Report for
2013
Coordinated by ICEH with funding from CBM, ORBIS, Sightsavers
and Shreveport Sees Russia
2013 IAPB Learning and Development for VISION 2020 Activities
The IAPB Learning and Development Programme for VISION 2020 is split into two
components:
National and regional VISION 2020 workshops
IAPB On line Information and Knowledge
A. VISION 2020 Workshops – Regional and National:
These are identified through the IAPB regional offices in partnership with National Prevention of
Blindness Coordinators (NPBCs)/ National Eye Health Coordinators (NECs) and other regional
stakeholders: WHO, INGOs, National training and research institutions. The purpose of the
workshops is to support National Governments in the development and delivery of quality eye
care programmes. Importantly they are a direct response to the needs expressed by the
Ministry of Health point people for blindness and visual impairment, the NECs, and therefore
relevant to the local need.
Complimentary to these regionally identified workshops are the workshops identified by IAPB
and WHO as being key to the roll out of the new WHO Action Plan, 2014 – 2019. WHO and
IAPB have identified a set of strategic initiatives for this and the workshop programme is an
important means to deliver on these initiatives, which are:
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Regional workshops to promote the roll out of the new Action plan (2013- 14)
Building capacity to gather data – specifically RAAB surveys (2014 onwards)
Developing and rolling out a new Eye Care Systems Assessment (ECSA) tool (2014
onwards)
In 2013 there were three joint WHO and IAPB regional workshops to roll out the new Action
Plan, these were in Latin America, Western Pacific and Africa. The Africa workshop was
supported by this programme.
A total of 11 workshops were held in 2013 covering the following WHO regions – 1 in Africa, 4
in South East Asia, 2 in Latin America, 4 in Europe. 2 were funded by Shreveport Sees Russia
(SSR).
Approximately 550 people participated in the 2013 programme.
The topics covered were:
WHO/IAPB : Action Plan roll out:
 Regional Planning meeting - IAPB + WHO (1)
Brazzaville, Congo
Community Eye Health:
 Community eye health management
(2)
Fernando de la Mora, Paraguay
Guatemala City, Guatemala
Planning for eye health:
 ‘Eye Facts’
(1)
Thimpu, Bhutan
Management of Eye conditions
 National ROP Workshop
(3)
Moscow, Russia
Sofia, Bulgaria
Bali, Indonesia
Tbilisi, Georgia
Prague, Czech Republic
New Delhi, India
Kathmandu, Nepal
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ROP Course
DR Course – Eastern Europe regional
Review of the Nat. Eye banking standards
Quality in Cataract Surgery
(1)
(1)
(1)
(1)
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Africa Region:
The main focus in Africa was to hold a strategic planning and coordination meeting with
WHO Afro to ensure that both sets of activities are aligned and complement each other. Key to
the success of this meeting was to wait for the new WHO Afro point person for Prevention of
Blindness and Deafness to be in place, unfortunately this recruitment and posting was long
delayed which meant that this workshop was not held until December. The implications of this
were that the other scheduled workshops for this region were postponed until 2014 as it was
important to the success of these workshops that they would link to the joint priorities identified
in the WHO Afro/IAPB planning workshop held in December. So both the HMIS workshop and
the Advocacy for HReH will now be held in early 2014.
The WHO Afro/IAPB alignment workshop was held in Brazzaville to ensure maximum
participation from WHO bringing together other key WHO departments – Immunisation and
Polio, Health and Data Information, NCDs as well as PBD( both Afro and also representation
from WHO headquarters, Geneva). There were also Ministry of Health participants from 15
countries. This broad representation helped ensure that the priority areas identified during the
workshop were representative of the needs of the Ministries of Health at National level.
The three specific objectives were:
 To agree on key priority areas for the implementation of VISION 2020 in sub-Saharan
Africa
 To formulate a joint work-plan and a coordination framework, highlighting ways to
operationalise agreed eye health priorities at regional, sub-regional and country level.
 To agree on ways and means to strengthen sub-regional and country offices with
skilled workforce in Eye Health in the monitoring & evaluating of Eye Health
Programme implementation.
Participants at the WHO IAPB Brazzaville workshop- December 2013
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The workshop was divided into 6 sessions, to address the three objectives. Two key documents
were referred to throughout: The WHO Global Action Plan for the Prevention of Avoidable
Blindness and The WHO-Afro Road Map for Scaling up the Health Work Force in Africa 20132025.
Outcomes:
During the workshop working groups were established to discuss the three areas of common
priority and to identify key issues under each. These then formed the basis of the joint set of
activities going forward.
HReH:
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Align our planning to the new WHO Global Action Plan.
Focus attention on the challenges facing the training institutions in Africa.
Address policy issues such as regulation, accreditation and rural retention.
Start with a robust situation analysis of the eye health work force in each country.
Strategic advocacy to influence change will be a key approach to addressing eye health
workforce issues.
HMIS:
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Finalise the draft African Catalogue of Eye Health Indicators.
Validate the catalogue.
Build capacity at national level to populate the catalogue.
PEC:
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Focus on policy issues and the need to integrate PEC into PHC
Work within the health systems strengthening approach
Provide information and support to countries
At the end of the workshop the plenary agreed set of recommendations and authorised the
technical group to finalise the coordination framework and to establish a more detailed set of
recommendations to take the work forward. At the time of writing IAPB Africa is awaiting the
final approval from WHO on the recommendations.
Also it is important to note that this was the first time that WHO Afro and IAPB Africa had held a
joint planning meeting, and it was agreed that this was essential and should become
formalised- which it duly was by establishing a joint set of recommendations around three
common themes.
By integrating their priorities around the delivery of the new Action Plan provided a clear
purpose to all parties and also ensured that all IAPB Africa activities have a clear mandate and
added weight as they have the approval and support of WHO. This is essential for the
workshops if they are to carry weight with the Ministries of Health and will help maximise their
impact.
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South East Asia Region:
This year saw an increase in IAPB activities for the region; this was down to the new impetus
provided by the incoming IAPB Chair. Initially a regional planning workshop was scheduled but
to tie in with the new priority of IAPB - the roll out of the WHO Action Plan, but it was decided to
postpone this to allow sufficient time to liaise with WHO and arrange a joint regional workshop
for SEA to roll out the action plan and to develop a set of joint priorities in the region. This would
then provide a frame for the future activities for IAPB SEA of which the workshops are key. This
workshop is scheduled for early 2014.
The other planned workshops went ahead and were specifically focussed workshops that had
been identified prior to the SEA regional planning workshop. These were:
1. ROP Indonesia:
This workshop was the third ROP workshop and was held in Bali to target the Western part of
the archipelago. The objectives of the workshop were to review the current guidelines and to
identify barriers and challenges to implementing a national ROP programme. Secondly to look
at the actions required to mitigate the challenges and lastly to update participants on current
research and practice in ROP globally as many of the participants had not had the opportunity
to attend one of the previous workshops.
Participants identified the barriers and challenges to implementing a national screening and
treatment programme and then made recommendations to address each. The challenges fell
under four broad areas:
Significant deficiencies in equipment, facilities, and general care for premature infants
Human resources: Lack of training and insufficient number.
Inadequate monitoring and reporting systems
Inadequate record keeping/documentation
Outcomes:
It was agreed that the current ROP guidelines did not need updating.
For the identified barriers and challenges to implementing a national screening and treatment
programme recommendations were made to address them along with corresponding actions to
be made by the National ROP Committee to take them forward. These will be followed up in six
to twelve months time. Details are shown in the workshop report – Appendix A.
2. Eye banking India:
This was a one day meeting to review and update the Indian eye banking standards. The
original document had been produced in 1999, it had been updated in 2009 but without looking
at the specifics. This meeting was an IAPB initiative who, by using its position as an umbrella
for many of the key stakeholders, was uniquely placed to bring them together and to act as an
impartial facilitator. The review of the standards was focussed on India but it was made clear in
the meeting that this document, once reviewed, would provide a template for other countries in
the region – specifically Bangladesh and Indonesia, both in terms of the process taken but also
the content of the new standards developed.
