Respective characteristics and contributions of two cataract surgery delivery models to the eye health national action plan in Rwanda

Cataract is the leading cause of avoidable blindness worldwide, and limited surgical access continues to affect elimination efforts, especially in low- and middle-income countries. In line with this burden, Rwanda implemented two complementary models for cataract surgery services: The Mobile Teams Outreach Cataract Surgery Model (MTO-CSM) and the Continuous Hospital-Based Cataract Surgery Model (CHB-CSM). This study compared the performance, quality adherence, efficiency, and cost-effectiveness of the two models. A retrospective, cross-sectional study was conducted across 10 health facilities (6 implementing MTO-CSM and 4 implementing CHB-CSM) between October 2022 and May 2023, covering data from October 2021 to September 2022. Data sources included hospital surgery registers, the Health Management Information System (HMIS), facility assessments, staff interviews, and financial records. Key indicators included the number of cataract surgeries (CS) performed, adherence to quality standards, total surgery time (in person-minutes), and the cost per CS. A total of 10,584 CS were performed. District hospitals contributed 2,337 surgeries, mainly under MTO-CSM. Kabgayi District Hospital and Rwanda Charity Eye Hospital, both implementing CHB-CSM, conducted 4,297 and 3,668 surgeries, respectively, accounting for 74% of the total national CS output. Quality compliance was higher at CHB-CSM facilities (an average of 88%, with 100% and 94% at Kabgayi and Rwanda Charity, respectively) compared to 58% in MTO-CSM sites. The average time per surgery was 801 person-minutes for CHB-CSM versus 1,950 person-minutes for MTO-CSM. The cost per surgery was RWF 207,224 (USD 193.7) for CHB-CSM and RWF 349,566 (USD 326.7) for MTO-CSM, making the outreach model 69% more expensive. The CHB-CSM had a higher surgical volume, better quality adherence, greater time efficiency, and a lower cost per case. In contrast, the MTO-CSM, although more expensive, played an essential role in expanding access to remote areas. A hybrid strategy, integrating the efficiency of continuous services with the outreach model’s equity focus, is recommended to achieve Rwanda’s national cataract surgery targets and the WHO’s 2030 goal for effective cataract surgical coverage (eCSC).