«WHA62/2009/REC/1 WORLD HEALTH ORGANIZATION SIXTY-SECOND WORLD HEALTH ASSEMBLY GENEVA, 18–22 MAY 2009 RESOLUTIONS AND DECISIONS ANNEXES GENEVA ...»
WORLD HEALTH ORGANIZATION
WORLD HEALTH ASSEMBLY
GENEVA, 18–22 MAY 2009
RESOLUTIONS AND DECISIONS
Prevention of avoidable blindness and visual impairment1
The Sixty-second World Health Assembly,
Having considered the report and draft action plan on the prevention of avoidable blindness and visual impairment;2 Recalling resolutions WHA56.26 on elimination of avoidable blindness and WHA59.25 on prevention of avoidable blindness and visual impairment;
Recognizing that the action plan for the prevention of avoidable blindness and visual impairment complements the action plan for the global strategy for the prevention and control of noncommunicable diseases endorsed by the Health Assembly in resolution WHA61.14, ENDORSES the action plan for the prevention of avoidable blindness and visual impairment;3 1.
2. URGES Member States to implement the action plan for the prevention of avoidable blindness and visual impairment, in accordance with national priorities for health policies, plans and programmes;
3. REQUESTS the Director-General:
(1) to provide support to Member States in implementing the proposed actions in the plan for the prevention of avoidable blindness and visual impairment in accordance with national priorities;
(2) to continue to give priority to the prevention of avoidable blindness and visual impairment, within the framework of the Medium-term strategic plan 2008–2013 and the programme budgets in order to strengthen capacity of the Member States and increase technical capacity of the Secretariat;
(3) to report to the Sixty-fifth and Sixty-seventh World Health Assemblies, through the Executive Board, on progress in implementing the action plan for the prevention of avoidable blindness and visual impairment.
(Sixth plenary meeting, 21 May 2009 – Committee A, first report) See Annex 5 for the financial and administrative implications for the Secretariat of the resolution.
See Annex 1.
-1ANNEX 1 Action plan for the prevention of avoidable blindness and visual impairment1 [A62/7 – 2 April 2009]
1. According to the latest WHO estimates, about 314 million people worldwide live with visual impairment due to either eye diseases or uncorrected refractive errors. Of these, 45 million are blind, of whom 90% live in low-income countries. The major causes of blindness are cataract (39%), uncorrected refractive errors (18%), glaucoma (10%), age-related macular degeneration (7%), corneal opacity (4%), diabetic retinopathy (4%), trachoma (3%), eye conditions in children (3%), and onchocerciasis (0.7%). The actual magnitude of blindness and visual impairment is likely to be higher than estimates indicate, as detailed epidemiological information on some causes (e.g. presbyopia) is still lacking.
2. With today’s knowledge and technology, up to 80% of global blindness is preventable or treatable. Cost-effective interventions are available for the major causes of avoidable blindness. Major international partnerships have been established in recent years, including the African Programme for Onchocerciasis Control, the Onchocerciasis Elimination Program for the Americas, the WHO Alliance for the Global Elimination of Blinding Trachoma and VISION 2020: the Right to Sight.
3. Two recently adopted Health Assembly resolutions (WHA56.26 and WHA59.25) focused on avoidable blindness and visual impairment, urging Member States to work on prevention, mainly through specific plans and inclusion of the subject in national health plans and programmes. Despite significant progress in the area of eye health, the prevalence of avoidable blindness remains unacceptably high in many countries and communities.
4. The plan aims to expand efforts by Member States, the Secretariat and international partners in preventing blindness and visual impairment by developing comprehensive eye-health programmes at national and subnational levels.
5. In order to intensify and coordinate existing activities, especially in low- and middle-income
countries, the plan seeks to:
(a) increase political and financial commitment to eliminating avoidable blindness;
(b) facilitate the preparation of evidence-based standards and guidelines, and use of the existing ones, for cost-effective interventions;
(c) review international experience and share lessons learnt and best practices in implementing policies, plans and programmes for the prevention of blindness and visual impairment;
(d) strengthen partnerships, collaboration and coordination between stakeholders involved in preventing avoidable blindness;
(e) collect, analyse and disseminate information systematically on trends and progress made in preventing avoidable blindness globally, regionally and nationally.
6. This plan focuses on the major causes of avoidable blindness and visual impairment, as defined in the draft eleventh revision of the International Statistical Classification of Diseases and Related Health Problems.1 The plan does not deal with categories of milder visual impairment or eye conditions for which evidence-based prevention and/or treatment interventions are not available; these cases will require effective and appropriate rehabilitation measures that enable people with disabilities to attain and maintain maximum independence and full inclusion and participation in all aspects of life.
7. Since blinding conditions are chronic and mostly due to noncommunicable causes, this plan complements the action plan for the global strategy for the prevention and control of noncommunicable diseases adopted by the Health Assembly in resolution WHA61.14. Prevention strategies differ significantly, however, as most blinding conditions do not share the risk factors, other than tobacco use, addressed in the noncommunicable disease plan. Although, as with noncommunicable diseases, primary health-care and community-based interventions are essential for preventing blindness and visual impairment, the provision of high-quality eye-care services needs specific skills, technology and infrastructure.
8. Evidence indicates that the magnitude of avoidable blindness caused by communicable diseases like trachoma and onchocerciasis and ophthalmological complications in measles is decreasing, whereas noncommunicable age-related eye conditions (e.g. cataract, glaucoma and diabetic retinopathy) are increasing. Programmes against both onchocerciasis and trachoma need continued efforts for control and to avoid recurrence. A coordinated intersectoral approach to both communicable and noncommunicable conditions is needed.
