Planning for VISION 2020 at the District Level: a Manual
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INTERNATIONAL CENTRE FOR EYE HEALTH Planning for VISION 2020 at the District Level A Manual Acknowledgements The preparation of this manual has depended heavily on the advice and support of the key personnel responsible for leading the selected eye care programmes so successfully over recent years. Kitwe Asiwome Seneadza, Medical Director Winston Mbao, Administrator Mudhole Sirigiri Babu Rao, Administrator Shamanna Ramaswamy, Group Leader ICARE Yaruquí Felipe Chiriboga, Medical Director María Agusta Vega, Administrator My gratitude respects the time devoted to my enquiries, both while visiting their eye care centres and also their patience and care in meeting my many subsequent e-mail requests. I hope that what I have written represents clearly and accurately the wise and whole-hearted commitment of these project leaders and their teams to the development of community eye health for their local communities. I also wish to acknowledge the support of Allen Foster and many colleagues at ICEH who have made very helpful suggestions as the work has progressed. Graham Dyer December 2006 ISBN 1 - 90 - 2541 - 20 - 0 Planning for VISION 2020 at the District Level A Manual Graham Dyer ICEH Preface VISION 2020: The Right to Sight was launched by WHO in February 1999. In the intervening seven years national governments and non-governmental organisations have progressively accepted this initiative as the best approach for improving eye health and preventing blindness. The realisation of VISION 2020 requires a commitment to develop programmes serving populations at the district level, where needs can be assessed, resources identified and community support motivated. While the need for district planning is clear, the means of bringing this about is more difficult to define. This manual is an attempt to document some lessons being learnt from three successful but different district models that have been developed in response to local conditions. The manual starts with two chapters introducing VISION 2020 and setting out a generic model for planning and implementing VISION 2020 at the district level. This is followed by three case studies that have been selected to represent the needs and programmes in three different continental locations. The manual concludes with a chapter of exercises to help apply the principles of district level planning to individual situations. The reader is encouraged to consider with each case study: 1. The key factors in designing the programme. 2. The major activities to implement the programme. 3. The effectiveness of the programme. It is hoped that this practical manual will assist eye health providers and programme managers to plan and implement VISION 2020 activities at the district level so reducing the prevalence of eye diseases and improving the vision of the population. My sincere thanks to Graham Dyer and all those who have contributed to this work. Professor Allen Foster Director of ICEH December 2006 Contents 1 Introduction 1 1. VISION 2020 – The Rationale 1 2. VISION 2020 – The Strategy 2 3. VISION 2020 – The District 3 2 Principles of District Planning 4 1. The planning model 4 Deciding where you are – a situational analysis 2. Assessing needs 5 3. Assessing resources 5 Deciding where you want to be 4. Defining the aim 7 5. Specifying the objectives 8 6. Defining priorities and strategies 9 Deciding how to get there 7. Preparing a timetable 10 8. Preparing a budget 11 Getting there 9. Establishing a management structure 12 10. Monitoring progress 13 3 Case Study 1– KITWE, ZAMBIA 15 4 Case Study 2– MUDHOLE, INDIA 40 5 Case Study 3– YARUQUĺ, ECUADOR 69 6 Summary - Designing a district programme for VISION 2020 96 Appendices 103 Ap1 The focus of National and District VISION 2020 Plans 103 Ap2 Needs assessment 104 Ap3 Situation analysis 105 Ap4 Questionnaire on available human resources, infrastructure 108 and equipment Ap5 Eye care infrastructure and human resources in relation to 110 need Ap6 Charting the need and means for improvement in eye disease 111 treatment Ap7 An action plan for improving cataract services 112 Ap8 Gantt Chart – A one-year time frame for district level VISION 2020 planning activities - a tracking tool to aid the monitoring 114 process Resources and references 115 Abbreviations AD Adilabad District LV Low vision AEPREC Association Ecuatoriana for PBL LVPEI LV Prasad Eye Institute AP Andhra Pradesh MD Medical director CB Childhood blindness MIS Management information system CBMI Christian Blind Mission MLOP Mid-level ophthalmic personnel International CBoH Central Board of Health MMED Master of Medicine CBP Copperbelt Province MoE Ministry of Education CBR Community-based rehabilitation MoH Ministry of Health CEC