Visual Impairment and Sustainable Development: Demand for and Impacts of Surgical Cataract Extraction in Sub-Saharan Africa

This dissertation is divided into three chapters, all originating from original fieldwork. Chapter One explores the impacts of blindness on blind subjects, their caretakers and their households in Amhara Region, Ethiopia, and demand for cataract surgery among those eligible for surgery. Chapter Two explores the impacts of cataract surgery taken up by the eligible: on the subjects themselves as well as their caretakers and households. Chapter Three explores demand for and impacts of cataract surgery among visually impaired members of the Mbola Millennium Village, located outside of Tabora, Tanzania. Variables of interest include, for the blind subjects and their caretakers, activities of daily living and time spent in productive activities, social participation, physical and mental health, and, for the blind subjects, vision-related quality of life and food insecurity. At the household level, we explore transfers and assistance, asset index, consumption, and food insecurity. In Chapter One, we find the blind subjects, their caretakers and households are indeed worse off along many of the above dimensions when compared with matched, non-blind subjects and their households. Among those eligible for cataract surgery in the Ethiopia sample, 76% report for surgery, and we find that gender, age and physical condition are key determinants. In Chapter Two, we find that those who do report for and receive surgery improve along a number of the dimensions listed above, though rarely to a point equal to their non-blind counterparts. Further, evidence of economic impacts at the household level is mixed. Chapter Three reinforces many of the findings from Chapters One and Two, including gender dimensions to uptake, improved quality of life for visually impaired individuals, and mixed results on economic impacts for subjects and their households