Eye care in health systems: guide for action

To address many of the challenges faced in the field of eye care – including inequities in access and lack of integration within the health system – eye care needs to be an integral part of universal health coverage (UHC): all individuals to receive the health services they need, of sufficient quality, without experiencing financial hardship. The concept of UHC is globally adopted as the key guiding principle for health planning. To this end, the Eye care in health systems – guide for action (the Guide) was developed as a manual for health planners. The Guide outlines strategies and approaches proposed by WHO that provide practical, step-by-step support to Member States in the planning and implementation of integrated people-centred eye care (IPEC). Planning periods covered in the Guide include those that are short-term (annual operational planning), as well as mid- to longer term (eye care strategic plans).

The primary audiences for Eyecare in health systems: a guide for action (the Guide) are governments of low- and middle-income countries and the agencies working with them to provide eye care to the people in need. It is designed for use at the national level but can also be used at the subnational level.

The Guide aims to be a practical resource for countries to analyse, plan, implement and review integrated people-centred eye care (IPEC). More specifically, it outlines recommended activities towards the development of:

1. an eye care strategic plan that outlines priorities;

2. a monitoring framework linked to the eye care strategic plan; and

3. one or multiple operational plans outlining actions in support of the implementation of the eye care strategic plan.

The Guide currently links four resources, or tools, developed by WHO (Figure 1), to support countries in their development of the plans and frameworks described above. The Guide was designed to be a dynamic resource, allowing the inclusion of additional tools at any time to facilitate the analysis, planning, implementation and review of IPEC in countries.

The Guide further describes and links the following four new tools developed by WHO to support country planning:

1. Eye care situation analysis tool (ECSAT)

Purpose: Questionnaire based survey tool to comprehensively assess eye care in a country.

2. Eye care indicator menu (ECIM)

Purpose: List of recommended eye care indicators to be collected regularly.

3. Package of eye care interventions (PECI)

Purpose: Planning and budgeting for eye care at each health system level.

4. Eye care competency framework (ECCF)

Purpose: Planning tool for eye care human resources based on competencies.

The “Analyse–Plan–Do–Review” cycle

The Eye care in health systems: guide for action describes a set of recommended actions across four implementation phases. The recommendations outlined can be modified depending on country needs.

The cyclical nature of the “Analyse–Plan–do–Review” process and its evolution over several years is represented in Figure 2. Phase 1 (Analyse) and Phase 2 (Plan) are carried out periodically, for example once every 5 years, whereas Phase 3 (Do) is ongoing and 4 (Review) is annual.

Completion of the first two phases (Analyse and Plan) takes approximately 12 months, depending on the country situation, A sample time frame and related responsibilities across the first two phases are provided in Annex 1.

The strategies, processes, actions, and sequence of the four phases described in the Guide are recommendations. Member States may select components based on national or regional situation and needs; for example a country may have an eye care strategic plan in place but may require a monitoring framework.

Importantly, success in strengthening eye care with the help of the fourphase process requires government leadership, readiness, and commitment.