Improving Cataract Services for Underserved Groups

Cataract is the leading cause of blindness globally, and a major cause of vision impairment, affecting an estimated 94 million people in 2020. The scale of this challenge is not spread equally however, with some places and population groups experiencing much higher prevalence of the potentially blinding condition. This is despite surgery being an existing, highly cost-effective treatment for cataract, as certain groups are less able to access safe, high-quality treatment.

A new global study led by the International Centre for Eye Health has identified the groups considered by panellists to be most underserved by cataract services in different world regions, as well as the most promising strategies to improve access for these groups. This information is useful as countries respond to the ambitious global target set by member states at the 74^th World Health Assembly to increase effective cataract surgical coverage (eCSC) by 30 percentage points by 2030. eCSC is a measure of how many people with cataract needing surgery have received it with a good outcome.

The study used a Delphi process, a widely used expert consultation method, to identify and prioritise underserved groups and promising strategies. Panel members were asked which groups in their setting experienced the most difficulty accessing cataract services, followed by what interventions in their area are most effective at increasing their access to both screening and surgical services.

Following a prioritisation process, at the global level the groups ranked highest in terms of being a large group and having the most difficulty accessing services were rural/remote dwellers, people with low socioeconomic status and people with low social support.

In terms of strategies to improve access to screening services, the panel considered the most promising strategies to be policy development for primary care screening programmes and strengthening the skills of primary care staff. Further strategies included establishing permanent services closer to the community level and eliminating the out-of-pocket costs for patients that need care.

Panellists thought access to surgical services could be improved by decentralizing services so that surgery was permanently available at the district level or below. Strengthening integration between screening, referral, surgery and follow-up and reducing out-of-pocket costs for surgery were also prioritised as good strategies.

We believe this to be the first study to answer these specific questions, and the range of strategies prioritised across regions highlights the need for context-specific approaches to improve access to cataract services and promote equity.

Recommendations from the study that can be considered by governments and their partners in pursuit of improvements in eCSC include:

• Supporting health information systems to strengthen monitoring of inequality and provide evidence for policy and planning
• Including social variables in the most commonly implemented survey tool, the Rapid Assessment of Avoidable Blindness
• Including the intersection of gender with other social attributes in future research to consider the disproportionate disadvantage experienced by some women

When planning services, we hope countries can refer to the list developed in this research for the activities most promising and feasible in their setting. The study can serve as a ‘menu of strategies’ that can be tested, alone or in combination with others to improve services within an area, ensuring that no one is left behind.

Publication: Ramke J, Silva JC, Gichangi M, The Cataract Access Study Group, et al. Cataract services for all: strategies for equitable access from a global modified Delphi process. PLOS Global Public Health. February 2022. https://doi.org/10.1371/journal.pgph.0000631

Image on top: Four patients who have had cataract surgery in the frame, focus is on patient with his green cap removed and a hand over his right eye smiling/Abir Abdullah