International Centre for Eye Health, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.
BMC Health Serv Res. 2013 Nov 19;13:480. doi: 10.1186/1472-6963-13-480.
Cataract 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.
Confidential 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.
Cataract 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.
The 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.
白内障是全球致盲的首要原因，低收入国家的负担最重。白内障手术是一种有疗效且具有成本效益的干预措施。尽管得到了主要非政府组织（NGO）的大力支持，但埃塞俄比亚南部地区的白内障手术目前仍不足以满足需求。我们分析了白内障手术服务的分布、生产力、成本和决定因素。
使用半结构式问卷对南部地区的所有眼科医生（眼科医生和非医师白内障外科医生[NPCS]）进行了机密访谈。使用开放式定性问卷对眼科保健项目管理人员进行了访谈。访问了所有眼科单位。收集了资源、成本以及手术产出率和决定因素的信息。
白内障手术的提供在南部地区分布不均：66%的单位距离地区首府 200 公里以内。外科医生与人口的比例差异很大，从首府的 1:70000 到包含 700 万人的地区没有服务提供。2010 年的白内障手术率（CSR）为每百万人口每年 406 例手术，区 CSR 范围在 204 至 1349 之间。平均手术量为每位外科医生每年 374 例手术。眼科医生和 NPCS 每年分别进行 682 例和 280 例白内障手术（p=0.03）。资源利用率仅为 56%，未充分利用。社区宣传计划与活动增加相关（p=0.009）。有几个因素与外科医生生产力的提高有关（p<0.05）：工作 2 年以上，在 NGO/私立诊所工作，在城市单位工作，有单位经理，开展外展计划和有满意的工作环境。2010 年白内障手术的平均成本为 141.6 美元（范围：37.6-312.6 美元）。单位从非政府组织获得其 70%以上的耗材。管理人员认为员工积极性差、社区意识薄弱以及政府支持有限是主要挑战。
基础设施和人员分布不均、社区利用不足以及政府关注和支持不足，限制了埃塞俄比亚南部地区白内障手术服务的提供。改善人力资源管理和实施以社区为导向的战略可能有助于提高手术产出率，并实现“视觉 2020：享有看见的权利”治疗可避免盲目的目标。
