CBM Inclusive Eye Health Initiative 2017 - 2021

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Ipyana (8yrs) has always been teased by children in the neighbourhood because he cannot see. He recently underwent surgery at CBM partner CCBRT in Tanzania and now his vision has increased significantly.

Introduction

There are still large numbers of people in the world’s poorest places who are blind and visually impaired and cannot access the support they need. Many people with disabilities and other marginalised people are not reaching eye health services and some services do not enable meaningful lifelong change.

We have developed the initiative plan within the framework provided by the CBM Federation Strategy 2021, contributing to CBM’s strategic goal of bringing transformative change to the lives and communities of persons with disabilities living in poverty, and the three associated target outcomes:

  1. Avoidable impairment reduced
  2. Persons with disabilities are empowered to exercise their rights
  3. Inclusive, resilient and equitable communities

The Federation Strategy emphasises the importance of Disability Inclusive Development as both a set of values and a practical approach for all of CBM’s work: ‘We see DID as a key element of where we want to drive our activities and impact. As such, it will ensure that all other initiatives are incorporating the thinking, criteria and approaches of DID into their initiatives.’ Accordingly, we have built the Inclusive Eye Health initiative plan on the principles of inclusion, comprehensiveness and integration (see box below), underpinned by sound technical leadership and the creation of a strong evidence base.

This five-year plan for CBM’s Inclusive Eye Health (IEH) Initiative sets out the future direction of all programme work within IEH and Neglected Tropical Diseases (NTDs), identifying strategic priorities and objectives for the initiative and defining key activities and approaches. The IEH Initiative plan includes NTDs because most of CBM’s NTD work is related to NTDs that affect the eyes (Trachoma and Onchocerciasis).

This initiative aligns with the frameworks of the WHO Vision 2020 Strategy and the Global Action Plan 2014-2019 ‘Towards Universal Eye Health’ , the UN Convention on the Rights of Persons with Disability, Agenda 2030 with its Sustainable Development Goals (SDGs), and the WHO Roadmap for NTDs.

Through this initiative, CBM will build on its success and expertise in reducing avoidable visual impairment and blindness  and ensuring people permanently affected can access support and opportunities.

Working definitions in the Inclusive Eye Health Initiative

Inclusion:
Ensuring eye health programmes are accessible and welcoming to all members of the community, i.e. people from all disability groups, including vision impairment, and other marginalised and socially excluded people; and proactively ensuring that people with long term vision impairment access their right to wider opportunities in rehabilitation, health, education, livelihoods and social inclusion.

Comprehensiveness:
Includes all of these elements:
  1. Promotion of healthy eyes and behaviour through awareness raising at all levels
  2. Prevention of eye diseases
  3. Curative interventions (medical, surgical, optical)
  4. Rehabilitation - access to rehabilitation services (Community Based Inclusive Development - CBID, low vision, inclusive education, livelihoods and social inclusion)
Integration:
Means that the work done is fully part of national health systems and policies.

Initiative Priorities & Objectives

The IEH Initiative has three priority areas:
  1. Strengthening national eye health systems - While we aim to support partners in the implementation of inclusive and comprehensive eye health services, it is through integration into national health systems that these services will become sustainable, fully locally owned, and delivered to contextualised quality standards.
  2. Improved access to inclusive, comprehensive eye care services - This includes multi-pronged interventions to prevent and treat avoidable blindness and to improve the quality of life of people with permanent visual impairment. CBM’s target groups are often socially excluded as well as lacking access to educational, economic and social opportunities. We will focus resources on partners that are fully committed to delivering inclusive and comprehensive services to communities most in need. We recognise that this shall require a phased approach.
  3. Neglected Tropical Diseases (NTDs)- By focusing on the poorest and most NTD-endemic communities, and strengthening integration with national systems, we will significantly expand access to preventative and curative services, with mass drug administration (MDA) for trachoma and onchocerciasis. For trachoma, we will lobby to ensure WASH activities are implemented for the full SAFE strategy . Within a DID framework, NTD programmes will develop referral networks to rehabilitation, counselling and mainstream education and livelihood opportunities (‘Disease Management and Disability Inclusion’). NTD programmes through partners will be maintained in some form even during instability and conflict.

