Publication:

A study of equity in availing free adult cataract surgery in northeastern Indian states of Mizoram and Meghalaya

Background Equitable access to free cataract surgery is essential for eliminating preventable blindness. This study evaluates equity in the uptake and follow-up of free adult cataract surgery in the Northeastern Indian states of Mizoram and Meghalaya.

Methods A cross-sectional study was conducted over a period of nine months, enrolling adults with operable cataracts. Participants were categorised based on the timing of diagnosis and surgery. Structured interviews were administered to 238 patients (Mizoram: n=100; Meghalaya: n=138) to collect data on demographics, economic status, surgery attendance, and post-operative follow-up. Data were analysed using SPSS to identify determinants of service utilisation and assess disparities.

Results Significant inter-state disparities were observed. Mizoram demonstrated higher surgery uptake (58% vs. 36%) and post-operative follow-up (95% vs. 45%) compared to Meghalaya. The Meghalaya cohort had a higher proportion of female participants (72% vs. 53%), illiteracy (52% vs. 8%), and low-income individuals (44% vs. 21%). While attendance did not differ significantly by gender or marital status, socioeconomic factors were critical. Higher post-operative attendance was associated with adequate income (77.5% vs. 61.1%, p=0.07) and lower indirect costs. Patients who did not attend follow-up incurred higher mean travel expenses (INR 1119 vs. INR 683, p=0.008). Living with adult children significantly increased attendance for both surgery and follow-up.

Conclusions Despite the provision of free surgery, uptake and follow-up are inequitable, heavily influenced by socioeconomic status, indirect costs, and household support structures. Targeted interventions to reduce indirect expenses and mobilize family support are necessary to achieve equitable access to cataract care in these regions.