Community eye care co-ordinator O Ophthalmologist CEH Community eye health OA Ophthalmic assistant CO Clinical officer OCO Ophthalmic clinical officer CSR Cataract surgical rate ON Ophthalmic nurse (D)BCS (District) Blindness control society OP Out-patient DHMT District health management team OPD Out-patients department DR Diabetic retinopathy OT Operating theatre ECCE Extra-capsular cataract extraction PBL Prevention of blindness EN Enrolled nurse PEC Primary eye care FOV Fundacion Oftalmologica del Valle PEEP Providing Eye Care through Empowered People GDP Gross Domestic Product PHC Primary health care HKI Helen Keller International PHO Provincial health office HR Human resources RACSS Rapid assessment of cataract surgical services IAPB International Agency for the RN Registered nurse Prevention of Blindness ICARE International Centre for the ROP Retinopathy of prematurity Advancement of Rural Eye Care ICEH International Centre for Eye RSS Right to Sight Society Health IDA International Development SSI Sightsavers International Agency IMF International Monetary Fund UN United Nations Organisation I/NGO International non-governmental UTL University Teaching Hospital, organisation Lusaka INR Indian rupees VC Vision centre IOL Intra-ocular lens WHO World Health Organisation KCH Kitwe Central Hospital Chapter 1 Introduction Illustrations Fig. 1.1 The VISION 2020 concept 2 Table 1.1 Planning at national and district levels 3 1. VISION 2020 – The Rationale ‘VISION 2020: The Right to Sight’ is a global management of avoidable blindness caused by initiative with the objective of eliminating ocular infection. The initiative has increased avoidable blindness by the year 2020. The public awareness and brought greater World Health Organisation (WHO), in professional and political commitment to collaboration with various international, non- blindness prevention. Co-ordination between governmental and private organisations under NGOs and partnerships linking UN agencies, the umbrella of the International Agency for governments, NGOs and the corporate sector Prevention of Blindness (IAPB), launched has increased to meet the challenge. However ‘VISION 2020: The Right to Sight’ worldwide despite these achievements and the probability on February 18th, 1999. Throughout this that VISION 2020 has made a considerable document the shortened term ‘VISION 2020’ contribution, there is much to do. For example will be used for this initiative. 17 million people remain blind from treatable According to WHO (2005), about 75% of cataract, for which one of the most cost- blindness is avoidable, either since it results effective healthcare treatments is available. The from conditions that could have been prevented goal of the programme is to save 100 million or controlled by applying available knowledge people from becoming blind from avoidable and interventions, or because that blindness can causes over the 20-year period to 2020. be treated successfully and sight restored. With The aim and strategy of VISION 2020 are increasing life expectancy, the global increase in relevant to all countries. Blindness has severe the elderly population is worsening the backlog human and socio-economic consequences for the treatment of blindness in many for all societies, but the costs are greatest in low- countries, while existing human resources and income countries. In May 2003 the World infrastructure, both in quantity and distribution, Health Assembly unanimously passed a are insufficient to meet this need. resolution urging member states to support the Recent data suggest that there are globally about global initiative for the elimination of avoidable 37 million blind people and 124 million with blindness, to set up national VISION 2020 low vision, excluding those with uncorrected plans by the end of 2005, and to start refractive errors. The severity of the problem implementation of an action plan by 2007. varies dramatically from place to place with the There is an ongoing need, country by country, prevalence of blindness varying for example to identify the priorities to reduce blindness and from 0.2% in Europe to 1.0% in Africa. visual impairment and to mobilize the resources to implement the programme – sustainable, The launch of VISION 2020 has brought comprehensive eye care appropriate to needs successes, for example in the prevention and and resources. 111 2. VISION 2020 – The Strategy The strategy underlying the planning and implementation of VISION 2020 programmes is built upon the foundation of community participation and has three essential components: 1. Training sufficient human resources and securing their availability at the point of need. 2. Strengthening and optimal use of the infrastructure, both with relation to service units and to the use of appropriate and affordable technology. 3.