Addressing Eye Care for Underserved Populations in East Africa
Introduction
Limited access to and low quality of cataract surgeries in low-income and rural areas of East Africa causes an increased burden of visual impairment for underserved populations. In East Africa, 30-50% of blindness is caused by cataracts, with the number of individuals suffering from cataracts in sub‐Saharan Africa estimated at 3.6 million and rising each year (Lewallen, 2006). Cataract-induced blindness inhibits children from attending school, adults from entering the workforce, and family members gaining the familial support and connection they need.
The World Report on Vision indicates that the burden of vision impairment tends to be greater in low- and middle-income countries and underserved populations (i.e. women, migrants, indigenous peoples, persons with disability, and persons living in rural communities) (World Health Organization, 2019). In many low-income regions, patient access to surgery and quality of surgeries provided are severely limited due to lack of resources. One study indicated that approximately 30 % of the global burden of disease is related to surgery and 25% of individuals who undergo surgery each year face financial hardship as a result. In Africa, where the risk of financial hardship from surgery is the highest (Shrime, 2016), approximately 413 million people live on $1.90 per day or less. Of those, 82% live in rural areas and earn their income primarily through farming (Beegle, 2016). In East Africa particularly, many patients are required to provide or pay for the supplies necessary for their surgeries in addition to the cost of the surgery itself. This necessity exacerbates an already strained population in a geographic region endemic to cataracts which could have been prevented or have yet to be addressed.
Disparity at an Individual Level
Individual health behavior is impacted by several factors including awareness, experiences, expectations, income, employment, and transportation. In Africa, where the risk of financial hardship from surgery is the highest (Shrime, 2016), approximately 413 million people live on $1.90 (USD) per day or less. Of those, 82% live in rural areas and earn their income primarily through farming (Beegle, 2016). As exposure to ultraviolet light from the sun increases risk of cataract and other eye conditions (Linetsky et al., 2014), those who work in agriculture and are already earning low wages are disproportionately at risk of developing cataracts. This would inhibit them from continuing to work, leaving these individuals with almost no means to provide what they need for basic food and shelter. Those who work in farming, especially a farm run by family, are also less likely to have received a formal education, thereby limiting their awareness and understanding of positive health behavior and western-based medical care (Linetsky et al., 2014). Additionally, in 2014, Sub- Saharan Africa recorded 2% of vehicle ownership per capita compared with 70% in the United States, 50% in Europe, and 6% in China (OECD, 2015). This indicates that those individuals in rural areas who are already at increased risk of cataract development and making meager wages, are also limited in their ability to travel when health services are needed. With limited transportation, low income, and increased risk of cataracts, the individuals living in rural areas of east Africa are disproportionately impacted by the burden of visual impairment.
Disparity at an Organizational Level
In many rural areas, availability of care is also limited to care provided by visiting eye professionals (Courtright, 2010). In Tanzania, Kenya, Zimbabwe, and Madagascar, where CharityVision is present, there is an average of 1-2 ophthalmologists per 1 million people in each country (Resnikoff, Felch, Gauthier, & Spivey, 2012). In rural regions where transportation options are scarce and the distance to the nearest clinic is great, individuals are unlikely to make the needed voyage to see one of the few ophthalmologists available. Low affordability in ophthalmic care adds strain to the already limited health services available. If individuals do save the funds and travel far distances to seek help, they are unlikely to be able to return for follow-up care (Courtright, 2010). Lack of organization-level support increases health disparity in these rural communities as access to proper health services is extremely limited.
CharityVision International
Brighton Kirk, who assists in overseeing CharityVision’s international programs, provided a comparison of cataract surgery cost based on the reports received from the CharityVision clinic director in Tanzania. In Tanzania, the average cost of cataract surgery owed by the patients is between $172 and $260. CharityVision partners with Deepak Care LTD in New Delhi, India which makes consumable cataract surgery packs which can be easily shipped overseas and distributed to hospitals and clinics in rural areas. Based on this collaboration and the program contracts with the local health professionals, CharityVision is able to distribute the Deepak consumable surgery packs for just $25 per pack. This reduces the cost of surgery by 85% to 90%. However, CharityVision covers the remaining 10%-15% through donated funds, ultimately providing the surgery at low- or no-cost for the patients themselves.
Between 2017and 2019, CharityVision performed 349 outreaches, screened 164,541 patients, donated 23,919 glasses, and performed 26,327 surgeries within the countries of Madagascar, Tanzania, Zimbabwe, and Kenya. These services were provided in collaboration with Salfa Eye Clinic, CharityVision Tanzania Clinic, Eyes For Zimbabwe, and the University of Nairobi as well as other supplier partners including Deepak Care LTD. For every person who receives cataract surgery, it is estimated that an average of 4 additional individuals previously burdened as caregivers are able to return to the workforce (Khanna, Pujari, & Sangwan, 2011). This not only builds a productive community- but adds significantly to the local economy. In addition to the services provided directly to patients, 1,752 consumable surgery packs were distributed to CharityVision’s partner clinics and hospitals, increasing local facility capacity to serve.
CharityVision has effectively reduced the cost of care for both the healthcare professionals and the patients alike, while also creating sustainable support for local healthcare infrastructure. The impact of this model in low-income areas of East Africa suggests a viable solution to be expanded in other resource-poor regions of both the developed and developing worlds.
References
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