Cirugia de catarata en hospitales del estado en cali segun el prestatario

Title

Situational Analysis of Cataract Surgical Services to underserved population from the provider perspective in the municipality of Cali - Colombia

I. Background and rationale

Prevalence of blindness has been quantified between 1.0 to 4.0 % for Latin-American countries. Of these 40 to 80% correspond to cataract as the main cause of blindness1. These figures still need to be confirmedfor the Colombian nation. Eliminating avoidable blindness is the core aim of the Vision 2020 initiative (V2020). This study will follow some of the V2020 guidelines in order to eliminate avoidable blindness from cataract in Colombia, in accordance with the Action Plan2 2006-2011 report, of V2020.

The current cataract surgical rate for Colombia has been estimated overall in 1700 cataractsurgeries per million people per year and the WHO has recommended health authorities to increase this rate up to 3000 in order to control the backlog of cataract for Latin America.

Every national program in prevention of blindness should start from a detailed knowledge of available physical and human resources. Simultaneously there should be an estimation of needs in the different areas ofinterest for every country, district or region. Then, after defining reasonable goals according priorities, a set of strategies are formulated to achieve them, through an efficient use of the available or new resources. Finally there should be regular monitoring and evaluation of the activities to re-start the cycle again. Lack of awareness, fear, limited affordability and access and a lack of activesearch for blind patients, have been shown to be main barriers to good surgical output in the Latin American context3.

The last Colombian National Census4 in 2005 collected information in limitations secondary to physical disabilities (vision, hearing, speaking, walking, learning, self-care). The specific question related to the visual function was: Who has limitations to see in spite of havingglasses? The percentage of people with at least one limitation of any kind was 6.3 % out of 42.9 million of Colombians. Of those 43.4 % (1.2 M) was due to visual limitation.

The Colombian Constitution states that the Nation should warrant all Colombian people to have access to health services whenever they are required. The current National Health Colombian System was redesigned since the year1993 with the purpose of increasing the population health coverage that at this stage only reached 25%5. The aim was to have 100% health coverage by the year 2001. For different reasons and according the government, only 82 % of people currently have full health coverage. Of those at least half are subsidized by the system, extending the benefits to very poor people all over the country.

Howeverthe missing 18 % (7 Million) of people who lack of any health coverage, corresponds to the underserved and poorest people in the country. The current government is working on how to increase the health coverage but this is going to take at least one more decade6.

The health issues of the underserved people are addressed through the network of national hospitals on a “pay as much as you can”basis, and the available budget is allocated according to “health priorities”. In addition, this hospital network has commonly shown poor efficiency due to administrative and political issues. At hospital level the priorities are usually given to life threatening conditions (associated to trauma or illness). As expected the available budget for cataract surgery is low and the patients have to pay atleast for their surgical consumables, which leave behind the poorest from the cataract surgical services. That situation is increasing the backlog of cataracts in our country and should be addressed promptly.

In 2006 Colombian Government officially signed the creation of the National Committee for Prevention of Blindness. There have been a few workshops on the subject so far, but there has...