ICO and Capacity Building for Human Resources for Eye Health · ICO and Capacity Building for Human...

ICO and Capacity Building for

Human Resources for Eye Health

William C. Felch, Jr.

Chief Executive Officer, International Council of Ophthalmology

“Human Resources for Eye Health (HReH): Bridging the Gap”

International Agency for the Prevention of Blindness, Council of Members

16 September 2013 | Brighton, United Kingdom

ICO and Capacity Building for HReH (Africa)

Public Need for Eye Care and What

Ophthalmologists Can Do

ICO Approach to HReH and Evolution of ICO

Commitments

Eye Care Delivery and Leadership Development

ICO Educational Programs and Resources 3

The Public Need for Eye Care

International: The Public Need for Eye Care

Cataract, 33%

Glaucoma, 2%

Age-Related Macular Degeneration, 1%

Corneal Opacities, 1%

Childhood Blindness, 1%

Trachoma, 1%

Uncorrected Refractive Error, 42%

Diabetic Retinopathy, 1%

Undetermined, 18%

Cat + URE = 75%

Global Causes of Visual Impairment—2010

BCVA<6/18

Pascolini D, Mariotti SP. Br J Ophthalmol 2011; Epub Dec 1. Slide from Serge Resnikoff.

International: The Public Need for Eye Care

The Distribution of Blind and Visually Impaired

of All Ages in the Six WHO Regions (in Millions)

WHO

Regions

Visual Impairment

(Millions)

Blind

(Millions)

AFR 26.3 5.9

AMR 26.6 3.2

EMR 23.5 4.9

EUR 28.2 2

SEAR 90.5 12

WPR 90.2 10.6

The distribution of Visual Impairment by age group: 0-14 years 7%, 15-49 years 28%, 50 years and older 65%

2010 WHO Data, Source: http://www.who.int/blindness/table/en/index.html. Slide from Hugh Taylor.

http://www.who.int/blindness/table/en/index.html

http://www.who.int/blindness/table/en/index.html

Nigeria: The Public Need for Eye Care

National Causes of Blindness—2012

BCVA<3/60

Cataract, 43%

Glaucoma, 17%

Uncorrected Aphakia, 9%

Other Corneal Scars, 8%

Trachoma, 4%

Optic Atrophy, 4%

Others, 3%

Phthisis/Absent Globe, 2%

Macular Degeneration, 2% Refractive Error, 1%

Onchocerciasis, 1%

Abdull, M. M., S. Sivasubramaniam, G. V. S. Murthy, C. Gilbert, T. Abubakar, C. Ezelum, and M. M. Rabiu. "Causes of Blindness and Visual Impairment in Nigeria: The Nigeria National Blindness and Visual Impairment Survey." Investigative Ophthalmology & Visual Science 50.9 (2009): 4116. Print.

What Can Ophthalmologists Do?

Study designed and conducted by ICO

Aim: To capture the dynamics of the global

ophthalmic population, including residents

Standardized survey e-mailed to 213 global

ophthalmic societies or individuals (March 2010)

Missing data gathered from direct correspondence

with ophthalmologist contacts (August 2010)

Number of Ophthalmologists in

Practice and Training Worldwide


Number of ophthalmologists in practice and training worldwide

• Of the 193 countries surveyed, 192 responded

(represents 99.99% of the global population)

Total number of ophthalmologists in the world

Ranging from 28,338 in China to 0 in some Small Pacific Islands, with 131

countries representing less than 5% of the total

204,909

Slide from Serge Resnikoff.

Number of Ophthalmologists in

Practice and Training Worldwide


China

United States of America

Russian Federation

Japan

Brazil India France Germany

Argentina

Poland Italy

Mexico

Spain

Other

Two-Thirds of

Ophthalmologists in 15 Countries



0 to 0.99

1 to 3.99

4 to 24.9

25 to 99.9

100+

Ophthalmologists

per Million Population


Africa: What Can Ophthalmologists Do?

0 to 0.99

1 to 3.99

4 to 24.9

25 to 99.9

100+

Ophthalmologists



Ophthalmic Growth Rate vs.

