MOBILISING A MOBILE SURGICAL TEAM AT THE DISTRICT LEVEL: A COST EFFECTIVE STRATEGY FOR CATARACT SURGERY IN MALII. VISUAL ACUITY OUTCOMES AND COST STUDY.

Objectives:To compare, in the region of Mopti in Mali, the cost and effectiveness of a proximity surgery strategy (advanced surgery close to the patients? residence) with surgery practised in a traditional ophthalmology centre (fixed surgery in a hospital environment). Methods:Two samples of 199 and 100 people operated on for cataract in the advanced and fixed strategies respectively, were included in this study. Results:The functional results were excellent since, after correction, 92.5% of the advanced, and 98% of the fixed, surgery patients had a vision higher than or equal to 6/19. The rate of patients? satisfaction was 96% for advanced surgery and 89% for fixed surgery. From a societal point of view, the advanced strategy was slightly less costly with a unit cost of 96.2 US$ compared to 96.9 US $ in the fixed strategy. On the other hand, advanced surgery was much cheaper (26.6 US$ vs. 36.5 US$) for the patient and their family because of reduced transportation costs and patient and attendant opportunity cost in terms of time. Conclusion:Operating patients using a proximity surgery strategy, whereby a regional ophthalmic team is mobilised at the district level, appears to be as cost effective as a classical fixed strategy. This innovative strategy should allow, if extended to all Malian regions, most patients needing surgery to be operated on.