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ADVOCACY FOR PEC
RONNIE GRAHAM,
DIRECTOR, HUMAN RESOURCES FOR HEALTH, SIGHTSAVERS
© Sightsavers
1. CHANGE
The first step in any advocacy activity is to know what you want to
change.
We can seek to change policy or practice
In 2012 a WHO Discussion Paper noted ‘In particular, it appears that
there has been insufficient attention paid to integrating eye care
into primary health’.
Our Proposition, or change theme:
In the case of PEC, we want to see a change from isolated examples of
best practice, often INGO funded, to the systematic integration of eye
health into existing Primary Health Care systems.
In other words, we are trying to change practice
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2. STRATEGIC ADVOCACY
The Advocacy & Campaigning Cycle
1. Know what you want to change
2. Identify the best influencing strategy.
3. Develop an Action Plan
4. Implement Action Plan
5. Monitor and evaluate progress
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3. The Policy Context is Favourable
Global Policy:
1978:
2008:
2008:
THE ALMA-ATA DECLARATION ‘HEALTH FOR ALL’
WORLD HEALTH REPORT ‘NOW MORE THAN EVER’
THE OUAGOUDOUGOU DECLARATION ON PHC AND HEALTH SYSTEMS
National Policy
15 NATIONAL HEALTH PLANS SURVEYED - 14 WITH PHC AS ‘GUIDING PRINCIPLE’
In Mali, 58% of population lives within 5k of a Front Line Health Facility,
rising to 67% in Zambia and 97% in Tanzania
Eye Health Policy
1999
2000>
2004
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Vision 2020
National Eye Health Plans
Technology Guidelines
WHA Resolutions: 56.26, 59.25 and 62.1
4. But The Evidence Base is Weak
4.1 Ocular Morbidities:
‘Ocular morbidity descries a range of diseases that are selflimiting, unlikely to cause permanent visual impairment and can
usually be managed in primary care... Studies that explore the
prevalence of ocular morbidity show that there are significant
numbers of people who experience these conditions. Lindfield,
2010.
• Study in Pakistan (2004) demonstrated a prevalence of NVICs of
14.6%.
• A pilot study in Kenya (2011) showed a high prevalence (nearly
13%) of ocular morbidity.
• Follow-up studies underway in Nigeria and Cameroon.
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4.2 HOSPITAL DATA
1. Cameroon Study in Mamfe and Kumba District
Hospitals. ‘Overall, patients with ocular morbidities
represented about 18% of all patients attending the two
district hospitals’ Sightsavers, 2010
2. Pakistan Study: Baseline data on the burden of ocular
morbidity at primary, secondary and tertiary levels in 8
districts. ‘Evidence suggests that ocular morbidity
accounts for at least 7% of all outpatient health visits
to secondary hospitals and 10% to tertiary hospitals....
and 18% of all patients seen by Lady Health Workers’.
Sightsavers, 2010
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4.3 PEC IN PRACTICE
In a recent review of 103 articles, three
provided evidence of the effectiveness of PEC.
Advises testing and documenting the actual
contribution of PEC to the delivery of eye care.
*Courtright, Seneadza, Mathenge et al. ‘Primary Eye Care in Sub-Saharan Africa: Do We
Have the Evidence Needed to Scale up Training and Service Delivery’, Annals of Tropical
Medicine and Parasitology, Vol. 104, No. 5.
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5. Disease Control
The recent WHO Discussion Paper noted that ‘there may have been missed
opportunities to link disease specific initiatives.... with the broader
development of comprehensive eye care systems... which need to become
integrated with primary health care’.
Old and New Priorities must be anchored in the community.
1. NTDs: Focal Diseases – Interventions are Community owned and directed
2. NCDs: New priorities – importance of establishing surveillance mechanisms
3. Childhood Blindness - Early identification is critical
4. RE/LV Emergence of the African Vision Centre - grounded in PEC
5. Other Ocular Morbidities – Treat at most appropriate level - ‘free up’ the
clinics
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5. The Advocacy Challenge ?
But where the evidence is weak, how should we proceed?
 Strengthen the evidence.... But it takes time !
 Take a policy decision and address known weaknesses
NOT IF.............BUT HOW
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6. Advocacy Success
1. PEC IN THE EMRO REGION:
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Compelling evidence of impact from Pakistan.
New Guidelines under development.
(Creating Synergies for Health System Strengthening, Khan, Khan, Bile and Awan, Eastern
Med. Health Journal, Vol. 16, 2010)
2. PEC IN THE AFRO REGION: Package of interventions under
development
3. INTEGRATING EYE HEALTH INTO BASIC NURSE TRAINING: Eye
Health to be included as a priority issue in a new competency
based nurse training curricula.
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WHAT NEEDS TO CHANGE ?
How many psychiatrists does it take to change a light bulb ?
Only one......
But the light bulb has to want to change !
The point is that health systems unlikely to change to
accommodate eye health.
So we need to
health systems.
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change to be accommodated by
6. Now More Than Ever
• A new paradigm of eye health service delivery is emerging.
• It moves us away from vertical and parallel approaches and seeks
to generate programme and national success as well as ‘project
success’.
• The parameters of the new paradigm are well understood:
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Strengthen health systems
Expand the eye health workforce
Integrate eye health into primary health care
Strengthen linkages with wider health systems
A new set of eye health indicators linked to Global Health
Observatories
– Adequate, predictable and sustained financial resources
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CHANGE REVISITED
At the beginning of the presentation, I proposed the change we
would like to see “....from isolated examples of best practice, often
INGO funded, to the systematic integration of eye health into existing
Primary Health Care systems”.
The capacity to finally consumate this change lies in our hands:
1. The policy environment is supportive
2. The evidence base is growing stronger – OM, hospital data,
programme success
3. A new paradigm of eye health service delivery is emerging based
on integration, alignment and universal coverage.
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Key Question
Can we now utilise a common
approach to strategic advocacy
to make the necessary
programme shifts ?
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