Rapid Assessment of Avoidable Blindness and Willingness to Pay for Cataract Surgery in Tribal Region of Surat District of Gujarat State, India

ABSTRACT

Aim

To estimate prevalence and causes of avoidable blindness among people ≥50 years and to assess willingness to pay (WTP) for cataract surgery in tribal region of south Gujarat, India.

Methods

A cross-sectional population based survey was conducted with 44 randomly selected clusters each having 50 people aged ≥50 years selected by probability proportional to size of sampling. Adults identified with cataract causing visual loss (<6/18) in any eye were interviewed to assess their WTP for surgery.

Results

Total of 2137 examined out of 2200 people enumerated (response rate 97.1%). The prevalence of blindness (Presenting Visual Acuity (PVA)<3/60 in better eye) was 2.23% (95% CI: 2.95%–1.51%). Cataract was main cause of blindness (67.3%) followed by corneal scarring (8.2%). Major barrier to cataract surgery cited by bilaterally blind people was lack of escort to the surgical facility (34.3%). Cataract surgical coverage (CSC) was 84.9% (eyes) and 92% (persons). Of the 492 people interviewed to assess WTP for their surgery, only 36.4% people were willing to pay.

Conclusion

The tribal population has a high poverty profile in India. Within this group, cataract remains the main treatable cause of blindness despite a high CSC. Assessment of barriers suggested that a well-coordinated outreach programme with free transport facilities to the surgical facility is required along with strategies to improve accessibility and prioritising cataract blind in the community. One-third of people were willing to pay for their surgeries implying that cross subsidization or tier system could be feasible for eye care programme sustainability.

KEYWORDS:

• Blindness
• RAAB
• willingness to pay
• tribal
• India

Acknowledgments

The study was a part of main author's thesis for his course -MSc in Community Eye Health- at London School of Hygiene and Tropical Medicine, London, UK. The study was possible due to collective support for the course from Commonwealth Shared Scholarship Scheme, British Council for the Prevention of Blindness, Alan and Nesta Fund, International Student House, London School of Hygiene and Tropical Medicine trust fund and Sightsavers. The authors are also grateful to Sarah Pollack of International Center for Eye Health, London and Dr. Praveen Vashist, Department of Community Eye Health, RP ,Center, All India Institute of Medical sciences , New Delhi, India for their expert inputs for the study.