Access to Cataract Services and the Eye Care System in Turkana County, Kenya: A RAAB-HSM-Based Situational Analysis

Abstract

Background: Access to eye care remains limited in low- and middle-income countries, particularly in rural and arid regions such as Turkana County in Kenya. The 2023 Turkana RAAB reported 6.6% blindness among adults aged ≥50 years, with cataract as the leading cause. Cataract surgical coverage (CSC) was 40.2%, while effective CSC (eCSC) was only 6.2%.

Objectives: To evaluate Turkana’s eye health system and services for cataract, refractive error, and diabetic retinopathy; compare postoperative cataract outcomes with the 2023 RAAB; and assess patient-reported access to cataract services at Lodwar County Referral Hospital.

Methods: A situational analysis using the pilot RAAB Health Systems Module was conducted in 13 facilities in 2023. Facility data were combined with interviews of 50 cataract patients at Lodwar County Referral Hospital in July 2024. Descriptive statistics and RAAB7 comparisons were applied.

Results: The cataract surgical rate was 781/million. Only 16.5% of operated eyes achieved ≥6/12 vision, compared with 23.8% in RAAB7. Median waiting time was 90 days. Refractive coverage was 0%, with only six distance spectacles dispensed in 2023. Diabetic retinopathy screening was available at two hospitals, but treatment was unavailable. Although 60% of patients accessed care within an hour, transport, accommodation costs, and low insurance coverage (37.5%) hindered access.

Conclusion: Turkana requires increased surgical capacity, improved outcomes, expanded refractive and diabetic retinopathy services, equitable distribution, quality monitoring, and stronger financing mechanisms.

Keywords: Cataract surgery; eye health systems; Turkana County; RAAB-HS; refractive error; diabetic retinopathy

DOI: 10.7176/IKM/16-3-01

Publication date: October 30^th 2026