or maintain the

existing coordinating mechanisms

(e.g. national coordinator, eye

health/prevention of blindness

committee, other national/sub national

mechanisms) to oversee implementat ion

and monitoring/evaluating the policies,

plans and programmes

Provide guidance to Member States on

how to d evelop and implement national

and s ubnational policies, plans and

programmes in line with the global action

plan

Provide Member States with too ls and

techn ical advice on primary eye care, and

evidence on good leadership and

governance practices in d eveloping,

implementing, monitoring and evaluating

comprehensive and integrated eye care

services

Establish/maintain global and regional

staff with responsibility for eye

health/prevention of visual impairment

Establish co untry positions for eye


where strategically relevant and resourcesallow

Advocate national/subnational leadership

for developing policies, plans and

programmes

Support n ational leadership in identifying

the financial and technical resources

required for implementing the

policies/plans and inclusion of primary

eye care in primary health care

Secure funding for key positions in the

Secretariat at headq uarters, regional and

country levels

2.2 Secure adequ atefinancial resources

to improve eye health and p rovide

comprehensive eye care services

integrated into health systems through

national policies, plans and programmes

Ensure funding for eye health within a

comprehensive integrated health care

service

Perform costbenefit analysis of

prevention of av oidable visual

impairment and rehabilitation serv ices

and cond uct research on the cost

effectiveness of eye health programmes

to opt imize the use of available resources

Provide tools and techn ical supp ort to

Member States in identifying co st

effective interventions and secure the

financial resou rces needed

Advocate at national and international

levels for adequate funds and their

effective use to implement

national/subnational policies, p lans and

programmes

Identify sources of funds t o complement

national investment in eye care services

and costbenefit analyses

%!


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ANNEX2

79


partners

3.1 Engage non-health sectors in

develop ing and implementing eye


policies and plans

Health ministries identify and engage

other sectors, such as thos e under

ministries of education, finance, welfare

and development

Report experiences to the Secretariat

Advise Member States on specific roles

of non-health sectors and provide support

in identifying and engaging non -health

sectors

experiences

Advocate across secto rs the added value

of multisectoral work

Provide financial and technical capacity

to multisectoral activities (e.g. water and

sanitation)

Provide sup port to Member States in

collecting and disseminating experiences

3.2 Enhance effective interna tional and

national partnerships and alliances

Promote active engagement in, an d where

appropriate, establish p artnerships and

alliances that harmonize and are aligned

with national priorities, policies, plans

and programmes

Identify and promote s uitable

mechanisms for intercountry

collaboration

Where appropriate, participate in and

lead p artnerships and alliances, including

engaging other United Nations entities,

that supp ort, harmonize and are aligned

policies,plans and programmes

Facilitate and suppo rt establishment of

intercountry collaboration

Promote participation and actively

supp ort partnerships, alliances an d

intercountry collaboration that harmonize

priorities, po licies, plans and programmes

3.3 Integrate eye health into pov erty-reduction strategies, initiatives and wider

socioeconomic policies

Identify and incorporate eye health inrelevant poverty-reduction strategies,

initiatives and socioeconomic policies

Ensure that people with avoidable and

unavoidable visual impairment have

access to educational opportun ities, and

that disability inclusion practices are

developed, implemented and evaluated

Write and disseminate key messages forpolicy-makers

Advise Member States on ways to

include eye health/prevention of visual

impairment in pov erty-reduc tion

strategies, initiatives and socioeconomic

policies

Advocate the integration of ey e healthinto p overty-reduction strategies,

initiatives and socioeconomic policies

%%


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HASSEMBLY

APPENDIX 4

NATIONAL INDICATORS FOR PREVENTION OF AVOIDABLE BLINDNESS AND VISUAL IMPAIRMENT

1. 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 s ound and representative surveys of prevalence provide the most reliable method. Add itionally, the R apid

Asses sment of Avoidable Blindness and the Rapid A sses sment of Cataract Surgical Services are two stand ard methodologies for

obtaining results for people in the age g roup with the highest prevalence of visual impairment, that is, thos e over 50 years of age

Unit of measurement Prevalence of visua l impairment determined from pop ulation 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 cadre

2.1 Ophthalmologists

Purpos e/rationale To ass ess availability of the eye health workforce in order to formulate a capacity development respons e for strengthening nationalhealth sys tems. Ophth almologis ts are the primary cad re 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 docto rs who have been trained in opht halmic medicine and/or surgery and who ev aluate and treat

diseases of the eye


collection

Registers o f national professional and regulatory bodies

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ANNEX2

81

Unit of measurement Number of oph thalmologists per one million population

Frequency of data collection Annually

Limitations The number does not reflect the proportion of ophth almologists who are not surgically active; clinical output (e.g. subs pecialists);

performance; and qu ality o f interventions. Unless disaggregated, the data do not reflect geog raphical distribution

Source of information Health ministry or national prevent ion of blindnes s/ey e health coordinat or/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 sys tems. In an increasing nu mber of coun tries, optometrists are often the first point of contact for perso ns with eye d iseases

Definition Number of optometrists certified by national institu tions based on gov ernment-app roved certification criteria


collection

Registers o f national professional and regulatory bodies

Unit of measurement Number of optometrists per one million pop ulation


Limitations The number does not denote performance, especially the quality of interventions to reduce avoidable blindness. There is a wid e

variability in knowledge and s kill of optometrists from one nation to another because curricula are not stand ardized

Numbers do no t reflect t he proportion of ophthalmic clinical officers, refractionists and other s uch groups who in some countr ies

perform th e role of opto metrists where this cadre is s hort staffed or does not exist

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


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HASSEMBLY

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 nationalhealth sys tems. Allied ophthalmic personnel may be characterized by different educat ional requirements , legislation an d practice

regulations, s kills and s cope of practice between cou ntries and even within a given country. Typically, allied ophthalmic p erso nnel

comprise opticians, ophthalmic nurses, orthoptists , ophthalmic and o ptometric assista nts, opht halmic and optometric technicians, v ision

therapists, ocularists , oph thalmic p hotographer/imagers, and o phthalmic administrators

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


collection

Compilation of national data from s ubnational (district) data from government, nongovernmental and private eye care s ervice p roviders

Unit of measurement Number of allied oph thalmic perso nnel per one million population


Limitations The numbers do not denote performance, especially the quality of interventions to reduce avoidable blindness. There is a wide

variability in knowledge and s kill. These data are useful for monitoring of progress in countries over time b ut 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


3. Cataract surgical se rvice delivery

3.1 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 blindnes s. Visual impairment and blindness from cataracts are

avoidab le because an effective means of treatment (cataract extraction with implantation of an intraoc ular 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 operation s performed per year per one million population


collection

Government health information records, surveys

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2013 Caribbean V2020 Regional Meeting

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