Table 4.

Results of in-depth interview with eye care managers

Discussion themes	Quotations
Feeling about the service	“… Still the service needs to be developed; surgeons are not using their potential”
	“…The service is not satisfactory…the backlog is still huge and attention for eye care is very poor”
Challenges
Distribution of services	“Eye care professionals are distributed disproportionately…no one is willing to go to the district secondary eye units”
	“Cataract surgeons were trained to address the need of rural communities in responses to shortage of ophthalmologists, but only few were happy to work in the secondary eye units, and most relocate to the major towns”
	“Expectation of the cataract surgeons is very high”
Poor community awareness	“The community is not aware of the service… they do not know that cataract surgery service is provided regularly at their nearest health facility…it is always thought the service is provided by external body through campaigns”
	“The eye care promotion messages are not reaching to the community in need of the service… they just do not understand what we are talking about… because health promotion materials and messages are delivered in Amharic… not in their local language”
Limited/no government support	“Government officials consider eye care as vertical NGO driven program…they just do not have any idea how huge the problem is…there is no sense of ownership”
Poor referral and reporting system	“There is no appropriate referral system in eye care… the eye units are not linked both horizontally and vertically”
	“…There is very poor reporting system, cataract surgery is usually under reported…different institutions provide the service… but we rarely get the report… if you have to know how much is really done, you should go and ask every health facility”
Surgical Supplies	“supplies are not available in the local market”
	“… we have to import everything… the offices concerned are slow in processing the clearance… there are times when we are forced to transfer the supplies to other African countries”
Solutions
Community awareness	“… Promotion of cataract surgery service should be done using local languages and appropriate media”
	“…Involve IECWs and local village leaders in mobilizing the service”
	“We should target improving the awareness of government officials”
Community based programs	“We need to establish comprehensive and regular outreach program”
	“…outreach service should be available to access the underserved communities” “…community based screening should be strengthened”
Future plans to improve service	“…establish primary eye care system and linking it with the existing secondary eye units, five primary eye units to one secondary eye unit”
	“…Improve the CSR, through ‘fast track strategy’… planned to perform 6000 cataract surgery per year on top of the existing number and then improving the number every year“