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Strengthening Nigeria’s cataract services and surgery response: Advancing effective cataract surgical coverage, sustained investments and human resources for eye health
*Corresponding author: Fatima Kyari, Department of Ophthalmology, College of Health Sciences, University of Abuja, Abuja, Nigeria. Fatima.Kyari@UniAbuja.edu.ng
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Received: ,
Accepted: ,
How to cite this article: Kyari F. Strengthening Nigeria’s cataract services and surgery response: Advancing effective cataract surgical coverage, sustained investments and human resources for eye health. Global J Cataract Surg Res Ophthalmol. 2026;5:6-7. doi: 10.25259/GJCSRO_20_2026
Cataract remains the leading cause of vision loss and blindness in Nigeria, yet it is one of the most treatable causes of vision impairment and blindness globally. Over 2.5 million people in Nigeria need to have cataract surgery to restore their eyesight. In the past decades, concerted advocacy and a drive for systems change have led to national and sub-national efforts that have demonstrated progress, but not at the scale or pace needed to close the cataract blindness gap. As Nigeria edges on with the Nigerian health sector renewal investment initiative (NHSRII), implementing the national eye health policy and operationalising the national eye health strategic plan, it is timely to revisit the fundamental levers that determine the success of cataract services and surgery: Effective cataract surgical coverage (eCSC), sustainable investments in eye health and the training and equipping of human resources for eye health (HReH). Together, these three prongs constitute a strategic pathway towards achieving universal eye health.
eCSC: BEYOND ACCESS TO QUALITY
Traditional cataract surgical coverage (CSC) measures how many people in need of cataract surgery actually receive it. However, the more meaningful metric, eCSC, captures both coverage and quality by measuring the proportion of operated eyes that achieve good visual outcomes (typically ≥6/12).
Across Nigeria, CSC varies widely between 28% and 39%, with some states reporting levels far below global benchmarks. In too many settings, cataract services are episodic, driven by intermittent ‘outreach’ and charity camps, rather than embedded in a predictable, people-centred health system. Even where surgical volumes are rising, concerns persist about variable outcomes, inadequate follow-up and gaps in surgical counselling and biometry to determine the correct intraocular lens power. Scaling cataract surgeries with acceptable quality and outcomes will enable public trust in the services. The need for central data system is highly recommended through the various state desk officers and the national eye, ear and sensory function programme of the federal ministry of health and social welfare.
To improve eCSC, Nigeria must prioritise
Quality-assured surgical pathways, including standardised biometry, appropriate intraocular lens (IOL) selection, protocols for managing complications and structured post-operative follow-up.
Ready availability of refractive services and spectacles/devices.
Health information systems to routinely capture cataract service data (volume, outcomes and equity indicators) and use them for planning, budgeting and quality improvement. Outcome monitoring systems should be integrated into facility dashboards and national data platforms.
Integrated eye care in existing general hospitals, comprehensive health centres and primary health care (PHC) facilities, using a hub-and-spoke model that links them to tertiary eye centres.
Outreach camps only as strategic gateways into permanent services, whereby every outreach location is linked to a designated base hospital where continuity of care and follow-up are guaranteed.
Support for enhanced training, especially in small-incision cataract surgery, phacoemulsification and cataract surgery combined with other ocular surgical interventions such as glaucoma or vitreoretinal surgery.
The goal should be not only to increase cataract surgeries but also to ensure proper follow-up, long-term care and sustained good visual outcomes.
SUSTAINABLE INVESTMENTS IN EYE HEALTH: FINANCING THE FUTURE
Eye health is underfunded in Nigeria’s health system. Most services rely on out-of-pocket payments, resulting in inequitable access and catastrophic health expenditures for many households. The dominant non-governmental organisation (NGO)-supported programmes and burgeoning private sector have helped fill gaps, but without a coordinated investment framework, fragmentation persists.
Sustainable financing for cataract services requires
Dedicated public financing for cataract services and essential eye health interventions embedded at primary, secondary and tertiary level government facilities.
Integration of cataract services, including post-op care, into national health insurance, ensuring affordability and reducing financial hardship.
Redesign of NGO-supported programmes so that their primary objectives include capacity building, infrastructure strengthening and system integration. Free or subsidised surgery should be channelled through and recorded locally so that the services grow within the health systems.
Investment in equipment renewal cycles, such as phaco machines, operating microscopes and diagnostic units.
Unlocking the healthcare value chain to enable local manufacturing of IOLs and strengthening supply chains for consumables. This will ensure predictable pricing and availability.
Eye health is a high-return investment: Cataract surgery restores productivity, independence and quality of life. Embedding eye health financing in national and state health budgets is essential to scale services sustainably and reduce avoidable blindness.
HReH: TRAINING, EQUIPPING AND RETAINING NIGERIA’S WORKFORCE
Nigeria’s ophthalmology workforce (ophthalmologists, optometrists, ophthalmic nurses, opticians and community healthcare workers) remains inadequate for a population exceeding 220 million. While training institutions have expanded intake, the quality, consistency and distribution of the workforce remain challenges.
A resilient eye health workforce requires
Investment in residency training, including simulation laboratories, structured wet laboratories, phaco training and mentorship. Ophthalmic surgeons are at the core of cataract services as the primary intervention is surgical
Task-sharing and team-based care, empowering mid-level cadres for community and primary level, competency-based care under strong governance
Retention strategies to curb brain drain, such as improved working conditions, access to equipment, career progression pathways and competitive remuneration.
Digital learning and tele-mentorship support continuous professional development and cross-institutional collaboration.
Empowering HReH sits at the heart of quality improvement. Without well-trained, well-equipped personnel, even the best-funded cataract programmes will underperform.
THE WAY FORWARDS: AN INTEGRATED APPROACH
Nigeria stands at a critical juncture: The political commitment to eye health is the strongest it has ever been, and the evidence base is robust. However, progress will depend on integrated action. within the whole-of-government compact, partnerships and domestic financing in the sector-wide approach (SWAp). Improving eCSC, investing sustainably and building a fit-for-purpose workforce must be pursued simultaneously, not sequentially. These three pillars reinforce each other: Strong financing supports quality care; quality outcomes build public trust and a capable workforce is the engine that drives both.
As the Nigerian issue of this journal highlights ongoing innovations and research in cataract surgery, it is imperative that we centre our national discourse on how to scale, standardise and sustain these gains.
The task ahead is substantial, but achievable. With focused leadership, collaborative partnerships and evidence-based policy implementation, Nigeria can move decisively towards eliminating cataract blindness and ensuring that every Nigerian, regardless of geography or socioeconomic status, has access to high-quality, vision-restoring cataract surgery to enable them to live, earn and thrive with dignity.