Table 3

Core indicators to monitor universal access to quality, affordable eye care services when needed

Indicator	Definition	Rationale	Data sources	Responsible entity	Comments
Accessibility of eye health services
Eye health facility density and distribution	By place of residence (urban/rural), total numbers (public and private) of primary, secondary, tertiary and low vision services per million population Additional subnational administrative or geographical divisions as relevant to setting	Place of residence should not be a barrier to accessing eye health services	Facility records, population data	Health ministry	Informs policy and planning about location of eye health services in relation to population density. Outreach programmes may be planned according to gaps in geographical access to static services
Eye health worker density and distribution	By place of residence (urban/rural), total numbers of ophthalmologist, optometrist, ophthalmic nurses and other allied ophthalmic personnel per million population Additional subnational administrative or geographical divisions as relevant to setting	Availability and accessibility of eye health workers dictates access to care	Facility records, data from professional or regulatory bodies, population data	Health ministry	Informs policy and planning on recruitment and distribution of human resources for eye health. Known disparities exist in the number and distribution of trained eye care personnel between countries and by urban and rural settings within countries
Affordability of eye health services
Coverage of national health finance pooling mechanisms that include eye care services	Proportion of population covered with health finance pooling mechanisms that include eye care services (considered individually): Outpatient care Cataract Refractive error services Glaucoma treatment Diabetic retinopathy treatment	Cost should not be a barrier to accessing eye care. Proxy for WHO/World Bank UHC financial risk protection indicators; catastrophic and/or impoverishing OOP payments unlikely to be discriminatory for monitoring affordability of elective eye care services	Health finance scheme reports and questionnaires	Health ministry	Informs policy about eye health financing and affordability. Coverage within the lowest wealth quintile should be reported alongside the total population to monitor equitable coverage of eye health financing
OOP payments for cataract surgery	Median (and range) of OOP payment made for cataract surgery as a proportion of median monthly household (or individual) income	Cost should not be a barrier to accessing eye care. Proxy for WHO/World Bank UHC financial risk protection indicators; catastrophic and/or impoverishing OOP payments unlikely to be discriminatory for monitoring affordability of elective eye care services	Population-based surveys	Health ministry (Surveys may be commissioned in collaboration with other stakeholders)	Informs policy about eye health financing and affordability. Additional services could be monitored in the same way
Effective coverage of cataract and refractive error services
Effective cataract surgical coverage	Among the population aged 50 years and older, people with operated cataract and good postoperative presenting visual acuity as a proportion of all people with operated cataract or operable cataract Disaggregated by sex	Sex-disaggregated effective coverage measures the UHC dimensions of access, quality and equity for the leading cause of blindness globally	Population-based surveys	Health ministry (Surveys may be commissioned in collaboration with other stakeholders)	Informs policy and planning about the met and unmet need for cataract surgical services; candidate WHO UHC tracer indicator
Effective refractive error coverage	Adults with refractive error corrected to a pre-defined visual acuity threshold with habitual correction as a proportion of all people with corrected and uncorrected refractive error Disaggregated by sex	Sex-disaggregated effective coverage measures the UHC dimensions of access, quality and equity for the leading cause of vision impairment globally	Population-based surveys	Health ministry (Surveys may be commissioned in collaboration with other stakeholders)	Informs policy and planning about the met and unmet need for refractive error services; candidate WHO UHC tracer indicator
Prevalence of vision impairment
Prevalence of VI	The prevalence of all cause distance and near VI (according to WHO definitions) Disaggregation by key equity measures Disaggregation by avoidable vs non-avoidable	Proxy measure of eye health; a measure of programmatic success in journey towards eye health as part of UHC	Population-based surveys	Health ministry (Surveys may be commissioned in collaboration with other stakeholders)	Disaggregated VI prevalence estimates inform policy makers about the impact of eye health systems on eye health among population subgroups

OOP, out-of-pocket; UHC, universal health coverage; VI, vision impairment.