Health system strengthening for vision care in The Gambia

Abstract

Introduction: According to global estimates, 39 million peopleare blind and 285 million are at risk of severe vision loss, with asignificant portion of this burden in Sub-Saharan Africa. SomeAfrican nations like The Gambia are beginning to tackle visionimpairment by addressing the problem through a health systemlens.Methods: A health system framework, focusing on system areas of leadership and governance, resources for vision care, and visioncare access, was used to understand and analyze how The Gambiahas increased access to vision care using a public–private pilotpartnership. A desk review of relevant literature, key informantinterviews with stakeholders, and a cross-sectional analysis ofseveral databases were used to understand the following aspectsof the pilot vision care model in The Gambia: leadership and governance, financial and human resources, and vision care access.Results: The results show that a coordinated public–private pilotpartnership between the government of The Gambia and the nonprofitorganization OneSight has led to improved leadership andgovernance for vision care, increased workforce and training, andsustainable financing for vision centers producing net revenueresulting in an increase in both the supply and demand foreyeglasses. The results also show that there is considerable variation in the prevalence of refractive errors and access toeyecare services across The Gambia, which can be influenced byaccessibility, awareness, and affordability.Conclusion: Using a health system framework enables asystematic examination of vision care services. Results from TheGambia provide an example of a public–private pilot partnershipthat can improve vision care for all