ICO and Capacity Building for Human Resources for Eye Health

ICO and Capacity Building for Human Resources for Eye Health William C. Felch, Jr. Chief Executive Officer, International Council of Ophthalmology Human Resources for Eye Health (HReH): Bridging the Gap International Agency for the Prevention of Blindness, Council of Members 16 September 2013 Brighton, United Kingdom

ICO and Capacity Building for HReH (Africa) Public Need for Eye Care and What Ophthalmologists Can Do ICO Approach to HReH and Evolution of ICO Commitments Eye Care Delivery and Leadership Development 3 ICO Educational Programs and Resources

The Public Need for Eye Care

International: The Public Need for Eye Care Global Causes of Visual Impairment 2010 BCVA<6/18 Diabetic Retinopathy, 1% Undetermined, 18% Cataract, 33% Cat + URE = 75% Uncorrected Refractive Error, 42% Glaucoma, 2% Age-Related Macular Degeneration, 1% Corneal Opacities, 1% Childhood Blindness, 1% Trachoma, 1% Pascolini D, Mariotti SP. Br J Ophthalmol 2011; Epub Dec 1. Slide from Serge Resnikoff.

International: The Public Need for Eye Care The Distribution of Blind and Visually Impaired of All Ages in the Six WHO Regions (in Millions) WHO Regions Visual Impairment (Millions) Blind (Millions) AFR 26.3 5.9 AMR 26.6 3.2 EMR 23.5 4.9 EUR 28.2 2 SEAR 90.5 12 WPR 90.2 10.6 The distribution of Visual Impairment by age group: 0-14 years 7%, 15-49 years 28%, 50 years and older 65% 2010 WHO Data, Source: http://www.who.int/blindness/table/en/index.html. Slide from Hugh Taylor.

Nigeria: The Public Need for Eye Care National Causes of Blindness 2012 BCVA<3/60 Macular Degeneration, Onchocerciasis, 1% 2% Refractive Error, 1% Phthisis/Absent Globe, 2% Others, 3% Optic Atrophy, 4% Trachoma, 4% Other Corneal Scars, 8% Cataract, 43% Uncorrected Aphakia, 9% Glaucoma, 17% Abdull, M. M., S. Sivasubramaniam, G. V. S. Murthy, C. Gilbert, T. Abubakar, C. Ezelum, and M. M. Rabiu. "Causes of Blindness and Visual Impairment in Nigeria: The Nigeria National Blindness and Visual Impairment Survey." Investigative Ophthalmology & Visual Science 50.9 (2009): 4116. Print.

What Can Ophthalmologists Do? Number of Ophthalmologists in Practice and Training Worldwide Study designed and conducted by ICO Aim: To capture the dynamics of the global ophthalmic population, including residents Standardized survey e-mailed to 213 global ophthalmic societies or individuals (March 2010) Missing data gathered from direct correspondence with ophthalmologist contacts (August 2010)

What Can Ophthalmologists Do?

What Can Ophthalmologists Do? Number of Ophthalmologists in Practice and Training Worldwide Number of ophthalmologists in practice and training worldwide Of the 193 countries surveyed, 192 responded (represents 99.99% of the global population) Total number of ophthalmologists in the world 204,909 Ranging from 28,338 in China to 0 in some Small Pacific Islands, with 131 countries representing less than 5% of the total Slide from Serge Resnikoff.

What Can Ophthalmologists Do? Two-Thirds of Ophthalmologists in 15 Countries China Other United States of America Russian Federation Spain Mexico Poland Italy Argentina Germany France India Brazil Japan Slide from Serge Resnikoff.

What Can Ophthalmologists Do? Ophthalmologists per Million Population 0 to 0.99 1 to 3.99 4 to 24.9 25 to 99.9 100+ Slide from Serge Resnikoff.

Africa: What Can Ophthalmologists Do? Ophthalmologists per Million Population 0 to 0.99 1 to 3.99 4 to 24.9 25 to 99.9 100+ Slide from Serge Resnikoff.

