A new study published in BMJ Global Health examines how two countries, Kenya and Nepal, are putting the World Health Organization’s effective cataract surgical coverage (eCSC) target into practice, and shows that progress depends not just on technical targets, but on how national eye care systems are organised.

The WHO has called for every country to increase eCSC by 30 percentage points by 2030. Unlike simple surgical coverage, eCSC measures both access to cataract surgery and the quality of visual outcomes. But while the global target is clear, there has been little evidence on how countries are actually trying to implement it. This study addresses that gap through a qualitative comparison of Kenya and Nepal.

The research, conducted as part of an ICEH Master’s Course project, included 20 interviews with senior stakeholders from government, non-governmental organisations, academic institutions and clinical networks. Ten interviews were undertaken in Kenya and ten in Nepal. They found that implementation is shaped less by centrally imposed plans than by the existing structure of each country’s cataract system.

In Kenya, cataract services operate through a devolved public system, with service delivery led by county governments and supported by national technical coordination and NGO partnerships. Kenya had recently conducted 15 subnational RAAB surveys (2022–23), which reported an eCSC of 26.7%.

In Kenya, cataract services are delivered through a devolved public health system, where responsibility for service delivery sits with county governments. National-level coordination provides policy direction and technical guidance, but implementation varies across counties depending on resources, workforce availability, and local priorities. NGOs and mission hospitals play an important complementary role, particularly in outreach and surgical delivery. The study highlights that Kenya’s approach is increasingly data-driven, with 15 subnational RAAB surveys conducted between 2022 and 2023, enabling more granular planning and identification of underserved areas. However, fragmentation across counties and reliance on external partners can make coordination challenging, particularly for maintaining consistent quality and follow-up care.

In Nepal, cataract services have a different structure, with a long-established network of NGO-led eye hospitals operating through a hub-and-spoke outreach model. These centres conduct high-volume surgery and extend services into rural areas through screening camps and referral pathways. While government oversight exists, service delivery is largely driven by these non-governmental providers, which have developed strong surgical capacity and efficiency over time. Nepal’s seven province-level RAABs (2018–21) reported a substantially higher eCSC of 57.6%, reflecting both higher surgical coverage and generally strong outcomes. However, the study notes that this model also depends heavily on external funding and institutional capacity, raising questions about long-term sustainability and equitable reach to the most remote populations.

Across both settings, the study finds that progress towards improving eCSC is shaped less by adopting a single “best” model and more by how well systems align service delivery, quality monitoring, and governance within their specific context. Public–private partnerships are central in both countries, but they require strong coordination and clear accountability to ensure consistent standards. A key gap identified is the limited routine measurement of surgical outcomes, which constrains efforts to improve quality at scale. The authors emphasise that achieving the WHO target will require not only increasing surgical volume, but strengthening postoperative care, refractive services, and outcome tracking.

Overall, the study’s main takeaway is that effective cataract surgical coverage is a systems outcome. Success depends on how countries organise and coordinate multiple actors (government, NGOs, and clinical providers) rather than on any single intervention. For policymakers and programme planners, the findings reinforce the need for context-specific strategies, sustained investment in quality as well as access, and stronger use of data to guide service delivery. As countries work towards the 2030 target, Kenya and Nepal demonstrate that there are multiple pathways to progress, but still require deliberate alignment of structure, data, and accountability to translate surgery into meaningful outcomes.

Publication

Arazi M, Puri L, Kiaraho M, Buchan J, Spicer N, Foster A. Implementing effective cataract surgical coverage: a comparative qualitative study in Kenya and Nepal. BMJ Glob Health. February 2026. https://doi.org/10.1136/bmjgh-2025-023025