Bringing eye health and NTD services closer to communities: a mixed method study

• To draw on an extended health system building blocks framework to explore how primary health care settings (PHCSs) in Sierra Leone can be supported to deliver essential eye care and post-elimination neglected tropical disease (NTD) services

Primary health care (PHC) is the backbone of a whole-of-society approach to health. It provides care for health needs throughout a person’s lifespan, and not just for specific diseases but comprehensively – ranging from promotion and prevention to treatment, rehabilitation, and palliative care. It sits as close as feasible to communities and people’s day-to-day life.

An integrated approach to service delivery through primary care settings is considered an effective and efficient way to deliver essential health services to all. To this effect, PHC provides the programmatic engine for universal health coverage (UHC) in many contexts. It reflects the right priorities and is a critical milestone along the road to achieving UHC targets.

Guidelines for PHC-led onchocerciasis services are being developed, and training is being delivered. However, the extent to which these new and recent guidelines are being translated into existing governance frameworks regulating primary eye care, and the extent to which PHCSs in the region are prepared to take on this new responsibility, remains unclear. There is also a lack of clarity around the changes that may be required to prepare them to take on these services.

This study will employ a mixed-method investigation approach to explore how eye care services are delivered by primary health care services in Sierra Leone, and their preparedness to take on post-elimination NTD services. These methods include secondary research/desk review of key documents and policies, key informants’ interviews, focus group discussions, and a facility-based survey.

Implications for policy and practice

Previous studies exploring primary eye care (PEC) have highlighted that training alone is insufficient to change practices at this level, due to the prevailing health system weaknesses and failures to address them. It is therefore important to understand whether and how the health system within each country is able to adapt to support newly-trained staff to deliver quality PEC services effectively, after and according to their training.

This study will seek to explore how the same toolkit is adapted for local context (domesticated), rolled out, and how eye care services are made available and used in three diverse settings in west Africa. The study will provide evidence to support both successful transition of NTD morbidity management interventions and improved availability of essential eye care services. These are critical steps for ensuring continuity of care for all patients who need it, and thus to progress towards UHC.

Findings from this study will be synthesised with similar studies from two other west African countries, Senegal and Liberia, to create a combined report describing the similarities and differences between the three settings and inform a consolidated set of recommendations that will be shared through regional and international networks, including at WHO AFRO.