In 1994, the World Health Organisation estimated that there were 38 million blind people in the world.1 This total probably increases by another million every 12 months. The average prevalence of blindness is about 0.7%, ranging from 0.3% in Western Europe and North America, to more than 1% in parts of sub-Saharan Africa.1

The leading cause of blindness in most countries is cataract—approximately half of all blindness is caused by cataract. At present it is thought that there are seven million blind people in Africa, of whom 3.5 million are blind from cataract. Precise figures for the incidence of cataract blindness in Africa are not available, but it is estimated that at least 600 000 Africans become blind from cataract each year.2 By 2030, it is estimated that the population of Africa will have grown to 1380 million.3 If current trends in the prevalence of blindness in Africa are maintained, the number of cataract blind people will double. However, the population is not merely growing, it is also aging. By 2030 the number of people aged 60 or above, will have increased by 150%.3As this age group is at greatest risk of cataract, it is likely that there will be a corresponding increase in the incidence of cataract blindness.

Despite the enormous need, relatively few cataract operations are performed in Africa. In the industrialised countries, the cataract surgery rate is about 2500–3500 cataract operations per million population per year, whereas in most African countries it is 100–500. Most ophthalmologists in Africa carry out less than 300 operations per year.2

Why are so few operations performed when so many people need surgery?

There are a large number of barriers that limit the access of blind people to cataract surgery. These can be divided into patient …