Outcome:
A review group was established to take the recommendations forward from the meeting and to
update the standards before submission to the Ministry of Health – this was done and the
standards are now with the Ministry pending approval.
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3. ‘Eye Facts’ Bhutan
This was a one day meeting to raise awareness amongst the Ministry of Health about blindness
and visual impairment needs in Bhutan. The meeting was held to coincide with World Sight Day
to help boost the profile and interest in the meeting. Originally the meeting had been called a
situational analysis workshop but in line with Bhutanese culture this was renamed ‘eye facts’
meeting. The meeting was lead by the Ministry of Health and the National Coordinator made a
presentation of the current situation in Bhutan highlighting some of the needs and challenges
faced. The main part of the meeting was focussed on discussion and developing a set of
recommendations.
These were:
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Scaling up of mobile eye camps and, access the eye care service to the remote
settlements using the feeder road networks.
Intensify mass advocacy campaigns and awareness program on Eye care
services.
Strengthen Regional Referral hospitals to secondary eye care service centres by
having one ophthalmologist each.
In order to strengthen school eye health programme, all trainee teachers at the
two teachers training colleges should be trained on eye screening.
Expand the eye department at Jigme Dorji Wangchuk National Referral Hospital
to upgrade it into a tertiary eye care centre.
Improve and strengthen the coordination between the health and education
ministries so that the School eye health programme receives enough attention.
The Eye Care Programme at the ministry needs to be made more dynamic and
vibrant.
Develop an effective National Plan of Action for Eye Care and National Blindness
Prevention Programme with strategies to address the constraints so that Bhutan
achieves the Vision 2020 targets.
Accelerate ophthalmic human resource development of all categories
Encourage private optical service and establish spectacle distribution system for
the underserved areas.
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Outcome:
These recommendations will provide the Ministry of Health a documented set of priorities for the
eye health programmes which will be incorporated in the health strategy frame work and the
annual work plan for National Eye Care Programme. The National Coordinator will be following
these up.
4.
Quality Assurance in Cataract surgery in Nepal
The main cause of the blindness in Nepal, like many other countries is cataract. More than
fifteen eye hospitals provide cataract services and in the year 2012 almost 320,000 cataract
services were performed. The numbers are satisfactory but the final visual outcome (at least six
to twelve weeks after surgery) is not available. There have been few population based studies
in 1990s and 2010, which showed that the long term good visual outcome is only at around 60
to 70%. The reported hospital data do not show long term visual outcome because post
operative follow up is poor. Each hospital follows its own cataract management
protocol/practices and there is no national uniformity, so performance evaluation across hospital
has become difficult. With this being the situation it was clear that a national protocol was
needed and that a workshop would be an opportunity to bring together the key decision makers
and practitioners to discuss how best to do this and to start the process.
The one day workshop was participated in by the Chief Medical Directors/ Medical Directors,
Medical Superintendents, Senior and Consultant Ophthalmologists, and delegates, dignitaries
and representatives of various eye hospitals, institutes and external development partner
organisations. A total of 22 papers were presented and open floor discussions were held on
them. It was found that there was paucity of data on long term visual acuity following cataract
surgery.
Outcome:
The workshop successfully concluded making recommendation and decision to form a team to
write a standard National Protocol for the management of cataract in Nepal, within June 2014,
which will be taken up by a follow up meeting of the Nepal Ophthalmic Society.
Quote from Suzanne Gilbert, Director, Center for Innovation in Eye Care
Seva Foundation ‘ ...I just returned from attending an IAPB VISION 2020 workshop organized
by Dr. G P Pokharel in Kathmandu.... The workshop presented Nepal's current approaches to
Quality Assurance for Cataract Surgery and new strategies for improving quality. Dr. Ravindran
from Aravind was Guest Presenter. There was intensive advance preparation and active
participation from all the major eye programs in Nepal. The group created action plans that are
practical and will be diligently supported by Dr. GP. I am delighted by the adaptability of the
V2020 Workshops to address priority needs as each program matures. I anticipate other
countries/regions will benefit from knowing the outcomes of this and other V2020 Workshops as
you are offering.’
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Latin America region:
In Latin America the workshops this year were both training programmes on Community Eye
Health.
1. Guatemala: Community Eye Health Course
The first workshop was held in Guatemala and targeted the public hospitals, as in the countries
of this region most health services are provided by public institutions. This training was in
response to requests from Ministry of Health to PAHO for assistance to improve the
management of ophthalmic public services. The programme was designed to strengthen the
organisational and financial capacity of public ophthalmology in three countries Central
American (Costa Rica, El Salvador and Honduras) to improve efficiency, affordability, and
quality of eye care services.
The workshop programme was designed to build on the recommendations from the evaluation
of the 2012 community eye health training workshop; specifically:
 to train up teams from each of the institutions attending so that they could support
each other on their return and also have greater strength in effecting change.
 to have one organisation overseeing the programme in its entirety to ensure that it
flows, that content is appropriate, leads to achieving the programmes objectives and
there is no duplication.
 to carry out an initial assessment of all the institutions attending to assess their needs
and to help identify the projects they would work on during the training
The specific objectives of the workshop were to:
 Analyse constraints to patient access and referral systems.
 Develop improvement strategies to patient services and management systems.
 Identify actions to improve skills sets and infrastructure.
 Identify constraints where a change in policy will influence positive change.
Outcomes:
Each of the three institutions developed a list of strategies during the workshop through a
combination of lecture, exposure and group work by the hospital team. These strategies form
the basis of a plan to implement changes by the team on their return to their hospital. Each
team is expected to conduct a briefing for the Hospital Director(s) and all other staff on the
training experience and the strategies developed. Additional refinement of the strategies is
expected before the first follow up monitoring visit by the PAHO/IEF technical team.
2. Paraguay: Community Eye Health Course
This was a similar workshop but targeted the non governmental and private institutions who are
the main providers of eye care services in the Latin American region. Similar to the Guatemala
course it built on the recommendations from the 2012 workshop and ensured that teams were
invited from each institution and also that there was a single organisation providing oversight for
the whole course to ensure that it flowed correctly and to avoid any duplication. Participants
came from 9 institutions from Bolivia, México, Perú and Paraguay.
The specific objectives were:
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Explain how to increase the number of patients accessing our services and how
to ensure better coverage of eye diseases.
Teach how to make the hospital sustainable in finance, human resources,
responding to the needs of the community and leadership
Show how to design systems and processes that enhance productivity and
maximise profitability.
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Explain how leadership can play an active role in creating a shared vision.
Explain how to achieve quality, both in clinical practice and in non-clinical
aspects
How to achieve change against the resistance
Provide guidance on how to achieve change against the resistance
Introduce innovative mechanisms for financing for Social Organisations
During the workshop the participants covered the following modules:
Demand generation: How do we increase the number of patients who access our services and
thereby ensure better coverage of eye disease in the community we serve?
Resource Utilisation: How do we design systems and processes to increase costeffectiveness and productivity? How do we ensure the right HR mix to facilitate this?
Quality: How can we assure quality – both in clinical as well as non-clinical aspects?
Sustainability: How can we ensure that the hospital will be sustainable in the 4 dimensions of
finance, human resources, responding to the community’s need and leadership?
Leadership: How can the leadership play a role in creating a shared vision and an enabling
environment in the hospital?
Change management: How do I deal with resistance when I try to implement the changes I
intend to make back at my hospital?
Outcomes:
All participants were given the information needed to prepare a project according to the VISION
2020 district plan and participate with the committees of their respective countries in the
formulation of a National Eye Health Plan. They were also shown the methods by which they
can perform advocacy with their governments and other government entities.
Various exercises were carried out after the lectures to critically analyse the existing situation of
each of the major causes of blindness and the projects needed to create or improve the eye
health care in the region, with special emphasis in community work. The sessions were
dynamic, and we consider that the participants will be able to influence their respective
communities and local governments for the development or improvement of existing projects.
The participants were also provided with the administrative, accounting, and marketing
techniques needed to improve programs, evaluate progress, and apply corrective measures.
These sessions generated a great deal of interest, and with the assistance of the speakers and
organizers, as well as some participants with knowledge in the field, many ideas were
generated related to sustainability, increased coverage, and quality of service.
