IAPB 9th General Assembly

Symposium 1The World Bank and Eye Health:Opportunities for collaboration

Peter Ackland

Monday 17th September 2012

70,000,000,000,000 Global World Product

Some global statistics for 2010(All figures US$)

6,500,000,000,000 Global Health Expenditure

5,500,000,000,000 OECD Health Expenditure

1,000,000,000,000 Health Expenditure rest

1,000,000,000,000 Health exp. – non OECD

Paying for Health in the non-OECD countries 2010(All figures US$)

490,000,000,000 Out of pocket Health Exp

420,000,000,000 Government Health Exp

26,870,000,000 Development Assistance Health

90,000,000,000 Insurance, Soc Security etc

26,870,000,000 Development Assistance

Development Assistance to low& middle income countries 2010

(All figures US$)

6,000,000,000 HIV / AIDS

1,500,000,000 Health System Strengthening

13,000,000,000 Eye Health Requirement

200,000,000 NCDs

26,870,000,000 Development Assistance

Sources of Development Assistance 2010(All figures US$)

12,000,000,000 Bilateral Devt. Agencies

1,500,000,000 World Bank

2,000,000,000 NGOs

Government and out of pocket expenditure account for 90+% health expenditure in most low income countries.

Conclusions

The $127bn required to strengthen eye health systems and eliminate avoidable blindness by 2020 has to come primarily from within countries.

Key advocacy target is national Governments. i) Increase their commitment to their expenditure on eye health. ii) Increase social protection and insurance provision to reduce out of pocket expenditure – and include eye health in this provision.

Premises

Engagement with the World Bank is important because of the INFLUENCE it has on national government policies and on other donors.

The World Bank and Eye Health

1,200 1,100

2,500

3,600

5,010 5,100 5,200 5,300

0

1,000

2,000

3,000

4,000

5,000

6,000

1985 1990 1995 2000 2005 2006 2007 20081985-2008

Number of cataract operations per million population in India.

1995-2002 World Bank supported India Cataract programme - $94m

World Bank Managed Trust Funds

Onchocerciasis Control Programme

Africa Programme for Onchocerciasis Control (APOC)

Elimination of transmission ofOnchocerciaisis by 2025 – a realpossibility.

World Bank

NEW OPPORTUNITIES

1- Eye Health in school health programmes. 2 - Results Based Financing programmes to include cataract and trichiasis surgery.

3 - Elimination of blinding trachoma.

Integrated, comprehensive school eye health programmes

Eye health needs What can be done in schools and at home Measure of success

Assessment and first aid kit

Eye health needs in children Teachers Curriculum Within primary schools Within secondary schools At home Who can help Indicator

0-5 yrs 6-10 yrs 11-15 ys    

Allergies; red eye etc ++ ++ ++ ++ Causes, treatment and what not to do Hand and face washing Hand and face washing Causes, treatment and 

what not to doLocal health facility to diagnose, treat and or 

refer  Tetracycline eye 

ointment

Injuries − ++ ++ − Prevention and treatment Safe environment Safe environment Safe environment

Local health facility to diagnose, treat and or 

refer  Torch; sterile eye pads 

and tape

Refractive error − + ++ − Symptoms; benefits of spectacle wearing

Vision testing and referral of individuals with reading 

difficulties

Vision testing by teachers with mechanisms to provide spectacles

Information for parents about benefits of spectacle use

Local eye unit; PTA; community leaders  

Visual acuity screening chart: 6/12 level; 3m rope. N8 reading test

Trachoma (rural areas) ++++ ++ − − Prevention and 

treatmentWater supply and 

sanitation; face washing; leaky tin

 Water supply and 

sanitation; face washing; leaky tin

Refer for confirmation; treat with tetracycline eye 

ointmentClean hands and 

faces; use of latrines Tetracycline in kit

Vitamin A deficiency (rural areas) ++++ + − − Prevention and 

treatmentNutrition; home gardening; 

hand washing and sanitation; deworming

 Nutrition; home 

gardening; hand washing and sanitation; deworming

  Clean hands and faces; use of latrines ----

Poor near vision +++

Poor distance vision +++

Other eye diseases e.g. glaucoma +

THE FEDERAL DEMOCRATIC REPUBLIC OF ETHIOPIA 

NATIONAL SCHOOL HEALTH AND NUTRITION STRATEGY

Ministry of EducationDRAFT: APRIL 2012

Cambodia

School screening for refractive errors research.

Global Partnership for Education.

Next step – operational research in 3-5 more countries.

Cambodia

Results Based Financing

Health system approach whereby payments are made to service providers who deliver defined health services to an agreed standard.

Some countries support demand side incentives to overcome barriers to poor people taking up services.

Opportunity to include cataract and trichiasis surgery in RBF packages.

16

MAURITANIA

MALI

SENEGAL

THE GAMBIA

GUINEA BISSAU GUINEA

SIERRA LEONE

LIBERIA

CÔTE D’IVOIRE

BURKINA FASO

GH

AN

ATOGO

BE

NIN

NIGERIA

NIGERCHAD SUDAN

CA

ME

RO

ON

CENTRAL AFRICAN REPUBLIC

ERITREA

ETHIOPIA

SOM

ALIA

KENYAUGANDA

RWANDA

BURUNDICO

NG

O

GABON

EQUATORIAL GUINEA

SAO TOME AND PRINCIPE

ANGOLA

NAMIBIABOTSWANA

ZAMBIA

TANZANIA

MALAWI

ZIMBABWE

MO

ZAM

BIQ

UE

SOUTH AFRICA

SWAZILAND

LESOTHO

MA

DA

GA

SC

AR

MAURITIUS

COMOROSMAYOTTE (Fr.)

SEYCHELLES

DEM. REP.OF CONGO

National Scale-up (3)Pilots Ongoing (7)Advanced Planning (7)

Under Discussion (8)

Impact Evaluation (8)

Current State of RBF in SSA

Ethiopia

Health Results Innovation Fund$500m till 2022

Nigeria

Burundi

Trichiasis surgery

Results Based Financing

Health System Strengthening

Neglected Tropical Diseases

Caroline AnsteyManaging Director of the World BankMeeting with IAPB – April 2012

OPPORTUNITY BECKONS

EYE HEALTH FINANCINGAS PART OF OVERALL HEALTH

SYSTEM STRENGTHENING

NOW NEEDS SERIOUSENGAGEMENT AT COUNTRY LEVEL

Thank you.