The 2013 Caribbean Regional V2020 Committees Meeting was held at the Pegasus Hotel, Kingston, Jamaica on 3rd and 4th December. The proceedings were chaired by Arvel Grant, Chief Executive Officer of CCB-Eye Care Caribbean.
The meeting provided a platform for sharing, learning and networking between V2020 Committees and persons involved in eye health and paid particular attention to Diabetic Retinopathy – one of the most prevalent causes of blindness in the Caribbean. The meeting also provided an opportunity for delegates to become familiar with the World Health Organization’s global eye health action plan 2014–2019 ‘Towards Universal Eye Health’ – http://www.who.int/blindness/actionplan/en/
Participants included delegates from 12 Caribbean countries (Antigua and Barbuda, Barbados, Belize, Dominica, Guyana, Haiti, Jamaica, St. Kitts and Nevis, St. Lucia, St. Vincent and the Grenadines, Suriname and Trinidad and Tobago), who were joined by representatives from the following organisations:
– International Agency for the Prevention of Blindness (IAPB)
– Pan-American Health Organisation (PAHO)
– The Caribbean Council for the Blind—Eye Care Caribbean Sightsavers
– Orbis International
– The Sussex Eye Hospital, UK
– The Queen Elizabeth Diamond Jubilee Trust
– Brien Holden Vision Institute
The Meeting was implemented with the technical and financial support of the Caribbean Council for the Blind (CCB), The European Union (EU), Pan American Health Organization (PAHO) and Sightsavers.
MEETING HIGHLIGHTS
Keynote Address:
In his keynote address, the Chief Medical Officer in the Jamaica Ministry of Health, Dr Kevin Harvey, said that the Jamaican Government is committed to the elimination of avoidable blindness by the year 2020, through delivery of the highest quality of health care to its citizens.
Dr Harvey stated that the Government is ‘pleased to have partnered with Vision 2020 through the Southern Regional Health Authority to service a catchment of over 600,000 persons by delivering quality eye care in that region.’
Towards Universal Eye Health
Dr Louis Pizzarello, Chair of the North American Region of the International Agency for the Prevention of Blindness (IAPB), discussed IAPB’s World Sight Day 2013 Report, also noting that in May 2013 ‘Towards Universal Eye Health: A Global Action Plan 2014-2019’ was adopted by Member States of the World Health Assembly. By doing so 194 countries acknowledged the importance of Universal Eye Health and have committed to reducing the prevalence of avoidable visual impairment and securing access to rehabilitation services for the visually impaired. Dr Pizzarello reminded participants that there are currently 285 million people with visual impairment around the world, with 4 out of every 5 cases avoidable.
Dr. Juan Carlos Silva, Regional Advisor – Visual Health PAHO, reminded participants of the objectives of the Strategic Framework for V2020: The Right to Sight (Caribbean Region) and also went into greater detail on the contents of the Global Action Plan (2014 – 2019), advising participants on actions that can be taken to help achieve its objectives.
The Status of V2020: The Right to Sight in the Caribbean
Philip Hand, Sightsavers Programme Manager (Caribbean) discussed the impact of the European Union funded project ‘Delivering V2020 in the Caribbean’ in the eye health related areas of organisational development, human resource and infrastructure development and public awareness.
In addition to developing eye health facilities in Antigua, Guyana, Haiti, Jamaica and St Lucia, the project also supports training for primary health care workers, low vision personnel, refractionists, optometrists, ophthalmologists, maintenance technicians, spectacle dispensing technicians-clerks and spectacle lab technicians.
Delegates had the opportunity to provide an update on eye health services in their country. This is an overview of some of their achievements, challenges and plans:
ANTIGUA – Opened three community vision centres in Claire Hall, Grays Farm and Johnsons Point (health centres) and plan to open several more; Situation Analysis of Diabetic Retinopathy Services undertaken in 2013; Limited national data available on surgical outputs.
BARBADOS – Currently drafting an Eye Care Policy and Strategy; Public sector Diabetic Retinopathy screening service to commence in 2013; No low vision services available in the public sector.
BELIZE – Situational Analysis of Blind & Visually Impaired Children in Belize published by UNICEF; National Diabetic Retinopathy Screening and Treatment Program starting; Lack of inclusion of eye health in MOH’s plans and policies
DOMINICA – New equipment available including Diode Laser Unit and Digital Camera; Dominica Government ratified the United Nation Convention of the Rights of Persons with Disabilities; Government financial support required for eye health, particularly human resource and infrastructure development.
