Chapter 4 Planning disease intervention - using cataract as an example
4.7 How to ensure sustainability
In the absence of effective prevention and sustainable ongoing surgical services - as contrasted with one-time campaigns - programmes must deal with the increasing problem of cataract blindness. Sustainability implies the ongoing availability of adequate resources - people and funds - and is dependent on the following elements:
- organizational structure which is able to make decisions when indicated
- culture of cost-consciousness
- optimal utilization of staff, infrastructure, and equipment
- utilization of community resources
- disciplined purchase policies
- cost-sharing programmes.
In many countries, eye care - especially cataract intervention - is becoming a major part of the total health cost. Someone has to pay for this care - governments, health insurance companies, patients, or donors. The cost of cataract intervention is made up of various components such as the cost of consumables, salaries, overheads, and depreciation of the infrastructure, equipment, and instruments. In addition, indirect costs incurred by the patient include transport, time lost from work, food, and accommodation.
To achieve sustainability, the costs of cataract surgery should be kept as low as possible without jeopardizing the outcome of the surgery. Approaches to keeping costs low include the following.
- Bulk purchase of consumables
Consumables such as IOLs, sutures, surgical instruments, and ophthalmic
drugs can be purchased at the national level to reduce costs and
administrative work for districts. Possibilities for local production of eye
drops, drugs, spectacles, and perhaps even IOLs and sutures, should also
be explored. - Optimal utilization
The best possible use of human resources and facilities can minimize
costs of salaries, overheads, and depreciation.
Financial
sustainability