Samuel (not his real name) was a groundsman at a top private school in Johannesburg. A colleague saw him every day – cleaning, moving slowly, visibly struggling. His vision was so poor that it limited everything he did. Then Samuel had cataract surgery at a Netcare facility, and arrived back on the job a changed man.
“He walked straight up to me and gave me a hug,” Mark recalls. “It was there that he said the words that I will find hard to forget: ‘I can now see the leaves on the trees.’”
Cataract surgery is one of the most cost-effective procedures in medicine. It is also one of the most backlogged. Over 800,000 South Africans are currently on the state waiting list for the operation – and the queue is growing, because the public sector simply does not have enough ophthalmologists to clear it. In some regions, a single specialist is responsible for an entire province. The waiting list in some areas extends to 2028.
This is the gap that South Africa’s major private hospital groups have moved to fill, each in their own way.
A sector-wide commitment
Netcare, Mediclinic, Life Healthcare and Lenmed all run cataract surgery programmes for indigent patients. The models differ – some work through MOUs with provincial health departments, others partner with NGOs – but the logic is consistent: use spare theatre capacity, draw on the goodwill of specialist surgeons willing to donate their time and get people off the waiting list.
Netcare’s foundation has been running its cataract programme for years, with word of mouth filling the pipeline. The foundation has now moved to operating on both eyes simultaneously, having found that treating one eye places undue strain on the other. Patients like Samuel – whose surgeon was Dr Genevieve Ephraim – come in unable to see their families and leave walking out on their own. Since the inception of the programme in 2005, over 5,000 patients have received the gift of sight.
The partnership between Life Healthcare and the South African Council for the Blind (SANCB), established in 2006, continues to play a vital role in expanding access to high care. Through four mobile eyecare clinics, the programme reaches patients in underserved areas far from major healthcare facilities, providing screenings and facilitating referrals for surgery. To date, it has enabled over 20,000 cataract surgeries for patients who would otherwise have had no access to treatment.
At Mediclinic, the model is built around formal MOUs signed with provincial government at HOD level. The hospital provides the theatre, the consumables and the post-operative care. The province identifies and transports the patient. The surgeon works pro bono. In one Western Cape collaboration, a single ophthalmologist performs 20 cataract procedures in a single day, once a year. More than 1,500 surgical cases have been completed across Mediclinic’s pro bono programme since it began.
Lenmed partners with the TIBA Services for the Blind to provide cataract surgery to approximately 115 indigent patients annually across hospitals where ophthalmology services are available. The outcomes are straightforward to measure: most come back.
More than sight
What makes cataract surgery such a powerful CSI intervention is what it unlocks beyond the operating theatre. As Bob Govender, Mediclinic’s industry affairs executive, puts it: “You help Granny today with her eyesight. She can now look after her grandchildren, which allows the parents to go and work, instead of having to stay home one at a time.” The economic ripple from restoring one person’s sight reaches an entire household.
For the sector, it is also a model of what public-private collaboration can look like at its most functional: each party contributing what it does best, patients receiving care with no distinction made between a medical aid patient and a CSI patient, and a waiting list – even if only incrementally – getting shorter.
At a glance
Key Figures
South Africa's cataract surgery crisis
South Africans on the state waiting list — in some provinces, the wait extends to 2028.
All four major hospital groups run cataract programmes for indigent patients, through different models.
Life Healthcare’s partnership with the SANCB has facilitated over 20,000 cataract surgeries since 2006.
Lenmed treats approximately 115 patients per year through its TIBA Foundation partnership; most achieve 20/20 vision.
Mediclinic has completed more than 1,500 pro bono surgical cases across its MOU-based programme.
The Netcare Foundation has given over 5,000 patients the gift of sight since 2005.