Costs and productivity of cataract surgery in different eye care settings in Kenya

Citation:
Karimurio J. Costs and productivity of cataract surgery in different eye care settings in Kenya. London: London; 1999.

Thesis Type:

MSc

Abstract:

Introduction

Cataract which is defined as opacity of the crystalline lens of the eye is the leading cause of visual impairment and blindness inKenyaand in the whole world in general. Majority of cataracts are age related. Resources allocated for the treatment of cataract inKenyalike in other developing nations, are not only scarce but have also been shrinking with time. Surgical removal of the opaque lens and correction with an intraocular lens implant are the only treatment options available inKenya. Prioritisation during planning and resource allocation should be done for the benefit of the majority. This can only be possible if we are aware of the costs incurred in cataract surgery and the ways by which costs can be contained. When the cost of cataract surgery is known, it is easy to estimate how much service user charges (cost recovery and cost sharing) to charge the patients. Overcharging lowers utilisation while undercharging threatens sustainability of the heath services. It is also possible to identify the costs of each cataract surgical item (or procedure) and plan how to contain the costs without compromising the quality. The exact cost per unit service (in this case cataract surgery) should thus be reviewed regularly.

Aim

To describe the costs and productivity of cataract surgery in the different Eye Care delivery settings inKenya.

Objectives :

To estimate and compare the costs of consumables used in cataract surgery in different eye care settings.

To estimate and compare the productivity of cataract surgery in different eye care settings.

Methods

Three Eye Units representing three unique Eye Care delivery settings inKenyawere selected for the study. Kikuyu Eye Unit represented the typical Kenyan NGDO setting, Lions Eye Unit a service club setting and Nakuru Eye Unit the Government Eye Care delivery setting. The productivity of cataract surgery was calculated from the information extracted from the Eye Units monthly returns and annual reports. The information was further counterchecked with the theatre registers and the data from the National Eye Health Information Office. The cost of each of the consumable items used for cataract surgery was calculated separately using the information gathered from hospital store records and from the surgeons and other theatre staff using the data collection form. The costs of all the items were finally summed up to get the unit cost of consumables used in a single cataract operation. The data were finally entered into summary tables. The productivity and costs of consumables for the three Eye Units were compared and conclusions made.

Results

Kikuyu performed 53%, Lions 9% and Nakuru 4% of all the 9495 cataract operations reported in the 1998 annual report of the Kenya Ophthalmic Programme.

Kikuyu Eye Unit theatre did 100, Lions 17 and Nakuru 7 cataract operations per week.

In one theatre day, Kikuyu operated on 20, Lions 9 and Nakuru 4 cataracts.

Cataract operations per surgeon per week was 13 at Kikuyu, 9 at Lions and 2 at Nakuru. None of the three Eye Units in the study had a waiting list for cataract surgery.

The unit cost of consumable items used in a single cataract operation was US$ 11.2 at Lions US$ 14.6 at Kikuyu Eye Units and US$ 23.5 at Nakuru.

The IOL and the corneal suture were the most expensive items. The two accounted for 40 %, 61 % and 63 % of the total cost of consumable items used in a single cataract operation at Lions, Kikuyu and Nakuru respectively.

Conclusions

None of the three Units had realised its full potential in productivity of cataract surgery. The IOL was the single most expensive consumable item used for cataract surgery at Kikuyu and Lions Eye Units. At Nakuru, it was the corneal suture.

Kikuyu Eye Unit which represented the typical Kenyan NGDO Eye Care delivery setting had the highest productivity of cataract surgery at the cost of US$ 14.6 per one unit of consumable.

Lions Eye Unit which represented an NGO Eye Care setting whereby the sponsoring NGDO also managed the day to day running of the unit it was sponsoring performed cataract operation at the lowest cost per unit of consumables (US$ 11.2). The unit had low productivity of cataract surgery when compared to Kikuyu.

Nakuru Eye Unit represented the Government of Eye Care delivery setting. The unit had the lowest productivity of cataract surgery and the highest cost of a unit cost of consumables (US$ 23.5).

Recommendations

- Improve cataract surgical services through Social Marketing.

- Monitor productivity and cost of cataract surgery regularly.

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