IAPB 9 th General Assembly Symposium 1 The World Bank and Eye Health: Opportunities for collaboration Peter Ackland Monday 17 th 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

World Bank supported India Cataract programme - $94m

World Bank Managed Trust Funds Onchocerciasis Control Programme Africa Programme for Onchocerciasis Control (APOC) Elimination of transmission of Onchocerciaisis by 2025 – a real possibility.

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 needsWhat can be done in schools and at home Measure of success Assessment and first aid kit Eye health needs in childrenTeachersCurriculumWithin primary schools Within secondary schools At homeWho can helpIndicator 0-5 yrs6-10 yrs11-15 ys Allergies; red eye etc ++ Causes, treatment and what not to do Hand and face washing Causes, treatment and what not to do Local health facility to diagnose, treat and or refer Tetracycline eye ointment Injuries++ Prevention and treatment 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 treatment Water supply and sanitation; face washing; leaky tin Refer for confirmation; treat with tetracycline eye ointment Clean hands and faces; use of latrines Tetracycline in kit Vitamin A deficiency (rural areas) Prevention and treatment 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 Education DRAFT: 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 DIVOIRE BURKINA FASO GHANA TOGO BENIN NIGERIA NIGER CHAD SUDAN CAMEROON CENTRAL AFRICAN REPUBLIC ERITREA ETHIOPIA SOMALIA KENYA UGANDA RWANDA BURUNDI CONGO GABON EQUATORIAL GUINEA SAO TOME AND PRINCIPE ANGOLA NAMIBIA BOTSWANA ZAMBIA TANZANIA MALAWI ZIMBABWE MOZAMBIQUE SOUTH AFRICA SWAZILAND LESOTHO MADAGASCAR MAURITIUS COMOROS MAYOTTE (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 Anstey Managing Director of the World Bank Meeting with IAPB – April 2012

OPPORTUNITY BECKONS EYE HEALTH FINANCING AS PART OF OVERALL HEALTH SYSTEM STRENGTHENING NOW NEEDS SERIOUS ENGAGEMENT AT COUNTRY LEVEL

Thank you.