Why eye health is crucial for universal health coverage

Eye health is universal. Everyone will require eye care services at some point in life, but universal health coverage (UHC) cannot be achieved unless all people have affordable access to the eye care they need.

A global priority, UHC is the linchpin of the Sustainable Development Goals (SDGs), particularly SDG3, and through the 2030 Agenda, countries have committed to achieving health for all through UHC. When integrated, lasting change and long-term impact can be brought to health systems and populations.

The link between eye health and UHC is clear, and there are key policy frameworks and steps that can be taken to include eye health in UHC efforts.

Recommendations from the World Report on Vision

Published in 2019, the WHO’s World Report on Vision aimed to address the world’s challenges concerning eye care and was directed towards ministries of health, development agencies, civil society organisations, researchers, practitioners and policymakers.

The report outlined the following recommendations for policymakers relating to UHC and eye health:

• Provide quality eye care services according to population needs to improve service coverage and reduce inequalities. This requires assessing both the met and unmet eye care needs of a population
• Ensure that eye health services include promotion, prevention, treatment and rehabilitation
• Ensure that the cost of priority eye care interventions is included in service packages covered by pre-paid pooled financing
• Deliver integrated people-centred eye care

The delivery of integrated people-centred eye care is a central recommendation of the World Report on Vision. Ensuring that people receive continuous eye care that fulfils their needs throughout their lives is crucial. Delivering this requires a fundamental shift in how eye care services are managed and delivered. It calls for mainstreaming eye health into national health systems and encourages more primary and community-led strategies. Primary health services should include eye health with referral to secondary and tertiary facilities as necessary.

Although countries may be at different stages, the steps they should take towards these recommendations are broadly set out below. However, as a first step, the WHO recommended conducting an up-to-date situational analysis to determine the current state of the eye health system and the epidemiology of eye health conditions. The evidence from this situational analysis can then inform the following steps.

Practical steps for integrating eye health into UHC

In the context of the above recommendations from the World Report on Vision, but taking into account that country contexts will vary, the following areas can be considered integral to delivering on UHC and eye health:

• Eye care services should be accessible and inclusive to all
• Eye health should be included in UHC policies, planning and resourcing. This includes UHC financing, human resource planning and monitoring
• Primary health care is the foundation of UHC and therefore, primary care level staff should be trained in basic eye care
• A robust referral system from secondary and tertiary care should be in place for the management of cases beyond the remit of primary care
• Financial barriers to accessing eye care should be eliminated by incorporating population needs into national health financing to pool risk and protect the most marginalised
• Eye care should be included in the package of essential interventions and essential medicines list
• Investing in and planning the health care workforce should include eye health professionals
• Eye health should be included in all aspects of UHC – promotion, prevention, treatment and rehabilitation
• Assistive technology policies and programmes should include its provision for vision impairment and the training of health workers

Conclusion and further resources

Most countries are already actively working towards achieving UHC and the SDGs. Incorporating eye care in their current work is crucial as projections show that blindness and vision impairment are set to increase. Integrating eye health into health systems and processes and through a people-centred approach is necessary to eliminate avoidable and preventable blindness and vision impairment.

Read the WHO’s Integrating eye care in health systems: guide for action for further details.

For more information on this briefing, please get in touch with Fiona Lawless at [email protected]