Patient flow and cost

District eye programmes Here, approximately 80% of the needs for eye care services are relatively simple, such as refractive errors or cataract surgery. The remaining 20% is made up of more complex surgical interventions (including retinal or vitreous surgery, for example). When an eye programme is well designed and well managed, solutions for simple needs (80%) can be delivered close to communities, with minimal investment and cost both to the patient and the provider. Staff at this 'primary' or 'community' level can be trained both to meet these simple needs and to recognise the 20% of patients that must be referred. The equipment required would be the minimum needed for an eye examination, and the services provided should include refractive error correction and first-level treatment of ocular infections and injuries. When such services are not available locally, however, the only option for patients is to go to the secondary (district or provincial) hospital or to a tertiary care facility. Then the cost goes up enormously, for both patients and providers. These centres of higher levels of care would then, for the most part, be treating conditions for which there are over-designed. They would be providing the same services with similar outcomes as in primary eye care centres, but at a significantly higher cost. Where eye care is delivered, and by whom, has a significant impact on resources and associated costs.