IAPB GA 9 Hyderabad 2012IAPB 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

Data Purposes 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

CSC - Impact IndicatorCSC - 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

CSC RAABs 1999 -2006 CSC RAABs 1999 -2006

Less than 20/400

Less/20/200

Brazil (Urban) 89 83

México ( 1 province ) 79 64

Chile (1 province ) 76 71

Argentina (Urban) 74 66

Cuba (Urban) 74 65

Venezuela (National) 70 59

Paraguay (National) 44 36

Guatemala ( 4 provinces rural)

38 29

Peru (2 provinces rural) 24 12

Converting Evidence in Policy 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

Regional Policies After Surveys

PAHO/WHO 49 DIRECTING COUNCIL CD 49.R11 2009

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

CSR - Performance Indicator: 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

•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

Countries with CSR > 2000 2009-2011

Countries with CSR > 2000 2009-2011

Countries with CSR < 20002009-2011

Countries with CSR < 20002009-2011

National Policies after Surveys National Policies after Surveys

Country Year of Survey

Year of Policy- Resolution- Plan

Paraguay 1999 2008

Peru 2002 2006

Argentina 2003 2006

Brazil 2003 2008

Venezuela 2004 2004

Guatemala 2004 2010

Mexico 2005 2007* National Commission

CSC - Priority Setting 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

CSR & CSC as Inequity Indicators 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

COLLECT & ANALYZE DATACONVERT DATA INTO POLICY

Thank you

COLLECT & ANALYZE DATACONVERT DATA INTO POLICY

Thank you