 Hello, everyone. Good morning. I'm fighting my carry. I work as an ophthalmologist at the University of Abuja Teaching Hospital. And I'm also associate professor at the London School of Hydrogen and Tropical Medicine. So I would like to share my screen now and Okay, so we're just going to be talking about the improving cataract services issue, which was talking about better access, better outcomes and better value. I will just like to acknowledge two of my residents who I believe thoroughly read the journal and came up with a summary of which this is what I have. I am presenting to you. So the focus of the issue is a balanced approach to outcomes and outlay together with strong partnerships to create a cataract service that puts patients at the centre and deliver eye health for all. And when we talk about partnerships, what are we really talking about? So it's not just about the hospital, because it's patient centres, we need to know what matters to them, ask for their feedback, know what they want. And then the community can also be very useful in terms of service delivery and also in identifying cataract patients because they live among themselves. As well as after care following surgery. Then of course the hospital management where the hub of the service is increasing the scope of sustainable service provision with a balance between income generation and cost containment. So in this issue we talked about how can we balance the two we know that we would like to increase the services but it's always at a cost. The hospital management is always trying to cut cost or at least contain cost. So we need to know how else we can do the income generation and that gives us the sustainable service. Then of course the eye care personnel is very important to the system, the roles, the responsibilities. There has to be respect within eye care personnel and team, and there has to be a transparent and fair human resources policies so the issue talked about this and gave examples of how teamwork can actually increase. So this strong partnerships can help to produce a high volume high quality and affordable cataract surgical service. Okay, so we can't really talk about a cataract service, you know in this day, without talking about effective cataract surgical coverage, which is the ECST it's the new global target recommended by the World Health Organization. And it's not only talking about measuring quantity but also measuring quality. So both are measured in the previous cataract surgical coverage measure, it was just about quantity, how much of people that need cataract surgery actually have it compared to those that need it. In terms of who are the people that have how many people have had cataract surgery and how many people actually need it, including those that have had it and those that haven't had it which is the denominator. So it's not just about numbers. It also increased the, it also stated the visual outcome of cataract surgery as a parameter to consider. And here, there's a cut off point of a presenting visual activity of 612 or better, which is really a high bar in the previous recommendation of what is good outcome is 618 or better. So this is quite a high bar, which means there has to be an improved quality. There has to be increased output. And then of course equitable access. We have to consider children. How do we, how do children access the service and how do women access access the service. Older adults, even though cataract is mostly for adults, but we also need to pay special attention to how older adults access the service and of course people with disabilities. So I'll just mention a few key highlights of how these were discussed in the journal. So there are articles that focused on the patient centered approach and we'll see the article that discussed patient feedback and how that feedback was integrated into the system to improve the service of that hospital. And then the patient reported outcome measures. So we're not always fixated on visual outcome 612. You know, what does that mean to patients and how does that affect their daily living activities. For example, look at the photo I have here, which is out of the journal as well. So acknowledgement to the photo, the journal for the photos. This is just the lady who has had cataract surgery not, I guess it's her first day post up and she's already back to her usual work, and she's happy with it. And then there are, there is an article that also talked about service operational policies being friendly to patients to improve access we have to think about how we can engage patients how we can make them happy in the environment. So there's a so there's a journal article that talks about that. Then of course the focus on patients needs. Then we have a few articles also that talked about teamwork and efficiency, where we have highly organized and efficient team based approach. And that could be in terms of efficient opera operationalization of the system. Like what we see here is the two bedded theater. Even if it's one surgeon, the surgeon can swing quickly between the two tables like finish one before the next one is set up and started on on the second table and before the first table is set up. You know, the surgeon has started on the other table so it's quite efficient. And then we talk about both purchase. This has been, you know, a long term strategy, you put resources together to buy a lot of consumables for example to reduce the cost quality of monitoring and improving the process shifting. This article talked about shifting from it. biometric contact by ultrasound biometric to immersion ultrasound biometric which improves the IO power prediction accuracy and that just changed the outcome of the cataract surgery in terms of, you know, surgery induced refractive errors. Then taken advantage of economies of scale by sharing infrastructure and salary costs between more patients. So this teamwork and these strategies to improve efficiency are all discussed in the journal. And then, finally, it's equitable access is also discussed in the journal. We have to think of how we can address them. And of course that, you know, they have barriers