title: Non-physician cataract surgeons in Sub-Saharan Africa: situation analysis.
abstract: OBJECTIVE
  Non-physician cataract surgeons (NPCS) provide cataract surgical services in some Sub-Saharan African (SSA) countries. However, their training, placement, legal framework and supervision have not been documented. We sought to do so to inform decision-making regarding future training.
  
  
  METHODS
  Standard questionnaires were sent to national eye coordinators and other ophthalmologic leaders in Africa to collect information. Face-to-face interviews were conducted at training programmes in Ethiopia, Tanzania and Kenya, and email interviews were conducted with directors at training programmes in the Gambia and Malawi.
  
  
  RESULTS
  Responses were provided for 31/39 (79%) countries to which questionnaires were sent. These countries represent about 90% of the population of SSA. Overall, 17 countries have one or more NPCS; two-thirds of the total 245 NPCS are found in only three countries. Thirty-six percent of NPCS work alone, but a formal functioning supervision system was reported to be present in only one country. The training centres are similar and face similar challenges.
  
  
  CONCLUSIONS
  There is considerable variation across SSA in the use and acceptance of NPCS. The placement and support of NPCS after training generally does not follow expectations, and training centres have little role in this. Overall, there was no consensus on whether the cadre, as it is currently viewed, is necessary, desirable or will contribute to addressing cataract surgical needs in SSA.
authors.affiliation: Kilimanjaro Centre for Community Ophthalmology, Moshi, Tanzania  IAPB/Africa, Cape Town, South Africa  Light for the World, Addis Ababa, Ethiopia.
authors.forename: Susan
authors.initials: S
authors.lastname: Lewallen
authors.forename: Daniel
authors.initials: D
authors.lastname: Etya'ale
authors.forename: Amir Bedri
authors.initials: AB
authors.lastname: Kello
authors.forename: Paul
authors.initials: P
authors.lastname: Courtright
mesh_terms: D017954:Africa South of the Sahara; D002386:Cataract / Q000150:complications; D002387:Cataract Extraction / Q000706:statistics & numerical data*; D002983:Clinical Competence / Q000592:standards*; D006282:Health Personnel / Q000706:statistics & numerical data*; D006295:Health Resources; D006801:Humans; D009885:Ophthalmology / Q000193:education*; D010820:Physicians / Q000600:supply & distribution*; D011795:Surveys and Questionnaires