Q&A: WHO's work on vision 'needs to go on,' expert Alarcos Cieza says

Alarcos Cieza, coordinator of blindness and deafness prevention at WHO. Photo by: Violaine Martin / WHO

NEW YORK — Aging populations and the rise of noncommunicable diseases are challenging the World Health Organization to look beyond their target of eliminating avoidable blindness by 2020.

WHO’s VISION 2020 strategy will end next year, but work on eliminating avoidable blindness is far from over, said Alarcos Cieza, the coordinator of blindness and deafness prevention at WHO.

“One has to admit that the work still needs to go on,” Cieza told Devex in a recent interview.

“Plans for eye care have been developed in countries, but in most of the cases they have not been promoted or established as an integral part of the overall health strategic plan.”

“Access and integration into universal health coverage is one of the things that the WHO is promoting strongly, and is not the reality in many countries of the world.”

— Alarcos Cieza, coordinator, blindness and deafness prevention, disability and rehabilitation, WHO

Vision has been on WHO’s agenda since 1969, when the World Health Assembly approved the first resolution on the prevention of blindness. In 2010, there were 285 million visually impaired people, according to WHO, which will release an updated world report on vision later this year.

Some progress has been made on addressing eye conditions and vision impairment in the last decade. Many low- and middle-income countries have seen rises in cataract surgery rates, for example, targeting the leading cause of blindness.

But a rise in other trends, such as aging populations living longer, calls for additional work on integrating vision care into universal health coverage, according to Cieza. Devex spoke with Cieza about why the mentality around eye care needs to change and what WHO is doing about it.

The conversation has been edited for length and clarity.

Why is the global work on vision so far behind where it needs to be?

A lot of progress has happened, but nevertheless there is still work that needs to be done, especially in light of population and health trends with people. People are living longer and therefore the number of people with some age related conditions, such as cataracts, will increase. Also, the number of people with diabetes and consequently the number of people with diabetic retinopathy is also increasing.  

One of the things we have also learned is that there needs to be more integration of eye care services. Diabetes is a good example. Eye care needs to be an integral part of diabetes care.

Also, eye care needs to be integral part of maternal and child and adolescent health programs. Integration will contribute to address some of the challenges the field is now facing.

Click here for a full view of the graphic. Source: WHO and IAPB

Does that mean that vision work is not being sufficiently developed at national levels?

Again, every country has a health and strategic plan, but eye care is frequently not seen as an integral part of it. The eye care agenda has been frequently planned and delivered as in a parallel system and not as an integral part of health. Also, in many countries, a high percentage of eye care services are delivered by the private sector, and usually the public and private sectors are not well coordinated. There is a need for much more coordination between the private and the public sectors.

“In many countries, a high percentage of eye care services are delivered by the private sector, and usually the public and private sectors are not well coordinated.”

We constantly receive requests at WHO in terms of more guidance. We provide this guidance and we are moving forward with developing some technical materials and tools that can point countries in a direction.

Are there any countries that are including vision in their plans for UHC?

The Global Initiative for the Elimination of Avoidable Blindness, Vision 2020 has been pivotal in achieving unified and coordinated advocacy for a number of key priorities in the field of eye care at a global, regional and national level....Nevertheless, eye care is still not considered, in many countries, an integral part of Universal Health Coverage and many people have difficulties in accessing even very fundamental interventions, such as cataract surgery or glasses for refractive errors. This is something that needs to change. Eye care services need to be part of universal health coverage so that people receive the interventions they need without experiencing financial hardship.

When you look at a lot of low- and middle-income countries, is there a base standard of vision care?

In most countries, it is not an issue of existing services. The question is whether you have access. Access and integration into universal health coverage is one of the things that the WHO is promoting strongly, and is not the reality in many countries of the world.

If you have the financial means you have services, but not otherwise.

Why is vision still not a standard part of health care in many countries?

Many factors have contributed to it. A strong private sector and having allocated too much for eye care plans that in many circumstances have been created, but have been created as separate plans from the global health sector plans and have been seen as separate services. These have been two fundamental factors.

What is involved with better integrating vision care into overall health care work? 

Eye care is an integral part of the WHO’s strategic plan and it is not seen as a separate plan or issue that is provided in parallel to other health services. That will be fundamental.

What we also need is better data and better monitoring assistance. When I say better data, I think the field has been very good in collecting information on what is still the unmet need for eye care.

But we do not have information on the need for countries to plan and develop services, and that is why, in many cases, there cannot be good coordination with planning. There is no good documentation.  

Devex, with financial support from our partner Essilor, is exploring challenges, solutions, and innovations in eye care and vision. Visit the Focus on: Vision page for more.

About the author

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    Amy Lieberman

    Amy Lieberman is the New York Correspondent for Devex. She covers the United Nations and reports on global development and politics. Amy previously worked as a freelance reporter, covering the environment, human rights, immigration, and health across the U.S. and in more than 10 countries, including Colombia, Mexico, Nepal, and Cambodia. Her coverage has appeared in the Guardian, the Atlantic, Slate, and the Los Angeles Times. A native New Yorker, Amy received her master’s degree in politics and government from Columbia’s School of Journalism.