|Health system domain||Enabling Factors||Challenges|
|Leadership and Governance||
Commitment and support to PEC programme by Ministry of Health, with memorandum of understanding in place for delivery of PEC|
Good engagement between VFAN and RMoH, and other eye sector stakeholders
|The eye health technical working group can be strengthened|
PEC examination included in community health insurance coverage|
External funding raised to support PEC and outreach activities
Cost of glasses can remain prohibitive for the poorest|
Payments received for glasses
are held centrally rather than in health centres with no clear communication of plans for allocation
|Health workforce||Integration of PEC curriculum into nursing schools||
Turnover of PEC trained health centre nurses leaving gaps in provision of PEC clinics.|
Supervision can be strengthened, with reports of inconsistency in frequency and purpose.
Competing priorities at health centres limits availability of nurses to provide PEC
|Medical products and technologies||
Inclusion of eye drops on essential medications list|
Secured supply chain for non-prescription reading glasses and adjustable glasses.
|Variable availability of eye drops and glasses can limit management options|
|Information and research||Integration of PEC indicators on health management information systems data, co-ordinated by RMoH.||
Data is held centrally and access can be difficult.|
Primary care data not routinely linked to secondary or tertiary care data, but collected locally by VFAN.
|Service Delivery||Successful integration of PEC delivery into health centres||Interface between different levels of care could be strengthened – increase communication and feedback between primary and other levels of care.|