Document Type

Theses, Ph.D


Available under a Creative Commons Attribution Non-Commercial Share Alike 4.0 International Licence



Publication Details

Successfully submitted for the award of Doctor of Philosophy to the Technological University Dublin, 2014.


The purpose of this thesis is to investigate potential key determinants of the success, or otherwise, of endeavours to address avoidable Visual Impairment (VI) by addressing Uncorrected Refractive Error (URE) in Mozambique and the wider region of sub-Saharan Africa by providing optometric services. It includes a Cost Benefit Analysis (CBA) of a higher education optometry training programme, barriers that might prevent the realisation of overarching goals despite a successful training programme, and a Willingness to Pay (WTP) analysis to inform the pricing structure and to determine the financial sustainability of the system. Methods A standard CBA methodology was applied to ascertain societal net benefit. Costs including those associated with establishing an optometry service. Benefits were calculated by considering how addressing URE could increase productivity. Disability weighting (DW) for VI was applied. The WTP and barriers studies were community-based cross-sectional using two-stage cluster sampling methodology stratified by urban and rural participants. Data were collected by means of face to face interviews using structured questionnaires in Nampula Province, Mozambique. WTP values were ascertained using a stated choice and a bidding game technique, where by the final value is stated after a negotiation. Results were verified using scope analysis and comparisons between WTP values and income levels. Results The potential exists, by addressing URE in 24.3 million economically productive persons, to achieve a net present value societal benefit of up to $1.1 billion by 2049, at a Benefit-Cost ratio of 14:1. Perceived cost to the individual needing to access services was the most significant barrier, identified by at least one in every two participants (53%). The second most frequently stated barrier, identified by over a quarter of participants (28%), was the lack of felt need. The average amount in USD participants would be willing to pay for refractive services was US$12 for stated choice and US$15 for the bidding game methodology. Conclusion An optometry training programme designed to address the burden of URE in Mozambique, and Lusophone Africa, is economically justifiable in terms of the increased productivity that would result due to its implementation. The cost of refractive services must be addressed if the burden of URE is to be reduced. While the average WTP value lies between US$12 and US$15, for the public optometry system in Mozambique to be viable, policy planers must consider that nearly 70% of respondents were not willing to pay this value. The price of having an eye test and spectacles must not act as a barrier to access.


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