the alan johns memorial lecture
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The Alan Johns Memorial Lecture. Serge Resnikoff MD, PhD. Alan Johns CMG OBE 1931 – 1995. Bangladesh 1983. The Alan Johns Memorial Lecture 13 Years After: are we still on track?. Global blindness 1998 - 2020. Million blind. x 2. Scenario without additional action. - PowerPoint PPT PresentationTRANSCRIPT
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The Alan Johns Memorial Lecture
Serge Resnikoff MD, PhD
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Alan Johns CMG OBE1931 – 1995
Bangladesh 1983
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The Alan Johns Memorial Lecture
13 Years After: are we still on track?
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4Global blindness1998 - 2020
Scenario without additional action
Millionblind x 2
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5Global Distribution of Blindness by Cause
(WHO/PBL, 1995)
Cataract42 %
Trachoma15 %
Glaucoma14%
Oncho.1 %
Other28 %
URE ?DR ?AMD ?
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6The Global Initiative for theElimination of Avoidable
Blindness
WHO NGOsTF IAPB
The Global Initiativefor the Elimination of Avoidable Blindness
by 2020
Aim: “to intensify and accelerate present prevention of blindness activities so as to achieve the goal of eliminating avoidable blindness by the year 2020”
Countries
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7The Global Initiative for theElimination of Avoidable
Blindness
The GlobalInitiative
Millionblind
Trend
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8
“VISION 2020 - the Right to Sight”
launched on 18 February 1999
by Dr G. H. BrundtlandWHO Director General
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1999
Kosovo
East Timor
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1999
Decision taken…
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1999
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VISION 2020
1999 - 2012
Percentage of individuals using the Internet
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1999 - 2012
VISION 2020
Mobile-cellular subscriptions per 100 inhabitants
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NASDAQ Composite index Feb 1999 – Sept 2012
VISION 2020
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Eye Care 1999 - 2012
ICCE
ECCE SICS
Phaco Femto L. ?
Anti-VEGF
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Global cataract targets
1995 2000 2010 20200
5
10
15
20
25
30
35
Cataractoperations(millions)
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17
Global cataract targets
1995 2000 2010 20200
5
10
15
20
25
30
35
Cataractoperations(millions)
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Global Health 1999 – 2012
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Obsession with epidemic outbreaks
• SARS in 2003 : 8000 cases, 800 deaths• Avian Flu H5N1 in 2004:
– “could kill 150 Mo people” (Chief Avian Flu Coordinator for the United Nations)
– $10 Billion spent in a couple of weeks– 46 cases, 32 deaths
• Swine Flu H1N1 panic in 2009– Case fatality rate 1/3 of seasonal flu
• Contrast with little interest in chronic conditions
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Pre-VISION 2020Main International Players
1946 (Relief in Europe)
1969
1948
1944 (reconstruction)
19961987
1999: 300+ organizations listed as active in International Health
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Post-VISION 2020New Major International Players
2006 - $ 1.5 Bo
2000 – 2006 - $ 3 Bo
Aug 1999 - $ 2.5 Bo
2002 - $ 3 Bo
2002 – $ 161 MoADFm2009
2001 – IDF
2001, 2006, 2010
NCDsUHC
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Current Major International Players
2012: 500+ organizations listed as active in International Health
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Trends in Development Assistance for Health
Ch J L Murray et al. Lancet Jul 2011
« Shift in the balance of contributions between the different channels, with UN agencies playing a smaller role and the Global Fund, GAVI, US and UK bilateral aid, and the Gates Foundation growing in importance ».