With the support of the didactic materials provided, they will be able to offer presentations on
priority diseases, organize advocacy meetings, and introduce CEH into training programs. All
the participants received electronic and copies of the educational materials in both English and
Spanish, as well as various references available on the Internet, to be used in their respective
institutions and other forums within their countries.
They were also given information about all the participants and organizations involved so that
they could create a network of contacts in the various countries that could provide them with
pertinent advice, and support and assistance in developing selected projects.
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Europe Region:
In the Europe region the priority themes identified in the IAPB Europe strategic plan are DR and
ROP. IAPB has the support of Shreveport Sees Russia (SSR) who provides funds to support the
IAPB Europe ROP programme. In 2013 activities supported were:
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National ROP workshop – Bulgaria (SSR funded)
Sponsorship of faculty for the first Russian National ROP conference (SSR funded)
ROP course at the Black Sea Ophthalmological Society Conference
VR observership – a 1 month observership for 1 paediatric ophthalmologist from
Moscow at the Associated Retinal Consultants, Michigan, USA. (SSR funded)
ROP training – a 2 week training programme for 2 paediatric ophthalmologists, 1 from
Ukraine and 1 from Russia at LV Prased Eye Institute, India. (SSR funded)
Regional DR Workshop, Prague, Lions Centre
1. National ROP workshops: Bulgaria
In 2013 SSR sponsored a national ROP workshop in Sofia, Bulgaria May 10th – 11th. This was a
follow up workshop to the 2009 workshop held in Varna, Bulgaria. This was a critical workshop as
it was the first to bring together both East and Western Bulgarian ophthalmologists to review and
update the guidelines produced in 2009. The workshop was well attended with 30
ophthalmologists, 30 neonatologists and 7 neonatal nurses. The workshop also had excellent
coverage on the national news. A team from the U.K. delivered the workshop and facilitated
group sessions; the team included an ophthalmologist, neonatologist and a neonatal nurse. Their
current ROP guidelines were discussed as well as the UK nursing guidelines, copies of which
were given to participants. The UK team also had the opportunity to visit a local NICU to observe
the screening and treatment of infants.
Outcomes:
It was agreed that a multidisciplinary approach was needed to manage ROP in Bulgaria and a
national ROP Committee to be established to take this, and other recommendations, forward.
Names for a national ROP committee were listed and will be pursued by Dr Chernodrinska who
has links to senior Ministry of Health decision makers.
Participants agreed that a standardised approach to collecting data from every unit was required
and the need to have a national database.
The UK team prepared a list of recommendations for the host which have been shared, many of
which depend on local advocacy with the Ministry of Health to make the necessary changes but
there are some recommendations which IAPB may be able to support.
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2. National ROP Conference, Helmholtz, Moscow, Russia
Support from SSR has enabled IAPB to build on our contacts in Russia, primarily with Professor
Ludmila Katargina of the Helmholtz Institute. Professor Ludmila is a very senior paediatric
ophthalmologist who advises the Ministry of Health on paediatric ophthalmology. SSR has
supported Professor Ludmila through sponsorship of influential international speakers who are
global leaders in ROP programming to attend key Russian conferences. They are Professor
Clare Gilbert, Professor Brian Darlow (a neonatologist) and Graham Quinn. They were invited to
present at the annual All Russia Ophthalmological Forum (AROF) conference in 2011 and 2012,
following which there was a request for the faculty to present at Russia’s first International
Scientific Conference on ROP 2013 April 11th -12th . This was the first of its kind and a significant
step forward; it also provides an exciting opportunity for our team to work and support Professor
Ludmila as she develops the Russian ROP programme.
The team (Quinn, Gilbert and Darlow) all made presentations at the conference and then there
were a series of questions and discussions, a positive move towards a more interactive approach
to meetings which is what the team have been advocating for.
Outcomes:
National Guidelines are being established, including determining which premature babies should
be examined for ROP.
Request for an international observership in VR surgery – now completed.
Identification of the need for training in ROP programme management and treatment to run
alongside the introduction of new lasers to all Provinces – now completed
The need to pilot a Provincial ROP programme and to start by having a Provincial level ROP
workshop – possibly Altai Province in 2014. Planning underway.
3. ROP Course and Regional Meeting: Black Sea Ophthalmological Society, Tbilisi,
Georgia
In order to develop more contacts in Eastern Europe and to assess needs with a view to
providing support to national ROP programmes IAPB Europe arranged for Professor Clare
Gilbert to give a course on ROP at the annual Black Sea Ophthalmological Society congress in
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Tbilisi, Georgia, May 24th – 26th. IAPB also provided travel grants for ROP ophthalmologists
nominated by their national ophthalmological society to attend the conference, Clare’s ROP
course, and to make a presentation of their national data on ROP.
Following the course a meeting was held with the sponsored country representatives to discuss
their data, common challenges and opportunities to work as a group to strengthen national
programmes. Also in the meeting ideas were gathered on inter regional support with some
countries well placed to support some of their neighbours.
Outcomes:
The outcome of this meeting was twofold, firstly a set of data and information on the status of the
national ROP programmes across the region. These data are being gathered by IAPB Europe. It
also highlighted the fact that there had been no surveys and there was very little data on the
prevalence of ROP.
Secondly a commitment to holding a regional ROP workshop in 2014 bringing together
neonatologists with the paediatric ophthalmologists. Since the meeting it has been agreed that
the Filtov Institute in Odessa, Ukraine will host it. This workshop will be the first to bring together
all those responsible for the care of premature babies – this was recognised as being critical to
the success of any initiative. The Odessa workshop will also be used to build up the confidence
and skills of new faculty with the aim of developing a cadre of workshop facilitators from the
region.
4. Training/Observerships – VR Observership, Michigan, USA
At Professor Ludmila’s request Graham Quinn secured an observership for Dr Densiova, the lead
VR surgeon at Helmholtz who operates on severe ROP cases that require VR surgery. She spent
one month, 19th November – 19th December, at the Associate Retinal Consultants practice in the
USA. http://www.associatedretinalconsultants.com/visiting_scholars.htm
Initial feedback from Dr Densiova indicates that the training is excellent and will enable her to not
only improve her clinical skills, but also some of the management practices. She also intends to
roll out her learning and new skills through training others.
Outcomes:
A jointly prepared article on Telemedicine with smart software for retinopathy of prematurity
screening for the journal - Russian Pediatric Ophthalmology. This will be helpful for the diagnosis
and treatment of ROP in Russia.
Complied a CD of materials for dissemination in Russia, Dr Densiova will prepare a programme
to share this knowledge with her colleagues.
Dr Denisova plans to apply telemedicine for retinopathy of prematurity screening in Russia more
widely.
She will conduct a training programme to improve surgical techniques in advanced stages of
retinopathy of prematurity and other pediatric vitreoretinal disorders and also to do FAG in babies
with retinopathy of prematurity and other vitreoretinal pathology under anesthesia using RetCam.
She will start a programme to conduct genetic investigations in pediatric vitreoretinal diseases in
Russia in order to apply gene therapy in the future.
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5. Training/Observerships: ROP Management Training – LV Prasad Eye Hopsital,
Hyderbad, India
During the ROP conference in Moscow in April 2012 Professor Ludmila was able to announce
that the Ministry of Health, being increasingly aware of the ongoing and potentially increasing
problem of blindness due to ROP, had agreed to supply each of the 49 regions of the country
with a wide-field digital imaging system for detecting babies with severe disease, a laser for
treatment and an indirect ophthalmoscope. It was clear during discussions that some training
would be required to ensure that the new equipment would be used effectively, safely and also be
embedded into a well organised ROP programme. Professor Gilbert was able to arrange for two
lead paediatric ophthalmologists, one from Russia and one from Ukraine, to be trained alongside
the internationally recognised expert Dr Subhadra at LVPEI, Hyderbad, India. The aim being that
they would then have the skills to enable them to train up others in advance of the new
equipment being received. This training provided a combination of clinical and
managerial/organisational skills over the two week period, 30th September – 12th October.
