International Ophthalmology 14: 227-230, 1990. �9 1990 Kluwer Academic Publishers. Printed in the Netherlands.

The International Agency for the Prevention of Blindness and non-governmental organisations: an effective network

Alan Johns Sight Savers, Haywards Heath, West Sussex RH16 1FN, UK

The International Agency for the Prevention of Blindness was founded in January, 1985. Two world organisations, the International Federa- tion of Ophthalmic Societies and the World Council for the Welfare of the Blind, took the initiative in establishing the Agency in response to the need expressed by the World Health Orga- nization for a central, multidisciplinary, non- governmental organisation to coordinate inter- national action and to mobilize interest and re- sources... From the outset the Agency saw itself not just as a central coordinator but as the generator of an international movement acting with and through a network of national, executive organisa- t ions.. .

Those excerpts from the Preface to Volume 1 of 'World Blindness and its Prevention', written by Sir John Wilson shortly after the Agency's First General Assembly in Oxford in 1978, encapsulate for me both the starting point and the catalytic nature of the IAPB's role with which I have been associated for practically the whole of the interven- ing period.

My perspective of the IAPB and its member non-governmental organisations is two-fold. On the one hand, I have worked for the Royal Com- monwealth Society for the Blind, or Sight Savers as it is now called, since 1978, initially in adminis- tering project work and subsequently as its chief executive. On the other hand, I have, together with my colleagues from other leading organisations, been in the vanguard of promoting a viable part- nership between the non-governmental organisa- tions (NGOs) who support blindness prevention

activities and education and rehabilitation services in developing countries - helping to build that effective network which is the subject of this arti- cle.

Some of the best examples of that partnership can be seen in the continent of Africa where IAPB's member organisations are working to- gether with governments and their national non- governmental organisations and with the WHO Programme for the Prevention of Blindness in training ophthalmic manpower and developing na- tional eye care programmes. Kenya, for example, has a population approaching 23 million, a land area twice the size of the British Isles and a comple- ment of government ophthalmologists numbering 18 - less than one per million people, compared with about one per 100,000 or less in the western world, and yet has a prevalence rate for blindness nearly 10 times higher.

Kenya's eye care programme has been forged over 20 years and on the way it has had to combat the major obstacles which beset most African countries: an acute shortage of ophthalmic man- power; a low density, scattered population making the application of a diagnostic and treatment pro- gramme both complex and potentially expensive and a lack of understanding on the part of those who suffer blindness, particularly in the rural areas where more than 85% of Africans reside, that much of that blindness is avoidable and that cat- aract, in particular, can be cured.

Kenya's eye health chain stretches from the cen- tral city hospitals to those in the provinces and thence to the health centres and dispensaries in the villages and remotest areas.

The key provision is that of some 70 ophthalmic

228 Alan Johns

clinical officers, highly trained in all aspects of eye health, who are crucial to the delivery of compre- hensive eye care services. They are assigned to 40 district clinics under the supervision of ophthalmol- ogists working in the provincial hospitals. They use mobile eye units to screen, treat and refer patients to the ophthalmologists and they train general health workers in order to add basic eye care to the services these workers provide at village level. About one in five of these ophthalmic clinical offi- cers is given advanced training in cataract surgery.

There are 19 mobile eye units working in the programme and one eye health education unit which is the focus of training for health workers, teachers and local government officers in basic eye health measures.

In 1988, Kenya's rural eye care services treated 250,000 patients and restored sight to over 4,000.

One of the key components of Kenya's success in overcoming the obstacles I referred to earlier is an energetic National Committee for the Prevention of Blindness, chaired by a senior medical adminis- trator in the Ministry of Health, with a secretariat provided by the Kenya Society for the Blind and a membership which includes representatives of sup- portive organisations, some of whom are members of the IAPB. It is those members - American, Canadian, West German, Dutch and Br i t i sh - who, over a decade or more, have provided financial and technical assistance for rural surveys and the training of ophthalmic personnel, capital costs for district eye clinics, vehicles and equipment and running costs for the mobile eye units. As a matter of interest, it was Sight Savers that provided Kenya's first ophthalmic clinical officer, Richard Amiani, with a motor cycle to reach rural clinics.

Here, then is a government eye care programme using the fullest support of its voluntary sector and, in a systematic manner, the funding and technical resources of a part of the network of NGO mem- bers of the IAPB.

That network bemuses many people with its acronyms and different groupings and perhaps an essential contribution within this paper is to give clarification to it.

The IAPB's current network extends to its Re- gional Committees, coterminous with those of the

World Health Organization, and relating to the 60 national committees now in existence for the pre- vention of blindness, the national NGOs and the field offices of the international NGOs. Repre- sentatives of the international NGOs come to- gether with those of the International Federation of Ophthalmic Societies, the World Blind Union and national committees to form the Agency's Ex- ecutive Board. Group E within that Board is cur- rently composed of the following organisations:

Asian Foundation for the Prevention of Blind- ness Christoffel Blindenmission Foresight Helen Keller International International Eye Foundation International Organisation against Trachoma Operation Eyesight Universal Organisation pour la prevention de la c6cit6 Sight Savers

It is this group, joined by the World Blind Union and the President of the IAPB, which forms the Consultative Group of Non-Governmental Orga- nisations to the WHO Programme for the Preven- tion of Blindness. It meets every other year to consult with the WHO's Programme Manager and Regional Prevention of Blindness Advisers in the exchange of information and the planning of global activities and, in alternate years, with the policy advisory group for the WHO Programme.

