The Cameroon Cataract Bond was launched last year as a new way of funding health care by bringing together public and private investors, health donors, and eye care delivery experts.

It is a pay-for-performance loan (also known as a development impact bond or DIB) which is supporting the Magrabi ICO Cameroon Eye Institute (MICEI) to provide as many as 18,000 cataract surgeries in Cameroon over five years. The loan means that low income patients can receive sight-saving surgery for free or at a subsidised fee. The fund will also help the hospital to become self-sufficient in five years.

In its first year the hospital conducted 103 outreach camps screening 11,284 patients and screened a further 42,899 patients in the hospital.

Staff throughout the hospital received training and mentoring from the Magrabi Hospital Group and Aravind Eye Care System. Two ophthalmologists completed Manual Small Incision Cataract Surgery training and nurses received refraction training. Training will continue throughout the project to expand the capacity to deliver eye care services in Cameroon.

The quality of surgeries exceeded World Health Organization standards with nearly 70 per cent of surgeries achieving a good visual outcome on the day after surgery. For those people who returned to the hospital for a follow up four weeks after surgery, 92 per cent achieved a good visual outcome, while only 2.8 per cent had a poor outcome.

Financially the hospital is performing better than anticipated after its first year and is on track to become financially sustainable within five-years.

The project aims to provide 40 per cent of all surgeries for the people in the poorest two groups of the national population. This target is hard to reach because the catchment area of the hospital is the capital city and surrounds, while more of the poorest people live outside urban areas.

Already 29 per cent of all patients were from the bottom two groups based on national poverty thresholds, and 45 per cent based on urban poverty thresholds. The project is working to better understand the barriers people face and develop strategies to increase access for the poorest.

The primary donor and founder of the hospital, Dr. Akef el-Maghraby, internationally renowned ophthalmologist and Chairman of the Magrabi Hospital Group says, “My goal is to make high quality eye care accessible to the people of Cameroon regardless of their ability to pay. We are grateful to our stakeholders for supporting the hospital’s path to sustainability so that we can continue to deliver on our promise. MICEI is the first project for the Africa Eye Foundation, and lays the foundation for a network of integrated and self-sustainable eye hospitals the organization plans to build across Africa.”

“We are encouraged by the progress made so far towards the goal of building greater eye care capacity for Cameroon and for the region,” said Peter Laugharn, President and CEO of the Conrad N. Hilton Foundation, the main financial contributor to the outcome funding pool. “We look forward to the continued partnership represented by this innovative financing mechanism to help support the sustainability of MICEI’s operations.”

Background

The Cameroon Cataract Bond is led by the Cataract Bond Design Coalition, which is formed of The Fred Hollows Foundation, the Conrad N. Hilton Foundation, Sightsavers, the African Eye Foundation and Volta Capital.

It is a type of Development Impact Bond, a results-based contract in which investors provide financing for social programs upfront, and donor organizations repay investors their principal plus a return based on realized performance in delivering social outcomes. In an environment where the need for international development funding often outstrips the resources available, these instruments offer a promising new solution for more effective, efficient financing.

Launched in March 2018, the Cameroon Cataract Bond provided a $2 million loan to the Magrabi ICO Cameroon Eye Institute (MICEI). This loan was financed by The Overseas Private Investment Corporation (OPIC) and the Netri Foundation. OPIC, the U.S. Government’s development finance institution, is one of the first development finance institutions to commit funding to a project using this kind of innovative financial instrument. The Netri Foundation, a private foundation that fights poverty through social impact investments, also provided upfront financing for this project.

The loan provides working capital to top-up $10 million already raised by the Africa Eye Foundation to launch the hospital. Cameroon was selected by the Africa Eye Foundation as the country for the intervention because the number of avoidable blindness cases in the country is set to double by 2020 if there is no systemic change in service delivery capacity.

If the hospital successfully meets four performance targets – volume, quality, equity and sustainability – a coalition of three outcome funders, The Conrad N. Hilton Foundation, The Fred Hollows Foundation and Sightsavers, will repay investors with interest, and provide a performance incentive to the hospital. Volta Capital is the financial intermediary who helped structure and raise this funding, and provides ongoing performance management of the bond during its implementation phase.

In Sub-Saharan Africa, the rate of blindness and vision impairment is twice the global average, with 80 per cent of cases preventable or treatable. Half of those living with avoidable blindness are affected by cataract.

An estimated 48,000 surgeries are needed each year in Cameroon to treat new cases of cataracts as well as the current backlog of people who need cataract surgery, estimated to be 115,000. There are just three ophthalmologists per one million people in Cameroon, compared with a global average of around 31 ophthalmologists per one million people.