Task-Shifting in Ophthalmic Care: An Operational Research Study on Nurse-Led Cataract Surgery in Rural Mali

Cataract is the leading cause of blindness in Mali, with a severe shortage of ophthalmologists concentrated in urban centres. Task-shifting is a potential strategy to address this rural-urban inequity, but evidence on its operational implementation within the Malian public health system is limited. This operational research study aimed to assess the feasibility, clinical outcomes, and health system enablers and barriers of nurse-led cataract surgery in two rural districts of Mali. A mixed-methods, observational study was conducted. Quantitative data on surgical output, patient demographics, and postoperative visual acuity at six weeks were collected from routine health records. Qualitative data were gathered through semi-structured interviews with trained ophthalmic nurses, health facility managers, and patients to explore operational experiences. Trained ophthalmic nurses performed 347 cataract surgeries. At the six-week follow-up, 89% of patients achieved a good visual outcome (presenting visual acuity of 6/18 or better). Qualitative analysis identified supportive supervision, reliable supply chains for consumables, and community sensitisation as critical factors for programme success. Task-shifting cataract surgery to specially trained ophthalmic nurses in rural Mali is operationally feasible and yields good clinical outcomes. This model can improve access to sight-restoring surgery in underserved regions. Integrate ophthalmic nurse surgical training into national health workforce plans. Establish dedicated supply chains and sustainable supervision mechanisms. Develop context-specific protocols and monitoring frameworks to support scale-up in other rural districts. task-shifting, cataract surgery, ophthalmic nurses, operational research, health systems, Mali, rural health This study provides original evidence on the implementation of a nurse-led cataract surgery model within the Malian public health system, informing policy on surgical task-shifting for rural eye care.