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The Global Action Plan: A new initiative to improve global eye health
At the 66th World Health Assembly of the World Health Organization in 2013, a motion was unanimously approved for the Global Action Plan for the Prevention of Avoidable Blindness and Visual Impairment 2014-2019 – Towards Universal Eye Health. The background to this was the fact that in 2010 there were estimated to be 285 million people worldwide who were visually impaired, of whom 39 million were certified blind. According to the 2010 data, 80% of visual impairment, including blindness, is avoidable.
The two 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 are said to exist in all countries. Visual impairment is more frequent among older age groups. In 2010, 82% of those blind and 65% of those with moderate and severe blindness were older than 50 years of age. Poorer populations are more affected by visual impairment. Ninety percent of the visually impaired live in the developing world.
The Global Action Plan (GAP) is a commitment endorsed by all WHO member states to improve eye health for everyone over the next 5 years. The GAP is considered to be the most important strategic document in eye health. It builds upon and replaces previous Vision 2020 and 2009-2013 action plans. It is described by the International Agency for the Prevention of Blindness as a significant step forward toward achieving “universal access” to eye health.
The GAP has a specific goal, which is to reduce avoidable visual impairment as a global public health problem and to secure access to rehabilitation services for the visually impaired. It is hoped to achieve this goal by improving access to comprehensive eye care services that are integrated into health systems.
The resolution determined the actions for member states, international partners and the secretariat to be structured around three objectives:
Objective 1 addresses the need for generating evidence on the magnitude and causes of visual impairment and eye care services and using it to monitor progress, identify priorities and advocate for greater political and financial commitment by member states to eye health.
Objective 2 encourages the development and implementation of integrated national eye health policies, plans and programs to enhance universal eye health with activities in line with WHO’s framework for action for strengthening health systems to improve health outcomes.
Objective 3 addresses multi-sectorial engagement and effective partnerships to strengthen eye health.
The GAP document states that “the elimination of avoidable blindness depends on progress in other global health and development agendas, such as the development of comprehensive health systems, human resources for health development, improvements in the area of maternal, child and reproductive health, and the provision of safe drinking water and basic sanitation.”
How will progress be measured? The three indicators for each member state comprise the prevalence and causes of visual impairment; the number of eye care personnel; and cataract surgery provision. Let’s look at these a bit more closely.
Firstly, information on the magnitude and causes of visual impairment and trends over time is essential to gauge the prevalence and causes of visual impairment. Without this information resource allocation, planning, and combining with other programs will be ineffective. Secondly, it is important to know not just the number of eye care personnel but the spread of skills and experience so that gaps in the workforce can be identified and the necessary recruitment initiated. Finally, the ability of member states to deliver a cataract surgical service needs scrutiny. The cataract surgical rate (the number of cataract surgeries performed per year, per million population) and cataract surgical coverage (the number of individuals with bilateral cataract causing visual impairment, who have received cataract surgery on one or both eyes) are valuable proxy indicators for eye care service provision. With data on the prevalence and causes of visual impairment, coverage for cataract surgery can be calculated in any member state. This is an important measure that provides information on the degree to which cataract surgical services are meeting needs.
This is an ambitious program that, if successful, will bring not only a huge boost to human happiness and well-being but economic benefits to these developing countries as many of those affected people are able to rejoin the workforce in a productive manner. We in the ophthalmic community should be prepared to do all in our power to move this forward.
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- Richard B. Packard, MD, FRCS, FRCOphth, OSN Europe Chairperson of the Editorial Board, can be reached at Arnott Eye Associates, 22a Harley St., London W1G 9BP, England; +44-20-7580-1074; email: eyequack@vossnet.co.uk.
Disclosure: No products or companies that would require financial disclosure are mentioned in this article.