Approximately 20 million people across the world are blind from cataracts [1]. The WHO stated the need for more collaboration between governmental and non-governmental agencies in an effort to remove cost as an obstacle to cataract operations.
Engaging in Cataract Surgery Partnerships (CSP) to deliver cataract surgeries in developing countries, appears to be a credible option and noteworthy contributor to increasing Cataract Surgical Rate (CSR) throughout the Caribbean Region. CSR is defined as the number of cataract surgery operations performed per year per million population [2].
CSP is an arrangement between two organizations or countries for the provision of cataract surgery in countries where there is no local or high-volume eye surgeon available. However, influencing health leaders to pursue CSP can be difficult due to lack of awareness of the impact on CSR or limited funding to make it happen [3].
In 2019, Trinidad Eye Hospital (TEH), a private cataract surgery provider embarked on a CSP starting with a Public-Private Partnership in Antigua & Barbuda which was funded by the government. Soon after, Private-Private Partnerships with St. Lucia and Dominica also developed, but at a cost to patients. During the CSP, TEH gained influence by building trust, conducting education sessions and sharing patient testimonies with decision-makers which resulted in CSP adoption and continuity.
When combined with cataract surgeries done in the public and private sectors (Table 1) the CSP increased CSR, in two out of the three countries. There was a 735.1% increase in CSR from 376 to 3140 in Antigua & Barbuda (Fig. 1) and in Dominica, a 65.8% increase from 2082 to 3452. In St. Lucia, public sector cataract surgery numbers were not available at the time of this publication, therefore CSR could not be calculated. As far as we are aware, TEH was the only CSP operational in all 3 countries during this period, and maintained a 2% complication rate.
Table 1.
The number of cataract surgeries delivered by the CSP and by non-CSP providers in both Antigua & Barbuda and Dominica for the period 2019−2023.
| YEAR | Country | |||
|---|---|---|---|---|
| Antigua | Dominica | |||
| Non- CSP | CSP | Non- CSP | CSP | |
| 2019 | 35 | 27 | — | — |
| 2020 | 36 | 16 | — | — |
| 2021 | 29 | 107 | — | — |
| 2022 | 44 | 262 | — | — |
| 2023 | 37 | 255 | 152 | 100 |
— represents no data available.
Fig. 1. Cataract Surgical Rates (CSR) for Antigua & Barbuda (2019-2023) and Dominica (2023) with and without Cataract Surgery Partnership (CSP).
The graph demonstrates the trend in Antigua & Barbuda’s overall CSR having formed a Cataract Surgery Partnership (CSP) for the years 2019-2023. The overall CSR included cataract surgery numbers from both non-CSP and CSP Providers. Also shown for Antigua & Barbuda is the CSR by non-CSP providers only over the same time period. The graph also shows overall CSR in Dominica having formed a Cataract Surgery Partnership (CSP) for the year 2023. Also shown for Dominica is the CSR by non-CSP providers only for the same year.
For CSP success, the following are recommended: -
-Trust among partners
-Time for education and training
-Testimonies from patients.
Building rapport with partners elevated patient care and empowering local human resources to learn through pre-operative and post-operative training was also beneficial [3].
Stakeholders heard patient testimonies that were emotionally moving and influenced leaders on a deeper level. In some cases, testimonies tipped the scales towards partnership in a matter of minutes.
There were some challenges adhering to surgery schedules due to infrastructural setbacks, lengthy approval processes and limited access to officials to clear obstacles. This consequently reduced the number of CSP surgeries performed.
Teaching and training the local pre-operative and post-operative teams to achieve the required standard of care was time consuming but valuable.
CSP is an effective tool towards reducing avoidable blindness, and can increase a country’s CSR. Building rapport and trust with stakeholders inspired confidence that collaboration can be beneficial. Interventions like this can be further developed and studied to increase uptake of cataract surgery in low-and middle-income countries [4].
Acknowledgements
We thank Professor Susan Mollan, University Hospitals Birmingham for her advice on this publication.
Author contributions
Ms. Franka Mohammed: First drafting of manuscript. Ronnie Bhola: Critical review of the manuscript. Ms. Anura Bodoe-Bunsee, Hazel Shillingford-Ricketts, Dharmendra Shah: Analysis of data.
Data availability
Data included in this article may be shared on reasonable requests to the corresponding author.
Competing interests
The authors declare no competing interests.
Footnotes
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References
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Data Availability Statement
Data included in this article may be shared on reasonable requests to the corresponding author.