Gender and use of cataract surgical services: experiences from Munawwar Memorial Hospital in District Chakwal, Pakistan

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Problem identified

In 2000 a survey of cataract blindness in our district showed that an estimated 3,095 people were bilaterally blind due to cataract, 647 males and 2,448 females (79%). The cataract surgical coverage for persons at VA<3/60 was 93% for males and 74% for females, a significant difference. At the <6/60 and the <6/18 level the differences were not significant (Haider S, Hussain A, Limburg H. Ophthalmic Epidemiology 2003, 10, (4), pp. 249-258).

Action taken

It was not possible to provide an exclusive service to females, but we examined barriers specific to women and took a series of measures to raise awareness, improve detection, streamline referrals, improve access, reduce costs, and to make the programme more friendly to the patients’ family members.

The following were put in place:

• A resident facility so the family can reach home for the evening

• Day case surgery to reduce effort and indirect costs

• Service over the weekends, when a younger family member may more easily accompany the elderly female patients

• Cost reduction through subsidy

• Transport to reduce indirect costs and improve access

• 1,650 Primary Health Care workers within this district were trained in Primary Eye Care, including detection and referral of the female blind.

Outcome

Community detection of cataract improved from 160 cataract patients identified at community level in 2001, to 463 identified in 2003. We were also able to increase the acceptance of surgery considerably in the four years. The rate of cataract surgery in females has remained consistently higher than males. The volume of cataract surgery has doubled but the male/female distribution remains roughly the same. Increasing the coverage in females with bilateral cataract may require more focused interventions.