9. In view of the adverse global economic climate it is essential to maximize the impact of existing resources and technical programmes across WHO that contribute to the prevention of blindness, and also influence the conditions that make populations vulnerable to visual impairment. An example of this is the use of immunization, and vitamin A supplementation in vulnerable populations, to reduce the risk of blindness due to corneal opacities.
RELATION TO EXISTING STRATEGIES AND PLANS
10. Prevention of avoidable blindness and visual impairment has been the subject of several resolutions adopted by the Health Assembly,1 which, inter alia, encouraged several international partnerships and alliances to work at the global level in this field. The action plan supports implementation of WHO’s Eleventh General Programme of Work 2008–2013 and the Medium-term strategic plan 2008–2013, particularly strategic objective 3, which covers work on prevention and control of avoidable blindness and visual impairment. It also supports the implementation of existing regional resolutions and plans.2
11. The Programme budget 2008–2009 describes the financial resources required by the Secretariat for work to meet strategic objective 3. For future bienniums, additional resources will be required.
Further progress in preventing avoidable blindness and visual impairment globally, regionally and nationally will depend on the amount of additional resources available. All partners – including intergovernmental and nongovernmental organizations, academic and research institutions and the private sector – will need to do more for resource mobilization at all levels.
12. This action plan is designed to cover the period 2009–2013, that is, the remaining five years of the Medium-term strategic plan.
SITUATION ANALYSISMagnitude, causes and impact of blindness and visual impairment
13. Determining the causes and magnitude of blindness is necessary for setting priorities, designing targeted strategies and establishing international blindness-prevention cooperation and alliances.
Recent years have seen much better availability of data on the causes and magnitude of blindness and visual impairment around the world. In the past, surveys on the causes used a variety of methods and definitions, but WHO’s development of standardized and feasible methodologies has facilitated collection from Member States of comparable epidemiological and health-system data, for example on the rapid assessment of surgical services for cataract and of avoidable blindness. The childhood blindness protocol is another example of such progress.
14. To date, epidemiological surveys have been conducted in 65 countries. However, the absence of surveys and lack of data in the remaining countries have greatly hampered detailed planning, monitoring and evaluation of interventions. In addition, missing epidemiological data on the status of Resolutions WHA22.29, WHA25.55, WHA28.54, WHA47.32, WHA51.11, WHA56.26 on elimination of avoidable blindness and WHA59.25 on prevention of avoidable blindness and visual impairment.
See resolution EM/RC49/R.6 on VISION 2020: The Right to Sight – elimination of avoidable blindness, resolution EM/RC52/R.3 on Prevention of avoidable blindness and visual impairment, document AFR/RC57/6 (Accelerating the elimination of avoidable blindness – a strategy for the WHO African Region) and PAHO: Draft Ocular Health Strategy and Plan of Action 2008–2012.
40 SIXTY-SECOND WORLD HEALTH ASSEMBLYvisual health in the population limits further analysis of the trends of visual impairment and the timely development of appropriate public health interventions.
15. Collection of reliable and standardized epidemiological data is a priority for countries where such data are not available. Action is also needed to develop modelling approaches in order to determine trends and set targets, so that the planning of efforts to prevent avoidable blindness and visual impairment can be more focused and evidence-based. Also required is an improved mechanism for systematically collecting standardized information on human resources, infrastructure and available technologies, and countries must be ready to respond to the observed needs.
Prevention of blindness and visual impairment as part of national health development plans and WHO technical collaboration with Member States
16. Despite the availability of WHO information on the magnitude and causes of blindness and strategies for their prevention, policy-makers and health providers in some countries are evidently not fully aware of available eye-care interventions, their cost–effectiveness and their potential to prevent or treat the 80% of global blindness that is avoidable. Country cooperation strategies reflect the agreed joint agenda between health ministries and WHO. So far, the inclusion of blindness prevention in such documents has been minimal, despite seven resolutions of the Health Assembly relating to prevention of avoidable blindness and visual impairment, the existence of WHO’s major, long-standing international partnerships on prevention of blindness, and major successes in reducing avoidable blindness, such as WHO’s Onchocerciasis Control Programme. Lack of adequate resources for preventing blindness at the country level is a major impediment. Additionally, faced with increasingly limited resources, donor and recipient countries often give higher priority to mortality-related disease control programmes than to those dealing with problems of disability. Also, experienced staff to coordinate blindness-prevention activities at the regional and country levels are in short supply.
17. Greater priority should be given to preventing blindness in health development plans and country cooperation strategies. Action is also needed to strengthen technical support and enhance the provision of expert advice to Member States where blindness and visual impairment are a major health problem.
National eye health and prevention of blindness committees
18. It is important to establish national committees and programmes for eye health and blindness prevention. Their role is to liaise with all key domestic and international partners, to share information and to coordinate such activities as implementing the national eye health and blindness-prevention plan. A functional national committee is a prerequisite for developing the national blindnessprevention plan and its implementation, monitoring and periodic assessment. Some countries, particularly those with decentralized or federated management structures, have similar committees at subnational level.
19. By the end of 2008, 118 Member States had reported the establishment of a national committee.
However, not all national committees are functional and, unfortunately, in many cases such committees have not successfully initiated effective action. In some instances, selected individuals, often dedicated eye-care professionals, are relied on to provide leadership and serve as the driving force for blindness-prevention plans and programmes. The committees’ membership is often not uniform, ranging from the ideal scenario, in which all key partners are represented (including the national health-care authorities), to a minimal group of dedicated eye-care professionals.
ANNEX 1 41