Coordinating Advocacy In sub-Saharan Africa

International Council of International Council of OphthalmologyOphthalmology

Coordinating AdvocacyCoordinating AdvocacyIn sub-Saharan AfricaIn sub-Saharan Africa

Daniel Etya’aleDaniel Etya’ale

ICO Council MemberICO Council Member

ICO World Ophthalmology RoundtableICO World Ophthalmology RoundtableWorld Ophthalmology Congress, Hong KongWorld Ophthalmology Congress, Hong Kong

27 27thth June 2008 June 2008


Context & Environment Context & Environment of Eye Care Delivery & of Eye Care Delivery & Blindness Prevention Blindness Prevention

in Africa in Africa

International Council of OphthalmologyInternational Council of OphthalmologyBlind vs Population, By WHO Regions

Africa , 11Africa , 19

Americas, 14Americas, 7

East. Med, 8 East. Med, 11

Europe, 14 Europe, 7

S. E. Asia, 26 S. E. Asia, 31

W. Pacific, 28 W. Pacific, 25

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Pop by Region (mil) No of Blind, by Region (mil)Pop by Region (% Total Pop) Blind by Region (% Total Blind)Pop by Region (% Total Pop) Blind by Region (% Total Blind)

AFRICA: A DISPROPORTIONNALLY HIGHER NUMBER OF BLIND

International Council of OphthalmologyInternational Council of Ophthalmology

AFRICA: THE HIGHEST CONCENTRATION OF THE POOREST PEOPLE


AFRICA: THE REGION WITH THE HIGHEST

“OUT OF POCKET” EXPENDITURE FOR HEALTH


INEQUALITY IN HEALTH SPENDING – BY REGION (WHO, 2000)


EXTERNAL AID AS PERCENTAGE OF TOTAL HEALTH SPENDING (2000)


AFRICA: A REGION WHERE DONOR

COMMITMENT FOR HEALTH CARE IS

QUITE VOLATILE & UNPREDICTABLE


VISION 2020

???

???


Africa Challenges in Africa Challenges in Coordination & Coordination &

Advocacy Advocacy

COUNTRY POLITICAL AND FINANCIAL COMMITMENTCOUNTRY POLITICAL AND FINANCIAL COMMITMENTA Clear and Coherent National Eye Care PolicyA Clear and Coherent National Eye Care Policy

A fully developed, V2020 compliant National PlanA fully developed, V2020 compliant National PlanA non fictitious budget line for Vision 2020 ActivitiesA non fictitious budget line for Vision 2020 Activities

COUNTRY POLITICAL AND FINANCIAL COMMITMENTCOUNTRY POLITICAL AND FINANCIAL COMMITMENTA Clear and Coherent National Eye Care PolicyA Clear and Coherent National Eye Care Policy

A fully developed, V2020 compliant National PlanA fully developed, V2020 compliant National PlanA non fictitious budget line for Vision 2020 ActivitiesA non fictitious budget line for Vision 2020 Activities

A COMPLETE & FULLY FUNCTIONAL EYE CARE SYSTEMA COMPLETE & FULLY FUNCTIONAL EYE CARE SYSTEM(Community, Primary, Secondary & Tertiary)(Community, Primary, Secondary & Tertiary)

A COMPLETE & FULLY FUNCTIONAL EYE CARE SYSTEMA COMPLETE & FULLY FUNCTIONAL EYE CARE SYSTEM(Community, Primary, Secondary & Tertiary)(Community, Primary, Secondary & Tertiary)

Eye careEye careTeamsTeamsO’GistsO’Gists

Opht. NurseOpht. NurseOptometr. Optometr. L.V. Techn.L.V. Techn.Comm. WkrComm. WkrManagersManagers

Eye careEye careTeamsTeamsO’GistsO’Gists

Opht. NurseOpht. NurseOptometr. Optometr. L.V. Techn.L.V. Techn.Comm. WkrComm. WkrManagersManagers

Essential Essential Eye Medic.Eye Medic.& Equipmt& EquipmtNation. ListNation. ListA ProcurmtA Procurmt& Distribut.& Distribut.

System that System that Works!Works!

Essential Essential Eye Medic.Eye Medic.& Equipmt& EquipmtNation. ListNation. ListA ProcurmtA Procurmt& Distribut.& Distribut.

