Barriers to the uptake of cataract surgery for women in urban Cape Town
Groote Schuur Hospital (GSH) is a mainly state-funded hospital in the southern suburbs of Cape Town, South Africa. The majority of patients presenting to the Department of Ophthalmology cannot afford private medical care. According to the most recent WHO data on blindness, women are 1.5 to 2.2 times more likely to be blind than men (WHO Bulletin Nov 2004). In 2004, a qualitative study was conducted in the Department of Ophthalmology to identify and understand the barriers that women face in accessing cataract surgery in and around Cape Town. Eighteen female cataract patients (14 pre-operative and four post-operative) were interviewed. Two focus groups were conducted, one with doctors and the other with nurses. Interviews with healthcare professionals and paramedical staff were also performed.
The study identified ten major barriers (Figure 1). Whilst the barriers were applicable to both men and women, they were often exacerbated for women.
Transport was identified as a major problem by both health care professionals and women. Whilst the State paid for cataract surgery, the socio-economic costs of surgery such as taking time off work and leaving daily responsibilities, acted as important barriers for women as well as their carers.
Stated barriers for women at the individual level included fear and lack of education. However healthcare professionals felt that barriers at the institutional and organisational level were more significant. These included availability of funding and the cost of consumables, medical staff and equipment, hospital organisation and administration (waiting times in the day hospitals, patient pathway at GSH, waiting lists for surgery) and health system organisation (lack of resources to conduct cataract surgery at the secondary district level hospitals so the tertiary level was saturated with cataract patients).
Strategies needed to overcome the barriers include:
- Community education
- Increasing the capacity for cataract surgery
- Fast-tracking patients to reduce waiting lists
- Decentralisation of ophthalmic care
- Increased Government and NGO funding for staff and resources
- Intersectoral collaboration (government, NGOs and corporate organisations).
Before these strategies can be implemented, increased resources and funding for the hospital and health-system are needed to increase the capacity for cataract surgery.