The 5 objectives of the IEH initiative are:

  1. a) Increased number of CBM supported countries with national health documents (e.g. policies; sector strategies; etc.) which integrate inclusive eye health (Priority area I) and b) Increased number of CBM supported countries which implement inclusive eye health (Priority area I)
  2. Reduction of prevalence of visual impairment in targeted districts (Priority area II)
  3. Increased percentage of partners providing comprehensive and inclusive district eye health services by 2021 (Priority area II)
  4. People and partners benefit from innovations pioneered and initiated by CBM (Priority area II)
  5. Increased proportion of people in target communities will have access to comprehensive, integrated and inclusive NTD programmes by 2021 (Priority area III)

Implementation

The three key programmatic areas outlined above – a stronger focus on inclusive and comprehensive eye care programmes, integrated into national systems – will be systematically applied to an increasing number of countries over 5 years, reaching a total of 30 countries in 2021. This will establish the IEH initiative as a new approach and new paradigm for CBM's work in eye health. It will be applied in the following ways:
  1. Inclusion: Disability Inclusive Development (DID) is CBM's key area of expertise. Under this initiative CBM will see inclusive practice strengthened and embedded across its supported eye health programmes, on a step by step basis. CBM will also promote and model inclusive practice to international networks and alliances, to other organisations and to ministries of health.
  2. Comprehensiveness: This initiative will ensure eye health programmes gradually become comprehensive in terms of promotion, prevention, curative interventions, and rehabilitation, at the primary, secondary and tertiary level of service delivery. This will require a strong focus on advocacy at international, regional, national and sub-national levels. CBM will focus on the major causes of visual impairment and blindness: Cataract, Uncorrected Refractive Error, Diabetic Retinopathy, Glaucoma, Childhood Blindness (including Retinopathy of Prematurity), as well as Trachoma and Onchocerciasis under the NTD umbrella.
  3. Integration into national systems through the Health Systems Strengthening approach : CBM will strengthen its approach in achieving sustainable outcomes with government health systems. The initiative will place much greater emphasis on influencing and tracking sustained positive changes within health systems. This initiative will principally target the district level eye health unit as the basic unit, which will act as a model for wider health system change. CBM's investment into working with national and sub-national governments and other key players such as national councils, as well as international networks and alliances, will be a further component seeking to embed long term systemic change. All NTD programmes will be integrated into national and sub-national plans to ensure these programmes support government systems and contribute to strengthening them, rather than working in parallel.

The IEH initiative will be led by CBM’s technical experts and will systematically promote the generation of evidence to inform practice:  
  1. Technical leadership: CBM Advisors in inclusive eye health will provide key technical leadership. Their work will cover the main areas for inclusive and comprehensive practice, together with system strengthening. They will be part of developing approaches and resources, working closely alongside CBM’s field personnel and partners – key to driving innovation, learning and effectiveness.
  2. Evidence and documentation: This will be key to understanding how best to build bridges between government policy and government implementation. It will also be important for quality assurance and innovative fundraising. This initiative will direct investment into the generation of quality evidence, systems and policy research for advocacy and prevalence surveys.

Emphasis will be placed on quality assurance of CBM-supported inclusive eye health services. This is measured in the following ways:
  1. Outcome of surgical and optical treatment in terms of the patient’s visual acuity post-surgery.
  2. Processes such as patient registration, out-patient records and patient reception, the whole surgical process and finally in-patient processes and discharge from the hospital, measured through patient satisfaction surveys.
  3. Innovative technology which improves patient safety, security and quality outcomes.


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