System that System that Works!Works!

MOH MOH PartnersPartners

NGDOsNGDOsMissionsMissions

FoundationsFoundationsUNUN

Prof. Assoc. Prof. Assoc. Training Centr.Training Centr.

MOH MOH PartnersPartners

NGDOsNGDOsMissionsMissions

FoundationsFoundationsUNUN

Prof. Assoc. Prof. Assoc. Training Centr.Training Centr.

A goodA goodMonitoringMonitoring

SystemSystemData Collect.Data Collect.Transmiss.Transmiss.& Feedback& Feedback

Activities Activities ReportsReports

A goodA goodMonitoringMonitoring

SystemSystemData Collect.Data Collect.Transmiss.Transmiss.& Feedback& Feedback

Activities Activities ReportsReports

Infrastruct.Infrastruct.Fully functional Fully functional Eye Care UnitsEye Care Units

Offering Cat. Surg. Offering Cat. Surg. + + Other Essential Other Essential

Surgeries Surgeries Minim. FunctionMinim. Functionalal

Equipmt. Equipmt.

Infrastruct.Infrastruct.Fully functional Fully functional Eye Care UnitsEye Care Units

Offering Cat. Surg. Offering Cat. Surg. + + Other Essential Other Essential

Surgeries Surgeries Minim. FunctionMinim. Functionalal

Equipmt. Equipmt.

CENTRAL AND REGIONAL COORDINATIONCENTRAL AND REGIONAL COORDINATIONCENTRAL AND REGIONAL COORDINATIONCENTRAL AND REGIONAL COORDINATION

NATIONAL COMMITTEE NATIONAL COMMITTEE FOR VISION 2020 ACTIVITIESFOR VISION 2020 ACTIVITIES

NATIONAL COMMITTEE NATIONAL COMMITTEE FOR VISION 2020 ACTIVITIESFOR VISION 2020 ACTIVITIES

Ultimate Goal


VISION 2020 Many Partners in AFRICAVISION 2020 Many Partners in AFRICA

46 COUNTRIES46 COUNTRIESIAPB, WHOIAPB, WHO

NGDOsNGDOs: Al Noor Foundation, Christoffel-Blindenmission : Al Noor Foundation, Christoffel-Blindenmission (Christian Blind Mission International), Helen Keller Worldwide (Christian Blind Mission International), Helen Keller Worldwide Organisation pour la Prévention de la Cécité, Operation Eyesight Organisation pour la Prévention de la Cécité, Operation Eyesight Universal, ORBIS International, Sight Savers International, The Universal, ORBIS International, Sight Savers International, The Carter Center, The Fred Hollows Foundation Dark & Light, Seva Carter Center, The Fred Hollows Foundation Dark & Light, Seva Foundation, International Centre for Eyecare Education , Lions Clubs Foundation, International Centre for Eyecare Education , Lions Clubs International Foundation, The International Eye Foundation, International Foundation, The International Eye Foundation, Operation Eyesight Universal, International Trachoma Initiative.Operation Eyesight Universal, International Trachoma Initiative.

Foundations & OthersFoundations & Others: , International Council of : , International Council of Ophthalmology, TheOphthalmology, The American Academy of Ophthalmology, etcAmerican Academy of Ophthalmology, etc

VISION 2020 Many Partners in AFRICAVISION 2020 Many Partners in AFRICA

46 COUNTRIES46 COUNTRIESIAPB, WHOIAPB, WHO

NGDOsNGDOs: Al Noor Foundation, Christoffel-Blindenmission : Al Noor Foundation, Christoffel-Blindenmission (Christian Blind Mission International), Helen Keller Worldwide (Christian Blind Mission International), Helen Keller Worldwide Organisation pour la Prévention de la Cécité, Operation Eyesight Organisation pour la Prévention de la Cécité, Operation Eyesight Universal, ORBIS International, Sight Savers International, The Universal, ORBIS International, Sight Savers International, The Carter Center, The Fred Hollows Foundation Dark & Light, Seva Carter Center, The Fred Hollows Foundation Dark & Light, Seva Foundation, International Centre for Eyecare Education , Lions Clubs Foundation, International Centre for Eyecare Education , Lions Clubs International Foundation, The International Eye Foundation, International Foundation, The International Eye Foundation, Operation Eyesight Universal, International Trachoma Initiative.Operation Eyesight Universal, International Trachoma Initiative.