LVPEI was identified as the perfect place due to their highly efficient ROP programme and also
the fact that they see a large number of children with ROP as it serves a very large and densely
populated area. This training was arranged to provide the skills to the lead ophthalmologist from
Moscow, who will, on her return, be able to train up others in the regional units. The main
purpose of this training was to prepare the unit staff in each region so that they would be ready
for the arrival of the new lasers and other equipment. This then would lay the foundations for
effective programmes in each region with both the skills and equipment in place. The true
strength of this is that IAPB has been able to respond directly to the needs expressed by the
partner, Helmholtz, not only does this ensure that the training is what is required and wanted but
also will help ensure that the trainees will be provided opportunities to utilise and pass on their
new skills on their return.
ROP training at LVPrasad Eye Institute with Dr Subhadra
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Outcomes:
Feedback from the doctors: ‘....We've spent quite a bit of time not just working with
patients but also discussing problems of ROP. She spoke about how they established
the whole thing with ROP starting from telling all the related specialists about the
importance of the problem, teaching trainees and make them want to learn, organizing
anaesthesiology care. We basically face same problems in Ukraine and it was nice to
exchange our experience.’
‘We are very grateful for the possibility to study in LV PEI in Hyderabad. Dr Subhadra is
a miracle woman, who firstly, is an excellent vitroretinal surgeon. Perhaps, she is one of
the best expert in vitroretinal surgery in ROP, ....Lectures of Dr Subhadra were dedicated
not only the treating of ROP, so to the different organizational problems, psychological
approaches to the parents, blind children.
I was very interested in the system of organization the help to children with ROP in India,
methods of education of screening and treatment of ROP..... The experience, I got
during the education. I will apply at organization of education programmes in diagnostics
and treatment of ROP in Russia.’
As illustrated so well in the feedback both doctors are very keen to put their learning into practice
on their return. Dr Astasheva specifically mentioned that she plans to apply what she learnt to
organise an education programme in the diagnostics and treatment of ROP in Russia. We will
request a follow up report six months after their return to post. We also hope to get first hand
feedback from Professor Ludmila at the next Russian ROP workshop.
6. Regional DR Workshop, Prague, Lions Centre
In line with the IAPB Europe’s second priority theme a regional DR workshop was arranged in
partnership with the Lions Centre, Prague. This workshop targeted junior ophthalmologists and
was designed to expose them to the latest advances in the management of diabetic retinopathy.
These workshops are considered an investment in the future leaders in ophthalmology in the
region and recognises that they may well not be able to implement all the changes required but
that as they rise up through the ranks they are equipped with the knowledge and expertise to
strengthen their national DR management programmes. The main objectives were :
 To introduce the current international activities in the area of prevention of avoidable
visual impairment and blindness and opportunities for the participants
 To provide a global overview of DR epidemiological data and international
collaboration in DR management
 To review in detail clinical diagnostics and treatment of DR
 To evaluate and discuss specific working conditions of the participants so that the
most suitable techniques are reviewed in detail and the participants are best advised
on how to improve their skills
 To organise round table discussions with DR experts discussing clinical cases and
answering participants questions
 To review and discuss marketing opportunities for diabetic retinopathy services,
including rehabilitation, as integral part of comprehensive patient centred eye care
services integrated in the health system
 To discuss possible ways the participants can develop their own projects to improve
DR services in their community and/or place of work
Outcomes:
There were 17 participants from 8 countries in the region. By the end of the workshop each
participant was give tools to assess the skills they had learnt and to measure changes in quality
of their own DR programme. All participants will be followed up by the organiser, Lions Centre, to
ascertain how well they have managed and to review their self assessments.
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B. On line Information and Knowledge
This period saw the launch of the IAPB Advocacy Guide and Tool Kit IAPB Advocacy Guide +
Tool Kit an educational resource to support anybody wishing to develop their skills in advocacy.
The guide was produced as an on line version and IAPB is hoping to secure funds to translate it
into French and Portuguese. The guide was primarily designed for the African context but is be
useful and applicable in any region as it provides the basic tenets and guiding principles for
developing an advocacy message.
To make the IAPB Council of Members more accessible to those who were unable to
attend the filming and streaming of key presentations and speeches was organised and
are available through the IAPB website: Council-members - brighton-2013
Several key interviews were also filmed, these were selected to support the upcoming
WSD and also the new IAPB Diabetic Retinopathy Group: Interviews - IAPB DR Group
Other interviews made during the 9GA were streamed in 2013 to support key messages
or news items that IAPB were promoting. These were:
http://www.iapb.org/news/ethiopia-integrate-eye-health-school-strategy - Eye Health
integrated into new child health strategy, Ethiopia
http://www.iapb.org/news/gbd-data-vision-loss-released - to support the GBD data launch
Key to IAPBs service to members is the provision of quality, up to date and concise
information on topics relevant to members work and the delivery of the new WHO Action
Plan. The priority was to first to update the information provided on the web pages for
each of the main cause of blindness and visual impairment. These pages provide the
background information in such a way that it can be accessible to people from a non
clinical background who are working in eye health. Each page provides a list of useful
resources and guidelines and the top references. This is a first stop for information that
will signpost readers to where more in depth information is available through its links and
references. These are consistently amongst the most popular pages on the IAPB website.
15
The pages are found here: http://www.iapb.org/knowledge/what-is-avoidable-blindness
Pages completed in 2013 were:
RE
DR
Gender
Trachoma
Childhood Blindness
Vitamin A Deficiency
Retinopathy of Prematurity
Glaucoma
Cataract
Management:
The annual planning and review meeting for the learning and development programme
was held on the 25th September 2013. This brought together the funders, with the
management team, to review the progress to date, discuss new initiatives and future
plans, and to look at funding commitments for the coming year. It was during this meeting
that IAPB were able to present the new initiatives identified by the WHO and IAPB
partnership and how the workshop programme was key to the delivery of these going
forward.
Information dissemination:
It had been noted in the 2013 planning and review meeting that communication on the
workshop successes needed to improve. In response to this the following initiatives were
made:
 Two articles were written for CBM – the first was a case study on Indonesia for the CBM
IAA 2012 report. The second was an article detailing the collaboration between IAPB and
CBM, but specifically focussing on the workshops, and other learning and development
activities and was for the CBM website as well as the annual report for 2013.
 The workshop manager attended a meeting at the CBM office in Brussels as part of an
induction for the new President of CBM. She make a presentation on the VISION 2020
workshops, the learning and development activities and future strategic direction of the
workshops.
 The workshops manager held an informal meeting with the point people in Sightsavers
who IAPB liaises with over the VISION 2020 workshops programme. As all parties were
new to this role it was a useful meeting to provide some background, discuss the
partnership moving forward and to look at what information and communication needs
Sightsavers had.
 The workshop manager made a presentation to the ORBIS UK staff, this was also an
opportunity to raise awareness within the funding organisations about the programme,
some background and details of its focus moving forward. It was also an opportunity to
find out what information would be useful to ORBIS UK for funding and communication
purposes.
16
Appendix A: Regional and national VISION 2020 workshops
Page
Africa
Brazzaville, Congo
WHO and IAPB: Regional Planning
18
South East Asia
New Delhi, India
Kathmandu, Nepal
Denpasar, Bali, Indonesia
Thimpu, Bhutan
Review of National Eye Banking Standards
Quality Assurance for Cataract Surgery
National ROP
‘Eye Facts’ – situational analysis
19
19
20
25
Latin America
Guatemala City, Guatemala
Fernando de la Mora, Paraguay
Community Eye Health Planning
Community Eye Health Planning
26
27
Europe
Prague, Czech Republic
Sofia, Bulgaria
Moscow, Russia
Tbilisi, Georgia
DR Course
National ROP Workshop
National ROP Workshop
Regional ROP course
29
30
31
32
17
AFRICA
Brazzaville,
Congo
National Planning
IAPB and WHO Planning Workshop
2nd – 3rd December
Aims and
objectives
Objective:
To contribute to improving the implementation of VISION 2020 in sub-Saharan
Africa
Specific objectives
The specific objectives of this meeting were:

Participants
To agree on key priority areas for the implementation of VISION 2020 in subSaharan Africa;
 To formulate a joint work-plan and a coordination framework, highlighting
ways to operationalise agreed eye health priorities at regional, sub-regional
and country level.
