Introduction Planning for VISION2020 is around a disease control strategy The priorities are of specific disease control but

t you develop a Comprehensive Eye Care (CEC) programme CEC includes community-based rehabilitation which identifies blind people in the community and takes the treatable e.g. cataract to the hospital CEC also includes rehabilitation of the incurable blind: mobility training, vocational placement, social adaptation Spiral Cycle of Planning Define Aim Aim: a direction; not necessarily achievable. Its the big picture Eradication; Elimination; Control VISION 2020 Aim: Elimination of avoidable blindness Elimination of cataract blindness in Kaduna Set Objectives Do not over-plan Setting SMART objectives enables one to have commitment and focus Take advantage of opportunities as they arise Try to recognise your communitys perspective and craft a solution that wins for both sides; creating a longer-term model of success Objectives are SMART SMART Objectives S specific M measurable A achievable, at the tip of your reach; requires effort R realistic T time-bound Example VISION 2020 Aim: Global elimination of avoidable blindness

Its general objective is to reduce global blindness to 0.3% by 2020 It has a time-frame and it is measurable Set Priorities of disease control based on 1.Magnitude: Burden of disease

Expected number of blind years 2.Feasibility of control: can you do something about it? Available skills (the know-how) Available resources 3.Cost-effectiveness: economic rate of return 4.Consider geographical spread of the disease Develop Strategy: The How Outlining strategies ensures success and completion

The best strategy is often not the optimal one, but the one that is easiest to implement Centered around specific objectives Activity-based Develop a Comprehensive Eye-Care Programme Develop an Eye-Care plan based on the principles I SEE I- Integration S- Sustainability E- Equity E- Excellence On the foundation of Community Participation A plan must include Activity: What? Target: When? Personnel: Who? Strategy: How? Cost: How much? Cataract The proposed 5-year plan Aim: To eliminate cataract blindness in Maiduguri by the year 2020

Objectives: 1.To achieve a CSR of 2000 by the next 5 years (OUTPUT) 2.To monitor and ensure the quality of surgery in order to achieve a good uncorrected visual outcome in at least 80% of operated cases by the next 5 years (OUTCOME) 3.To make cataract surgery more affordable and cost-effective in order to achieve selfsustainability by the next 5 years (OUTLAY) Strategies to increase output (CSR) How Many? Gradually increase number of surgeries done over 5 years Efficient service: Improve work culture and management Create Demand HRD: Enhance training of surgeons, nurses and supporting staff Strategies to ensure good outcome How good? WHO guidelines for monitoring VA outcomes Appropriate technology Build and maintain surgical skills Surgical technique: ECCE + PC IOL or SICS + PC IOL Pre-op IOL power calculation Post-op refraction Implement monitoring Develop system of follow-up in the community Strategies to make surgery affordable How much? Consider subsidy monitor patient paying capacity Cost-containment; Cost-sharing; Cost-recovery; value for money Income generation Childhood Blindness This should be in the plan as a service for: 1.Teaching institution/Tertiary/Referral centre 2.V. poor rural area with malnutrition 3.Blind school responsibility as an eye-care provider for the school Childhood Blindness

Aim: To eliminate childhood blindness due to cataract and (VAD)

vitamin A deficiency

Objectives: (related to 1 3 above) 1.To have a child eye-care centre dealing with cataract, glaucoma and optical/low vision services in children 2.A survey for assessment of VAD and control measures 3.To examine all blind school children and determine those who could be helped Strategy for child eye-care centre Teach/educate workers on VAD Vitamin A supplementation with measles immunization Ante-natal vitamin A supplementation Nutrition education for mothers Trachoma Trachoma is a focal disease Targets are set in relation to the magnitude of the disease in the community.

Aim: To eliminate trachoma blindness by 2020

Objectives: 1.To reduce the number of people with TT from 200/1000 to 20/1000 population in the next 5 years. Note:The Ultimate Intervention Goal (UIG) is to reduce number of people with TT to 1/1000 population 2.To reduce the prevalence of TF/TI from 10% to <5% in 1-10 year-olds in the next 5 years Strategy for control of trachoma blindness S Surgery: Bilamellar tarsal rotation by ophthalmic nurses in the community A Antibiotics: Use azithromycin, one dose/year, mass treatment F Face washing/Facial cleanliness: A Health Promotion E Environmental control: Water, sanitation, economy (e.g. micro-credit scheme). It is a Developmental goal Glaucoma Situational analysis is done to estimate the number of people at risk number with glaucoma number blind from glaucoma

Aim: To eliminate glaucoma blindness by 2020

Objectives: 1.To find the late imminently blind glaucoma patient (case-detection) 2.To achieve a glaucoma surgical rate (GSR) of 200 eyes/million population/year in the next 5 years. Strategy: How do we find the glaucoma patient? 1.VA screening in the community and referral of all those with VA<6/60 for diagnosis 2.Fundoscopy and IOP measurement of referred cases done by ophthalmic nurses. Specific examination by ophthalmologist for patients if vertical cup/disc ratio (VCDR) >0.6; IOP > 21mmHg 3.If more resources are available, can check VCDR in all >40 year-olds 4.Outline exact mode of fundoscopy 5.Outline exact method of IOP measurement: Shiotz, hand-held e.g. Perkins or tono-pen, etc. Strategy: Increase GSR 1.Trabeculectomy (with antimetabolites) to all diagnosed patients 2.Surgery done at the ?secondary level 3.Use a cataract programme to promote glaucoma intervention 4.Improve public health awareness and Create demand Diabetic Retinopathy Developed countries and the urban populations of developing countries In 1m population: 30-50,000 diabetics (3-5%) Of which 6-10,000 have diabetic retinopathy (20%) Of which 500 have diabetic maculopathy and proliferative disease (500 per million per year incidence) Plan for Control of Diabetic Retinopathy? How do we find the patient with diabetic retinopathy? Need to know diabetics Hospital-based register What is the treatment strategy? LASER for the retinopathy Vitreo-retinal surgery for advanced disease Issues: Available equipment and maintenance Trained personnel

 Screening? Adult screening for diabetes not feasible, not cost-effective Screening of diabetics for diabetic retinopathy Have LASER available before embarking on screening programme Summary 1.The AIM is to implement VISION 2020 2.The objectives are planned around major causes of blindness in the community: cataract, childhood blindness, refractive error, trachoma, etc; depending on your priorities 3.Other objectives are around human resource development (HRD), infrastructural development (ISD) and the context in which you do that 4.The Strategy: is the HOW to achieve each objective/target 5.Phase in project years (PY). Make a 12 year plan, go year by year: remember, the more we do, the more we dilute our resources 6.Plan for a million population. Even if doing for 3 5 million, replicate the plan in the next million population Summary 7. Plan activity along budget-lines. Include operational costs and inflation. 8.The programme should be sustainable in 3-5 years. Generate income to cover costs. 9.Integrate the programme within the existing healthcare system/structure. 10.Is eyecare a priority in the picture of HIV, malaria, TB, etc? Selling point: do do-able programmes with minimal resources, giving a positive impact.