The 66th World Health Assembly (WHA) concluded on 27 May, 2013 with agreement on a range of new public health measures and recommendations aimed at securing greater health benefits for all people, everywhere.
At the WHA “Towards universal eye health: a global action plan 2014-2019” – was endorsed by delegates. This is an action plan that aims to further improve eye health, reduce avoidable visual impairment and secure access to rehabilitation services. The global target is to reduce the prevalence of avoidable visual impairment by 25% by 2019.

Mr Peter Ackland, CEO, International Agency for Prevention of Blindness ( IAPB) was at the WHA. We posed some questions to him to understand the global action plan better and what it means for India. Following is the text of the Q and A with Mr Peter Ackland.

V 2020 India: The global action plan 2014-2019 towards universal eye health for all was endorsed during the recently concluded WHA. This is a big achievement for the eye care fraternity. Can you share with our readers the importance of the action plan, especially with year 2020 approaching?

Peter Ackland: The new Global Action Plan (GAP) is now the most important strategic document that we have in the field of eye health at global level. It builds upon and replaces previous VISION 2020 and 2009 – 2013 Action Plans. It is important because it keeps eye health and the elimination of avoidable blindness and visual impairment on the radar of health policy makers. With so much current international interest in the Neglected Tropical Diseases and the four priority non-communicable diseases (cancer, respiratory diseases, heart diseases and diabetes) we have to fight for attention for our cause of better eye health.

V 2020 India: What are the unique features of this action plan?
Peter Ackland: The GAP has an overall target – which is to reduce the prevalence of avoidable visual impair-ment by 25% by the year 2019 from the baseline of 2010. This is important as once achieved it will continue the downward trend we have seen in the age standardised prevalence rate of both blindness and moderate & severe visual impairment in the period 1990 to 2010.

The GAP is structured around three clear objectives:

The first objective focuses upon generating evidence on the magnitude and causes of visual impairment and on the state of eye health services and using this evidence to advocate for greater political and financial commit-ment by national governments to eye health.

Objective two encourages the development of policies, plans and programmes to enhance universal eye health. It refers to the need for integration of eye health into strengthened health systems.

Objective three stress the need for multisectoral engagements and effective partnerships.

Each objective has a number of proposed actions for national governments, the WHO Secretariat and Interna-tional Partners – IAPB and VISION 2020 India would fall into this latter group.

Overall the GAP summarises well current thinking within IAPB and its’ Members as to how we are most likely to raise the profile of eye health, vision impairment and rehabilitation and establish the services required to bring eye health to the most marginalised and poorest groups in society.

V 2020 India: Can you briefly describe the steps towards drafting the action plan and who all were involved in the entire exercise?

Peter Ackland: The first important step was that made at the World Health Assembly Executive Board meeting of Jan 2012 when a decision was made to ask the WHO Secretariat to prepare a new Action Plan to succeed the 2009 -13 Action Plan. A few months prior to this meeting IAPB had established a work group to advocate to Member States represented on the Executive Board for a new Plan, so we were very happy with this outcome. The WHO then prepared a discussion document and invited stakeholders to express their views as to what should be included in the new Action Plan. IAPB and many of our Members responded to this online consulta-tion. At the World Health Assembly in May 2012 the Australian delegation and IAPB hosted a lunch time semi-nar which was very well attended. By June, WHO had posted a “zero draft” of the new Action Plan and estab-lished a web-based consultation process. By September the “First draft” had been prepared followed by two a web-based consultation process. By September the “First draft” had been prepared followed by two meetings in October where Member States and NGOs in official relations with WHO, including IAPB, were able to comment on the content and the targets. The penultimate draft was then prepared for the Executive Board meeting of January 2013 where it was heartily endorsed and recommended for adoption. This subsequently happened at the WHA in May 2013.
Overall the consensus has been that the process was genuinely consultative, that views and comments were taken on board throughout the process, and that the final draft adopted at the WHA was very good content wise.

V 2020 India: The preparation involved several stakeholders. Were there any challenges that you faced while the proposal was being drafted?

Peter Ackland: The key challenge was to ensure that the process to develop and promote the new GAP was driven by Member States. WHO has over the past couple of years been engaged in a reform process that has stressed that the WHO is accountable to the 194 Member States and not to civil society or private sector interests. Thus it would have been counter-productive if IAPB had been seen to be at the forefront. Accordingly our advocacy strategy was to build relationships with Member States and encourage them to promote the GAP at the meetings. At this point I should pay tribute to the work of Lesley Podesta, the Chair of the IAPB work group, and Sanjeev Commar, a consultant engaged to help with the work in Geneva – both know the WHO system very well and their political antennae meant we were able to get the balance right. At the IAPB 9th General Assembly in Hyderabad in September 2012 VISION 2020 India arranged for us to meet senior Indian government officials and we were able to talk about the new GAP. Likewise we met the high level Chinese delegation that attended the 9GA. Getting the support of these countries and the leadership displayed by Australia, Mexico and Saudi Arabia in particular was the key to success.

V 2020 India: You in your blog have mentioned that now it is time for implementation. So what are the next steps? And how will this plan be implemented universally?

Peter Ackland: Important though the new GAP is it will only add value if it is now taken up seriously at country levels and national governments take responsibility for implementing the GAP in their country. Future IAPB advo-cacy work will now shift to country level – though we would hope all countries will take action the reality is that if we are to make impact on the global prevalence of blindness and visual impairment some big countries just have to succeed.
Very obviously India would be amongst those important target countries where we must see real progress. To this end we are lucky to have VISION 2020 India that is already well established in-country, plus a positive relationship with the government and many eye health leaders and champions. The development of eye health already in-cluded in the 12th National five year plan of India already lay a good foundation for implementing aspects of the new GAP. Unfortunately in many other countries these coalitions and plans to promote eye health are less well es-tablished. Part of IAPB’s future role will be to help establish strong local capacity to advocate for change.
We have been discussing with WHO how we can catalyse local interest in the new GAP. One thing we have thought of is to encourage the development of an approved WHO eye health service assessment tool which can be used in each country as a situational analysis of current provision and identify areas that need strengthening. Another proven approach has been to encourage localised prevalence surveys, such as RAABs. Global data or even national level data in big countries like India, can easily seem distant to policy makers and politicians whilst a local survey that identifies the size and causes of blindness and visual impairment is harder to ignore and more likely to interest people to want to do something about the situation.

V 2020 India: Vision 2020 India participated toward preparing the draft proposal along with other Vision 2020 programmes. What role do you think all the Vision 2020 programmes around the world can play to take this for-ward? What are the steps that they can take to successfully implement this action plan?

Peter Ackland: Local advocacy to promote national implementation of the new GAP is the key to success. The national VISION 2020 bodies are perfectly placed to be the organisations that lead the advocacy in their country. To a large extent advocacy work is very locally based – it is about knowing how political and policy decisions are made and who the key people are to build relationships with and to seek to influence. Much of this is culturally specific. There is no way that this can be led from outside the country.

Though IAPB can share resources and promote learning useful for advocacy based upon experiences of VISION 2020 organisations across different countries, ultimately it is local action that will win the day for us. These are exciting times and the new GAP provides us with the opportunity to make a lasting impact – I hope everyone reading this will feel they have something to offer to make this all happen – because you all do!

V 2020 India: Thank you Mr Ackland.