 To agree on ways and means to strengthen sub-regional and country offices
with skilled workforce in Eye Health in the monitoring & evaluating of Eye
Health Programme implementation.
44 people including WHO representatives, IAPB Africa, 13 INGO representatives,
Ministry of Health representatives from 15 countries
Faculty/Organiser IAPB Africa in partnership with WHO
Summary –
Sessions were held on:
proceedings and
Overview of the eye health situation
outcomes
Global and regional initiatives to address eye disorders
The WHO-Afro Work Plan 2014 – 2015 – this session introduced the six priority
issues in the workplan:
 Immunisation
 NTDs
 School Health
 HMIS
 HR for Health
 Primary Eye Care
The IAPB Africa HR for eye Health strategy which identified 4 areas of priority
 Research
 Advocacy
 HR for eye health
 HMIS
The next session was to formulate a joint work plan. Three areas of common
interest were identified:
 HR for Eye Health
 HMIS
 Primary Eye Care
The last session was for group work to develop recommendations for each area to
be taken forward by WHO-Afro and IAPB Africa together.
Difficulties
Follow-up
None cited
The following day was a 1 day technical meeting to finalise the coordination
framework and establish a more detailed set of recommendations to move the
agreed priority areas forward.
18
SOUTH EAST ASIA
New Delhi, India
Review of National Eye Banking Standards
12th September
Aims and
objectives
To evaluate the current standards of eye banking in India vis-à-vis the current
international standards.
To update the standards as required ready for submission to the Ministry of Health
Participants
20 International and national stakeholders
Faculty/Organiser IAPB SEA – Dr T P Das
Summary –
proceedings and
outcomes
The first eye banking standards had been developed in 1999 and updated in
2009 but without detailed specifics.
It was recommended that accreditation for eye banking institutions should be
done regularly, every 2 or 3 years and that there should be a common consent
form.
A review group was established to take the recommendations forward and then
submit their report to the entire group.
It was agreed that the process and outcome of this meeting would be
implemented in other countries within the region.
Difficulties
None cited
Follow-up
The review group would prepare a joint review report which would be sent to the
NPBC , Ministry of Health for adoption.
Kathmandu,
Nepal
Aims and
objectives
Quality Assurance for Cataract surgery
14th December
Objectives: To review the following:
 Distribution of cataract blindness, cataract surgical rates, cataract surgical
coverage and cataract blind in Nepal. (Zones and Districts)
 Different approaches to cataract surgery in Nepal: Hospital direct visits,
screening camps, surgical camps and surgeries in Primary Eye Care
centres/surgical centres.
 Types of surgeries – extra capsular cataract surgery, Small incision cataract
surgery, phaco-emulsification surgery.
 Surgical outcome of cataract surgeries.
 Intra operative, post operative complications and their management.
 Co morbidities with cataract and prognosis.
 Relevance of common protocol for cataract surgery in Nepal in reference to
optimum visual outcome and medico-legal aspect. Role of Nepal Ophthalmic
Society in the development of the protocol.

Follow up visits.
Expected Outcomes:
 Compilation of present status of cataract surgeries in different hospitals and
regions of Nepal.
19
 Visual outcome of surgeries in different hospitals and with different methods.
 Recommendation of safe approach to cataract surgeries which will lead to
better visual outcomes.
 National Protocol for cataract management.
Participants
Chief Medical Directors/ Medical Directors, Medical Superintendents, Senior and
Consultant Ophthalmologists, and delegates, dignitaries and representatives of
various eye hospitals, institutes and external development partner organisations
Faculty/Organiser
Tilanga Institute of Ophthalmology, Kathmandu, Nepal
Dr G P Pokarel
Successes




Difficulties
Follow-up
Denpasar, Bali,
Indonesia
Compilation of present status of cataract surgeries in different hospitals and
regions of Nepal.
Visual outcome of surgeries in different hospitals and with different methods
documented.
Recommendation of safe approach to cataract surgeries which will lead to
better visual outcomes.
National Protocol for cataract management.
None cited
The workshop successfully concluded making recommendation and decision to
form a team to write a standard National Protocol for the management of
cataract in Nepal, within June 2014, which will be taken up by a follow up
meeting of Nepal Ophthalmic Society.
National ROP Workshop
28th – 29th October
Aims and
objectives
To review and update the national ROP guidelines
To assess barriers for implementing the guidelines nationally and to develop
actions to rectify this.
Participants
54 individuals from 30 hospitals, representing various districts from 20 provinces in
Indonesia, attended the 3rd ROP Workshop. The participants consist of 22
ophthalmologists and 32neonatologists/paediatricians. 22 participants have
attended the previous workshops, while the rest are new to the Indonesia National
Workshop on ROP.
Faculty/
Organiser
2 international facilitators - Prof. Dr. Glen Gole and Dr. R. V. Paul Chan.
Organisers: Prof. Rita S. Sitorus MD, PhD;
Rinawati Rohsiswatmo,MD, PhD
Julie Dewi Barliana, MD
Successes
In day one of the workshop, general lectures were given by Prof. Dr. Glen Gole
(Retinopathy of Prematurity – from Classification to Treatment; Sequelae of
Prematurity; Treatment of ROP: Overview),
Dr. R. V. Paul Chan (Anti-VEGF Treatment for ROP and Their Long Term Adverse
Events),
Dr. Rinawati Rohsiswatmo (Prevention of ROP: Neonatologists’ Perspective),
Dr. Susilo Chandra (Anesthetic Support in ROP Treatment), and
20
Nurse Daryati (Nurses’ Role in ROP Screening).
Afterwards, recapitulation data on ROP screening and treatment from the
participants were presented by Dr. Julie D. Barliana, as a representative of the
National Committee on ROP & Premature Infants. This data was provided by the
participants before the workshop commenced.
Following the presentations, the participants were divided to groups of
ophthalmologists and neonatologists, where a discussion to identify the barriers of
ROP screening and treatment was done.
Day 2 of the workshop was dedicated to group work. Morning session started with
group discussion, where the participants (neonatologists and ophthalmologists)
were divided to four groups, according to Indonesia geographical region. The
issues that were discussed among the participants in the groups
were:
 How to solve the barriers in ROP screening & treatment?
 Revising Indonesia national ROP program guideline,
 Developing a referral system for ROP screening and treatment,
 Revising the 2010 plan of action in preventing ROP& increasing ROP
awareness among public &healthcare professionals.
Afterwards, a plenary session was conducted, wherein representatives of each
group presented the group work results.
Following the plenary session, conclusions and recommendations were developed.
The conclusions consist of:
Conclusions
Revision of Guideline of ROP and Action Plan- it was agreed the existing
guidelines should remain.
Problem Solving on Barriers
a. Significant deficiencies in equipment, facilities, and general care for premature
infants still exist:
In many hospitals, oxygen supply provision still faces difficulties, due to complex
geographic conditions in many areas in Indonesia. In many neonatology units in
Indonesia, essential equipment deficiencies include oxygen blenders, pulse
oximeters, and CPAP machines. These deficiencies occur primarily due to financial
limitation. Therefore, district health departments and the ministry of health still
struggle to provide the essential equipments in all area. Aside from the oxygen
therapy in the NICUs, overall care and treatment for premature infants in many
hospitals are considered inadequate. Holistic care of premature infants from the
delivery rooms up to the NICUs (including nutrition management, pain and stress
management, and also infection prevention) need much improvement. Ophthalmic
equipment deficiencies particularly noted were a widespread lack of indirect
ophthalmoscopes (with lenses, lid specula, and scleral depressors) and laser
indirect ophthalmoscopes.
