This study was conducted across countries in Francophone Sub-Saharan Africa (FSSA) where French is widely used as an official or administrative language. These countries share similar health system structures largely inherited from the former French colonial administration and exhibit comparable health strategies and indicators.

Despite ongoing efforts, these countries face significant challenges in reducing the prevalence of uncorrected refractive errors (URE). None of the countries in this region meet the recommended minimum ratio of human resources for eye health. In addition, optometry remains insufficiently integrated into national eye care delivery systems in most countries. Until 2020, only two optometry training institutions existed in the region, located in Mali and Cameroon.

Eye care services in FSSA countries are generally delivered through a combination of government services, non-governmental organizations (NGOs), and the private sector. Health systems are typically organized in a three-tier pyramidal structure. The primary level, located at the health district level, provides basic eye care services and community education on hygiene and prevention. The secondary level is responsible for coordination, supervision, and management of regional health facilities and provides treatment for most eye diseases, including surgical interventions. The tertiary level, usually located in national or university hospitals, offers specialized care and serves as the main center for training and research.

Participants were selected through a two-stage process involving primary and secondary targets. Primary targets consisted of the national coordinators or managers of eye health programs in each of the 21 countries included in the study. Contact with these coordinators was facilitated by the national eye health coordinator. When coordinators or their deputies could not be reached, information was obtained through the network of alumni from the CHU-IOTA, including ophthalmologists, nurses, and optometrists. Primary targets were responsible for providing lists and contact information for key eye health actors and partners in their respective countries, including ophthalmologists, optometrists, opticians, ophthalmic technicians, and NGOs.

Secondary targets were selected from these lists using a purposive sampling approach to ensure representation while avoiding redundancy. Five ophthalmologists and five optometrists per country were selected. When the number of professionals exceeded five, random selection was performed; if fewer than five were available, all were included. For ophthalmic technicians and opticians, six participants per profession were selected in each country, considering geographic distribution to ensure regional representation. When the number of regions exceeded six, random selection was applied, while all available personnel were included if fewer than six were identified. Technical and financial partners involved in eye health, particularly NGOs, were also included. When more than ten partners were identified in a country, a random selection of ten organizations was made.

Data were collected using an online questionnaire developed based on the World Health Organization Eye Health Systems Assessment Tool (ECSAT) [13]. The questionnaire primarily focused on issues related to refractive error and followed the health systems framework, including six key components: leadership and governance, human resources, financial resources, eye care service delivery, infrastructure and equipment, and health information systems.

Before dissemination, the questionnaire and related tools were translated into French and pre-tested among trainees undergoing training at CHU-IOTA during the study period. This pre-testing phase allowed refinement of the questionnaire to improve reliability, validity, and clarity of the questions.

Data collection was conducted in two phases. The first phase involved gathering information on eye health resources and identifying NGOs and partners through direct contact with primary targets via email, supplemented in some cases by telephone calls. The second phase consisted of administering the online questionnaire to all selected participants according to a structured framework based on the six components of the eye health systems assessment tool.

Each questionnaire sent by email included an informed consent form that participants had to accept before completing the survey. Several reminders were sent via email and telephone calls to encourage participation and improve response rates.

Ethical approval was obtained from the Ethics Committee of the Faculty of Medicine and Odontostomatology, Mali (Ref No: 2019/47/CE/FMPOS). Electronic informed consent was obtained from all participants.

The data collected online were exported and analyzed using SPSS version 20 (IBM Corp., Armonk, NY, USA). Descriptive statistical analyses were performed to characterize eye health resources and the organization of eye care systems in FSSA countries.

Descriptive statistical analyses were performed using SPSS version 20 (IBM Corp., Armonk, NY, USA).

Seventy percent reported the existence of national eye health policies; however, 65% indicated absence of refractive-specific operational guidelines (See Table 2).

The financial aspects of services related to refractive errors were investigated, both in terms of the specific availability of budgetary resources and the existence of healthcare coverage programs.

Figure 1.Distribution by country response.

Table 1.Respondent characteristics (N = 151).

Table 2.Governance indicators.

According to respondents, 58.80% stated that a specific allocation for eye care does not appear in the Ministry of Health’s budget. Additionally, 23% were unaware of the existence of such a specific allocation (See Figure 2Figure 2).

Regarding the geographical distribution of eye health professionals, 45.95% of respondents stated that the government is not taking steps to ensure that this distribution of professionals meets the country’s needs, and 24.32% were unaware of the existence of any policy to this effect (See Figure 3Figure 3).

According to 79.17% of respondents, educational institutions that train eye health professionals are minimally involved in the development of government plans and strategies concerning eye care professionals (See Figure 3Figure 3).

Figure 2.Specific allocation for eye care in the Ministry of Health budget.

Figure 3.Human resources management involvement.

In healthcare facilities, 54.5% of respondents believe that the cost of an eye exam is affordable for the local population. Regarding the treatment of refractive errors with glasses, 58.8% of participants believe that the cost of glasses is unaffordable for the population, and according to 69.7% of respondents, these glasses are simply not available (See Figure 4Figure 4).

Figure 4.Availability and affordability of eye care-glasses.

Only 24.1% reported computerized health information systems and Government institutions or structures are the primary sources of information for the eye care health information system, followed by NGOs and private institutions.

The survey included a section on the equipment and infrastructure needed to provide services related to refractive errors and eyeglass supply facilities.

Retinoscopes were unavailable in 33.3% of facilities, and phoropters were absent in 66.7%. Spectacle production units were available in 43.3% of settings (See Table 3).

Table 3.Equipment availability.

The study relied on self-reported data and may be subject to response bias. The response rate may limit generalizability; however, representation across 18 countries provides meaningful regional insight.