Sierra Leone study identifies barriers to integrating eye care into primary care

Researchers examined the integration of primary eye care into Sierra Leone’s primary healthcare system following adoption of the WHO training manual in 2020. The mixed-methods study, published in BMC Public Health, included 57 interviews with trained primary healthcare workers, ophthalmic specialists, health managers and NGO partners, plus a survey of 32 facilities across four districts. Interviews explored implementation experiences; facility assessments examined infrastructure, equipment, medicines and eye care data systems.

Healthcare workers reported greater confidence, improved knowledge and better ability to identify, manage and refer patients with eye problems. Participants also described improved counselling, fewer harmful practices and more appropriate referrals, with perceived reductions in pressure on secondary services. However, limited supervision and refresher training, workforce shortages and inadequate equipment and medicines hindered implementation. Cost and travel barriers limited referral uptake. Facility surveys identified gaps in electricity, water, essential supplies and integration of eye care records into routine information systems.

The findings suggest that training needs complementary investment in supervision, referral pathways, staffing, infrastructure and supply chains. Reported clinical benefits were based on participant accounts rather than measured patient outcomes, and the supplied text provides no numerical estimates of facility deficiencies. Irish Aid funded the research and reportedly had no role in study conduct or reporting; the authors declared no competing interests.