Influencing Government to reduce cost of cataract surgeries in public hospitals

CBM, in collaboration with local partners, is implementing a SiB programme in Ivory Coast which is focused on reducing blindness through increasing the number of cataract surgeries in 6 regions. The programme will provide 7 hospitals with essential eye care equipment and consumables and train ophthalmologists in eye surgery. It places a strong emphasis on public regional hospitals, where eye surgery is currently unavailable due to a lack of equipment and trained doctors. The programme will also improve access to surgical eye care and awareness of the prevention of blindness through collaboration with the Ivory Coast Red Cross, who will conduct community outreach through their existing volunteer network, and by working with local disabled people’s organisations to conduct advocacy and awareness raising activities.

At the moment, the Ivorian cataract surgery rate is only 170 per 1 million inhabitants. One of the main barriers to people accessing cataract surgery is the very high costs charged by eye health providers both in the public and private sector. Currently, prices for cataract surgery, excluding examinations and medicine, fluctuating between 200 000 FCFA (325 USD) and 400 000 FCA (650 USD) in a country where average monthly income per inhabitant is under 102 USD per month.

Therefore, CBM’s SiB programme has included an advocacy component to reduce the cost of cataract surgery as one of its key objectives. Hence the intention is  not only to reach the programme goal of performing 14,776 cataract surgeries but to have a long term impact on financial accessibility which is expected to lead to a higher surgical rate in the country.

As the programme is working mostly with public hospitals, the government will be the key target for the advocacy campaign both at national and regional levels.

The first stage of the advocacy strategy has been to target the Programme National de la Santé Oculaire et de la Lutte contre l’Onchocercose (PNSOLO), the national programme for eye health and the fight against river blindness. Both CBM and its partner the Confédération des Organisations des personnes handicapées (COPHCI)lobbied PNSOLO and the Ministry of Health to persuade them of the importance of lowering surgery costs in the four Regional Hospitals (CHRs) where eye surgery theatres were being set up by the SiB programme, as those will be the first regional hospitals in Ivory Coast to deliver cataract surgeries.

Having convinced the Head of PNSOLO, she became a strong advocate for lowering surgery costs. She addressed the issue with the Directorate-General of the Ministry of Health and received their support to take forward the discussions with regional health authorities and the targeted CHRs.

A few months later, a joint PNSOLO-CBM team travelled to each of the four regions (San-Pedro, Man, Yamoussoukro and Korhogo) and met with the Regional Hospitals and the regional Health authorities which led to the following outcomes:

• Support from the regional authorities to reduce costs.
• Agreement from the hospitals to reduce the cost of preoperative laboratory tests. The additional income from surgeries will offset the lost income.
• Agreement from the hospitals to apply a unique fixed price for cataract surgery. The price still yet to be established will be somewhere between 50,000 FCFA (80 USD) and 100,000 FCFA (160 USD. Moreover, this cost will include postoperative drugs for two weeks.

A formal agreement will be signed between the Ministry of Health and the Regional hospital confirming the commitments and setting the price for the surgeries. PNSOLO is leading the development of the convention which will then be validated by the legal department of the Ministry of Health.

So far, the programme has been quite successful in advocating for cost reductions and is hoping that more can be achieved with continuous efforts and support from CBM’s partners. The next step in the advocacy strategy will be to address the question of lowering costs with the University Hospitals (CHUs), two of which are also involved in the SiB programme. COPHCI and CBM will both be leading these advocacy efforts.

COPHCI will also be focussing further advocacy activities towards the Ministry of Economy. As prices for cataract surgeries depend partially on the cost of consumables COPHCI is advocating for the Ministry of Economy to recognise all product involved in cataract surgery as a social goods which would mean that custom duties on imports would be reduced for the public sector and non-profit organisations, which is hoped would lead to further reduction in surgery prices.

Jules Kouassi,
SiB programme manager
CBM Ivory Coast
[email protected]