SDGs: what’s in it for eye health?

This is a crucial year for the future of development as efforts to design a new global framework to replace the Millennium Development Goals (MDGs) culminates as the UN readies to adopt a new set of Sustainable Development Goals (SDGs) at a high-level plenary meeting in New York on 25-27 September 2015.

Here Peter Ackland, Chief Executive of IAPB, talks about the relevance of the post-2015 debates for eye health and blindness prevention, the work IAPB and member organisations have been doing and the opportunities for the whole sector.

What is the current consensus on what the new SDGs should look like?

Most authorities seem to believe that the recommendations of the Open Working Group (OWG) which were presented in July 2014 will form the heart of the new SDGs, when they are finally approved at the forthcoming UN General Assembly in September 2015. The OWG identified 17 overall goals and beneath them 169 sub-goals/targets. Work is going on currently by the UN statistical commission to identify the main indicators that will be used to monitor progress against these goals and there are high level discussions about how this ambitious agenda might be funded.

With so many conflicting priorities and ambitious areas of work, how can SDGs benefit our agenda?

The OWG report made nine references to people with disabilities in the 169 sub-goals and targets. An important principle is the stated need to apply and monitor progress against all relevant targets for the least wealthy and most vulnerable members of society. Additionally the 3rd goal, related to health, contained two sub-goals of particular interest to our work – a target around the elimination objectives of the Neglected Tropical Disease movement (which includes trachoma and onchocerciasis work) and the promotion of universal health coverage which provides opportunities to include eye health services.

Being a part of the SDGs is important as the SDG framework will guide and prioritise the development agenda and allocation of government resources and overseas development assistance for the next fifteen years to 2030.

UHC is certainly a ‘powerful concept’ – to use Margaret Chan’s own words – but can it ever be achieved? Where does one start to monitor progress for example?
The core idea behind the UHC sub-goal is that by 2030 there should be 80% coverage of essential health services for everyone and, crucially, no-one having to miss out on health services because they are unable to afford them. The indicators to measure this are yet to be finalised but one will relate to a measure of financial protection / levels of out of pocket expenditure for health services. The second indicator proposed by the WHO and World Bank is to monitor the coverage of essential health services by looking at the coverage of a small number of core or “tracer” treatment and preventative health interventions.

We all know the old quote “what gets measured gets managed”; with so many health services competing for a place in the ‘measurement sun’ then, can eye care ever be considered?
Although cataract surgery was not included in the initial small list of tracer interventions proposed by WHO and the World Bank to be used to monitor UHC, IAPB has been presenting the case that it should be, and that the Cataract Surgery Coverage (CSC) fits all the criteria required of the “ideal” UHC indicator. I have been to see key people in the WHO and World Bank about this and presented to them our case, and the considerable amount of CSC data that we have been able to compile from the many population surveys (mainly RAAB studies) that have been conducted in recent years. We understand that WHO is producing a 2015 baseline report on UHC, to be published in May, and I have been led to believe that this will include data on CSC. I am not one to “count my chickens before they are hatched” but if we can get CSC into this first UHC monitoring report then, as you say, what gets measured, gets managed.

So, how hopeful are we the SDGs may in the end include an eye care indicator, and what would be the opportunities from that?
We have to be realistic – none of the nine sub-goals under the heath goal are going to specifically make reference to eye health. However infectious blinding conditions will be included within the overall NTD sub-goal and as explained above if we can get cataract surgery included in the small basket of treatments that are monitored within the linked UHC process then that will be a major breakthrough. Governments will want to show progress against the indicators used to monitor the SDGs so we can expect to see investment in the health systems needed to deliver both NTD control and cataract surgery. As we know an investment in cataract surgery is always a good start for the development of wider eye health systems. In terms of disability it would a major disappointment at this late stage if there are not some very specific targets related to realising the rights of persons with disabilities – this will benefit people with irreversible sight loss in terms of their education and employment opportunities as well as other areas.

How can IAPB members help make this a reality then?
Over the next 2-3 months governments are negotiating the final content of the SDGs. Our advocacy work continues as we need to retain the positive references to disability and the favourable health references made by the OWG in the final framework. Members can help by reinforcing these messages with their government officials involved in the SDG debate, and particularly by promoting eye health firmly incorporated and integrated within universal health policies, such as national insurance schemes or similar. In the future members can help by funding RAAB studies to ensure we keep CSC on the radar as a useful indicator to monitor UHC, as would promoting its collection and reporting in national health management information systems.