60+ Population Growth Rate

All Ages 60+

Ophthalmologists growth rate + 1.2% + 1.2%

Population growth rate + 0.77% + 2.9%

Actual growth rate + 0.43% - 1.7%

On average, the population aged 60+ is growing more than

twice as fast as the number of ophthalmologists

Ophthalmic population is declining 1.7%

per year compared to the population aged 60+



Very broad picture

System being set up to improve data collection

The gap between need and supply is widening in

both developing and developed countries

Needs to be urgently addressed in

training eye care teams now focused on

meeting community needs


Conclusions

Need for Training: Eye Care Teams

Particularly in Low Resource Countries:

• Not enough ophthalmologists and other eye

care providers to provide the care needed

• Mal-distribution: Lack of providers where

most needed

• Not enough training programs

• Existing training programs not focused on

public needs, e.g., for community eye health

• Lack of infrastructure and professional

development for those who are trained

Hugh Taylor, February 2012

Need for Training: Principles

• Training in ophthalmology should focus on meeting needs of

communities and populations, not just individuals

• Dr. Para: “If ophthalmology is your profession, prevention of

blindness is your business”

• Needs are best met by eye care teams, trained together to work as teams

• Comprehensive eye care should be an integral part of the health care

system

• Eye care training should be integrated with training for the rest of the

health care system

• Those who are trained need infrastructure, support and continuing

professional development


Eye Health Personnel Needed

Teams of:

• Ophthalmologists (surgeons and “eye doctors”)

• Subspecialists (pediatric, retina, etc.)

• Primary physicians trained in eye care

• Optometrists or refractionists and opticians

• Ophthalmic nurses

• Allied eye health professionals/Mid-level eye personnel (MLEP)

• Eye health managers

• Community eye health workers


What the International Council of

Ophthalmology is Doing

Mission of the ICO

The International Council of Ophthalmology

works with ophthalmologic societies and others

to enhance ophthalmic education and improve

access to the highest quality eye care in order to

preserve, restore and enhance vision for the

people of the world.

Collaborating Organizations

WHO

IAPB

AOI

INGOs

Supranational Organizations

APAO

MEACO

PAAO

SOE

Commitments

Education

Eye Care Delivery

Leadership and Society Development

Membership: The Global Ophthalmic

Community

~80 National Ophthalmic Societies

~30 International Subspecialty Societies

International Council of Ophthalmology

Programs Supported by the ICO Foundation,

Member Organizations, and the income from WOCs

Slide from Bruce Spivey.

ICO History

ICO Leaders Visit Nigerian Residencies and OSN

April 2004

Evolution of ICO Commitments

Improve Access to Quality Eye Care

Prevent Avoidable Blindness and Vision Loss

Education

International Council

of Ophthalmology




Education Eye Care Delivery


of Ophthalmology






of Ophthalmology Society and Leadership

Development







Development Teaching the Teachers

What Is a World Alliance for Sight?

ICO Programs

Eye Care Delivery/Capacity Building

Clinical Guidelines and Standards

Workshops and Materials for Advocacy/VISION 2020

Task Force on Uncorrected Refractive Error

School Eye Health Program

Task Force on Diabetic Eye Care

Ethics Committee

School Eye Health Programme

Targets for Pakistan and Nigeria

School Eye Health Program

CHEF International

International Council of Ophthalmology Foundation

Light For The World, Austria

Light For The World, Netherlands

Lions Aravind Institute of Community Ophthalmology (LAICO), India

JOS University Teaching Hospital, Nigeria

Partners:

ICO Programs: Eye Care Delivery

Task Force on Diabetic Eye Care:

1. Define and disseminate technical guidelines for screening,

patient evaluation and treatment of diabetic retinopathy

2. Evaluate how education needs to change to assure that

ophthalmologists and others have required skills and

knowledge

3. Define key indicators to evaluate the effectiveness of

diabetic retinopathy programs







Development

National Societies and ICO Members by Country

0 to 0.99

1 to 3.99

4 to 24.9

25 to 99.9

100+

Ophthalmologists


National Societies Only

ICO Member

National and

ICO Members by Country

Sub-Saharan Africa has a

small population of

ophthalmologists…

And there are a number of

countries with

no professional

ophthalmological

society

Evolution of Regional Societies

National Societies Only

ICO Member

National and

ICO Members by Country

Regional Societies

Regional Society

Members by Country

There are a growing

number of regional

ophthalmological

Societies,

now including the Africa

Ophthalmology Forum

Advisory Leadership Group for SSA

First Meeting, March 2007 in Dubai:

ICO Leadership Development

Fourth Meeting, October 2008 in Lagos, Nigeria:

Advisory Leadership Group for SSA

ICO Leadership Development

• Fifth Advisory Leadership Group meeting:

Bahrain, March 24–24, 2009,

at MEACO Congress

• Evolved into Africa Ophthalmology Forum

• ICO World Ophthalmology Roundtable on

Leadership Development (WORLD) at

AAO in 2009–2013

• Future: WORLD Online?




Education


of Ophthalmology

ICO Programs

Education

World Ophthalmology Congress (Tokyo, April 2-6)

Examinations • Basic Science

• Clinical Sciences

• Advanced Exam

• New Foundation Assessment (2013 – online)

Fellowships (from developing countries) • ICO Three-Month International Fellowships: > 600 since

2000)

• ICO/Helmerich Fellowships

• ICO/Fred Hollows 12-Month Fellowships

(2012)

• Experimenting with Sandwich Fellowships

CME/CPD • Guidelines and Support for Societies

• Visiting Professors

ICO Programs

Education

Support for Regional Training Centers

• Slovenia (Retina and Oculoplastics)

• Beijing (Diabetic Retinopathy)

• Nigeria (Catholic Hospitals)

• Cameroon (Magrabi ICO Eye Institute, Yaounde)

- Subregional Center of Excellence

- Training in French and English

- Ophthalmologists, nurses, optometrists,

orthoptists, low vision, etc.

- Comprehensive eye care services regardless of

ability to pay

- Operational research

- Center for telemedicine and tele-education

- Collaboration with CBM, ORBIS and many

partners

ICO Programs: Magrabi ICO Eye Institute

1 September 2013

ICO Programs: Magrabi ICO Eye Institute

Projects Start of Activities:

Second Quarter 2014

Construct: Country Profile

Country Stats - Afghanistan

Ophthalmologists 128

Subspecialists(L1-L3) 16

Subspecialists(L3) 3

Ophthalmologytrainingcentres 7

Centresprovidingsubspecialtyservices 0

Centresprovidingsubspecialtytraining 0

100%government,100%residency

L2residency–3to4years

Faculty 28

Studentsinprogramme 37

ToplineStats

Ophthalmologists1:234,375pop

Ophthalmologists0.32/75,000pop

Subspecialists(L3)1:10millionpop

AlliedEyeHealthProfs1:256,410 Optometrists 6

Orthop sts 0

OphthalmicAssistants 46

OphthalmicNurses 65

Na onalsubspecialtytrainingcurriculum-None

ICO Programs

Education: Teaching the Teachers

• Courses for residency program directors

(22 since 2004) • Ethiopia 2008

• Ghana September 2013,

• Paris May 2014 for Francophone Africa

• World Ophthalmic Education Colloquium

at WOC

• Conferences for ophthalmic educators

• EyeExcel (with Aravind and Seva)

• Training Trainers of Eye Health Personnel

ICO Programs

Education: Teaching the Teachers

• International Curricula:

• For residents, allied providers and medical

students (2006)

• For ophthalmic assistants (2009) and

refractionists (2011)

• New curriculum for residents (2011–2012)

• For subspecialty training (2012–14)

• OSCARs and other assessment tools

• Online courses & tools for teachers

• Web based teaching (2012)

• Webinars (2013)

• Center for Ophthalmic Educators

(educators.icoph.org)

ICO Programs: Teaching the Teachers

2012 Strategic Plan for ICO Education

Training Teams to Meet Public Needs

Curricula and Expectations for Training

Programs

Continuing Professional Development

Accreditation and Certification

Teaching the Teachers

Technologies for Teaching and Learning

1

2

3

4

5

6

The Future of Ophthalmic Education

What’s Next?

• Evaluating real outcomes of

educational programs

• Re-focus on community needs,

teams, critical competencies and

supporting change

• Blended learning: in person and

online

• More collaboration

Thank You for your attention.

[email protected]

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