Retinopathy of prematurity (ROP) is a largely avoidable cause of blindness in children worldwide, requiring high-quality neonatal care, early detection and treatment. In middle-income countries throughout Latin America, Eastern Europe and South Asia, there has been a rise in ROP blindness due to a combination of increased survival of preterm infants, resource-scarce medical environments and lack of policies, training and human resources. However, Argentina is an example of country where rates of ROP blindness have declined and ROP programmes have been successfully and effectively embedded within the health and legal system. The purpose of this study is to describe the activities and stakeholders, including Ministry of Health (MoH) and UNICEF, involved in the process, from recognition of an epidemic of ROP blindness to the development of national guidelines, policies and legislation for control. Using a retrospective mixed methods case study design, data on rates of severe ROP was collected from 13 neonatal intensive care units from 1999 to 2012, and on the proportion of children blind from ROP in nine blind schools in seven provinces. Legislative document review, focus group discussions and key informant interviews were conducted with neonatologists, ophthalmologists, neonatal nurses, parents, MoH officials, clinical societies, legislators and UNICEF officials in seven provinces. Results are presented combining the stages heuristic policy framework and Shiffman including: agenda setting, policy formulation, implementation and evaluation. By 2012, ROP had declined as a cause of blindness in children in schools for the blind as had rates of severe ROP needing treatment in the NICUs visited. Multiple factors played a role in reducing blindness from ROP in Argentina and successfully coordinating its control including national advocacy, leadership, legislation and international collaboration. Lessons learned in Argentina can potentially be scaled to other LMICs in Latin America and beyond with further context-specific research.

Prematuro" (ROP), se creó en 2003. Objetivos. Describir la implementación y resultados alcanzados por el programa en la efectividad, acceso y calidad en la atención de la ROP (2004-2016). Población y métodos. Estudio descriptivo, retrospectivo, de una cohorte dinámica, en instituciones adheridas al registro. Población elegible: la totalidad de recién nacidos prematuros con factores de riesgo para desarrollar ROP. Resultados. Los servicios incorporados aumentaron de 14 a 98; cubrieron 24 provincias. Los niños < 1500 g registrados en 2004 fueron 956, y 2739 en 2016. El 22,7 % de estos presentó algún grado de ROP y el 7,8 % requirió tratamiento (ROP grave). La pesquisa superó el 90 % y aumentaron los tratamientos en el lugar de origen (57 %-92 %). La incidencia de casos inusuales sigue siendo elevada (17,3 % de los tratados) y aún se registran oportunidades perdidas. El uso de drogas antiangiogénicas se triplicó desde su inicio en 2011. Conclusiones. Se observan logros significativos en términos de representatividad, alcance y adherencia al programa, también en el acceso a la pesquisa y tratamiento en el lugar de origen; sin embargo, la incidencia de ROP es aún elevada. La subraya la necesidad de fortalecer aún más las acciones del programa en cuanto a servicios.

Introduction. The ROP Argentina Group was created in 2003 and is responsible for the National Program for the Prevention of Blindness in Childhood by Retinopathy of Prematurity (ROP) in Argentina. Objectives. To describe the program implementation and results achieved in relation to ROP care in terms of effectiveness, access, and quality (2004-2016). Population and methods. Descriptive, retrospective study with a dynamic cohort carried out in facilities that are part of the registry. Eligible population: All preterm newborn infants with risk factors for ROP. Results. Participating health care services increased from 14 to 98 and covered the 23 provinces and the Autonomous City of Buenos Aires. A total of 956 infants were born with < 1500 g in 2004 and 2739, in 2016. Of these, 22.7 % had some degree of ROP and 7.8 % required treatment (severe ROP). Vision screening exceeded 90 %, and treatments at the place of origin increased (57 %-92 %). The incidence of unusual cases is still high (17.3 % of treated cases), and missed opportunities are still recorded. The use of anti-angiogenic drugs trebled since 2011, when they started to be used. Conclusions. Significant achievements were observed in terms of program representativeness, scope, and adherence, and also in relation to screening access and treatment at the place of origin; however, the incidence of ROP is still high. The persistence of unusual cases and missed opportunities evidences deficiencies in the quality of health care and outpatient follow-up and underlines the need to strengthen the program actions in relation to services.

Background: A persistent challenge in international development is the lack of coordination both between recipient governments and donors, and implementing partners with the same donor. Coordination or cooperation is a conclusion of countless aid summits, but remains trapped in the theoretical-tangible methods of coordination are rarely offered. Here, we present a USAID-developed coordination mechanism, the District Operational Plan (DOP), implemented in 34 districts across Uganda by the Strengthening Decentralization for Sustainability (SDS) Programme. Structure/Method/Design: The objectives of the DOP are to ensure that USAID projects are aligned with district development plans, eliminate duplication and strengthen the district and USAID's joint coordination, implementation, monitoring, and evaluation of activities within the district. The DOP mechanism is threefold and includes a signed memorandum of understanding between district local government, USAID, and implementing partners (IPs); commitment to quarterly District Management Committee (DMC) meetings integrated into already-existing district planning meetings; and a sharing of quarterly workplans and reports with district heads of departments (HoDs). Prior to the quarterly meetings, the HoDs consolidate and analyze submitted work plans for duplication of activities or coinciding of scheduled activity dates. Results (Scientific Abstract)/Collaborative Partners (Programmatic Abstract): The DOP is a collaboration between district local government, USAID-Uganda, and USAID-funded IPs. SDS acts as a secretariat to USAID-Uganda and thus plays a key role in working with local governments to ensure the DOP is enacted. Non-USAID IPs also participate in this collaborative effort via DMC meetings if invited by the district leadership. Summary/Conclusion: The DOP initiative began in February 2012. To date, 78 DMC meetings have been held across 34 districts with an average of 69% USAID IPs present at each meeting. Technical assistance to district leaders in meeting facilitation, leadership, and integrated budgeting and planning has been delivered. So far, 13 districts have incorporated or invited non-USAID development partners into the coordination meetings. As a result of DOP implementation, some districts have reported improved understanding of IP activities, an improved leveraging of resources, and IPs have collaborated with one another on similar activities. Challenges include insufficient commitment by high-level officials in some districts, poor IP participation in DMC meetings due to "meeting fatigue," and late submission of work plans by some IPs.This innovative initiative is being studied by USAID missions outside Uganda for potential replication. Addressing the lack of applied government project-donor feedback and coordination mechanisms is a critical step toward recipient country-driven development and empowerment.