RESUMO
Cataracts are common in Mali, where there are 60,000 people awaiting surgery for blindness caused by cataracts. This major cause of disability in adults could be used as an effective entry point into the national health system. The development of an effective referral system should increase the recruitment from districts and increase the standing of the highest level health centers. Surgery should be decentralized and carried out at the district level. A specialist surgical team, based at the regional hospital, would operate with portable equipment in the district health centers, with patients being referred by peripheral health centers. The success of this approach depends on the development of strong functional relationships between peripheral and district health centers and of interpersonal relationships between the staff members involved. This new approach should lead to a major reduction in the level of disability whilst strengthening and promoting the district health system as a whole.
