THE NEED FOR ADVOCACY &

PROMOTING EYE HEALTH IN INDIA

Thulasiraj RavillaLAICO – Aravind Eye Care System

Why Advocacy

Plan ≠ Performance

Money ≠ Resources

Resources ≠ Results

Ideas ≠ Action

Any program to succeed needs .. Resources – Finance Resources – Program input Right policies Enabling environment Right Structure & Governance Partners in implementation These don’t fall in place automatically Advocacy is all about making these

happen

Advocacy Model

Target Group

Purpose

Advocacy & SensitizationStrategies

Desired Outcomes

Target Groups

Policy Makers Funding agency Providers (eye care professionals) Enabling agencies (Education

departments) Community Patient

Advocacy Focus - Policy MakersPurpose:

Ensuring that blindness control stays on the agenda of MOH – GOI & State Health Ministries

Financial commitment Supportive policies Legislations Approvals

Strategies: Workshops Evidence based intervention strategies Impact assessment Evidence of money well spent

Advocacy Focus - Funding AgenciesPurpose:

To mobilize required resources Budget/expense approvals

Strategies: Workshop on National/State plans Workshops on project details Evidence of regular monitoring Impact assessment

Advocacy Focus – Eye Care Providers

Purpose: Alignment Involvement Increasing quality/efficiency/coverage

Strategies: Inclusion of Community Ophthalmology

(Vision 2020) in the PG curriculum Sessions in State, National association

meetings

Advocacy Focus - Enabling Agencies

Purpose: Cooperation Taking on additional responsibilities

Strategies: Activity Focused Workshops Legislation/Directives from Policy makers

Advocacy Focus - CommunityPurpose:

Influencing health seeking behaviour Support of outreach, case finding

Strategies: Health education Social marketing Awareness campaigns Including eye health in school curriculum State launches of Vision 2020 Write-up/programmes in popular media

Advocacy Focus - Patient

Purpose: Compliance – treatment, follow-up, care

Strategies: Counselling Disease or treatment specific information

Case Study – Examples from India

Advocacy for right “Program Structure” Eye Care coordination committee to be

constituted at National level District Blindness Control Societies (idea piloted

and developed by DANPCB-DANIDA) VISION 2020 – The Right to Sight India: a

consortium of non-governmental organizations working in eye care

State Eye Health Societies

Request for increased financial allocation

from about $ 100 to $ 400 Million(request made in Sep 2006)

XI Five Year Plan (2007-12)

CATARACT SURGERIES: 1985-2005CATARACT SURGERIES: 1985-200512.19

12.09

11.96

11.85

10.96

11.97

15.12

16.05

19.14

21.67

24.71

27.23

30.35

31.71

33.56

36.44

37.00

38.57

41.98

44.91

48.21

0.00

10.00

20.00

30.00

40.00

50.00

60.00

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

World Bank Project

World Bank Project

Quality: 5% with IOL in 1993 increased to 90% in 2005

Evidence: Funding enhances performance

Tenth Plan (2002-07): Target Vs. AchievementsTenth Plan (2002-07): Target Vs. Achievements

ActivityActivityTarget Target

(2002 - 2007)(2002 - 2007)AchievementAchievement

(till 2002-2006)(till 2002-2006)

Cataract operationsCataract operations 16,753,00016,753,000 17,366,89617,366,896

Spectacles to school Spectacles to school childrenchildren

313,500313,500 915,120915,120

Eye donationsEye donations 175,000175,000 92,43692,436

Training of ophthalmic Training of ophthalmic SurgeonsSurgeons

1,2001,200 1,0301,030

Grants-in-aid to NGOsGrants-in-aid to NGOs 8989 4545

Evidence : Have capacity to deliver

Tenth Plan Performance:Tenth Plan Performance:Budget Allocation & ExpenditureBudget Allocation & Expenditure

YearYear Allocation ($ Millions)Allocation ($ Millions) Expenditure ($ Millions)Expenditure ($ Millions)

2002-032002-03 21.2521.25 21.1621.16

2003-042003-04 21.5021.50 21.4121.41

2004-052004-05 22.0022.00 21.8321.83

2005-062005-06 23.3323.33 23.2123.21

2006-072006-07 22.5022.50 7.327.32

(Total allocation for 10th Plan was $ 110 Millions)(Total allocation for 10th Plan was $ 110 Millions)

Evidence: Have capacity to absorb funding

Major challenges to be addressedMajor challenges to be addressed Reaching the underserved populationReaching the underserved population

Providing Comprehensive Eye CareProviding Comprehensive Eye Care

Enhancing the quality of Services & monitoring outcomesEnhancing the quality of Services & monitoring outcomes

Human Resource Development - training all cadresHuman Resource Development - training all cadres

Developing Sustainable Infrastructure through a public-private Developing Sustainable Infrastructure through a public-private partnership for service deliverypartnership for service delivery

Remaining Technologically current in Eye CareRemaining Technologically current in Eye Care

Monitoring the impact - epidemiology of BlindnessMonitoring the impact - epidemiology of Blindness

Rationale: What needs to be done?

BUDGET 2007 – 2012 BUDGET 2007 – 2012 ($ Millions)($ Millions)

ActivityActivity Total outlayTotal outlay

InfrastructureInfrastructure 3838HRDHRD 2121Disease ControlDisease Control 338338Programme ManagementProgramme Management 2424

TOTALTOTAL 421421(Total allocation for 10th Plan was $ 110 Millions)(Total allocation for 10th Plan was $ 110 Millions)

The Pitch: $ 110 M to $ 421 M

Ultimate purpose of Advocacy Improved Eye Care Services More persons served (prevention, cure

and rehabilitation) Universal coverage Goals of Vision 2020 met

Course Schedule

Speakers Title1. Mr R D Thulasiraj

The need for Advocacy and its Importance in Promoting Eye Health in India

2. Mr Peter Ackland

IAPB’s Advocacy Goals for VISION 2020 and the IAPB Advocacy Training Programme

3. Dr Abdulaziz Al Rajhi

Advocacy Strategies and Lessons Learned from EMR’s success in Securing Support for Recent WHA Resolutions

4. Ms Jennifer Gersbeck

Advocacy Strategies and Lessons Learnt from Securing Australian Government Support for the Australian Blindness Initiative

5. Mr William Felch

The ICO Advocacy Network

6. Plenary Q&A session + Secrets of Successful Advocacy based on the Experiences of Audience