Visible expansion, fragile effective coverage: using repeated eye health system assessments to interpret limited change in eye health outcomes in Sierra Leone, 2013–2025
Summary
This article looks at the differences in eye health results over time in Sierra Leone, using four national reports between 2013 and 2025.
Blindness among adults aged 50 years and older had a little change. Cataract surgical coverage went up, with slightly fewer women and more men receiving the services. By 2025, eye health services were coordinated in a better way, were available in more places, had more healthcare workers and equipment and there were more reports in the health system. Despite these improvements, the eye health system still faced challenges, including limited local funding, staff shortages in some areas, unreliable supplies and equipment, and weak use of data to guide decisions.
Repeated eye health system assessments can help explain why visible service expansion may not lead quickly to better eye health for the population. To make eye health services better in future, there is need for stronger local funding, enough staff in the right places, reliable supplies and maintenance, and regularly checking that everyone can access the services.