There was a widespread feeling that there was often no dedicated space for
examination in busy nurseries (e.g. dark side rooms in nursery with appropriate
resuscitation equipment. These could also be purpose built or modified for laser
use).
b. Human resources:
Lack of ancillary personnel was perceived as widespread and significantly
interfering with the ability of the ophthalmologists to perform efficient screening
sessions in the nursery. Of particular note was that there were often no properly
trained nurses to assist examination. ROP screening was inefficient because
nurseries often lacked coordinators to facilitate examinations, document findings &
21
arrange follow up. Insufficient number of nurses in neonatology units, imbalanced
ratio of neonatology nurses to number of infants in the NICUs, and lack of training
of ROP screening & its documentation for neonatology nurses aggravate the
overall condition of ROP screening in many areas. On another note, there are
insufficient ophthalmologists to act as screeners and many ophthalmologists are
unable to use the indirect ophthalmoscope and lack training in the use of the
indirect laser.
c. Inadequate monitoring and reporting systems:
Data collection was thought to be deficient because of a lack of personnel to
centrally coordinate and collect data because there was often no designated PIC
(person-in-charge) in each province/region and there was inadequate
administrative support to the National Committee.
d. Inadequate record keeping/documentation:
Lack of suitable documents was considered a major obstacle. Standard forms for
parents to bring with them to follow-ups, parent information sheets explaining ROP,
need for follow-up, and a separate information leaflet explaining treatment need to
be developed. There exists no central database of patients screened and treated,
in particular. The old website often not utilized and had been deactivated.
In response to the conclusions, the following recommendations were developed:
Recommendation – Revision of Guideline of ROP and Action Plan
Leave the existing National Guideline for ROP Screening and Treatment unaltered.
Management of ROP with anti-VEGF would be added in the guideline; in particular
regarding its indications, precautions, and follow-up recommendation.
Recommendation – Problem Solving on Barriers
a. The significant deficiencies in equipment and facilities need to be remedied in
the following ways:
Oxygen blenders, pulse oximeters, and CPAP machines must be provided in
hospitals. Socialization to the ministry of health regarding situation in Indonesian
neonatology units must be done. Therefore the ministry of health recognizes the
importance of providing essential oxygen therapy equipments in the NICU. Pulse
oximeters, as one of the basic equipments, should be procured independently in
each hospital. Cooperation with pulse-oximeter producers need to be developed in
terms of equipment provision.
In areas where oxygen supply provision is considered difficult, socialization of new
inventions of neonatal medical equipments that are already available in Indonesia
may also be performed.
Equipments which could act as oxygen concentrators (therefore eliminating the
need of pure oxygen supply) may be introduced. Furthermore, new equipments are
also able to deliver specific amounts of oxygen concentration without utilizing
oxygen blenders. These equipments use a conversion table to set the oxygen
concentration which needs to be delivered to the infant. Procurement of these new
equipments is potential to decrease required financial needs.
On another note, the deficiencies in ophthalmic equipment are long standing and a
whole country approach was considered necessary. Some alternatives include
approaching administrators in each hospital, the ministry of health, or establishing
cooperation programs with NGOs. With an appropriate documentation, an NGO
could then be approached to provide a bulk purchase of indirect ophthalmoscopes
and ancillary equipment. There should be at least one treatment centre in every
province equipped with a laser indirect ophthalmoscope. Government should be
lobbied to provide this.
Dedicated space for examination (e.g. dark side rooms in nursery with appropriate
resuscitation equipment) should be provided in each hospital and planned for in
future hospitals); this could be used for laser and other procedures (e.g. PDA
ligation).
22
b. Human resources:
Enough properly trained nurses to assist examination should be provided at each
hospital. In general, additional neonatology nurses need to be trained. This is
mandatory to adjust the nurse to patient ratio in the NICUs and to prevent work
overload within currently available neonatology nurses. Specifically, hospitals
should appoint coordinators (ROP nurses) to maintain the ROP book (registering
all babies who will qualify for screening and setting up the date for screening),
assist examinations, document findings, talk with the patient’s families, and arrange
follow up. In future Indonesia National ROP Workshops, nurses from each
hospital’s neonatology unit need to be invited and involved. Therefore they can be
properly trained, especially in terms of documenting premature infants who need to
be examined, aiding ROP screening, and documenting findings in the ROP
recapitulation book.
Furthermore, both neonatologists’ and ophthalmologists’ knowledge and skills need
to be continually improved. Separate continuing medical educations and
workshops on holistic care of premature infants need to be developed for the
paediatricians/neonatologists. Topics of the training include general care of
premature infants, starting from the delivery room (room temperature regulation,
oxygen therapy, and stabilization during the 1st hour, ventilation-circulation and
blood glucose monitoring, and patient referral mechanism) up to the
NICU/neonatology ward (infection control and prevention, complication prevention,
stress and pain management, nutrition management, and developmental care). On
the ophthalmologists’ side, gaps in training and skills of ophthalmologists who wish
to look after premature infants should be identified and training programs in ROP
diagnosis and treatment should be instigated.
c. Inadequate monitoring and reporting systems:
Personnel to centrally coordinate and collect data should be appointed along with a
designated ophthalmologist PIC designated for each province/region.
Administrative support to the National Committee should be provided.
d. Inadequate record keeping/documentation:
Providing standard forms for parents to remind them to attend follow-ups. Parent
information sheets explaining ROP, the need for follow-up, and a separate form
explaining treatment need to be developed.
A central database of patients who have been treated needs to be developed.
More resources need to be provided on the website (including electronic data
forms) to make it more attractive.
Difficulties
None reported
Follow-up
ACTION PLANS
1. Reactivate National Committee for ROP website
Post screening guidelines on ROP website.
2. Problem Solving on Barriers
a. Deficiencies in facilities in equipment:
Committee:
-Funding for maternal improvement program to be sought for oxygen blenders,
pulse oximeters, and CPAP machines so that they are provided in all hospitals
which care for premature infants.
Cooperation with producers of the essential equipments need to be developed as
an alternative method.
-Survey network hospitals and network members to ascertain hospitals which do
not have indirect ophthalmoscopes (and ancillary 28D lenses, specula scleral
depressor) for screening premature infants. Once number of indirect
ophthalmoscopes required is determined, an overall cost for bulk purchase needs
to be ascertained. NGOs involved in blindness treatment and prevention needs to
23
be approached as funding sources.
-Case needs to be made to government, to provide at least one centre in every
province equipped for the treatment of ROP with a diode laser indirect
ophthalmoscope.
-Socialization of new inventions of oxygen-therapy and oxygen-monitoring
equipments, which are more feasible to provide financially.
-Dedicated space for examination (e.g. dark side rooms in nursery with appropriate
resuscitation equipment) should be provided in each hospital with a level 3 nursery
(and planned for in future hospitals.
-Every NICU should have clear clinical guidelines for preterm infants who receive
supplementary oxygen, regarding oxygen saturation targets, as well as for other
key aspects of NICU care.
b. Human resources:
Government:
Train nurses to assist at ROP screening examinations.
Hospitals:
Appoint coordinators (ROP nurses) to maintain the ROP book, assist examinations,
document findings, talk with the patient’s families, and arrange follow up.
Committee:
-Involve neonatology nurses in the upcoming Indonesia National Workshop on
ROP.
- Identify gaps in training and skills of ophthalmologists who wish to look after
premature infants by carrying out survey.
Indonesian Paediatricians Society:
Develop training programs in general care of premature infants.
Indonesian Ophthalmologists Association:
Instigate training programs in ROP diagnosis and treatment.
c. Inadequate monitoring and reporting systems:
Committee:
PIC to be designated for each province/region. Appoint secretariat to provide
support to the National Committee. Duties will include to centrally coordinate &
collect data, develop and maintain database (especially treated children) and
website (especially need to make it more user friendly).
d. Inadequate record keeping/documentation:
Committee:
Standard forms need to be developed for parents to remind them to attend followups. The committee will develop:
- Parent information sheets explaining ROP, the need for follow-up, and a separate
form explaining treatment.
- Electronic ROP-examination data forms and additional information to be added to
the ROP website.
24
Thimpu, Bhutan
‘Eye Facts’ – a Situational Analysis
9th October
Aims and
objectives
Participants
To gather data on blindness and visual impairment for Bhutan.
