Supply-side determinants of cataract surgery output in South Africa

Abstract

Background: Cataracts are the leading global cause of blindness. Despite having an adequate number of ophthalmologists, South Africa has not achieved the World Health Organization (WHO) Vision 2020 target of 2000 cataract surgeries per million population annually.
Aim: This study aims to examine supply-side factors influencing cataract surgery output by exploring provider characteristics, perceived barriers, enablers and proposed strategies to increase surgical volume.
Setting: South Africa.
Methods: A cross-sectional survey was conducted on the 399 medically trained members of the Ophthalmology Society of South Africa (OSSA) between May 2024 and June 2024.
Results: The response rate was 19.7% (79/399). In 2023, nearly half of the respondents performed fewer than 200 cataract surgeries, while only 15% performed more than 500. Surgeons performing ≥ 201 surgeries were more likely to be male (prevalence ratio [PR] = 2.26; 95% confidence interval [CI]: 1.33–3.85), older, particularly 56–65 years old (PR = 5.00; 95% CI: 1.73–14.49), more experienced (> 10 years: PR = 6.74; 95% CI: 1.78–25.48), qualified specialists (PR = 10.76; 95% CI: 1.61–72.10), full-time private-sector employed (PR = 4.50; 95% CI: 2.14–9.47) and performing phacoemulsification (PR = 1.35; 95% CI: 1.22–1.84). Common barriers to increased output included non-surgical responsibilities (28%), limited theatre time (25%), poor patient access (24%) and inconsistent consumable supplies (22%), particularly in the public sector. Respondents identified several enablers, such as adequate theatre staff (56%), dedicated eye theatres (49%), functioning equipment (43%) and motivated staff (41%). Proposed included improving theatre utilisation (24%), stabilising consumable supply chains (24%) and strengthening staff motivation (19%).
Conclusion: Cataract surgery rates (CSR) in South Africa remain suboptimal. Addressing provider-identified barriers, leveraging enablers and implementing targeted strategies may enhance surgical output.
Contribution: This study provides insights into supply factors affecting cataract surgery output in South Africa.