Evaluation of alternate outreach models for cataract services in rural Nepal

Abstract

BackgroundBharatpur Eye Hospital in Chitwan District, a primarily agrarian setting in south-central Nepal, reduced the number of diagnostic screening and treatment (DST) camps by one half (151 to 75) in an attempt to increase both the efficiency of its outreach program and the number of people that go directly to the hospital for service. The Hospital evaluated the two program models in terms of program costs, cataract surgical utilization, hospital direct payment and patient equity.MethodsThe study is a prospective, before and after, study of the impact of an alternate outreach model on cataract service utilization patterns and cost per outreach camp and cost per cataract surgery at Bharatpur Eye Hospital, comparing the service years July 2006 to June 2007, with July 2007 to June 2008. Study findings were based on routinely gathered hospital and outreach administrative data.ResultsThe total cost of the DST camps decreased by approximately US$2000. The cost per camp increased from US$52 to $78 and the cost per cataract surgery decreased from US$ 3.80 to $3.20. The number of patients who went directly to the hospital, and paid for cataract surgery, increased from 432 (17%) to 623 (25%). The total number of cataract surgical procedures at Bharatpur Eye Hospital remained very similar between the two service years (2501 and 2449, respectively). The presenting visual acuity and sex of the two cataract surgical populations were very similar (favouring women, 53 and 55% in the two years, respectively). A shift toward younger men and women occurred with a 245 (64%) increase in people age 50-59 years, and shift away from people age 70 years and older with a 236 (22%) reduction. The age and sex distribution of the direct paying patients were very similar in the two years.ConclusionThe new, more concentrated, more rural DST model of service delivery reduced overall outreach program costs, cost per cataract surgery transported, while increasing direct payments to the hospital, with a significant decrease in the number of people age 70 and older in the first year.

Longevity in Nepal: health, policy and service provision challenges

“…As noted above, there is a lack of research in this area, although the work of MICDA (2008) over the past ten years in Chitwan, is a notable exception. A few studies exist that explore the health needs of the elderly in relation to conditions such as uterine prolapse (Bonetti et al, 2004), cataract services (Kandel et al, 2010), parasitic infections (Shakya et al, 2006) however, overall there is a paucity of research into the health needs of the elderly in Nepal. One study examines metabolic syndrome amongst inmates of a home for the aged (Pemminati et al, 2009) and another on self-reported health problems of the elderly (Kshetri and Smith, 2010).…”

Strategies for cataract and uncorrected refractive error case finding in India: Costs and cost-effectiveness at scale

“…Only a handful of studies have examined the costs of other case finding strategies such as health facilities 29 , 30 or community outreach. 31 , 32 In these instances, the geographical scope has been limited to a particular facility, hospital or locality with uncertainty about how these might generalize at scale.…”