July 2003

Human Resource Development for VISION 2020
Adenike Abiose

It is now four years since the launch of VISION 2020: The Right to Sight, the Global Initiative for the Elimination of Avoidable Blindness by the year 2020. Significant progress has been made in addressing the three pillars of the initiative, namely disease control, human resource development and appropriate technology; as well as the support activities of advocacy and resource mobilisation.

Progress has been made in partnership with industry for the provision of some of the required technology and equipment at affordable prices; and in systems for monitoring for quality of outcome of surgery and other aspects of VISION 2020. Advocacy has resulted in placing blindness prevention and sight restoration high on the global and some national health care agenda. The recognition that the public health problems posed by blindness and visual impairment are real, and that urgent steps need to be taken to stem the tide, has culminated in the passing of resolution WHA56.26 at the recently concluded World Health Assembly.

This resolution on the elimination of avoidable blindness is indeed a significant milestone for the Global Initiative. The resolution recognised that 45 million people in the world today are blind and a further 135 million people are visually impaired, and acknowledged that 90% of the world's blind and visually disabled people live in the poorest countries of the world.

It is a known fact that lack of manpower is a major factor in the persistence of this disproportionate burden of blindness. Manpower development in the poorest countries is now a priority that must be urgently addressed if member states that have committed themselves to the WHA resolution are to succeed in the elimination of avoidable blindness by the year 2020. These countries, which are in greatest need of VISION 2020, urgently need the manpower to plan, implement, monitor and evaluate the programme at the community, regional, subnational and national levels.

The human resources presently available are inadequate not only in quantity, but also in quality. A compounding factor is that in the absence of national eye care plans, manpower development for eye care service provision has, in many of these countries, not been based on real needs. The manpower developed has continued in the 'traditional' way to serve individual needs rather than the needs of population units. Such manpower has been concentrated in urban institutions, rather than in rural areas where the vast majority of the population in need live. The question then is, who will attend to the needs of the most needy majority?
The time has come for a change in attitude, and the WHA resolution provides the challenge. There is an urgent need to re-orient manpower development, particularly in developing countries, towards population needs. In order to maximise the utilisation of the few highly trained personnel, the importance of team work must be re-emphasised, and the necessary skills for this acquired during training. The greatest asset a country has to ensure success in the enterprise VISION 2020 is her manpower, and this includes not only professionals like ophthalmologists, optometrists, ophthalmic nurses; but also allied personnel like opticians, instruments and pharmacy technicians, community health workers and the community itself.

Their training must be matched with the provision of equipment and resources needed for optimal performance. Efficiency must reside not only the supply chain, but also in the supervision chain inherent in teamwork. Human resource development is perhaps the most expensive component of VISION 2020 and it is the pillar for which the professionals have a responsibility. The design and implementation of training programmes for all eye care personnel must not only focus on high quality, but also include elements to ensure equity in the services provided.

In 2001 the International Council of Ophthalmology launched its "Vision for the Future", which is in partnership with VISION 2020: The Right to Sight. International Optometry at about the same time, in recognition of the important role they have to play in correcting uncorrected refractive error, shifted attention to community optometry in their "Sight for the World" and targeted the training of trainers equipped to meet the needs of communities.

What is now needed?
The partnership and teamwork which have led to the success of VISION 2020 at the global level, must now trickle down to the national and subnational levels, and to the communities. The concept of the development of teams with appropriately trained high level, midlevel, primary and community level personnel for eye care service provision is not new, nor are successful models lacking. This strategy cannot however be implemented in isolation from the national governments, the national environment, the public sector health system structure and the national policies guiding its operation: administration and educational systems, the private sector, professional organisations, nongovernmental development organisations, the individual professionals and the communities, who are the consumers. The involvement of all these stake holders right from the planning stage is essential if the concept is to be translated into a sustainable action plan for VISION 2020.

Planning for human resource development is an essential part of national health plans, and planning adequately for manpower for VISION 2020 must be part of the national VISION 2020 plan development. A perfect national Human Resource Development plan may not succeed unless there is a change in attitude of all stakeholders. The training of ophthalmologists must ensure a balance of nonsurgical and surgical skills relevant to the disease pattern in the country. The trainees must appreciate the importance of clinical audit and outcome monitoring. They must be taught to function as part of a team, recognise their limitations and the importance of low-vision and rehabilitation services in the provision of a comprehensive service, have communication and educational skills, which will enable them to be involved in the training of mid-level and allied personnel. In developing countries, community ophthalmology, epidemiology, management of eye care programmes and their relationship with other arms of the health care system must be essential components of the curriculum.

However, the countries in greatest need of these skills are those that lack the capacity and the resources to plan for and implement such comprehensive training. There is an urgent need for international ophthalmology, professional organisations and eye-care industry in more advanced countries to support training centres in needy countries with the infrastructure, the equipment and technology, training resources, trainers and continuing professional education, which are needed to impact positively on the next generation of ophthalmologists being trained. The ultimate performance of the ophthalmologist is a reflection of the training they receive, and this is closely related to the quality of trainers, and the facilities available for their training.

The training models being developed for optometrists and all other cadres of eye care personnel to meet immediate community needs should be encouraged and scaled up. Member states would need to provide an enabling environment for the necessary changes, to enable the provision of technical, material, infrastructure and equipment support needed and the recognition, certification and provision of a career structure for all trained members of the VISION 2020 team.

In conclusion, the successful implementation of resolution WHA56.26 of the 56th World Health Assembly calls for a change of attitude to manpower development for VISION 2020. Teams appropriate to the needs of each country should be developed and adequately equipped to perform the functions expected of them. The time for upgrading and accelerating training and retraining programmes is now, and such training must be linked to VISION 2020 national plans, so that critical areas of need are given priority attention. The partnership, which has enabled the success so far achieved by VISION 2020 at the global level, should cascade down to the national, sub-national and community levels, so that the community units in greatest need, who are currently unserved, will feel the impact of VISION 2020 within the next five years.

  1. Resolution of the World Health Assembly, WHA56.26, 28 May 2003
  2. Vision for the future: International Ophthalmology Strategic Plan to Preserve and Restore Vision. (2001) Editor Eileen C. Duldulao
  3. Srien A. Holden & Kylie Evans (2001) Correcting Uncorrected Refractive Error: Sight for the World. lAPS News, Number 30, April 2001
  4. Pararajasegaram R.(2000) Changing Eye-care Training for VISION 2020- The right to Sight. lAPS News, Number 27,July 2000.

This article is a modified version of a presentation at the workshop on Human Resource Development for VISION 2020 in Africa, which took place at the PAACO meeting in Tunis on 21 May 2003.

Prof. Adenike Abiose
Sightcare International
PO Box 10392, Kaduna, Nigeria
Tel. +23462417373
Fax. +234 62 410873
Email: abiose@infoweb.abs.net