Health system strengthening for vision care in The Gambia

Introduction: According to global estimates, 39 million people suffer from blindness and 285 million are at risk of severe vision loss, with a significant portion of this burden in Sub-Saharan Africa.  Some African nations like The Gambia are beginning to tackle vision impairment by addressing the problem through a health system lens.  
Methods: A health system framework, focusing on system areas of leadership and governance, resources for vision care, and vision care access, was used to understand and analyze how The Gambia has increased access to vision care using a public-private pilot partnership.  A desk review of relevant literature, key informant interviews with stakeholders, and a cross-sectional analysis of several databases were used to understand the following aspects of 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 pilot partnership between the government of The Gambia and the nonprofit OneSight has led to improved leadership and governance for vision care, increased workforce and training, and sustainable financing for vision centers producing net revenue resulting in an increase in both the supply and demand for eyeglasses.  The results also show that there is considerable variation in the prevalence of refractive errors and access to eye care services across The Gambia, which can be influenced by accessibility, awareness, and affordability.
Conclusion: Using a health system framework enables a systematic examination of vision care services.  Results from The Gambia provide an example of a public-private pilot partnership that can improve vision care for all.