Ophthalmic Growth Rate vs. 60+ Population Growth Rate All Ages 60+ Ophthalmologists growth rate + 1.2% + 1.2% Population growth rate + 0.77% + 2.9% Actual growth rate + 0.43% - 1.7% On average, the population aged 60+ is growing more than twice as fast as the number of ophthalmologists Ophthalmic population is declining 1.7% per year compared to the population aged 60+ Slide from Serge Resnikoff.

What Can Ophthalmologists Do? Conclusions Very broad picture System being set up to improve data collection The gap between need and supply is widening in both developing and developed countries Needs to be urgently addressed in training eye care teams now focused on meeting community needs Slide from Serge Resnikoff.

Need for Training: Eye Care Teams Particularly in Low Resource Countries: Not enough ophthalmologists and other eye care providers to provide the care needed Mal-distribution: Lack of providers where most needed Not enough training programs Existing training programs not focused on public needs, e.g., for community eye health Lack of infrastructure and professional development for those who are trained Hugh Taylor, February 2012

Need for Training: Principles Training in ophthalmology should focus on meeting needs of communities and populations, not just individuals Dr. Para: If ophthalmology is your profession, prevention of blindness is your business Needs are best met by eye care teams, trained together to work as teams Comprehensive eye care should be an integral part of the health care system Eye care training should be integrated with training for the rest of the health care system Those who are trained need infrastructure, support and continuing professional development Hugh Taylor, February 2012

Eye Health Personnel Needed Teams of: Ophthalmologists (surgeons and eye doctors ) Subspecialists (pediatric, retina, etc.) Primary physicians trained in eye care Optometrists or refractionists and opticians Ophthalmic nurses Allied eye health professionals/mid-level eye personnel (MLEP) Eye health managers Community eye health workers Hugh Taylor, February 2012

What the International Council of Ophthalmology is Doing

Mission of the ICO The International Council of Ophthalmology works with ophthalmologic societies and others to enhance ophthalmic education and improve access to the highest quality eye care in order to preserve, restore and enhance vision for the people of the world.

International Council of Ophthalmology Collaborating Organizations WHO IAPB AOI INGOs Membership: The Global Ophthalmic Community ~80 National Ophthalmic Societies ~30 International Subspecialty Societies Commitments Education Eye Care Delivery Leadership and Society Development Supranational Organizations APAO MEACO PAAO SOE Programs Supported by the ICO Foundation, Member Organizations, and the income from WOCs Slide from Bruce Spivey.

ICO History ICO Leaders Visit Nigerian Residencies and OSN April 2004

Evolution of ICO Commitments International Council of Ophthalmology Education Improve Access to Quality Eye Care Prevent Avoidable Blindness and Vision Loss

Evolution of ICO Commitments International Council of Ophthalmology Education Eye Care Delivery Improve Access to Quality Eye Care Prevent Avoidable Blindness and Vision Loss

Evolution of ICO Commitments International Council of Ophthalmology Society and Leadership Development Education Eye Care Delivery Improve Access to Quality Eye Care Prevent Avoidable Blindness and Vision Loss

Evolution of ICO Commitments Teaching the Teachers International Council of Ophthalmology Society and Leadership Development Education Eye Care Delivery Improve Access to Quality Eye Care Prevent Avoidable Blindness and Vision Loss

What Is a World Alliance for Sight?

ICO Programs Eye Care Delivery/Capacity Building Clinical Guidelines and Standards Workshops and Materials for Advocacy/VISION 2020 Task Force on Uncorrected Refractive Error School Eye Health Program Task Force on Diabetic Eye Care Ethics Committee

School Eye Health Programme

Targets for Pakistan and Nigeria

School Eye Health Program Partners: CHEF International International Council of Ophthalmology Foundation Light For The World, Austria Light For The World, Netherlands Lions Aravind Institute of Community Ophthalmology (LAICO), India JOS University Teaching Hospital, Nigeria

ICO Programs: Eye Care Delivery Task Force on Diabetic Eye Care: 1. Define and disseminate technical guidelines for screening, patient evaluation and treatment of diabetic retinopathy 2. Evaluate how education needs to change to assure that ophthalmologists and others have required skills and knowledge 3. Define key indicators to evaluate the effectiveness of diabetic retinopathy programs