GUYANA – Guyana Eye Care Strategic Framework (2013-2020) approved by Ministry of Health and included in the National Health Plan; Continued strengthening of public sector screening and treatment for glaucoma; Need to increase numbers of eye health professionals and source funds for diabetic retinopathy screening and treatment programme.
HAITI – Eye clinics of two public hospitals equipped (Eliziar Germain & St Nicholas); CNPC working with Orbis to deliver and further develop an effective surgical programme model; Working with Government to include eye health indicators in the National Health Plan.
JAMAICA – No National eye health data made available; Mandeville Regional Hospital facility update shows decrease in number of persons visiting clinic and number of surgeries in 2013; Mandeville plans include opening new operating theatre for eye health and development of DR screening and treatment programme.
ST KITTS & NEVIS – Improvement in school screening programme and acquisition of equipment, including a fundus camera, B-scan and indirect ophthalmoscope; No public sector refractive error programme; Plans to finalise Strategic Framework, policies and other guidelines for the Ophthalmic Unit.
ST LUCIA – World Glaucoma Day, World Sight Day and White Cane Day celebrated and used to sensitize the population; Selective Laser Trabeculoplasty Study in its final stages; Plans to develop operating theatre at Victoria Hospital and undertake Diabetic Retinopathy services situation analysis.
SURINAME – Strong central ophthalmology department providing a high standard of eye care, utilising outreach for national coverage; Sub-specializations available including Paediatric ophthalmology, Vitreo-retinal and Glaucoma; Plans include construction of new eye hospital and further involvement in scientific research.
TRINIDAD & TOBAGO – DM Ophthalmology and ophthalmic nurses training ongoing; Cataract surgery waiting lists reducing; Plans to introduce DR screening programme and undertake National Eye Survey.
Focus on Disease Control—Diabetic Retinopathy
Improving Diabetic Retinopathy Screening and Treatment Programmes in the Caribbean
Discussions were opened by Dr Michael Eckstein, Consultant Vitreoretinal Surgeon, Clinical Lead Sussex Diabetic Retinopathy Screening Programme, Brighton and Sussex University Hospital, UK.
Dr Eckstein informed delegates of the reasons why Diabetic Retinopathy (DR) is so important:
– Fourth most common cause of world blindness
– 1 in 5 of all diabetics become significantly visually impaired after 15 years
– Most common cause of blindness in the working population of industrialized countries
– Incidence / prevalence is increasing
– Is both preventable and treatable
Dr Andrew Cooper, Director of Programmes – The Queen Elizabeth Diamond Jubilee Trust, provided an overview of The Trust and its focus on fighting blinding diseases like Trachoma, Glaucoma and Diabetes across the Commonwealth.
Dr Cooper invited delegates to become involved in development of a Caribbean DR Screening and Treatment Programme proposal for consideration by the Trust. Proposal development should consider, among other things, how to incorporate services into wider public health systems; how to implement a cost effective and sustainable model; how learning from elsewhere can be incorporated and how to build on existing programmes.
Delegates worked together, using the Caribbean Diabetic Retinopathy Programme Concept paper as a guide, to identify the key players, key stages, timelines and resources required for full proposal development. This excellent opportunity to collaborate with The Queen Elizabeth Diamond Jubilee Trust and expand DR screening and treatment services in the Caribbean will be taken forward in 2014.
Learning & Information Sharing
A series of lively thematic discussions were held throughout the meeting where experiences and information were shared – some key points are captured below:
Creating effective National V2020 Committees
– V2020 Committee should ensure involvement and coordination of different organisations and community representatives
– V2020 Committee must include Ministry of Health and NGO representatives and should include Ministry of Finance representative
– Utilise resources and capacities of different Committee members to develop or bring in new resources
– Consolidate and report national eye health data on a quarterly or six-monthly basis
– Build relationships with media to help create public awareness & promote initiatives / services.
Incorporating Primary Eye Care (PEC) into Primary Health Care (PHC)
– Primary Eye Care training for PHC workers should be ongoing
– Training should be targeted at those who have the remit to use it
– Ensure the necessary basic tools are available at primary level – guidelines, VA testing, referral pathways, public information materials.
– Introduce a few components of PEC initially. Keep it simple, stick to priorities and create something that can be built on and developed over time.
