IAPB & WHO: Working Toward Integrated, People-Centered Eye Care

An integrated, equally distributed, people-centered eye health system is the way forward, and the government should put people and the community — not diseases — at the center of health.

This is the message from Dr. Amanda Davis, regional chair of the International Agency for the Prevention of Blindness (IAPB), Western Pacific, in her welcome message at the 2020 Asia Optometry Conference. 

Founded in 1975, IAPB is the premier eye health body that brings together a network of 160 member organizations from around the world. One of its important roles is to create and disseminate knowledge and to be a facilitator and key partner to many agencies, regionally. Recently, it has formed an important partnership with the World Health Organization (WHO). The partnership resulted in WHO releasing its first-ever World Report on Vision in 2019, which provides a comprehensive overview of eye health worldwide.

The report provides recommendations and a strategic framework to guide action at the national, regional and global level for the next decade, said Dr. Davis, who oversaw the growth of the IAPB’s public health division and also assisted in the development of eye care services in 54 countries. Dr. Davis said the report provides a critical moment to inform and persuade global leaders about the magnitude and unacceptability of vision loss globally. Thus, the finding is very relevant to the region — and also to the conference.

Lower Income Areas Bear the Burden

The report showed that at least 2.2 billion people worldwide have vision impairment. “Out of these, at least one billion have vision impairment that could have been prevented or have yet to be addressed,” she said, adding that people in low- and middle-income countries are four times as likely to have vision impairment.

“This is the challenge that we are facing. We know that one-third of the world population is impacted, and services are out of reach for eye care because the facilities and welfare is unfairly distributed or inaccessible,” said Dr. Davis. She said there are many vulnerable individuals who fall into the marginalized group in society. 

“Most of them just need glasses, some need low-cost surgery and others to see a doctor regularly. This vulnerable group includes women, older people, people with disabilities, ethnic minorities and indigenous people,” she said.

Lighting the Way Ahead

In her address, Dr. Davis proposed the way forward, which she said is a result of concerted efforts in the last 30 years to create an integrated, equally distributed and people-centered health system. “Governments need to integrate eye care into health services. We need to build a strengthened health system — where health and services include treatment, early detection and prevention,” she said.

She also elaborated on what integrated, people-centered eye-care means, which hinges on three key interrelated areas. “An integrated, people-centered eye care service recognizes the continuous need at the stage of promotion, prevention, treatment and rehabilitative intervention. 

“It drives all areas of health care and coordinates eye care services across and beyond the health sector to other sectors. More importantly, it recognizes that people have different needs in eye health that change throughout different stages in their life,” said Dr. Davis.  She then spoke on four key strategies required to implement integrated, people-centered eye care (IPEC). First and foremost, she said any strategy taken must empower and engage people and communities.

“Empowering and engaging is about enabling people and caregivers to be effective users of health care services, and ensuring that they have the right information and education to embrace preventative services and access treatment and rehabilitation,” she said. Secondly, it must involve reorienting the model of health care to ensure eye health is integrated into all primary health; aiming at individuals through primary care and population-based interventions.

“We need to increase the adaptability of health systems, while changing demographics and lifestyles, pertinent to this region. Reorienting also focuses on continual care and preventive intervention that are more cost-effective to lead to improved health,” she said. Next, implementation must include coordinating services within and across sectors. Pace management and team-based care require a viable health network by integrating medical programs into health programs. And this includes linkages between various health care areas. 

“It is also critical to include those outside of the health sector — such as social services, governance, finance and education. This is primarily a government and leadership issue requiring strong actions to coordinate an intersection,” she stressed. Last but not least, Dr. Davis spoke on creating an enabling environment which is based on WHO’s policy working alongside leadership and governance, and focused on information data, workforce and health system financing to ensure access to all essential sectors.

While all these are important strategies, Dr. Davis said we could do something now to make it happen. She said that both the public and private sectors should invest more in eye health to integrate and scale-up people-centered eye care. “Make eye health an integral part of Universal Health Coverage; reframe eye health within the SDG Framework to ensure that it addresses the changing demographic. “We should help the vulnerable and leave no one behind. We need to strengthen monitoring and accountability and always work together with one another,” she said.

One of the main roles of IAPB is advocacy, she said. IAPB works to raise the profile of eye care with key international institutions and receives the attention and resources needed to achieve universal access to eye health. The agency works with many countries to advocate and help raise awareness. “We are facilitating our members to work with local governments, to assist implementation and to ensure that our members are well-informed and connected. And we do this at national, regional and global level,” she said. 

The agency’s roles include providing data and information to enable access to up-to-date knowledge, information and practice. It plays a part in strengthening networks and supporting active partnerships between members and other key sectors. “IAPB also establishes a baseline for strategy set-up and facilitates communication at international forums. A global-level mechanism is crucial for holding stakeholders accountable,” said Dr. Davis. She said IAPB helps coordinate the launch of the World Report on Vision and continues to champion and draw attention to the Report, as well as the WHO to develop technical tools and accountability framework.

“We at IAPB believe that no one is needlessly visually impaired. Everyone should have access to the best possible standard of eye health; those with irreparable vision loss can achieve their full potential,” she concluded.

Editor’s Note: The Asia Optometric Congress (eAOC 2020 Virtual) took place from November 18-19, 2020. Reporting for this story also took place during the event.