Challenges of delivering cataract services in Nigeria

In this step Professor Caleb Mypet discusses how to create demand and deliver high output and high quality cataract services in challenging circumstances.

Cataract services are not readily available in Nigeria. At present there are about 3 ophthalmologists per million population and most eye care services are located in the major cities far away from the people that need them. As a result, patients are often uninformed about what and where to seek the treatment of cataract. Rural patients turn to traditional healers for “couching” (a procedure that involves dislodging the cataractous lens into the vitreous, using an sharp instrument and physical pressure on the eye).

Traditional healer © ODI CC BY-NC 2.0

When patients go to the cities for treatment, they are faced with:

• Difficult access and transport services
• A hospital appointment system
• Several hospital visits before surgery is scheduled.
• Direct and indirect costs is often a major deciding factor on uptake of surgery.
• Anxiety due to long waiting time for surgery

The low surgical rate often is linked with inefficiency at hospital level. Getting on the list for surgery does not usually guarantee it will be done. Delays and cancellations for various reasons such as power failure, absence of the surgeon and lack of efficient use of allocated theatre time, difficulties with equipment etc.

Professor Mpyet suggests a number of key approaches to addressing these challenges in the video. Can you suggest or share effective methods from your own setting, that can be used to address patient information on cataract surgery? Which challenges must be considered before implementing your preferred approach, either in your setting or in Zrenya our hypothetical case study from week 2?