Including Refractive Error in school children in national policies and plans
– PAHO guidelines available for Caribbean on screening school children
– Guyana school screening guidelines available
– Include teachers associations & PTAs in issues concerning school screening and child eye health
– Guidelines should be updated to deal with compliance.
National Eye Health Surveys
– Need to convince MOH and other key stakeholders that a national survey is necessary and a good use of resources
– Important to have baseline data for any health issue and surveys are a means of doing this
– Surveys provide a means of measuring and demonstrating progress. Being able to show progress and impact is important to governments.
– Survey is also a tool for planning and promotes effective use of resources.
Engaging non-health sectors in eye health / prevention of visual impairment
– Media – health personnel are not always the best educators and communicators. Using media professionals for public awareness and developing communications skills of health personnel is beneficial.
– Human Rights groups –have a strong lobby and posing eye health as a right can help to cultivate relationships and put eye health on the agenda
– Ministry responsible for infrastructure – need roads to access care, develop centres.
– Ministries of Labour – Employment of persons with visual impairment, health and safety in the workplace relating to prevention of visual impairment.
– Ministries of Finance –can put the economic argument forward regarding prevention of blindness cost benefits, cost effectiveness and value for money.
Developing the Guyana Eye Care Strategic Framework
In 2013 the Guyana V2020 Committee facilitated the finalisation of the Guyana Eye Care Strategic Framework (2013-2020). This document was endorsed by the Ministry of Health, with an abridged version included in the National Health Plan.
Dr Shailendra Sugrim, Chair of the National Vision 2020 Committee and Consultant Ophthalmologists & Glaucoma Specialists at the Georgetown Public Hospital guided delegates through the process of framework development, which included:
– Utilising the Strategic Framework for V2020: The Right to Sight (Caribbean Region) as a guide
– Undertaking a study of the eye care sector in Guyana (commissioned by PAHO)
– Publication of the report Situation Analysis: Eye Care in Guyana
– Planning meeting with stakeholders in 2012 – utilising their expertise and the Situation Analysis to draft the Guyana eye care framework
– Establishing a writing and editing committee and review mechanism
– Final draft approval by Ministry of Health
– Abridged version included in National Health Plan
– Publication of the Guyana Eye Care Framework (2013-2020)
This rigorous and efficiently implemented process has resulted in a publication which will guide development and delivery of eye care services in Guyana.
Research – Knowledge, Attitude and Practice (KAP) studies
Glaucoma KAP study
Glaucoma is the leading cause of irreversible blindness worldwide, but blindness from glaucoma is preventable by early detection and appropriate treatment.
In this study the agencies involved aim to explore the knowledge, attitudes and practices of patients living with glaucoma in four Caribbean countries: Barbados, Guyana, Jamaica and St. Lucia. The results of this study will enhance our understanding of the issues which are affecting glaucoma patients and having an impact on their ability to manage their disease. In the long term, study findings should inform public health policy and clinical strategies to improve the care of glaucoma patients.
Dr Dawn Grosvenor, Consultant Ophthalmologist, Glaucoma Specialists and Principal Investigator for the study explained why the study is necessary, how it was developed, who is involved and what the implementation timelines are, noting that data collection had just commenced as of December 2013.
Diabetic Retinopathy KAP Study
Diabetic Retinopathy is a relatively common complication of diabetes and left untreated it can lead to irreversible blindness. Dr Charles O Pierce, Research Registrar, Ophthalmology, University of Southampton, UK and Principal Investigator explained how this study aims to identify the educational needs of diabetic patients and also inform future health awareness strategies. The study will take place in Barbados, St. Lucia, Guyana and Jamaica and as of December 2013 it is in the early stages of development.
What the Delegates had to say…..
‘Very informative and interesting meeting; participants are able to benchmark best practices for improvement within their own countries’
‘Highlight training opportunities for eye health professionals’
‘Very good meeting which highlighted that we still have a lot of work to do if we are to realise the goals of V2020’
‘Great, great meeting – very well organised and informative’
‘Include more examples of successful eye care programmes and best practice’
‘Schedule more time for discussing national problems and seeking group solutions’
‘I will take information back to my country and work with others to form a V2020 Committee’
The organisers and supporters would like to thank everyone for their continued commitment to achieving the goal of eliminating avoidable blindness by integrating equitable, sustainable, comprehensive eye-care systems into national health systems.
We look forward to continued and productive collaboration.
Report on the 2013 Annual Meeting of Vision 2020 Committees – Representatives for the Caribbean