Table 4.
Core indicators to monitor universal access to quality, affordable eye care services
| Definition | Rationale | Data sources | Responsible entity | Comments | |
|---|---|---|---|---|---|
| Accessibility of eye health services | |||||
| Eye health facility density and distribution | Total numbers (public and private) of primary, secondary, tertiary, and low vision services per million population, by place of residence (urban or rural); additional subnational administrative or geographic divisions as relevant to setting | Place of residence should not be a barrier to accessing eye health services | Facility records, population data | Health ministry | Informs policy and planning about location of eye health services in relation to population density; outreach programmes might be planned according to gaps in geographic access to static services |
| Eye health worker density and distribution | Total numbers of ophthalmologist, optometrist, ophthalmic nurses, and other ophthalmic personnel per million population, by place of residence (urban or rural); additional subnational administrative or geographic divisions as relevant to setting | Availability and accessibility of eye health workers dictates access to care | Facility records, data from professional or regulatory bodies, population data | Health ministry | Informs policy and planning on recruitment and distribution of resources for eye health; known disparities exist in the number and distribution of trained eye care personnel between countries and by urban and rural settings within countries |
| Affordability of eye health services | |||||
| Coverage of national health finance pooling mechanisms that include eye care services | Proportion of population covered with health finance pooling mechanisms that include eye care services (considered individually): out-patient care, cataract, refractive error services, glaucoma treatment, and diabetic retinopathy treatment | Cost should not be a barrier to accessing eye care; proxy for WHO, World Bank, UHC financial risk protection indicators; catastrophic and impoverishing out-of-pocket payments unlikely to be discriminatory for monitoring affordability of elective eye care services | Health finance scheme reports and questionnaires | Health ministry | Informs policy about eye health financing and affordability; coverage within the lowest wealth quintile should be reported alongside the total population to monitor equitable coverage of eye health financing |
| Out-of-pocket payments for cataract surgery | Median (and range) of out-of-pocket payments made for cataract surgery as a proportion of median monthly household (or individual) income | Cost should not be a barrier to accessing eye care. Proxy for WHO, World Bank, UHC financial risk protection indicators; catastrophic and impoverishing out-of-pocket payments unlikely to be discriminatory for monitoring affordability of elective eye care services | Population-based surveys | Health ministry (surveys might be commissioned in collaboration with other stakeholders) | Informs policy about eye health financing and affordability; additional services could be monitored in the same way |
| Effective coverage of cataract and refractive error services | |||||
| Effective cataract surgical coverage | Among the population aged 50 years and older, people with operated cataract and good postoperative presenting visual acuity as a proportion of all people with operated cataract or operable cataract (disaggregated by sex or gender) | Sex-disaggregated or gender-disaggregated effective coverage measures UHC dimensions of access, quality, and equity for the leading cause of blindness globally | Population-based surveys | Health ministry (surveys might be commissioned in collaboration with other stakeholders) | Informs policy and planning about the met and unmet need for cataract surgical services; candidate WHO UHC tracer indicator. |
| Effective refractive error coverage | Adults with refractive error corrected to a predefined visual acuity threshold with habitual correction as a proportion of all people with corrected and uncorrected refractive error (disaggregated by sex or gender) | Sex-disaggregated or gender-disaggregated effective coverage measures UHC dimensions of access, quality, and equity for the leading cause of vision impairment globally | Population-based surveys | Health ministry (surveys might be commissioned in collaboration with other stakeholders) | Informs policy and planning about the met and unmet need for refractive error services; candidate WHO UHC tracer indicator |
| Prevalence of vision impairment | |||||
| Prevalence of vision impairment | The prevalence of all cause distance and near vision impairment (WHO definitions); disaggregation by key equity measures and by avoidable versus non-avoidable vision impairment | Proxy measure of eye health; a measure of programmatic success. Journey towards eye health as part of UHC | Population-based surveys | Health ministry (surveys might be commissioned in collaboration with other stakeholders) | Disaggregated vision impairment prevalence estimates inform policy makers about the impact of eye health systems on eye health among population subgroups |
Seven core indicators identified through the indicator prioritisation exercise, done by this Commission. UHC=universal health coverage.