$27 Bo
« Funding for HIV/AIDS continued to rise, while programmes targeting maternal, newborn, and child health received the second largest share. Non-communicable diseases received the least amount of funding compared with other health areas »
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Misfinancing global health: a case for transparency in disbursements and decision makingDevi Sridhar, Rajaie Batniji, Lancet 2008
Visual Impairment*
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1999 - 2012
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1999 - 2012
Social Determinants of Health
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NTDs
2003 2010 2011 2012
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Attributable fractions
Population level Intervention
Risk Factors
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NCDs and Chronic Diseases
2005
Risk Factors Approach
Population-basedInterventions
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Pan Retinal Photocoagulation Carpet-Bombing
Diabetes Primary preventionIn addition to
Diabetic Retinopathy management
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New metrics for Health System Performance(Fairness, Responsiveness…)
Focus on importance ofHealth System Financing andOut of Pocket Expenditures
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CMH: 2000 - 2008
10% improvement in life expectancy is associated with annual economic growth increases of 0·3–0·4%
« Improved health contributes to economic growth »
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WHR 2010
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WHR 2010
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Universal Health Coverage “Movement”
• Universal Health Coverage:“everyone can use the health services
that they need ” • At the centre of UHC is a package of services
that are available when needed without causing financial hardship to the user
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UHC: no longer a distant dream?
• The 25 wealthiest nations all now have some form of universal coverage (apart from the USA).
• Also several middle-income countries: e.g. Brazil, Mexico, and Thailand
• Lower-income nations are making progress e.g. the Philippines, Vietnam, Rwanda, and Ghana, India, South Africa, and China
• Cross-country learning have developed, e.g. the Joint Learning Network (Ghana, Mali, Nigeria, Kenya, Vietnam, Thailand, India, Indonesia, the Philippines, and Malaysia)
• Adapting rather than adopting what others do.
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Lessons learnt
• UHC in isolation is no guarantee of effcient care.• UHC reforms must be accompanied by measures to ensure
that :– services are available and of good quality;– health workers are well trained, motivated, and close to people;– drugs and equipment are available and distributed appropriately.
• UHC requires multi- sectoral collaboration with ministries and institutions dealing with fiscal and monetary policy, education, labour and social security
• Strong political leadership and commitment is important to make such collaboration work.
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Where is the money coming from?Is International Aid needed?
• On the one hand, UHC has to be driven by forces from within a country, not from outside. In that respect Aid is not the answer.Government expenditures for health from countries’ own sources: US$410 Bo in the developing world in 2009, i.e. 16 times larger than the total development assistance for health. Even in the African region, external sources represent only 11% of the funds spent on health.
• On the other hand, International Aid is necessary in lowest income countries ($40 billion per year)
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Issues related to the package of services
• UHC is always defined in terms of coverage of a minimum basic package of health needs
• Usually prioritises effective low-cost interventions for the excess disease burden of the local population
• Typically:– group I diseases (Comm. D. and MCH conditions)– and a subset of group II (NCD) and group III (trauma)
diseases that can also be addressed with high effectiveness at low cost.
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Issues related to User Fees
• « Direct out-of-pocket payments levied at the time when people need services not only inhibit the poor and disadvantaged from seeking health care, but are also a major cause of impoverishment for many who obtain it » (David Evans et al. WHO, Lancet, 2012)
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Issues related to User Fees
• « Regardless of the euphemism chosen to describe shared payments, they are in reality a locked gate that prevents access to health care for many who need it most. They should be scrapped » (Lancet, Editorial 8 Sept 2012)
End of cost-recovery?
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Great transitions in health
• First: demographic transition• Second: epidemiological transition • Third: Universal Health Coverage
Health is a Right
Health is a Collective Good
Is Sight a Collective Good (?)
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Many things have changed
However, …
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Global Causes of Blindness
URE; 3Glauc; 8
CO; 4
Tra; 3
DR; 1
AMD; 5
Child Bl; 4 Und.; 21
Cataract42 %
Other28
Glauc.,14
Tra.,15
Oncho.,1
Cataract51 %
1995 2010
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Global Causes of Visual Impairment
Cataract; 33%
Glaucoma; 2%AMD; 1%
CO; 1%ChBl; 1%
Trachoma; 1%
URE; 42%
DR; 1%
Undetermined; 18%
WHO/NMH/PBD/12.01
Cat + URE = 75%
+Presbyopia
Cat + D & N URE = 91%
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Thank you