Vision Center Determinants of Cataract Follow-Up in Rural India

Cataract remains the leading cause of avoidable blindness in India despite substantial expansion of surgical services over the past two decades. While surgical coverage has improved, optimal visual outcomes depend on effective post-operative follow-up, which remains inconsistent across decentralized Vision Center-based systems, particularly in rural and semi-urban settings. Routine program data show wide variation in post-operative cataract follow-up compliance among Vision Centers operating within similar organizational and geographic contexts, suggesting the influence of facility-level determinants. This phased mixed-methods implementation study aims to identify facility-level factors influencing post-operative cataract follow-up compliance and to develop an evidence-based framework to strengthen follow-up systems. Phase 1 will involve retrospective analysis of three years of integrated Health Management Information System- Vision Centre Management Information System (HMIS-VCMIS) data from approximately 120 Vision Centers to establish empirical benchmarks and classify centers as high- or low-performing. Structured facility assessments and qualitative interviews with Vision Center staff, program managers, and post-operative patients will be conducted to identify operational practices, workflows, and contextual factors associated with follow-up performance. Phase 2 will focus on co-design, pilot testing, and early implementation of a Follow-Up Strengthening Intervention Framework in selected low-performing Vision Centers. The intervention will include standardized counselling workflows, follow-up tracking and reminder systems, role clarification, supervisory feedback mechanisms, and peer-learning support from high-performing centers. Changes in follow-up compliance will be monitored using routine data over a 12-month implementation period, alongside process evaluation to assess feasibility, fidelity, and acceptability. Findings from this study will generate practical evidence to strengthen post-operative cataract follow-up systems and inform scalable quality improvement strategies within decentralized Vision Center networks.