Foundations & OthersFoundations & Others: , International Council of : , International Council of Ophthalmology, TheOphthalmology, The American Academy of Ophthalmology, etcAmerican Academy of Ophthalmology, etc


• GlobalGlobal

• Regional/Sub-Regional/Sub-RegionalRegional

• CountryCountry

1313

Three Levels of OperationThree Levels of Operation

• OKOK

• Work in Work in ProgressProgress


• OKOK



Africa Challenges in Coordination & Advocacy


Achievements so farAchievements so far

Addis Ababa, 2006 & Accra, 2007:• Two coordination/consultation/advocacy

meetings with all NGDOs

Accra, April 2008:• All stakeholders coordination/advocacy

meeting: WHO, IAPB, NGDOs, Countries, ICO, Training Institutions, Other sub- regional health organisations involved in Eye care

Addis Ababa, 2006 & Accra, 2007:• Two coordination/consultation/advocacy

meetings with all NGDOs

Accra, April 2008:• All stakeholders coordination/advocacy

meeting: WHO, IAPB, NGDOs, Countries, ICO, Training Institutions, Other sub- regional health organisations involved in Eye care



The Addis Ababa & Accra meetings:Main outcomes:• A consensus on work together among

NGDOs• An agreement on building NGDOs

coalitions at sub-regional and country to support eye care and blindness prevention

• To date, 2 sub-regional coalition groups (West & Southern Africa) are already working well

• Joint funding of projects also started

The Addis Ababa & Accra meetings:Main outcomes:• A consensus on work together among

NGDOs• An agreement on building NGDOs

coalitions at sub-regional and country to support eye care and blindness prevention

• To date, 2 sub-regional coalition groups (West & Southern Africa) are already working well

• Joint funding of projects also started



The Accra “All stakeholders meetings”:

Main outcomes:• A consensus on ways to accelerate

VISION 2020 activities throughout the region, in a more equitable way (support to “neglected countries”)

• A proposed new structure for IAPB mandate & Coordination in Africa

• The development of the new SS African Strategic and Business Plan

The Accra “All stakeholders meetings”:

Main outcomes:• A consensus on ways to accelerate

VISION 2020 activities throughout the region, in a more equitable way (support to “neglected countries”)

• A proposed new structure for IAPB mandate & Coordination in Africa

• The development of the new SS African Strategic and Business Plan

MINISTRY of HEALTHMINISTRY of HEALTHChairman, Nat’nal Coord,Chairman, Nat’nal Coord,

SecretariatSecretariat

LOCAL NGDOSLOCAL NGDOS+ Mission Eye + Mission Eye Care ServicesCare Services

INTERNATIONAL INTERNATIONAL NGDOs & NGDOs & OTHER OTHER

AGENCIESAGENCIES

THE PROPOSED COORDINATION STRUCTURE AT THE PROPOSED COORDINATION STRUCTURE AT COUNTRY LEVELCOUNTRY LEVEL

PROFESSIONAL GROUPSPROFESSIONAL GROUPSO’gists, OCOs/AMOs, O’gists, OCOs/AMOs, Optometrists, NursesOptometrists, Nurses

TRAINING TRAINING INSTITUTIONSINSTITUTIONS

DISTRICT PROGRAMS DISTRICT PROGRAMS Regional Ophthalmologists Regional Ophthalmologists

District Eye Workers District Eye Workers (+NGO/Mission Eye Workers)(+NGO/Mission Eye Workers)

WHO & OTHER WHO & OTHER UN AGENCIESUN AGENCIES

PRIVATE PRIVATE SECTORSECTOR

SCHOOL EYE SCHOOL EYE HEALTHHEALTH


Resources for AdvocacyResources for Advocacy

The importance of Country Data &

PoliciesMore & More data on

HRD, Eye Care Structures &

InfrastructureDisease Control

Activities are now availableThe new V2020

Strategic Document

ICEH Journal: Advocacy

E.g., MDG

Contact WHO/PBD

Contact IAPB or WHO

www.cehjournal.org

Coordinating Advocacy In sub-Saharan Africa

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