Technology for VISION 2020
The Global Initiative for the Elimination of Avoidable Blindness (World Health Organization, 1997), which is VISION 2020’s base document, emphasises the need for appropriate and affordable technology for the delivery of eye care on a global scale. The past ten years have already seen initiatives which have immeasurably increased access to eye care in developing countries. The outstanding achievement has been the mass production of low cost, high quality intraocular lenses, first by Aurolab in India, and then by the Fred Hollows Foundation. These organizations have substantially reduced the cost of IOLs, which are now widely distributed on the world market, and thus brought high quality cataract surgery within the reach of millions more people.
IAPB Technology for VISION 2020 Working Group
By 2001 working groups had formed to address VISION 2020 priorities such as low vision and refractive errors. However, it was only in October 2001 that the International Agency for the Prevention of Blindness (IAPB) decided to set up a working group on technology. This group met for the first time at a workshop on 26th and 27th April 2002 in Sydney, Australia, after the International Congress of Ophthalmology. Twenty four people representing 15 organizations attended.
The workshop’s objectives were:
- To share information about current availability of resources on appropriate technology for eye care
- To identify priorities for development, taking into account common needs and the resources available
- To agree the way forward.
The working group recognized the wide variation which exists between countries regarding norms and standards of eye care equipment, and committed itself to promoting the use of high quality equipment and consumables within national eye care programmes. Further, the group seeks to encourage the development of appropriate national standards and monitoring systems. A series of priorities were agreed by members of the group on which they will work over the coming year.
1. Establishing a purchasing network.
It was agreed to set up an e-mail network among the procurement managers responsible for purchasing equipment and consumables for their organizations. The intention is to share information on the suitability of items as well as on issues such as freighting and customs requirements. Procurement managers interested in joining the network should contact Philip Hoare at Sight Savers International (email@example.com).
2. Identifying equipment and consumables for development.
It was recognized that further work needs to be done to identify low-cost items for development and how these will be developed. There was discussion over the increasing need for low cost lasers, particularly in the treatment of posterior capsule opacification after cataract surgery. The group felt that research was needed to determine the scale of need for treatment of PCO, as well as for angle closure glaucoma, and agreed that this should be followed up.
3. Achieving a common standard list of equipment and consumables.
Several organizations have lists to assist staff and partners order suitable items. However, it was felt that these lists needed to be reviewed and consolidated. It would be helpful to include sections appropriate for setting up services at primary and at secondary level, as well as for training purposes. The list would need to be flexible and adaptable for regional differences, and, most important, information relating to suppliers and manufacturers should be included, with local maintenance and servicing facilities, and guide prices.
Providing an up-to-date service to eye care partners has major financial implications to which the group will have to give further thought. In the meantime, the International Resource Centre at the International Centre for Eye Health has offered to act as a collection point for existing lists, and for the collation of information on equipment maintenance (see below). All technology group members, and readers of this article, are asked to ensure that copies of relevant information are sent to the Resource Centre, ICEH, at the address given on this page.
4. Providing service support, education and training.
Aravind Eye Hospitals in Tamil Nadu, India have considerable experience in delivery of high quality services. Two colleagues from Aravind made presentations on the equipment requirements for high volume cataract surgery and on issues around servicing and maintenance. Many items of essential eye care equipment lie idle for lack of maintenance or, simply, spare parts. The working group agreed that in order to achieve the objectives of VISION 2020 and aid sustainability, it would be necessary to:
- Integrate equipment maintenance personnel into the eye care team and provide training
- Ensure that all eye care personnel achieve a basic understanding of the principles and practice of maintenance
- Increase the availability of training, information, and post-training support.
A short training course for maintenance personnel has been running at Aravind four times a year for several years and Aravind has facilitated the establishment of a similar course in Kaduna, Nigeria. A different model, of itinerant service personnel, exists in Pakistan and may also start in Kenya. Nevertheless, this represents a fraction of the need, and the working group agreed that ways have to be found to expand maintenance training. One idea is the establishment of ‘technology centres’.
5. Distribution networks.
How often do we find that eye care personnel are hampered by the lack of appropriate and functioning equipment? Ministry of Health eye units, as the end users, often have little or no influence over the ordering and procurement process. This leads to problems such as inappropriate, incomplete, non-standard items being received, so that the equip-ment is unusable, the ophthalmic personnel cannot work effectively and their morale suffers, as indeed do their patients. The working group considered the feasibility of a network of regional or national technology centres which could facilitate:
- Bulk purchasing of agreed high volume items
- Advocacy for the registration of essential items not yet included on national Essential Drugs and Appliances lists
- Importing procedures, storage, maintenance, and distribution.
While recognizing the difficulties of making this concept operational, the group agreed to investigate it further to see whether it would be workable in one or more countries.
These were some of the key issues discussed by the IAPB Technology for VISION 2020 Group. They recognized that improving access to appropriate equipment and supplies is vital to the development of eye care services and the ultimate success of VISION 2020. The group acknowledged that more can quickly be done to make available existing information through the e-mail purchasing network, and potentially through the ICEH Resource Centre. However, some of the other proposals, such as the development of information on the internet, have financial implications which will take time to resolve. We hope to bring readers progress reports in future editions of the Journal.