Turning fine words into action: suggestions for high-level advocacy.

Advocacy is a crucial activity for achieving the goals of VISION 2020: The Right to Sight. Progress towards the elimination of avoidable blindness depends on political will and on making available more human and financial resources. In order for this to happen, advocacy is necessary: it can influence the policies and practices of key decision makers, particularly governments, the Word Health Organization (WHO), and development and funding bodies. The passing of two resolutions in support of VISION 2020 at the World Health Assembly meetings of 2003 and 2006 was a good start. These resolutions call on member states to prepare national VISION 2020 plans and to mobilise resources for their implementation. They also require WHO itself to provide support to these member states. These resolutions were the result of extensive advocacy and lobbying by many members and partners of the International Agency for the Prevention of Blindness (IAPB), led by IAPB’s Eastern Mediterranean Region team. However, the resolutions are only the start of the process. In the long run, if VISION 2020 is to succeed, it must be given higher priority and be supported by more funding. The challenge now is for national and international leaders in eye health to persuade WHO and national governments to turn these fine words and sentiments into action. This can only be achieved through carefully planned, coordinated, and sustained advocacy, aimed both at WHO and at national governments. Advocacy is needed at international level to ensure that eye health is included in WHO’s action plans for the different WHO regions, e.g. Africa or Southeast Asia. These regions determine their own priorities in consultation with the member states in their region. In order to ensure that WHO gives additional support to VISION 2020 in a particular region, it is important that governments press for this support at WHO regional meetings. IAPB regional coordinators should direct their advocacy efforts towards the leaders of those countries best placed to play this role (i.e. those who have the most influence in that region). On a national level, advocacy is needed to ensure that the prevention of visual impairment is included in the country cooperation strategy document (CCS). This document is drawn up by WHO for each country in which it operates. It reflects the medium-term vision of WHO for its cooperation with a specific country and defines a strategic framework for achieving this vision. If the elimination of avoidable blindness is not in this document, it is unlikely to be included in the country’s ‘joint programme’, the plan that attaches a budget to the priorities identified in the CCS. Although the CCS is drawn up in collaboration with each country’s government, the process is led by the country WHO representative. Advocacy should target the country WHO representative, as well as the national government concerned, as the latter can put pressure on the WHO representative to include the elimination of avoidable blindness in the CCS. The timing and processes of the document’s preparation should be taken into account. Similarly, poverty reduction strategy papers (PRSPs) represent a good opportunity for advocacy at national level. PRSPs form the first step in the implementation of the Millennium Development Goals (see article on page 62). They are prepared and updated every three years by many countries, a process which involves the government itself as well as external development partners, including the World Bank and the International Monetary Fund. In some countries, the inclusion of blindness prevention in a PRSP could be a realistic advocacy objective. To have maximum impact, national advocacy activities should be closely coordinated among relevant individuals and organisations. Such coordination should be the responsibility of national VISION 2020 committees, who should develop advocacy strategies with specific and clear objectives and action plans. The support of leading international non-governmental organisations (NGOs) and IAPB coordinators will be important in this process. While there are plenty of challenges, there is also plenty of encouragement to be derived from advocacy successes to date, which have resulted in higher priority being accorded to blindness prevention and in the allocation of increased resources. The example of Pakistan is described on page 65, but similar success has been achieved in other countries, India and Australia being notable examples. It is worth noting that, both in India and in Australia, the VISION 2020 national bodies are very active, have a clear advocacy agenda, and enjoy strong support from the NGO community. This is the model which needs to be replicated. Richard Porter Deputy Director, IAPB, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.