By Olivia Iloetonma and Barbara Kong
Winesi March has never seen his 18-month old grandson – he has only ever heard him cry. Prior to going blind from cataracts, Winesi was the breadwinner: his maize farm fed his family and kept his children in school. But as his cataracts developed, he had to rely on his wife and children for tasks as simple as bathing. He stopped growing his maize. He could no longer see the path to his farm.
Winesi’s blindness and its impact on his household is part of a widespread and growing problem across developing countries. Four out of five blind people are needlessly blind, most of them live in developing countries, and the reason for their blindness is more often than not due to cataracts.
A broken financing model
Cataracts, the partial occlusion of the eye lens, affect both men and women, especially above 50. Untreated cataracts lead to blindness for millions of people in developing countries due to high cost of quality care and low cataract surgery capacity. Funding for eye health services makes up just a sliver of local and international health funding—in Cameroon, it is only a fraction of the 2% GDP spending on health. In Central Africa alone, our estimates show that 75,000 people suffer from cataract blindness and another 3 million are at risk, but there are only 122 active ophthalmologists in the region. Cataract surgery should be a relatively straightforward and cost-effective procedure, but public health systems are underfunded and service providers are constrained by scarce, competitive, and expensive financing.
The bottom line is, the financing model for eye health in developing countries is broken. And as a result, those who can least afford to are losing their sight.
Opening the eye health space to private investors
Innovators have found a way to ease this quintessential development problem. The Aravind Eye Hospital in India has pioneered and revolutionized an innovative and cost-effective approach to tackling cataracts in the developing world—a social enterprise model that delivers high-quality cataract surgeries for $40 each, half the cost of an annual Amazon Prime membership. Aravind hospitals gross over $10 million annually through 300,000 cataract surgeries, half of which are free or subsidized. This model proves that it is possible to provide sustainable, affordable quality cataract surgery at high volumes, with fees from those who can pay subsidizing treatment costs for those who cannot.
So what if we could replicate this model in Central Africa? Unfortunately hospitals looking to do so face a financing wall. A sub-specialty eye hospital in Cameroon that could perform 6,000 surgeries per year and build local capacity would cost about $13 million to build, equip, and staff before serving a single patient. The drip-drop of public finance is not going to cut it. Private investors find the prospect too risky. From the hospital’s point of view, a debt investment would compromise financial sustainability and ability to scale while keeping costs low.
What we need is an entirely new financing model that brings private funders into the eye care space by sharing the risk across public and private partners. A third-party promise to pay for performance could be the key making this possible.