One current example of this relationship can be seen in the agreement of five members of the Con- sultative Group to sponsor the WHO Subregional Workshop on Blindness Prevention to be held in Lome, Togo, in April. This workshop will concen- trate on strategies for the development of ophthal- mic personnel in French speaking West African countries and follows the objectives of a similar workshop held in Accra in 1988.

Most members of the Consultative Group also join a number of other NGOs, based mainly in Europe and Scandinavia, in annual meetings of what is known as the Partnership Committee. The function of this Committee is to provide a forum for the exchange of information about project work in

The International Agency for the Prevention of Blindness 229

developing facilities for education and rehabilita- tion for incurably blind people as well as blindness prevention and cure. Members of the Partnership Committee thus relate to the WHO through the IAPB and the Consultative Group and to ILO, UNICEF and UNESCO through the World Blind Union and the International Council for the Edu- cation of the Visually Handicapped. The network does not finish there because, over the past year, members of the Partnership Group who are based in the countries of the European Economic Com- munity (EEC) have established a further grouping of NGOs called European Partners for Blindness Prevention. This has as its prime objective the pro- motion of coordination and joint programming be- tween its members, and representations to the EEC on the subject of blindness prevention in developing countries.

None of the organisations referred to above has a superfluity of funding or the desire to pass anodyne resolutions resulting from interminable meetings. They meet because the volume of programme funding they support, now attaining $35 million annually, demonstrably requires a high level of coordination between them. This increase in re- sources, in parallel with that which has been achieved by the WHO Programme for the Preven- tion of Blindness, has been one of the dominant factors in strengthening the IAPB network over the decade since its First General Assembly.

A rapid expansion of resources has also had a significant impact on the way in which the interna- tional non-governmental members of the IAPB work, and here I must turn to the perspective given to me by close association with the work for the organisation I know best. Even twenty years ago, the Royal Commonwealth Society for the Blind was allocating two-thirds of its income, de- rived almost wholly at that time from the private sector, to the prevention and cure of blindness - principally the nascent eye camp programme in South Asia and the provision of mobile eye units in Africa.

Today, as Sight Savers - a name designed to make its major activity more easily identifiable and understood - the Society has moved away from the funding of ad hoc projects to that of providing, on a

committed basis, comprehensive eye care facilities in national programmes which have a high content of training ophthalmic personnel in developing countries. Sight Savers, in monitoring the use of funds and providing technical and consultative aid to the planning of national programmes, has devel- oped a network of overseas offices and a staff of eye care consultants in Asia, Africa and the South Pa- cific, all of whom relate to the field staff of in- ternational partner organisations and the Regional Committees of the IAPB. Like them, Sight Savers is actively engaged in developing the management and professional services of its national partners towards a target of selfsustainability. Sight Savers co-funding from the public sector, principally with the British Government's Overseas Development Administration and the European Economic Com- munity, now provides roughly a tenth of its income and enables a commitment to a five-year pro- gramme such as the one it has just agreed with the Ministry of Health in Uganda for the training of ophthalmic clinical officers.

Sight Savers works with most of the organisa- tions listed above as members of the IAPB Exec- utive Board, in parts of Africa, Asia, the Carib- bean and the South Pacific. The complementary nature of that role and a further demonstration of the network's capabilities is to be seen in the Agreement which the international division of the Spanish national organisation, made recently with the Pan American Health Organisation to support the post of Prevention of Blindness Adviser for Latin America and the Caribbean over the next three years. This is a region in which Christoffel Blindenmission, Helen Keller International, the In- ternational Eye Foundation and Operation Eyesight Universal are all working in eye care activities.

It is my impression, talking to the health profes- sionals in different countries, that the resources of the IAPB and its member organisations, together with the scope and nature of their work are still, as yet, imperfectly understood. Without doubt, to those of us who work within that network, the past ten years have witnessed remarkable successes but at the same time we remain conscious of the for- midable challenge we continue to face in combat- ing avoidable blindness.

230 Alan Johns

The Agency's Fourth General Assembly, to be held in Nairobi in November, 1990, has a theme 'Sustainable Strategies - Agenda for the 1990s', designed to address these issues and to assist its members to maintain the network which has been built so patiently since its First General Assembly. I look for even greater collaboration, a growing number of consortium approaches, an improved dialogue with members of the International Feder- ation of Ophthalmic Societies, an evaluation of the role of the IAPB Regional Committees, a strength- ening of the relationship with the national commit- tees and the introduction of health planners to the deliberations of the Agency.

I hope, too, that this next Assembly will assist in emphasizing the Agency's international role.

Among other aspects, there is so much valu~ development in the delivery of ophthalmic serv! in the developing world which needs to be ex~ ined for its applicability to the developed wo The network that we in IAPB now enjoy has suited in an international effort against blind~ which is one of the best coordinated among health programmes. Our task now is to shape it the needs of the nineties and beyond.

Address for offprints: A. Johns, Sight Savers, P.O. Box 191, Haywards Health, West Sussex RH16 1FN, UK.