Organization and Delivery of Refractive Error Services in Francophone Sub-Saharan Africa: A Multicountry Cross-Sectional Study

Background: The effective organization and delivery of refractive error services are essential for reducing avoidable visual impairment. Limited evidence exists regarding how refractive services are structured and implemented within Francophone Sub-Saharan Africa (FSSA). This study assessed the organization and delivery of refractive error services across FSSA countries. Methods: A multicountry descriptive cross-sectional survey was conducted between March and August 2020 among eye health stakeholders across 21 FSSA countries. A structured questionnaire derived from the World Health Organization (WHO) health system building blocks framework evaluated governance, financing, human resources, service delivery models, health information systems, and infrastructure. Descriptive statistical analyses were performed using SPSS version 20. Results: Of 500 distributed questionnaires, 151 were completed (30.2%), representing 18 participating countries. Seventy percent reported the existence of national eye health policies; however, 65% indicated absence of refractive-specific operational guidelines. Strategic workforce planning was absent or unknown in 66.2% of cases. Refractive services were predominantly concentrated in urban areas (67.6%), with limited primary-level integration. Only 24.1% reported computerized health information systems. Equipment shortages included retinoscopes (33.3%) and phoropters (66.7%). Spectacle affordability and availability were inadequate in 58.8% and 69.7% of settings, respectively. Conclusion: Substantial structural and operational gaps limit the effective organization and delivery of refractive error services in FSSA. Strengthening governance, workforce planning, infrastructure, and service decentralization is essential to enhance equitable access to refractive care.