Abstract
BackgroundCataract is the leading cause of blindness worldwide, with the greatest burden found in low-income countries. Cataract surgery is a curative and cost-effective intervention. Despite major non-governmental organization (NGO) support, the cataract surgery performed in Southern Region, Ethiopia is currently insufficient to address the need. We analyzed the distribution, productivity, cost and determinants of cataract surgery services.MethodsConfidential interviews were conducted with all eye surgeons (Ophthalmologists & Non-Physician Cataract Surgeons [NPCS]) in Southern Region using semi-structured questionnaires. Eye care project managers were interviewed using open-ended qualitative questionnaires. All eye units were visited. Information on resources, costs, and the rates and determinants of surgical output were collected.ResultsCataract surgery provision is uneven across Southern Region: 66% of the units are within 200 km of the regional capital. Surgeon to population ratios varied widely from 1:70,000 in the capital to no service provision in areas containing 7 million people. The Cataract Surgical Rate (CSR) in 2010 was 406 operations/million/year with zonal CSRs ranging between 204 and 1349. Average number of surgeries performed was 374 operations/surgeon/year. Ophthalmologists and NPCS performed a mean of 682 and 280 cataract operations/surgeon/year, respectively (p = 0.03). Resources are underutilized, at 56% of capacity. Community awareness programs were associated with increased activity (p = 0.009). Several factors were associated with increased surgeon productivity (p < 0.05): working for >2 years, working in a NGO/private clinic, working in an urban unit, having a unit manger, conducting outreach programs and a satisfactory work environment. The average cost of cataract surgery in 2010 was US$141.6 (Range: US$37.6–312.6). Units received >70% of their consumables from NGOs. Mangers identified poor staff motivation, community awareness and limited government support as major challenges.ConclusionsThe uneven distribution of infrastructure and personnel, underutilization by the community and inadequate attention and support from the government are limiting cataract surgery service delivery in Southern Ethiopia. Improved human resource management and implementing community-oriented strategies may help increase surgical output and achieve the “Vision 2020: The Right to Sight” targets for treating avoidable blindness.
Highlights
Cataract is the leading cause of blindness worldwide, with the greatest burden found in low-income countries
It included all parts of the region where cataract surgery services were delivered and where ophthalmologists and non-physician cataract surgeons (NPCS) were based
A complete list of all 16 health facilities where cataract services were being delivered was generated from records of the Regional Health Bureau and supporting non-governmental organization (NGO)
Summary
Cataract is the leading cause of blindness worldwide, with the greatest burden found in low-income countries. Cataract is the leading cause of blindness and low vision in Ethiopia: >0.5 million people are blind and about 1.2 million are severely visually impaired [5]. The Cataract Surgical Rate (CSR) is the number of cataract operations/million population/year. It is an internationally recognized measure of cataract surgery service activity and an indicator of the availability and acceptability of the service to the population [8,9]. Vision 2020: The Right to Sight, is a World Health Organization (WHO) led global initiative to eliminate avoidable blindness, which recommends a target CSR for Sub-Saharan Africa (SSA) of around 2000 operations/million/year to address the current cataract blindness backlog [9]. Ethiopia recorded a CSR of 360 in 2006 [11]
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