Cataract Surgical Rate and Service Coverage Gap Analysis Across the Six Geopolitical Zones of Nigeria

The cataract surgical rate (CSR) is the primary metric for monitoring progress toward eliminating cataract blindness, yet comprehensive analysis of its zonal distribution and the underlying service coverage gaps across Nigeria's six geopolitical zones has not been conducted in recent years. This study conducts a geopolitical zone-level analysis of CSR and cataract service coverage gaps across Nigeria. A secondary data analysis design will be employed, drawing on data from the Nigeria National Blindness and Visual Impairment Survey, Federal Ministry of Health annual health statistics, state eye care programme reports, and the IAPB Africa data repository covering 2019 to 2023. CSR will be calculated per million population per year for each geopolitical zone using operative volumes from public and private hospitals. Coverage gap analysis will estimate the number of persons with operable cataract not receiving surgery in each zone and identify the human resource, financial, and infrastructure correlates of service gaps. Spatial and statistical analysis will characterise the North-South gradient in cataract service delivery. Nigeria's CSR remains well below the WHO recommended threshold of 2,000 surgeries per million population per year, with northern zones historically lagging behind southern counterparts due to fewer ophthalmologists, lower health service utilisation, and cultural barriers. This study provides the most current zone-level evidence to guide the Federal Ministry of Health's National Eye Health Policy implementation plan. Recommendations will address targeted ophthalmologist postings, subsidised surgical services, and surgical training expansion across the Northern zones. Keywords: cataract surgical rate, service coverage, geopolitical zones, Nigeria, blindness prevention