The Challenge of Universal Eye Health in Latin America: distributive inequality of ophthalmologists in 14 countries

Abstract

BackgroundNo comprehensive study currently exists on the supply of ophthalmologists across Latin America. We explored sociogeographic inequalities in the availability and distribution of ophthalmologists across 14 Latin American countries.MethodsThe National Ophthalmologic Societies of Argentina, Bolivia, Brazil, Colombia, Costa Rica, Chile, the Dominican Republic, Ecuador, Guatemala, Mexico, Paraguay, Peru, Uruguay and Venezuela provided data on affiliated ophthalmologists by first-order subnational divisions in 2013. Human Development Index (HDI) estimates at the corresponding subnational division were used as equity stratifiers. Distributional inequality of ophthalmologists within each country was assessed by the health concentration index (HCI) and the index of dissimilarity (ID), along with the mean level of ophthalmologists per population.ResultsAcross all countries studied, there were 5.2 ophthalmologists per 100 000 population on average (95% CI 5.0 to 5.4) in 2013, with a mean HCI of 0.26 (0.16 to 0.37) and a mean relative ID of 22.7% (20.9% to 24.7%). There was wide inequality in ophthalmologist availability between countries, ranging from 1.2 (1.1 to 1.4) in Ecuador to 8.6 (8.5 to 8.8) in Brazil. All countries had positive (ie, pro-rich) HCI values ranging from 0.68 (0.66 to 0.71) in Guatemala to 0.02 (−0.11 to 0.14) in Venezuela. Correspondingly, redistributive potential to achieve equity was closest in Venezuela (ID: 1.5%) and farthest in Guatemala (ID: 60.3%). Benchmarked against regional averages, most countries had a lower availability of ophthalmologists and higher relative inequality.ConclusionsThere is high inequality in the level and distribution of ophthalmologists between and within countries in Latin America, with a disproportionate number concentrated in more developed, socially advantaged areas. More equitable access to ophthalmologists could be achieved by implementing incentivised human resources redistribution programmes and by improving the social determinants of health in underserved areas.

Variations and Trends in Health Burden of Visual Impairment Due to Cataract: A Global Analysis

“…9 The number of ophthalmologists per million people varied with socioeconomic development, with higher concentration in regions with higher HDI and per capita gross domestic product. [19][20][21] Globally, the preoperative visual acuity with regard to cataract surgery was associated with increasing HDI and per capita income. 22,23 The cost was the main barrier to utilization of cataract surgery in some developing countries.…”

Estimated number of ophthalmologists worldwide (International Council of Ophthalmology update): will we meet the needs?

“…Recent studies of human resources in eye health in sub-Saharan Africa and Latin America have confirmed these trends of poor distribution and the inability of the cadre to keep up with the population rates. [4][5][6][7] Amidst technological advances, population demand patterns and evolving models of care, complete data for eye health professionals is an integral component to understanding if we can meet the needs of the global population.…”

National survey of blindness and visual impairment in Guatemala, 2015

“…Fewer than one-third of cataract surgeries were performed in public hospitals. The number and availability of ophthalmologists is an issue in Guatemala (7) . Not only is the number of ophthalmologists per capita considerably below the Latin American average, but they are highly concentrated in the wealthiest areas of the country.…”

“…The country has an estimated 1.3 ophthalmologists per 100,000 people, and most opthalmologists practice in Gua temala City. The average for Latin America is 5.2 ophthalmologists per 100,000 people (7) .…”