National Societies and ICO Members by Country Sub-Saharan Africa has a small population of ophthalmologists And there are a number of countries with no professional ophthalmological society Ophthalmologists National and per ICO Million Members Population by Country 0 National to 0.99 Societies Only 1 ICO to 3.99 Member 4 to 24.9 25 to 99.9 100+

Evolution of Regional Societies There are a growing number of regional ophthalmological Societies, now including the Africa Ophthalmology Forum National Regional and Society ICO Members Members by Country by Country National Regional Societies Only ICO Member

ICO Leadership Development Advisory Leadership Group for SSA First Meeting, March 2007 in Dubai:

Advisory Leadership Group for SSA Fourth Meeting, October 2008 in Lagos, Nigeria:

ICO Leadership Development Fifth Advisory Leadership Group meeting: Bahrain, March 24 24, 2009, at MEACO Congress Evolved into Africa Ophthalmology Forum ICO World Ophthalmology Roundtable on Leadership Development (WORLD) at AAO in 2009 2013 Future: WORLD Online?

Evolution of ICO Commitments International Council of Ophthalmology Education Improve Access to Quality Eye Care Prevent Avoidable Blindness and Vision Loss

ICO Programs Education World Ophthalmology Congress (Tokyo, April 2-6) Examinations Basic Science Clinical Sciences Advanced Exam New Foundation Assessment (2013 online) Fellowships (from developing countries) ICO Three-Month International Fellowships: > 600 since 2000) ICO/Helmerich Fellowships ICO/Fred Hollows 12-Month Fellowships (2012) Experimenting with Sandwich Fellowships CME/CPD Guidelines and Support for Societies Visiting Professors

ICO Programs Education Support for Regional Training Centers Slovenia (Retina and Oculoplastics) Beijing (Diabetic Retinopathy) Nigeria (Catholic Hospitals) Cameroon (Magrabi ICO Eye Institute, Yaounde) - Subregional Center of Excellence - Training in French and English - Ophthalmologists, nurses, optometrists, orthoptists, low vision, etc. - Comprehensive eye care services regardless of ability to pay - Operational research - Center for telemedicine and tele-education - Collaboration with CBM, ORBIS and many partners

ICO Programs: Magrabi ICO Eye Institute 1 September 2013

ICO Programs: Magrabi ICO Eye Institute Projects Start of Activities: Second Quarter 2014

Construct: Country Profile

Country Stats - Afghanistan Ophthalmologists 128 Subspecialists (L1-L3) 16 Subspecialists (L3) 3 Ophthalmology training centres 7 Centres providing subspecialty services 0 Centres providing subspecialty training 0 Topline Stats Ophthalmologists 1:234,375 pop Ophthalmologists 0.32/75,000 pop Subspecialists (L3) 1:10 million pop Allied Eye Health Profs 1:256,410 Na onal subspecialty training curriculum - None 100% government, 100% residency L2 residency 3 to 4 years Faculty 28 Students in programme 37 Optometrists 6 Orthop sts 0 Ophthalmic Assistants 46 Ophthalmic Nurses 65

ICO Programs Education: Teaching the Teachers Courses for residency program directors (22 since 2004) Ethiopia 2008 Ghana September 2013, Paris May 2014 for Francophone Africa World Ophthalmic Education Colloquium at WOC Conferences for ophthalmic educators EyeExcel (with Aravind and Seva) Training Trainers of Eye Health Personnel

ICO Programs Education: Teaching the Teachers International Curricula: For residents, allied providers and medical students (2006) For ophthalmic assistants (2009) and refractionists (2011) New curriculum for residents (2011 2012) For subspecialty training (2012 14) OSCARs and other assessment tools Online courses & tools for teachers Web based teaching (2012) Webinars (2013) Center for Ophthalmic Educators (educators.icoph.org)

ICO Programs: Teaching the Teachers

2012 Strategic Plan for ICO Education 1 2 3 4 5 6 Training Teams to Meet Public Needs Curricula and Expectations for Training Programs Continuing Professional Development Accreditation and Certification Teaching the Teachers Technologies for Teaching and Learning

The Future of Ophthalmic Education Evaluating real outcomes of educational programs Re-focus on community needs, teams, critical competencies and supporting change Blended learning: in person and online More collaboration What s Next?

Thank You for your attention. wfelch@icoph.org