Beyond prevalence: A complete catchment eye health system profile using rapid assessment of avoidable blindness, a population-based eye health survey, and the first implementation of the newly developed health system module.

BACKGROUND

Planning eye care services often relies on either population need or facility capability, but seldom both. We provide a complete catchment-level assessment by integrating Rapid Assessment of Avoidable Blindness epidemiological estimates with the new Health System Module..

METHODS

A population-based survey using the Rapid Assessment of Avoidable Blindness, including a diabetic retinopathy module, was conducted in a defined service area of a surgical centre and its affiliated vision centres. The Health System Module captured cataract, refractive, and diabetic retinopathy service availability and data quality across all major providers.

RESULTS

Of the 4,095 participants enumerated, aged 50 and older, 3,867 (94.4%) were examined. The age- and sex-adjusted prevalence of blindness was 2.2%, higher in women (2.8%) than men (1.6%) (p < 0.001), while visual impairment affected 29.5%. Unoperated cataract accounted for 76.5% of blindness, 84.3% of severe, and 54.7% of moderate impairment; uncorrected refractive error caused 79.2% of mild impairment. Cataract surgical coverage was 59.6% at 6/12 and 70.3% at 6/18, with a 36.6% quality gap. A higher proportion of operated patients had a good outcome (74.4%) when surgery was performed within 2 years, compared with 57.0% when performed earlier (p < 0.0001). Distance refractive error coverage was 14.0%, lower among women (9.5%) than men (19.5%) (p < 0.001). Of the 14 providers, data on cataract surgeries were available from 12, on glasses from four, on visual acuity before and after surgery from one, and on DR services from none. Combined RAAB and Health System Module results showed that although the cataract surgical rate of 7,165 surgeries per million people annually exceeded the national average, an estimated 41,165 individuals had blindness or visual impairment from cataract in both eyes.

CONCLUSION

Integrating RAAB with a structured health system assessment enabled a unique, comprehensive situational analysis linking epidemiological needs with service capacity. It also highlighted data gaps, feasibility and operational limitations regarding data for cataract, refractive, and diabetic retinopathy services in the region. This model can guide regional planning and strengthen monitoring of effective coverage. However, challenges in data collection can reduce the programmatic utility of the Health System Module.