Africa, Cataracts, Surgery, Barriers


Purpose: Millions of individuals in sub-Saharan Africa are needlessly blind from cataracts. While progress was made towards the Vision 2020: The Right to Sight goals, Ethiopia, Ghana, and Zambia fell short of the recommended cataract surgical rate (CSR) on a national level. The purposes of this study were to describe possible economic factors impacting surgeon surgical productivity, possible barriers to attaining the recommended CSR, and surgical services in each of these countries.

Methods: An online survey was sent to ophthalmologists practising in Ethiopia, Ghana, and Zambia. Responses were collected between June 25, 2021 and January 30, 2022.

Results: Responses were received from 122 ophthalmologists from Ethiopia, Ghana, and Zambia. The estimated participation rate was 47% (122/257). A large percentage of respondents reported that their current financial reimbursement does not incentivise maximum productivity in themselves (56%, 68/122) nor their staff (61%, 74/122). Private practice was the most agreed upon work setting to have the best reimbursement incentives (77%, 94/122), whereas government hospitals were least agreed upon (4%, 5/122). Distance to cataract surgical centres, lack of surgical centres, and lack of surgical equipment were within the top ten most agreed upon barriers by respondents within each of the countries.

Conclusions: The lack of financial incentives to maximise cataract surgical productivity and the barriers to surgical uptake identified in this study suggest surgical underperformance of operational capacity and that increased eyecare funding is needed within these countries.

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Life Sciences


Health Science

University Standing at Time of Publication

Full Professor