Evaluation of the Utilisation of Cataract Surgery Services in South India - Article Example

 Evaluation of the Utilisation of Cataract Surgery Services in South India Introduction: Blindness is a major health problem in India. It has been estimated that about 12 million people are suffering from blindness in India, the dominant cause of which is cataract. Cataract accounts for nearly two-third of blind population in India. The Government of India launched National Programme for Control of Blindness in 1976 and the World Bank Assisted Cataract Blindness Control Project in 1994, with the aim to bring down the incidence of blindness from 1.4% to 0.3%. To achieve this, eye care infrastructure and human resources were developed, accessibility to eye care services were increased and quality of eye care services were improved. As a result, many cataract surgeries were performed and are being performed at various visual camps to restore vision of the affected persons. Cataract is easily treatable by surgery (C. WHO, 1991). Though extra capsular cataract extraction (ECCE) is much better than intra capsular cataract extraction (ICCE) in terms of outcome and patient satisfaction (Gillies et al., 1998), not many surgeons are trained in ECCE. Also, it is much costlier and takes longer time. Consequently, a substantial part of cataract extractions are still performed as ICCEs. Other than these aspects, the utilization of these services also may not be satisfactory. In a study by Nirmalan et al (2004), it has been reported that a large proportion of people who required eye care did not utilize eye care services at the time. The reasons cited in this study were “no money”, “no time”, “no escort”, “did not think the problem was important”, “fear”, “advised by others to do something else” and “did not know where to go”. In our study, we would like to evaluate the utilisation of cataract surgery services mainly in South India and find out reasons for not utilization so that policies can be recommended to improve these health services. Background of the study: Many studies have been conducted to demonstrate the efficiency of these cataract intervention programmes. The performance of such programmes is assessed by the total number of cataract surgeries performed each year. However, these statistics have a limited value, because it is not only the number of surgeries performed that is of significance, but also the number of individuals benefiting and the extent of that benefit (Foster 1992). Ideally, the success rate should be defined by the percentage of eye operations that result in restoration of sight in one year (Limburg et al. 1996). Aim: The aim of this study is to evaluate the health care utilization of patients undergoing cataract surgery in South India so that recommendations can be made about eye health policies and improvement can be made on the utilization of existing cataract surgery facilities. Also, the study aims at encouraging future eye health policies in a way which takes locally available resources and realistic perspectives into account. Materials and Methods: The study will be conducted at the LV Prasad Eye Institute (LVPEI) in Hyderabad and Sankara Eye Institute in Cooimbatore. The sample will consist of 60 participants who will fall in to two different groups of patients based on their residential status- urban and rural. These will be further divided in to two subgroups – respondents to offered cataract surgery services and non-respondents to offered cataract surgery services. Key-informants will be ophthalmologists, administrators and the community-screening programme co-ordinators working at these two hospitals. The focus groups will include those patients who responded to offered cataract surgery services but have not taken part in the face to face interviews and are willing to take part in a focus group discussion while being at one of the two participating hospitals. The basis of data collection in this study will be a semi-structured interview with an aim to give indications as to where further research is needed in order to improve current eye health services delivery. A standard set of questions will be developed for the face to face patient interviews, key informant interviews and focus group discussions which will be administered by a trained local research assistant. The questionnaire will be designed in such a way that it will be understood by all participants irrespective of their educational level and will use simple language. Study design: The study will be a non-experimental, exploratory, qualitative approach aimed to obtain a cross-sectional view of the health care utilization behavior of cataract surgery patients. Data collection will be through interviews with patients and their key informants and focus group discussions. Data collection: A standard set of questions will be developed for the face to face patient interviews, key informant interviews and focus group discussions. The face to face interview will use a questionnaire administered by a local research assistant. A male research assistant will interview male patients and a female research assistant will interview female patients. Both focus group discussions will be facilitated by a research assistant. Data analysis: For this type of study, most of the data will be qualitative and a small amount will be quantitative. Since data processing will be difficult for qualitative data (Fieldmann, 1995), the data will be categorized using codes as far as possible. This data will be analyzed using a special computer software designed to analyze qualitative data. This will either be NVIVO or (qsr) NUDIST, depending on which one seems to be more appropriate once the data have been translated and transcribed. Quantitative data will be analyzed using Windows SPSS 7.5 through which basic descriptive analysis will be done. Information about frequencies and means will be provided in the form of tables, charts and graphs. Ethical considerations: The study will be submitted to the Curtin University Ethics Committee and any other Ethics Committees, as required, for approval prior to commencement of the study. The anonymity and confidentiality of participants will be respected; questionnaires will have an identification number only. Data will be entered into a database which will be password protected. Paper data will be stored in a locked box accessible only by me. Significance of the study: This study will evaluate the utilization of cataract surgery services in South India, based on which, policies regarding health services will be recommended so that more and more people avail these facilities. References 1. Feldmann, M. S., 1995. Strategies for Interpreting Qualitative Data. Thousand Oaks, London, New Delhi: Sage Publications. 2. Foster, A. 1992. "A Simple Methodology for Evaluating Surgical Cataract Services in Prevention of Blindness Programmes." Journal of Community Eye Health 10: 2-5. 3. Gillies, M., Brian, G., La Nauze, J., Le Mesurier, R., Moran, D., Taylor, H., et al., 1998. “Modern surgery for global cataract blindness: Preliminary considerations.” Archives of Ophthalmology, 116(1): 90-92. 4. Limburg, H., Kumar, R., & Bachani, D., 1996. "Monitoring and Evaluation of Intervention Programmes for Cataract and Refractive Errors in India." British Journal of Ophthalmology 80: 951-55. 5. Nirmalan, P. K., Katz, J., Robin, A. L., Krishnadas, R., Ramakrishnan, R., Thulasiraj, R. D., et al., 2004. “Utilization of eye care services in rural south India: the Aravind Comprehensive Eye Survey.” British Journal of Ophthalmology, 88: 1237-1241. 6. WHO, C.,1991. “Use of intraocular lenses in cataract surgery in developing countries: Memorandum from a WHO meeting.” Bulletin of the World Health Organization, 69(8): 657-666. Read More