1. IAPB GA 9 Hyderabad 2012 USING CSR/CSC AND OTHER METRICS TO SET TARGETS AND GUIDE POLICY Juan Carlos Silva MD MPH PAHO-WHO Office Americas

2. Data Purposes –Identify a problem –Measure its magnitude and key determinants –Develop plans or policies –Monitor existing programmes & progress –Advocacy –Resources mobilization –Identify a problem –Measure its magnitude and key determinants –Develop plans or policies –Monitor existing programmes & progress –Advocacy –Resources mobilization

3. CSC - Impact Indicator Identify a problem and its magnitude Impact of services at the various levels of visual impairment Policy: Strengthening cataract surgical services Target: Increase coverage and reduce BL & SVI prevalence Identify a problem and its magnitude Impact of services at the various levels of visual impairment Policy: Strengthening cataract surgical services Target: Increase coverage and reduce BL & SVI prevalence

4. CSC RAABs 1999 -2006 Less than 20/400Less/20/200 Brazil (Urban)8983 México ( 1 province )7964 Chile (1 province )7671 Argentina (Urban)7466 Cuba (Urban)7465 Venezuela (National)7059 Paraguay (National)4436 Guatemala ( 4 provinces rural)3829 Peru (2 provinces rural)2412

5. Converting Evidence in Policy Develop regional strategies Disseminate data widely –Congresses –Courses –Publications Coalitions –IAPB –PAHO –PAAO Approach Policy Makers Develop regional strategies Disseminate data widely –Congresses –Courses –Publications Coalitions –IAPB –PAHO –PAAO Approach Policy Makers

6. Regional Policies After Surveys PAHO/WHO 49 DIRECTING COUNCIL CD 49.R11 2009 Proposed actions for Member States Cataract Assess cataract surgical services Measure prevalence, coverage and barriers Establish district specific programs and PEC Develop HR for cataract programs IEC strategies Proposed actions for Member States Cataract Assess cataract surgical services Measure prevalence, coverage and barriers Establish district specific programs and PEC Develop HR for cataract programs IEC strategies

7. CSR - Performance Indicator: Useful to set targets to increase outputs Policy: Improve availability, accessibility, affordability & productivity of cataract services to increases outputs Allows easy comparison between countries: Policy: Capacity building in countries in more need Useful to set targets to increase outputs Policy: Improve availability, accessibility, affordability & productivity of cataract services to increases outputs Allows easy comparison between countries: Policy: Capacity building in countries in more need

8. Indicators Increase the number of countries that conducted a RAAB from 9 to 14 by the year 2013. 14 countries in 2011+ 2 repeat Reach a cataract surgical rate (CSR) of 2,000 in the majority of countries by the year 2013. (Target 18) 15 countries in 2011 Indicators Increase the number of countries that conducted a RAAB from 9 to 14 by the year 2013. 14 countries in 2011+ 2 repeat Reach a cataract surgical rate (CSR) of 2,000 in the majority of countries by the year 2013. (Target 18) 15 countries in 2011 PAHO – WHO 49 DIRECTING COUNCIL CD 49.R11 2009 PAHO – WHO 49 DIRECTING COUNCIL CD 49.R11 2009

9. Countries with CSR > 2000 2009-2011

10. Countries with CSR < 2000 2009-2011

11. National Policies after Surveys CountryYear of SurveyYear of Policy- Resolution- Plan Paraguay19992008 Peru20022006 Argentina20032006 Brazil20032008 Venezuela2004 Guatemala20042010 Mexico20052007* National Commission

12. CSC - Priority Setting Coverage in people by level of Visual Impairment –Priority BL and SVI Coverage in eyes –total surgical workload for the ophthalmologists Policy: Focus efforts on bilateral blind or SVI people Coverage in people by level of Visual Impairment –Priority BL and SVI Coverage in eyes –total surgical workload for the ophthalmologists Policy: Focus efforts on bilateral blind or SVI people

13. CSR & CSC as Inequity Indicators CSC higher in urban versus rural population Policy: Develop cataract programs for rural people CSC – CSR higher in male or female Policy: Develop gender sensitive programs CSC lower in poor – uninsured - ethnic groups Policy: Increases coverage to underserved population CSC higher in urban versus rural population Policy: Develop cataract programs for rural people CSC – CSR higher in male or female Policy: Develop gender sensitive programs CSC lower in poor – uninsured - ethnic groups Policy: Increases coverage to underserved population

14. COLLECT & ANALYZE DATA CONVERT DATA INTO POLICY Thank you