Evaluation of an application for investments in cataract surgery, Ethiopia.

Problem: The World Health Organization recommends a benchmark for uncorrected visual acuity of ≥ 6/12 in 80% of patients at 4 to 6 weeks following cataract surgery. In low-resource countries, reaching this benchmark is challenging and assessing progress is difficult. Approach: This intervention involved modest investments recommended by the Better Operative Outcome Software Tool (BOOST) application (app). The investments targeted specific causes of poor cataract surgery results at hospitals in Ethiopia to improve vision outcomes. Fifteen ophthalmic surgeons from 11 public secondary and tertiary eye care centres in five regional Ethiopian states collected pre-intervention data using the BOOST app. Based on 20 consecutive patients with vision < 6/60, BOOST identified case selection, intraoperative complications or postoperative refractive error as the leading causes of poor outcomes. Each facility then invested 2500 United States dollars (US$) to target its leading cause, recorded outcomes for 60 consecutive cataract patients, and then compared the proportion with uncorrected vision ≥ 6/12 before and after the intervention. Local setting: All 11 centres are Orbis International partners and services provided at the facilities are highly subsidized or free of charge. Relevant changes: After implementing targeted interventions at the facilities to address undetected ocular comorbidity, surgical complications or postoperative refractive errors, 501 (56.0%) of 894 patients had good results (≥ 6/12), compared to 289 (32.2%) of 897 patients before the intervention. Lessons learnt: Using the BOOST app as an approach for quality monitoring and improvement enables benchmarking across contexts and can enhance surgical outcomes when paired with recommended targeted investments.