A qualitative investigation into the barriers to the provision of free cataract surgical services: An ophthalmic service provider

Objectives : The provision of comprehensive cataract surgical services (CSS) is the cornerstone of blindness control efforts in India; however, systematic data on provider-specific bottlenecks emanating from the northeast Indian regions are scarce, hindering further planning and addressing various eye care inequities. Materials and Methods: We designed a cross-sectional qualitative study, involving in-depth semi-structured interviews with a variety of professional ophthalmic service providers (OSPs) to understand provider-specific bottlenecks. A two-pronged approach was adopted, that involved investigating OSP-specific barriers that are endogenous and exogenous in nature. The standard economic factors of production framework was used to examine the endogenous determinants, while the standard analytical framework was adapted to examine exogenous bottlenecks. Interviews were audiotaped, transcribed, and then analyzed using thematic analysis. Results: A total of 10 OSPs participated in the study . Predominant provider-specific barriers that are endogenous to OSP include human resource management, such as inadequate staffing and staff retention, as well as organizational factors, including institutional policies and practices that set the agenda and priorities for the provision of comprehensive CSS. Exogenous barriers concerning OSP include structural barriers like difficult mountainous terrain, remote-scattered geographic location of communities, infrastructural bottlenecks like inadequate road and railway networks, and limited internet connectivity. Sociocultural bottlenecks include a lack of awareness in the community coupled with local beliefs, myths, and misconceptions about cataract surgery. Conclusion: Service impediments afflicting OSPs in the northeastern regions of India appear to be two-pronged. Investing in human resource capacities and intensifying awareness generation activities would mitigate most of the reported barriers.