In May 2013, the World Health Organization (WHO) World Health Assembly
(WHA) approved Resolution WHA 66/11, Universal eye health: a global
action plan 2014-2019 (hereafter referred to as the GAP). In preparation
for the year 2020, this updated GAP includes a global target to reduce
the prevalence of avoidable visual impairment by 25% by 2019 from the
2010 baseline. To measure progress made against the global target, the
WHO requires collection of 3 core indicators from member states on a
of visual impairment and causes of visual impairmentCataract surgical services: Cataract surgical rate (CSR) and Cataract
surgical coverage (CSC)Number of eye health professionals by cadre (ophthalmologists,
optometrists and allied eye health personnel).
With less than 5 years until 2019, it is important to implement the
indicator data collection from an early stage in order to monitor the
GAP progress and identify best practices and preferred reporting
mechanisms that can be adopted across the globe. The Fred Hollows
Foundation supported Global Indicators Field Testing Project to Pilot
the WHO Global Indicators in Latin America was approved in October 2013,
with additional financial support from Orbis and IAPB for 2013-2015.
The project is managed by Strategic Solutions, Inc, in partnership with
the International Agency for the Prevention of Blindness (IAPB) and
Orbis, and with the collaboration of the Pan American Health
Organization (PAHO). The core research team carrying out the project
includes: Marissa J. Carter (Strategic Solutions, Inc), Kristen Eckert
(Strategic Solutions, Inc), Van Lansingh (IAPB Latin America), Juan
Carlos Silva (PAHO), and Joan McLeod-Omawale (Orbis). The long-term goal
of this project is to formalize and implement a regional mechanism in
Latin America to collect and report eye care indicators in collaboration
with ministries of health (MoHs), national VISION 2020/prevention of
blindness committees, national professional societies, and regulatory
bodies in five countries: Chile, Honduras, Mexico, Peru, and Uruguay.
Important objectives include evaluating the feasibility of accurate data
collection, the reliability of the indicators, and the adequacy of the
metrics used to define the indicators, as well as barriers to obtaining
these data. The project will conclude with development of a research
protocol to implement the global indicators in other regions of the
world along with a paper presenting lessons learnt.
On March 10-12, 2014, the First Latin America Global Indicators Workshop
was organized in Lima, Peru. Twenty-three participants representing
Strategic Solutions, IAPB, Orbis, PAHO, the International Council of
Ophthalmology, the University of São Paulo-Ribeirão Preto, and the MoHs,
national societies of ophthalmology, and the national committees of
Peru, Uruguay, Honduras, Mexico, and Chile participated to gain an
understanding and awareness of the WHO global indicators related to the
prevention of blindness.
During the workshop, delegations presented on the current situation of
data collection (including successes and shortfalls) in their countries,
developed country data collection strategies, and drafted a project
work plan for implementation over the next 6-9 months. The workshop
provided participants with a special understanding of the importance of
comprehensive data collection from the public and private sector.
Key lessons learned in Lima include:
- Inter-sectoral and inter-institutional cooperation is essential to the success of complete and accurate data collection.
The value of this workshop was that, for the first time, it brought
together the three stakeholders in each country that carry-out data
collection and motivated them to work together, develop concrete work
plans and data collection strategies, and improve the implementation of
global indicators in their respective countries. An important outcome
was that the concept of the National Committee was reignited in
countries that have done without in recent years.
- The emphasis of a complete data registry, the role of
standardization in epidemiology and data collection, and the data
validation process were very important lessons learned. The CSR
reporting gold standard is defined as when every cataract surgery is
collected by the MoH, but these numbers are difficult to obtain from
ophthalmologists who work in private practice and are not affiliated
with national societies. It is recommended to validate the
number of cataract surgeries performed annually in each country with
intra-ocular lens import and sales data. This will require
inter-institutional cooperation with the ministries of economy, as well
as industry in some cases. A pending solution is the development of
mathematical models that can estimate private sector data, where data
are known to be incomplete.
- There is great variation and inconsistency from one country
to the next on how countries organize and define a comprehensive eye
care team of professionals. A very important lesson learned regarding
the feasibility of data collection was the challenge of standardizing
global indicators for the different eye health personnel cadres.
The WHO GAP includes the core indicator number of eye care personnel,
broken down by cadres based on the number of ophthalmologists,
optometrists, and allied eye health personnel in each country in order
to determine the availability and gaps of the eye health workforce. In
Latin America, there is no standardization of optometrists and allied
eye health personnel. Some countries do not allow optometry as a field.
There are no criteria for ophthalmic assistants, which, in some
countries are sometimes nurses trained by ophthalmologists on the job
rather than having formal ophthalmic training. Minimum competency
requirements for optometry and allied eye health personnel and Latin
American regional certification for ophthalmologists and surgical
training are needed in order to better measure and collect the related
data. The lack of standardization and universal definition of eye health
personnel is likely to be an issue also in some other regions of the
- This project implementation, requires consistent and clear
follow-up communications with the research team and all participants,
coordination among the three main sectors in each country, and continued
knowledge-sharing between all stakeholders to maintain the motivation
from the learning of each country’s experience. This includes
ongoing technical support from the research team to help provide the
resources and tools needed to effectively carry-out data collection in
each country and assist the governments to take further action they
promised when they signed the WHA 66th resolution.
By the end of 2014, it is estimated the countries will complete or be close to completing Phase 2 Implementation by carrying out the actions proposed in their respective global indicator work plans to strengthen data collection. Phase 3 Data Collection will then take place during 2015 and be followed-up with Phase 4 Final Analysis and Evaluation.
A final report will be published containing summary data, lessons
learned, and best practices that can be used in the same or similar
projects in other regions of the world.