that face specific barriers. Here we have an example of women by enhancing the experience of care increasing their awareness and reducing their non medical costs because oftentimes when we talk about cataract service surgical service we think of the medical costs, but we do have non medical costs and largely women affected. Then increasing demand and uptake. I think I was glad to see that systematic review showed that outreach cataract surgical services are really still very much needed. And in some communities in some countries, that is what will really scale up demand and also uptake. Then reducing financial barriers which is another key component of cataract surgical service you have to think about multiple sources of funding. So this is it, we talked about all these three important parameters in the journal, the patient approach, the teamwork and increasing efficiency and ensuring equitable access. Thank you very much. Thanks so much. I mean, and hi everyone. Hello from Pakistan. I'm some run I asked me, I'm deeply technical director for our health and effective at airport for your site servers also work very closely with World Health Organization and I a baby in the field of vision care. So referring back to the issue on community engagement that I mean talked about. In this issue we explored why engaging with communities in the work that we do is crucial to ensure access to I care for all. I'm going to share some key learning and messages that emerge from different articles. So, as part of this issue we applied a health system strengthening lens to community engagement and explored what needs to be done to ensure universal I health coverage with a very specific focus on identifying challenges of reaching the most vulnerable population groups. And then how we can work with communities to find the right solutions. The issue also highlighted why it is important for us to involve the community, not only in the design and planning and implementation processes, but also making sure that they are engaged in monitoring the quality and impact of I care interventions. And then their role in advocacy that cannot be underestimated. The choices of making sure that we have the right advocacy messages in place and the chances of advocacy success are always high when communities are part of it and they own it. So we all know that health system strengthening lead to equitable access to I care and one key message from the issue is moving I health for all is critical to making progress towards universal health coverage. This would give access to all individual and communities to the health services that they need, where they need them, when they need them without making sure that without incurring any financial issues. So for this to happen integration of I care in universal health coverage and delivering integrated people centered I care for all is central. So making sure that we apply a health system strengthening framework. That's the way we will be able to address the barriers that we face in terms of inclusive service delivery, I health workforce data and evidence governance and quality of care. The need to embrace technology and innovation is also highlighted and you'll find really good examples about it. That we can learn from and also integrate into our work. The article on demand site financing mechanism also share really good examples and tools that can help us to increase access. While making sure that we are effectively using our resources improving the efficiency of service provider and empowering communities along the way. Next slide please. So there is no doubt that meaningful engagement of communities is really important if you want to maximize the impact of our work and a strong starting point is to better understand what a community needs. And that means including people with disabilities woman and girls and other vulnerable groups. So active and continuous engagement with communities going to help us to understand their need. So we can plan and deliver I care services accordingly. And this then is going to have a ripple effect in terms of generating demand and improving uptake of services and we're going to hear about it from Suresh. Shorty. Social behavior change communication also been identified as a key strategy that support communities to make long term change in their behavior. And that includes how they look after their eye health and how and when they seek I care. So we need to factor that into our work and also make sure that we invest in this area properly. And last but not the least accountability. For us as a sector to be accountable to our respective communities and then also making sure that we empower communities to hold all I care stakeholders accountable including national and local governments. So in some big community engagement and integrated people centered I care has a tremendous potential to ensure equitable inclusive I care that meets the need of our communities. Thank you very much back to you. I'm just looking at you because, you know, the article you wrote for us in the journal and the cat track issue was about taking an eye unit and just completely increasing massively increasing the cat track surgical output and that had so much to do with community engagement. So where, where do you start in practice, you know as an eye health practitioner, which seems like sort of a chicken and egg you need the community to do that I can you need good I get to get the community so where's a good place to start. Yeah, thank you. I mean, no, I completely agree with what Surana said and phase added, you know, the community context is very important. And it is different with different communities. If you're working in a pastoralist area, or in a different area that culture that know the way you address the community the way you reach the community is different. From my perspective to your question, you know, I worked there and I was sharing my experience as about the hospital in Western Kenya, where I worked for six years as a hospital director assigned there. And looking at the potential, the huge catchment area the hospital service and the need around what we did was we looked at two