Introduction
To increase efforts to improve eye health globally, the Sixty-sixth World Health Assembly endorsed the Universal eye health: a global action plan 2014–2019 by adopting resolution WHA66.4.[1] The action plan reflects five principles: universal access and equity, human rights, evidence-based practice, a life-course approach and empowerment of people with visual impairment. The action plan is based on the health system approach, in which eye care programmes are integrated into the wider health care system at primary, secondary and tertiary levels.
The plan presents Member States with a set of actions from which they can choose those most appropriate to their setting and needs. In order to do so and to make progress towards universal access to high-quality, comprehensive, integrated eye care, the interventions must be based on evidence about the extent and causes of visual impairment in the population and the gaps in current provision of eye care. The “eye care service assessment tool” (ECSAT) allows users to collect data and information on the provision of eye care at country or district level and to determine whether it meets the objectives of the global eye health action plan.
ECSAT has three main sections, which follow the structure of the global eye health action plan. Section 1 covers the availability of data on the prevalence and causes of visual impairment, gaps in eye care services and use of evidence for securing support for eye health. Section 2 provides guidance for assessing the status and functionality of a country's eye care service on the basis of the six areas of the WHO framework for strengthening health systems. Section 3 gives guidance for determining the extent to which eye health is covered in multisectoral agendas and for engaging in national and international eye health partnerships.
Modular structure of ECSAT
The modular structure of ECSAT allows the user to either complete the entire set of questions or to select sets of questions for specific areas. Completing the entire set of questions will give a more comprehensive overview of the available data and information on eye health and eye care service provision; however, the modular structure gives users the option of collecting data and conducting research in specific areas, such as eye care services in general or the eye care available for people with specific conditions, such as uncorrected refractive errors, cataract, glaucoma, ocular complication in diabetes, retinal eye disorders and selected eye conditions in children. Additionally, for instance, the user can focus on assessing the provision of services for low vision and rehabilitation, management and financing of eye care, human resources for eye care, evidence for advocacy and multisectoral engagement.
How to use ECSAT
Each section of ECSAT contains a set of questions that prompt the respondent to tick boxes, provide narrative or both. The information necessary to complete ECSAT is usually derived from interviews with personnel at the ministry of health and other relevant government institutions (such as the ministries of finance and education), national societies of eye care professionals, organizations for people with visual impairment, desk examination of publically accessible sources and, to a certain extent, proactive collection of information. Completion of the ECSAT questionnaire should not take an unreasonable amount of time. It should rather result in understanding which information is available, consideration of whether it is needed, given the overall status of eye care provision in the country or district, and agreement on the steps to be taken to obtain the necessary information. ECSAT should thus be used as guidance for identifying gaps that require further consideration.
Users of ECSAT
ECSAT is designed primarily for national and district eye care planners, policy-makers, professional standard-setting agencies, their international and national partners and other health care professionals. It is intended to help decision-makers and others understand the additional actions required to obtain evidence and to identify gaps in eye care service provision, in order to strengthen access to high-quality, comprehensive, integrated eye care services.
Use of information obtained with ECSAT
Many Member States have established eye health or prevention of blindness committees, which are usually led by ministries of health charged with planning and implementation of evidence-based interventions at national and district levels. This has resulted in plans and similar strategic documents on eye health or prevention of blindness that are integrated to various degrees in national health programmes. The current plans and strategies of some Member States should be updated in line with resolution WHA66.4 on the global eye health action plan, while in others new plans and strategies are required.
The prerequisite for evidence-based work to update or prepare a national or district plan for implementation of the global eye health action plan is the availability of information on the current epidemiology of eye disease and the provision of eye care services in the country or area. Analysis of this information should result in identification of gaps and needs. While the main aspects of eye care service provision that are to be reviewed and assessed are described in the global eye health action plan, ECSAT was designed to facilitate information collection in a structured way. A new or updated national plan of action for implementing the global eye health action plan can be based on the information obtained with ECSAT.
ECSAT is also intended to assist implementation of evidence-based interventions, as periodic completion of the questionnaire can provide data and information for assessing the impact of interventions and identify trends and newly emerging needs. These findings should be included in refining and updating national plans for continuous activities. The process and suggested use of ECSAT are illustrated below.