ArticleHealth science reports2026
From Aid Dependency to Self-Reliance: Lessons From Sierra Leone and Rwanda's Strategies for Eliminating Preventable Blindness in Africa: A Perspective Study.
Article in Health science reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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6 authors.
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Abstract
Background and Aims: Preventable blindness remains a leading cause of disability in low-income countries (LICs), with 91.5% of cases in Sierra Leone and 83.9% in Rwanda considered avoidable. Reliance on foreign aid has supported eye care development in Africa, yet has also fostered systemic dependency. As donor fundg declines, the need for sustainable, locally led eye health systems becomes urgent. This perspective examines how Rwanda and Sierra Leone, both postconflict LICs reliant on foreign aid, have pursued divergent approaches to eliminate preventable blindness. Rwanda via a nationally led, integrated strategy and Sierra Leone through a fragmented, donor-dependent model. Methods: A comparative case study was conducted using national policy documents, peer-reviewed literature, Rapid Assessment of Avoidable Blindness (RAAB) surveys, and program evaluations. We assessed governance structure, financing models, workforce capacity, and service delivery. Outcomes included prevalence of blindness (PB), cataract surgical coverage (CSC), workforce growth, and health financing trends. Results: Rwanda reduced PB from 1.6% (95% CI: 1.0-2.2) to 1.1% (95% CI: 0.7-1.4) (2006-2015), while CSC increased from 47.2% to 68.4%. National initiatives such as integration of eye health into the health sector strategic plan, community-based health insurance coverage for 83.5% of the population, and task-shifting to 2797 trained primary eye care nurses, expanded access to over 2.4 million people. Sierra Leone's PB increased from 4.9% (95% CI: 3.8-6.0) to 5.4% (95% CI: 4.3-6.7) (2011-2021), and CSC improved from 40.5% to 50.5%. Despite formal eye health policies, 55% of health expenditures remain out-of-pocket, and 36.2% of financing derives from donors, leaving the system fragmented and aid-dependent. Conclusion: Nationally led, integrated strategies like Rwanda's prove more effective than donor-dependent models in sustainably reducing preventable blindness. This highlights the need for African countries to prioritize integrated financing, workforce development, and data-driven policy frameworks, actions critically urgent amid shrinking global health aid.
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