title: The Challenge of Universal Eye Health in Latin America: distributive inequality of ophthalmologists in 14 countries.
abstract: No 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.
  
  
  
  The 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.
  
  
  
  Across 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.
  
  
  
  There 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.
authors.affiliation: Department of Health Policy and Management, Columbia University Mailman School of Public Health, New York, New York, USA.
authors.forename: Hannah
authors.initials: H
authors.lastname: Hong
authors.affiliation: Sustainable Development and Health Equity, Pan American Health Organization, Washington District of Columbia, USA.
authors.forename: Oscar J
authors.initials: OJ
authors.lastname: Mújica
authors.affiliation: Instituto Mexicano de Oftalmologia, Mexico City, Mexico.
authors.forename: José
authors.initials: J
authors.lastname: Anaya
authors.affiliation: Instituto Mexicano de Oftalmologia, Mexico City, Mexico.
authors.forename: Van C
authors.initials: VC
authors.lastname: Lansingh
authors.affiliation: Instituto Mexicano de Oftalmologia, Mexico City, Mexico.
authors.forename: Ellery
authors.initials: E
authors.lastname: López
authors.affiliation: Prevención de Ceguera y Salud Ocular, Organización Panamericana de la Salud, Bogotá, Colombia.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Silva
mesh_terms: D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D007843:Latin America; D000072163:Ophthalmologists / Q000706:statistics & numerical data* / Q000600:supply & distribution*; D009885:Ophthalmology; D012955:Societies, Medical
keywords: OPHTHALMOLOGY; PUBLIC HEALTH; SOCIAL MEDICINE