To present this and discuss how to address the challenges
To develop a set of recommendations
25 including - Ministry of Health, Eye Care personnel, IAPB SEA
Faculty/Organiser The National Coordinator with support from IAPB SEA
Successes
The meeting discussed the current situation of blindness and visual impairment in
Bhutan and then came up with a set of recommendations:










Scaling up of mobile eye camps and, access the eye care service to the
remote settlements using the feeder road networks.
Intensify mass advocacy campaigns and awareness program on Eye care
services.
Strengthen Regional Referral hospitals to secondary eye care service
centers by having one ophthalmologist each.
In order to strengthen school eye health program, all trainee teachers at the
two teachers training colleges should be trained on eye screening.
Expand the eye department at Jigme Dorji Wangchuk National Referral
Hospital to upgrade it into a tertiary eye care center.
Improve and strengthen the coordination between the health and education
ministries so that the School eye health program receives enough attention.
The Eye Care Program at the ministry needs to be made more dynamic and
vibrant.
Develop an effective National Plan of Action for Eye Care and National
Blindness Prevention Program with strategies to address the constraints so
that Bhutan achieves the Vision 2020 targets.
Accelerate ophthalmic human resource development of all categories
Encourage private optical service and establish spectacle distribution
system for the underserved areas.
Difficulties
None cited
Follow-up
The recommendations developed will be taken forward by the National Coordinator
25
LATIN AMERICA
Guatemala City,
Guatemala
Aims and
objectives
Community Eye Health – for public institutions
7th – 11th October
The objective is to provide technical assistance to develop and implement hospital
improvement plans, by conducting a five day training workshop for selected
participants from the four public eye hospitals in Costa Rica, El Salvador and
Honduras.
Objectives: The main objectives of the workshop were to:
1. Analyse constraints to patient access and referral systems.
2. Develop improvement strategies to patient services and management systems.
3. Identify actions to improve skills sets and infrastructure.
4. Identify constraints where a change in policy will influence positive change.
Participants
Participants: The workshop was attended by 23 participants from four hospital
teams:
1. Hospital de Especialidades del Instituto Salvadoreno del Seguro Social (ISSS)
El Salvador
2. Hospital San Felipe, Honduras
3. Caja Costarricense del Suguro Social (CCSS), Costa Rica
4. Clinica Dr. Carlos Duran Cartin, (a satellite clinic of CCSS), Costa Rica
Faculty/Organiser Facilitators: The workshop was facilitated by a team of eight persons:
1. Dr. Juan Carlos Silva, Regional Adviser Blindness Prevention, PAHO
2. Raheem Rahmathullah, Director Sustainability Initiative, IEF, USA
3. John M. Barrows, Vice President Programs, IEF, USA
4. Arq. Juan Francisco Yee, Administrator, Visualiza, Guatemala
5. Dr. Mariano Yee, Ophthalmologist, Visualiza, Guatemala
6. Dr. Cesar Gonzales, Ophthalmologist, Divino Nino Jesus, Peru
7. Ing. Alberto Lazo, Administrator, Divino Nino Jesus, Peru
8. Katie Ulin, Program Manager, LAC, Orbis International, USA
Successes
This workshop built on recommendations from the 2012 evaluation and had teams
from each institution attending. It also had a pre workshop assessment phase
where each hospital was visited to carry out a baseline assessment.
The workshop gave a series of presentations on the following themes:
Patient Demand
Improving quality
Improving efficiency
Changes within the country regulation and policy environment
There were also field visit to observe efficient management techniques in
operation.
The next part of the workshop was for the teams to work together to develop their
own improvement strategies and actions.
Difficulties
Follow-up
None cited
By the end of the workshop, each team consolidated their major actions and
prepared a basic plan to improve the functions at their hospital. The facilitators then
concluded the workshop by facilitating a discussion of the next steps expected by
each team in the next 12 months.
The strategies for each hospital are available as separate documents.
26
Fernando de la
Mora, Paraguay
Aims and
objectives
Community Eye Health
25th – 30th November
Train teams of eye care hospitals in community eye health








Specifics Objectives
Explain how to increase the number of patients accessing our services and
how to ensure better coverage of eye diseases.
Teach how to make the hospital sustainable in finance, human resources,
responding to the needs of the community and leadership
Show how to design systems and processes that enhance productivity and
maximise profitability.
Explain how leadership can play an active role in creating a shared vision.
Explain how to achieve quality, both in clinical practice and in non-clinical
aspects
How to achieve change against the resistance
Provide guidance on how to achieve change against the resistance
Introduce innovative mechanisms for financing for Social Organizations
Participants
24 participants representing teams from 9 institutions from Peru, Bolivia, Paraguay,
Mexico
Faculty/organiser Organised by Fundacion Vision: Pablo Cibils, Andy Hing , Paraguay and IAPB Latin
America – Van Lansing
Faculty: Joseph Sanil, Aravind, India
Cesar Gozales, Associacion Civil Divino Nino Jesus, Peru
Fernando Frydman, Cenmtro de Management Social, Argentina
Miriam Cano, Instituto de Prevision Social, Parguay
Successes
 All participants were given the information needed to prepare a project
according to the VISION 2020 district plan and participate with the
committees of their respective countries in the formulation of a National Eye
Health Plan in accord with the objectives set forth in May 2003 resolution of
the World Health Organization (WHO). They were also shown the methods
by which they can perform advocacy with their governments and other
government entities and comply with the WHO resolution of May 2006.
Various exercises were carried out after the lectures to critically analyze the
existing situation of each of the major causes of blindness and the projects
needed to create or improve the eye health care in the region, with special
emphasis in community work. The sessions were dynamic, and we consider
that the participants will be able to influence their respective communities
and local governments for the development or improvement of existing
projects.

The participants were also provided with the administrative, accounting, and
marketing techniques needed to improve programs, evaluate progress, and
apply corrective measures. These sessions generated a great deal of
interest, and with the assistance of the speakers and organizers, as well as
some participants with knowledge in the field, many ideas were generated
related to sustainability, increased coverage, and quality of service.

With the support of the didactic materials provided, they will be able to offer
presentations on priority diseases, organize advocacy meetings, and
introduce CEH into training programs. All the participants received
electronic and copies of the educational materials in both English and
Spanish, as well as various references available on the Internet, to be used
in their respective institutions and other forums within their countries.
27

They were also given information about all the participants and
organisations involved so that they could create a network of contacts in the
various countries that could provide them with pertinent advice, and support
and assistance in developing selected projects.
Other Results:
Difficulties
Follow-up

Fundación Visión reinforced the alliance with the Paraguayan Universidad
Católica de Nuestra Señora de la Asunción) (Catholic University of Our
Lady of the Assumption) permitting the issuance of certificates of
participation worth academic credit, something made possible by the fact
that the university is listed with the WHO world directory of medical schools
and the Foundation for the Advancement of International Medical Education
and Research (FAIMER).

The teachings shared by some speakers about their experience with other
successful projects in prevention of blindness and with excellent
management were of great importance to demonstrate what can be
accomplished in the eye-care field with the proper management of human,
equipment, and economic resources.

This year the course had duration of 5.5 days, we reduced it compared to
previous courses were 11 days seemed to be too much. We consider that
this was appropriate; however we suggest that for the future courses, it
should not be longer than 9 days.

The curriculum and presenters should be confirmed at least 9 month ahead
of time for the next course, in order to avoid logistical problems.
All teams brought information, data and the concept of a project they wanted to
develop during the course. These were duly completed and will form the actions
that will be implemented on their return. Fundacion Vision will be following up on
these action plans.