approaches one was institution based that you know the service that we provide at the center for those who come looking for the service at the center, like any other hospital. The second approach was also to reach out to the community 50, 60 hundred kilometers away where the services are not there and we try to address their needs by going out there so the two approach are a little bit different. The hospital based approach worked very well. First, we worked on ourselves on the institution, no building systems, bringing the capacity in terms of looking into our equipment, our staff, our working environment, our patient flow. No, making it trying to make it patient centered from the moment that patients come into the, you know, the compound to be properly communicating with addressing their needs, respectfully, you know, managing them and so on. And improving the efficiency of the system on the ground in a way like where we even went to the level of probably operating patients who have come from far, almost the same day, if they're ready and if they're, you know, preparing them counseling them, because usually we lose patients if we return them back, they put a lot of effort to come from 60 kilometers, you know, a blind, bi-laterally blind person with the help and probably sometimes they come selling their resources and all the cow and returning them back is like sending them or condemning them to not to have service or not to come back and so on. So, we worked strongly in improving the capacity, the systems on the ground, worked on our staff in the way they handle our patients, more effective, efficiently, and not giving appointments. You know, sometimes patients coming in the morning, sitting out there, not being attended well, all that, you know, brings in a negative impression by the patients and a negative, you know, word of mouth to the community and so on. So, we improved on that and that improved the institution based service, both in numbers, in quality, and in outcome as well. The second approach was, you know, the outreach service that we expanded and there as well is where, especially the community engagement, the community issue comes in. The outreach services usually work strongly if you have people on different communities where you go, people who reach out and who know the community, who know the culture, who know the tradition, who will reach out to them, influence them, that we are coming as a team, there is a service. There should be also a good organization on the ground in terms of, you know, where you do the consultations, where do you do the surgeries, and they're very strong, you know, using local radios, or the churches, the public gatherings and so on, so that they reach out to the people so that people are informed, that there is a good service coming to them, so they benefit from that. That is an important component of the outreach service, good mobilization, sending out good information. And then again, still your quality of service provision, you shouldn't be minimizing it as much as possible, the quality or the standard of service that you have been offering at your center. You still keep that quality. Sometimes when you are out of your center, there are challenges that will hold you back a little bit and so on, but we still try to maintain that quality service and also work with schools, other centers where the operative environment is also good enough, not substandard and so on. So it's mobilization, it's reaching out and working with people, influencing the community on the ground, they can be alliance clubs, they can be community organizations, women's organizations and so on. So we did work with various community level organizations in terms of doing our outreach and reaching out to the needy in the outreach service. So what we did was a little bit different for both aspects of service. Hannah, I was just looking at you, you were involved very much with the community issue and you wrote about the last mile, reaching people at the last mile. And I think that probably dovetails quite well with what Dimitri was saying that having to reach hospitals and centers need to reach right out into the community. So I just wondered if you have some thoughts and thoughts to share and tips and some approaches or principles on that. I think much of what we did has been mentioned, but let me share very practical examples. A lot of us, I mean, we would probably be an ophthalmologist or a nurse at the hospital and I would draw from my own experience of what I had to do in the Gambia. One is to take care of the team at the base hospital and one success factor was to have a person responsible for that community engagement. So we had a nurse who knew the culture and everything concerned with the community to lead on that aspect within the hospital base. And then the second point was to make ourselves understand what the community is. So at the community level, who does the patient go to, who do they consult, what are the systems, what are the traditional. So we educated ourselves first to understand what that's led by this lead person at the hospital. Then we designed a way to contact the community using this person as the lead person. So in bite size, you cannot do the whole country at once. So you would select a geographical area and then use that person to transmit or change or understand what I help in is with the traditional systems, the women's groups, community health workers, just shaking hand and making friends with the community first. So they understand us and we understand them. And we made that the third aspect was that whoever was working at the community, we helped them in a bite-sized way. We understood that they would be taking care of 5,000 population area, so the work is not too much for them. And then the next level would be 10,000. And whatever they were doing, the integration is so important that eye health is not seen as an asylum. It's not seen as whatever else is going on in the community. And because that person is working in all other areas, the success is that if they're talking about the child, they would mention eye health. If they're measuring blood