1. Pitfalls in Bypassing National Health Systems Daniel Etya’ale Executive Director, IAPB Africa IAPB Africa Promoting Eye Health, Preventing Blindness, Enhancing Life

2. Reasons why National Health Systems may be bypassed 1. Not very responsive and too slow to get things quickly done 2. Poorly managed and highly bureaucratic 3. Can’t be trusted 4. Work against “our” reporting requirements to the donors 5. Short term objectives won’t be met

3. SOME PITFALLS 1. Planning & Working on a short term agenda: Produces quick results, but  Danger: Even after 30 years (3+3+3+3+3+3+3+3+3+3), one could still be working only on short term  Little capacity built (admin, managerial, organisational, planning) built  Chronic dependence created

4. SOME PITFALLS 1. Planning & Working on a short term agenda: Produces quick results, but Ex: HRD  Ex 1: Task shifting: various names over the years: ex: Cataract surgeons, a cadre introduced in E. Africa the mid 1950s as a short term solution to a mega-challenge  Still justified today, 60 years later in almost identical terms.

5. SOME PITFALLS 1. Planning & Working on a short term agenda: Produces quick results, but Ex: HRD  Ex 2: Short term trainings to boost service delivery or statistics, with little consideration given to country minimum requirement for certification/integration  Many disgruntled service providers produced over the years

6. SOME PITFALLS 2. Talking partnerships, but acting as if only NGOs can deliver VISION 2020. Ex: HRD  Ex 1: In Africa, in 2006 - NGDOs represented 20-25% of the eye care infrastructure - Were contributed up to 80% of national statistics in cataract surgery  But that represented only 20-20% of what needed to be done

7. SOME PITFALLS 2. Talking partnerships, but acting as if only NGOs can deliver VISION 2020. Ex: HRD  Ex 2: Working based on improved statistics rather that on impact  Ex Morocco,

8. Morocco National statistics (2005) Cataract (Target CSR: 3000 surgeries/million population) No OperatedEstimated No In Need of Surgery% 234359000025 Glaucome (Target for country: 500 surgeries/million population) No OperatedEstimated No In Need of Surgery % 636150004 Rétinopathie diabétique (Lasers: 500 lasers/mil. pop) No of LaserTtsBesoins en Laser ? ?15000

9. SOME PITFALLS 3. Lessons from the oncho programme  Ex 1: Incentives  Ex 2: Motivation of Community distributors in Ivermectin distibution  Cameroon: Country management of the first rare deaths related to Co- endemicity Loa loa and Oncho