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EUROPE
Prague, Czech
Republic
Aims and
objectives
DR Course
6th – 7th December

To introduce the current international activities in the area of prevention of
avoidable visual impairment and blindness and opportunities for the
participants
 To provide a global overview of DR epidemiological data and international
collaboration in DR management
 To review in detail clinical diagnostics and treatment of DR
 To evaluate and discuss specific working conditions of the participants so
that the most suitable techniques are reviewed in detail and the participants
are best advised on how to improve their skills
 To organise round table discussions with DR experts discussing clinical
cases and answering participants questions
 To review and discuss marketing opportunities for diabetic retinopathy
services, including rehabilitation, as integral part of comprehensive patient
centred eye care services integrated in the health system
To discuss possible ways the participants can develop their own projects to
improve DR services in their community and/or place of work
Participants
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Faculty/Organiser LECOP
Successes
BY THE END OF THE COURSE THE PARTICIPANTS WERE ABLE TO:
 Understand epidemiology of DR and how to collect necessary information
so that they can identify the current needs at their work place
 Understand the latest developments in clinical diagnostics and treatment of
DR
 Provide their DR services with more confidence after having an opportunity
to observe practice and listen to presentations by DR specialists and
discuss their own cases
 Monitor and evaluate the quality of DR services
 Develop their own suggestions for improving availability and affordability of
DR services in their work place, in their community, and potentially at the
national level
 Understand the role of public eye health and their potential involvement in
international cooperation projects in ophthalmology.

Difficulties
None cited
Follow-up
MEASURABLE OUTCOME:
IN 6 MONTHS THE PARTICIPANTS SHOULD REPORT TO LOEC ON THE FOLLOWING :
 Self-assessment of the impact of the teaching program on the participants
skill development and improvements in eye care service provision
 Involvement in DR clinics, the tasks performed, new skills gained and
practised
 Suggestions for improvements in the LOEC curriculum and teaching
approaches
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Sofia, Bulgaria
National ROP
10th – 11th May
Aims and
objectives
The objective of this workshop was to update the national criteria for screening and
treatment of children with ROP-Varna 2009, updating the standard protocol for data
coverage and establishment of a national committee for ROP involving
ophthalmologists, neonatologists and healthcare professionals to work on creating
a national program for ROP.
Participants
30 ophthalmologists,30 neonatologists and 7 nurses registered for participation
during the first day
Faculty/Organiser Dr Chernodrinska
Faculty: Gill Adams, Dr Shad Husain and Julie Flanaghan
Successes
A series of presentations were made to update all participants on the latest
developments in the screening and management of infants at risk of or having
ROP.
Gill spoke about using specialist small paediatric condensing lenses to get a good
view of the fundus, using an irritating vectis as an indenter and methods of
providing treatment without using general anaesthesia such as sub tenon’s block.
Julie and Shad emphasised the importance of empowering nurses and team
working, reducing the risk of severe ROP by preventing unnecessary exposure to
oxygen, and development of written and accessible guidelines that include
saturation target ranges for preterm babies receiving supplemental oxygen.
In particular Julie discussed the importance of promoting nursing interventions
such as “skin-to-skin”, developmental care practices such as modification of
lighting and noise within NICU, effective positioning of infants and encouraging
expression of breast milk/breast feeding. Stressing these practices not only
promote parental involvement but are also recognized practices which have
beneficial effects on patient outcomes. The nurses acknowledging they knew about
these concepts but did not practice them due to the limited nursing resources
available. The group discussed how the presence of the parents performing care
and nursing their infant would free up the nurses time and enable them to attend to
other infants.
They also discussed the problems they encountered with keeping updated. The
group was encouraged to organise local multidisciplinary training sessions on
topics such as neonatal resuscitation to improve both medical and nursing skills.
Both doctors and nurses were interested in visiting a neonatal unit in United
Kingdom to see how neonates were managed over there and how the
multidisciplinary team worked. The UK nursing guidelines were referred to for a
number of topics discussed, these were left at the end of the workshop for them to
read and possibly adapt to their own practice.
The rest of the workshop was dedicated to group work and for participants to look
at their roles and responsibilities and areas they could and needed to change to
improve their ROP programmes. In particular the emphasis was on the teams
working together – neonatologists, nurses and ophthalmologists.
It was agreed that a multidisciplinary approach to management would be helpful to
all concerned. The genesis of a national ROP committee was floated and names
were suggested. The suggestion of obtaining data from every unit was supported
to allow the development of a national database.
Difficulties
Not all the participants stayed for the full two days.
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Follow-up
A set of recommendations were made by the team and shared with the Bulgarian
host. These recommendations will be followed up on 1 year later. These are:
Recommendation: Help ensure guidelines are made available for all NICU nurses
and neonatologists and provide training in their application.
Recommendation : Advocate with decision makers to improve ratios of nurses:
infant.
Recommendation: Nursing Interventions – Engage parents in the care of neonats
to improve patient outcomes and also free up time of NICU nurses to monitor
temperature and oxygen levels and other care.
Recommendation : Look for ways to update skills of NICU staff in multi
disciplinary teams –with emphasis on oxygen management and nutrition. Provide
access to written evidence based information.
Recommendation : Senior management to look at ways to improve team work
between nurses and doctors and ophthalmologists and to empower nurses as
leaders.
Recommendation: Look at ways to record national data on births (total and live)
by gestational age, birthweight and location of birth to provide information for the
planning of neonatal and ROP services.
Recommendation: Senior management to look at the possibilities of moving the
Retcams into the neonatal units and to advocate for neonatal units to be co located
with obstetric units.
Recommendation: Training in the sue of sub Tenon’s anesthetic to allow laser
treatment when inadequate anesthetic/neonatology care is available
Recommendation: Improve skills in indirect ophthalmoscopy using a 30D lens.
Recommendation: Improve skills in good laser treatment
Moscow, Russia
National ROP
12th -13th April
Aims and
objectives
This was the first International Scientific Conference on Retinopathy of Prematurity
for Russia and was used for presentations on research from across Russia and
some neighbouring countries and also international faculty presented on the most
up to date information on ROP screening and treatment.
Participants
Over 250 individuals were registered and attended the conference, mostly
ophthalmologists from throughout the country
Organiser/
Faculty
Professor Ludmila Katargina, Chair, Pediatric Ophthalmology, Department of
Ophthalmology, Moscow Helmholtz Research Institute for Eye Diseases.
Faculty: Clare Gilbert, Graham Quinn, Brian Darlow
Successes
An important outcome of this meeting is that national guidelines are being
established, including for determining which premature babies should undergo
ROP examination for detection of serious ROP: less than 2000g birth weight and/or
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less than 35 weeks gestational age.
The team made a series of suggestions for the way forward:
 Develop more focal workshops in regions in Russia, to be attended by
ophthalmologists, neonatologists, and ideally, neonatal nurses who play
an essential role in the care of preterm infants. A provisional plan was
made to have a workshop in Altai in 2014.
 Provision should be made to conduct a blind school study in some of
the major cities using the WHO classification system. This would
provide important information about the current status of ROP blindness
in children in Russia.
 Develop a situation analysis in NICUs throughout Russia to determine
the number of:
a. NICUs caring for premature babies
b. The number of infants <2000 and <1500 g BW per year who are
admitted and their survival rates
c. NICUs that have an ROP program
Difficulties
None cited
Follow-up
National Guidelines are being established, including determining which premature
babies should be examined for ROP.
Request for an international observership in VR surgery – now completed.
Identification of the need for training in ROP programme management and
treatment to run alongside the introduction of new lasers to all Provinces – now
completed
The need to pilot a Provincial ROP programme and to start by having a Provincial
level ROP workshop – possibly Altai Province in 2014. Planning underway.
Tbilisi, Georgia
Regional Black Sea ROP Course
25th – 26th May
Aims and
objectives
Participants
 To assess the ROP programme status in the Black Sea countries
 To make new contacts from each of these countries
 To determine how IAPB can provide support to ROP programmes in this
region
10 people from Georgia, Turkey, Romania, Bulgaria and Ukraine
Faculty/Organiser Black Sea Ophthalmological Society and IAPB Europe
Cost to IAPB
$9,783
Successes
Contacts were made with a group of ROP practitioners and leaders from each of
the Black Sea countries.
Data were collected on the current ROP situation in each of the countries
Informal support networks were made between individuals
The group agreed on a set of next steps, primarily to hold a regional ROP
workshop in 2014.
Difficulties
Follow-up
None cited
A follow up workshop has been scheduled for teams from NICUs in each Black
Sea country. This workshop will be for ophthalmologists, neonatologists and
neonatal nurses.
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