pressure, they would mention. So integrating into whatever they did. So that was to summarize, half the person at the institution who would be responsible have a team. That person, as some runner said, is context familiar, context knowledgeable. And then that person would guide the rest of the team at the main hospital. And then that person would transmit and be a bridge between the institution and the community. When you think of community, most times we think of that last mile, as you say, but the last mile could exist in the prison. The last mile could exist in schools. The last mile could exist in the markets. So that concept of that person who is not being reached is the last mile. And how do you do that? You can integrate eye health into anything they're doing in health, but you can also see them as a resource. So the health system would be a resource. So whatever resource they are using to see the child resource they're using to see the noncommunicable diseases, you would then push in eye health into that. So they use that resource because in eye health, you may not have the resources. But if you piggyback eye health into them, any other program, or any other captive population, we piggyback. And that has to be an objective, a set objective with strategies and plans and people who would be responsible for integrating into those resources. The third resource that is very good is the community development. They are responsible, say, for water or agriculture or nutrition or the non health government system. So integrating into that. I cannot overemphasize the point of the people at the third level or the institution, having a team responsible for making this happen. A bridge person that would link the tertiary to the community and the way of measuring that you're actually being successful in those areas. So apart from measuring the quality and the quantity, let's also have a way within the team of measuring whether we are achieving that last mile, whether we are achieving the integration. So my name is Faith Langat. I work in Tenwick Hospital, Bomet County as a project manager coordinating vision impact projects in Bomet County. Our role is to ensure that we link, we are actually like a bridge between the patient and the healthcare system. So we strengthen the health, the health system, we use the existing health systems at a time base. And we are lucky in Bomet that our community health strategy is very vibrant. We have all the community health volunteers in all the community units. It's well structured, it's well managed, it's well supervised. Such that if you go to a community unit right now and call for the ten community health volunteers, they'll all come. So our role there is to link that to our health. So for example, through the vision impact project, we need screeners and we use community health assistance to screen. So our role here is to ensure that the community health assistance gets the best and very high quality training on identification and prevention and referral of eye problems. Our eye conditions. So we take them through a rigorous three days training on primary eye care and disability included in disability inclusive development training. And we also do a five days training on PIC because this is the system that we use in referral, in identification also in data collection and referral over our patients. So we ensure that they are well trained. We also train them to mentor the community health volunteers because we don't train the community health volunteers. So we train them so that as they work with the community health volunteer, he mentors them so that once they leave, then we have a sustainability plan so that the community health volunteers will also be sensitive that we need to refer patients who have white spots or patients with allergies. Or the teary red eyes or children who have screens, we need to refer them. So, so we ensure that they get good training. We also train or some skills upgrade cost to nurses and clinical officers. This also maintains this with our staff who will work in the dispensaries and health centers. So we take the services closer home to the people. So we also ensure that they also undergo a three months training here in tenor hospital. And by the time they go back to their facilities, they're able to identify treats and also refer cases to either the secondary facility, which is our country for a hospital or to tenor hospital. Now they also, of course, conduct the treatment outreaches together with staff from the county referral hospital and the tertiary facility tenor hospital. So they also conduct the treatment outreaches. So by providing them that quality training, then in the treatment outreaches we don't minimize the chances of missing out on very important here. Critical aspects. Yes. Thank you. I'm so glad you can be with us today as well. That was great. And I think just a very quick question. I'd like you to elaborate on, I mean, you do a huge amount of training and ensuesing people in the community to engage and train. It must take a huge amount of energy. So how do you motivate community members, these different volunteers and role players, as Hannah was talking, these different people who are already engaging with communities. How do you get them enthusiastic about iHealth and achieve what you do? Please unmute yourself. There we go. Okay. So for us, iHealth here in Bomet County, it's like something that is new. We know, of course, there is high health, but to the community volunteers, it's something that is relatively programs that have not been done if I can say so. So people are really still very excited, very enthusiastic about it. You teach somebody and already they are saying that they can relate to a person they saw in the community or even their own relatives. So we are not having a bit of a challenge getting them interested. Also in the community, people are really interested. They come in very large numbers to the treatment outreaches. And so it's very important that we maintain very high standards of training, both for the screeners and also for the health staff. Fantastic. Thank you so much, Faith. Brilliant. I'm going to...