In 2013, the WHO called for eye care to be integrated into broader health planning. Its 2019 World Report on Vision identified ocular health as an essential component of any universal health coverage (UHC).
However, accomplishing this will require an updated menu of indicators aligned with the universal health coverage’s dimensions of access, according to a publication in the British Journal of Ophthalmology.
The report offers governments such a menu. These guidelines are designed to help monitor and improve eye health and eye health services at a national level, and to support progress towards achieving universal access to eye care.
The recommendations outline 22 indicators, including 7 core indicators, themselves divided into 4 categories, that represent the key concepts in eye health.
The 7 core indicators were developed by panelists from 39 countries. The list includes recommendations regarding (1)eye health facility density and distribution, (2) eye health worker density and distribution, (3) coverage of national health finance pooling mechanisms that include eye care services, (4) out-of-pocket (OOP) payments for cataract surgeries, (5) effective cataract surgical coverage (eCSC), (6) effective refractive error coverage (eREC), and (7) prevalence of vision impairment. The selected priority indicators received high core scores (based on whether panelists believed all countries could be encouraged to adopt them) and composite scores (based on whether panelists believed it was feasible, actionable, reliable, and internationally comparable).
Health ministries would be responsible for monitoring, relying on data sources including population-based surveys, facility records, and health finance scheme reports.
The research identified ECSC and eREC as candidate WHO UHC tracer indicators that align with the UHC dimensions of access, quality, and equity for the leading cause of blindness and the leading cause of vision impairment globally, respectively.
In addition to catastrophic and impoverishing expenditures, the standard UHC financial risk protection indicators, the researchers proposed proxy measures of OOP payments for cataract surgery and coverage of national health finance pooling mechanisms.
Human resources and infrastructure for eye care per capita can be reported more frequently than service coverage estimates, with minimal cost. Countries would need to monitor distribution by rural/urban and public/private settings to be UHC-aligned and could use geocoding infrastructure in monitoring.
Prevalence of vision impairments, which impacts education and employment in addition to individuals’ quality of life, continues to serve as a key measure of eye health.
Unilateral vision impairment, “people-centered” eye care, disease-specific indicators for glaucoma and age-related macular degeneration, trachoma and onchocerciasis, and broader health and financial indicators (such as government health spending, water and sanitation, and demographics) that may be relevant to eye health were not prioritized.
The researchers proposed field-testing of the new indicators in several settings and continual review.
Limitations of the study included the reflection of preferences of those invited to participate; limited participation from several groups and regions, for instance the fact that only 40% of the panel were women. Personal interests and familiarity with certain concepts over others may have led to confirmation bias.
McCormick I, Mactaggart I, Resnikoff S, et al. Eye health indicators for universal health coverage: results of a global expert prioritisation process. Br J Ophthalmol. Published online March 12, 2021. doi:10.1136/ bjophthalmol-2020-318481