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Cameroon Cataract Development Impact Bond

The Cameroon Cataract Development Impact Bond is an example of a new way of funding eye health care in LMICs through a pay-for-performance loan. It is being used to address avoidable blindness through the provision of 18,000 cataract surgeries in Cameroon over the next five years.

This is a type of Development Impact Bond, a results-based contract in which investors provide financing upfront, and outcome funders repay the investors according to the success of the intervention. In an environment where resources are scarce, these instruments offer a promising new solution for more effective, efficient financing.

The initiative is led by an eye health sector partnership, which provided a $2 million loan to the Magrabi ICO Cameroon Eye Institute, financed by the U.S. International Development Finance Corporation (formerly the Overseas Private Investment Corporation) and the Netri Foundation. The implementing organisation is the African Eye Foundation; the outcome funders are Conrad N. Hilton Foundation, The Fred Hollows Foundation and Sightsavers; and the bond is managed by Volta Capital. A cross-subsidisation pricing model is used to provide quality cataract treatment services to the poor at low or no cost, while raising revenue from wealthier fee-paying patients. The hospital aims to be financially self-sufficient in five years.

Launched in March 2018, during the first year the hospital screened 54,000 people for cataract and performed 2,300 vision-restoring cataract surgeries. Staff at the hospital, including ophthalmologists and nurses, also received training and mentoring. The quality of operations exceeded WHO benchmark standards (80% achieving 6/18 or better), with 92% of patients able to see 6/18 or better following their surgery.1 Financially, the hospital is performing better than anticipated after its first year and is on track to become financially sustainable within five years.



  1. Spaan E, Mathijssen J, Tromp N, McBain F, ten Have A, Baltussen R. The impact of health insurance in Africa and Asia: a systematic review. Bull World Health Organ 2012; 90(9): 685-92.