{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T17:27:14Z","timestamp":1783013234991,"version":"3.54.6"},"reference-count":30,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T00:00:00Z","timestamp":1769385600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T00:00:00Z","timestamp":1769385600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Science Reports"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims<\/jats:title>\n                    <jats:p>Preventable blindness remains a leading cause of disability in low\u2010income 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\u2010dependent model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A comparative case study was conducted using national policy documents, peer\u2010reviewed 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Rwanda reduced PB from 1.6% (95% CI: 1.0\u20132.2) to 1.1% (95% CI: 0.7\u20131.4) (2006\u20132015), while CSC increased from 47.2% to 68.4%. National initiatives such as integration of eye health into the health sector strategic plan, community\u2010based health insurance coverage for 83.5% of the population, and task\u2010shifting 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\u20136.0) to 5.4% (95% CI: 4.3\u20136.7) (2011\u20132021), and CSC improved from 40.5% to 50.5%. Despite formal eye health policies, 55% of health expenditures remain out\u2010of\u2010pocket, and 36.2% of financing derives from donors, leaving the system fragmented and aid\u2010dependent.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Nationally led, integrated strategies like Rwanda's prove more effective than donor\u2010dependent models in sustainably reducing preventable blindness. This highlights the need for African countries to prioritize integrated financing, workforce development, and data\u2010driven policy frameworks, actions critically urgent amid shrinking global health aid.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/hsr2.71771","type":"journal-article","created":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T04:15:36Z","timestamp":1769487336000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["From Aid Dependency to Self\u2010Reliance: Lessons From Sierra Leone and Rwanda's Strategies for Eliminating Preventable Blindness in Africa: A Perspective Study"],"prefix":"10.1002","volume":"9","author":[{"given":"Babatunde Ismail","family":"Bale","sequence":"first","affiliation":[{"name":"Faculty of Life Sciences University of Benin Benin City Edo State Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3726-1293","authenticated-orcid":false,"given":"Lynette Delali","family":"Amematekpor","sequence":"additional","affiliation":[{"name":"College of Science Kwame Nkrumah University of Science and Technology Kumasi Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ebunoluwa Anne","family":"Ajibola\u2010Ajo","sequence":"additional","affiliation":[{"name":"Faculty of Life Sciences University of Ilorin Ilorin Kwara State Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seriki Yetunde","family":"Mutiat","sequence":"additional","affiliation":[{"name":"Benjamin S. Carson Snr School of Medicine Babcock University Ilishan\u2010Remo Ogun State Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ojo Onakhe","family":"Emmanuel","sequence":"additional","affiliation":[{"name":"Faculty of Life Sciences University of Benin Benin City Edo State Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adeleke","family":"Oluwatimilehin","sequence":"additional","affiliation":[{"name":"Faculty of Science Lagos State University Lagos Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,1,26]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13690-023-01188-y"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-031-40858-8_418-2"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/ICU.0000000000000647"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.4081\/jphia.2018.892"},{"key":"e_1_2_13_6_1","doi-asserted-by":"crossref","unstructured":"Organisation for Economic Co\u2010operation and Development Cuts in Official Development Assistance: OECD Projections for 2025 and the Near Term OECD Policy Briefs. 2025 https:\/\/doi.org\/10.1787\/8c530629-en.","DOI":"10.1787\/8c530629-en"},{"key":"e_1_2_13_7_1","unstructured":"H.Larkin Aid Cuts Threaten Global Eye Care Progress European Society of Cataract and Refractive Surgeons. 2025 https:\/\/www.escrs.org\/channels\/eurotimes-articles\/aid-cuts-threaten-global-eye-care-progress."},{"key":"e_1_2_13_8_1","doi-asserted-by":"crossref","unstructured":"S.Basnet E.Jolley E.Schmidt et al. 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National Strategic Plan for Eye Health(Ministry of Health 2018) https:\/\/www.moh.gov.rw\/index.php?eID=dumpFile&t=f&f=107221&token=24cefc219994054304d0a368ddc0533fac40172e."},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.14.143149"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-025-12776-9"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.xops.2022.100168"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.4314\/rjmhs.v4i3.5"},{"key":"e_1_2_13_17_1","unstructured":"International Agency for the Prevention of Blindness Primary Eye Care: The Rwanda Model (International Agency for the Prevention of Blindness 2016) https:\/\/www.iapb.org\/news\/primary-eye-care-the-rwanda-model\/."},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.11604\/pamj.2020.37.55.20376"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/IIO.0000000000000534"},{"key":"e_1_2_13_20_1","first-page":"43p","volume-title":"Rapid Assessment of Avoidable Blindness (RAAB) Report, Sierra Leone","author":"Jolley E.","year":"2022"},{"key":"e_1_2_13_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijgo.2016.10.001"},{"key":"e_1_2_13_22_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13561-017-0159-1"},{"key":"e_1_2_13_23_1","doi-asserted-by":"publisher","DOI":"10.1093\/heapol\/czad100"},{"key":"e_1_2_13_24_1","unstructured":"Ministry of Health and Sanitation (Sierra Leone) National Health Accounts 2019\u20132020 Study Report(Ministry of Health and Sanitation 2021) https:\/\/mohs.gov.sl\/download\/48\/reports\/17556\/final-nha-2019-2020-study-report.pdf."},{"key":"e_1_2_13_25_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-020-05279-2"},{"key":"e_1_2_13_26_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2023.1096224"},{"key":"e_1_2_13_27_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2022-068348"},{"key":"e_1_2_13_28_1","doi-asserted-by":"publisher","DOI":"10.7189\/jogh.11.07001"},{"key":"e_1_2_13_29_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0252905"},{"key":"e_1_2_13_30_1","unstructured":"United Nations Children's Fund Rwanda UNICEF 2023\u201324 Health Budget Brief(United Nations Children's Fund Rwanda 2024) https:\/\/www.unicef.org\/rwanda\/media\/5736\/file\/UNICEF_2023-24%20Health%20Budget%20Brief_layout_corrections_25-3-24.pdf."},{"key":"e_1_2_13_31_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41433-020-01335-7"}],"container-title":["Health Science Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/hsr2.71771","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/hsr2.71771","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/hsr2.71771","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T17:11:20Z","timestamp":1783012280000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/hsr2.71771"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,26]]},"references-count":30,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,2]]}},"alternative-id":["10.1002\/hsr2.71771"],"URL":"https:\/\/doi.org\/10.1002\/hsr2.71771","archive":["Portico"],"relation":{},"ISSN":["2398-8835","2398-8835"],"issn-type":[{"value":"2398-8835","type":"print"},{"value":"2398-8835","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,26]]},"assertion":[{"value":"2025-07-27","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-14","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-26","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e71771"}}