Task-Sharing in Refractive Error Correction: A Partnership Model for Sustainable Eye Care in Ghana

Ghana’s eye care system faces a significant challenge. Despite some progress, approximately 300,000 Ghanaians are blind, and around 332,000 suffer from severe visual impairment (IAPB Ghana Eye Health Summit, 2023). Furthermore, fewer than 150 ophthalmologists are responsible for meeting the eye care needs of over 30 million people (Eye Africa Media, 2020).  This creates an overwhelming burden as routine refractive error cases consume specialist resources whilst 70% of patients requiring vision correction remain undiagnosed (iDE-GV2020 Ghana Pilot Study, 2025).  

The Clinical Context and Challenge 

Ghana presents classic “optometry desert” conditions, particularly severe in northern regions where eye care professionals are critically scarce. With only a few ophthalmologists (about two) in the region (in private practice), the bulk of refraction and low vision services are rendered by ophthalmic nurses/refractionist (Bawku Eye Care Programme Study, 2007). 

The traditional pathway to glasses creates systematic barriers: travelling to urban centres, waiting weeks for appointments, and paying 650-1,000 Cedis creates obstacles that leave millions with uncorrected vision, whilst our eye care professionals handle routine refractive cases that could be managed through validated task-sharing approaches. 

A Partnership Solution, Not Competition 

Global Vision 2020’s partnership with International Development Enterprises (iDE) Ghana offers a complementary solution. Rather than competing with existing eye care services, we’re creating a systematic triage to identify and serve routine refractive cases, freeing valuable clinical time for conditions requiring specialist intervention. 

Our Technology and Standards: 

• USee testing system: Validated by Johns Hopkins University clinical trials, demonstrating 92% efficacy in delivering appropriate refractive correction for patients achieving 20/30 vision or better 
• IAPB-compliant lenses: Meeting quality standards required for UK and US markets — international-quality eye care made accessible and affordable 
• Task-sharing protocol: Trained healthcare aids provide accurate refractive assessment with minimal specialist supervision 

Evidence from Northern Ghana Pilots 

Between May and June 2025, we conducted controlled pilots across five sites in Tamale, training 24 healthcare and non-medical workers in the USee protocol. 

Clinical Results: 

• 372 patients screened across urban and peri-urban settings 
• 30% conversion rate (110 patients fitted with corrective lenses) 
• 70% of patients were previously unaware they required vision correction 
• Average visual acuity improvement: from worse than 20/50 to 20/30 or better 

Case Documentation: 

Market Trader: A female trader with deteriorating near vision received reading glasses (150 Cedis). She reported immediate improvement in customer recognition and transaction accuracy. “I can now see clearly and do my work with ease. It will help me earn better and live more meaningfully.” 

University Professor: An academic received reading glasses through our mobile clinic, allowing him to maintain his research schedule without traditional clinical pathway disruptions. 

Student: A 12-year-old male, previously experiencing academic difficulties, was fitted with distance correction. Immediate classroom visual acuity improvement correlated with enhanced academic performance and restored confidence. 

Task-Sharing Protocol and Professional Integration 

Our model operates as a systematic triage rather than a competitive service delivery: 

1. Primary Screening: Community-level visual acuity assessment using standardised charts 
2. Refractive Testing: USee system deployment for spherical correction determination 
3. Professional Referral: Automatic referral for complex cases (astigmatism >0.75D, suspected pathology, paediatric cases requiring specialist assessment) 
4. Quality Assurance: Retesting station validation and professional oversight integration 

This ensures ophthalmologists and optometrists receive appropriately triaged referrals whilst routine refractive cases are managed through validated task-sharing protocols. 

Business Opportunities for Eye Care Professionals 

Our pricing model (130-250 Cedis complete) targets market segments currently excluded from traditional optical services without undercutting existing specialist providers. 

Partnership Benefits: 

• Referral stream optimisation: Complex cases directed to appropriate specialist care 
• Capacity utilisation improvement: Reduced routine caseload, enabling focus on advanced procedures 
• Market expansion: Previously untreated population segment brought into the formal eye care system 

Through iDE’s established last-mile community networks, we’ve demonstrated market viability with a 30% conversion rate, proving both demand and sustainable business potential whilst supporting existing services. 

The Broader Health System Impact 

Recent national studies show that the five main causes of moderate to severe visual impairment were refractive error (44.4%), cataract (42.2%) (Ghana VISION 2020 Assessment, 2019) — demonstrating that nearly half of visual impairment cases could benefit from our task-sharing approach. 

By systematically addressing the 70% undiagnosed refractive error population, we can: 

• Reduce clinic congestion with routine cases 
• Enable specialist focus on complex conditions requiring advanced intervention 
• Create referral pathways that strengthen rather than bypass existing services 
• Expand the total market for eye care services through improved accessibility 

Moving Forward Together 

Global Vision 2020 has successfully dispensed over one million glasses across 65 countries, establishing robust quality control protocols. However, optimal integration within Ghana’s healthcare system requires comprehensive regulatory mapping and engagement with the relevant professional bodies. 

The 70% undiagnosed rate represents both a significant clinical challenge and a substantial opportunity. We’re committed to building a model that supports Ghana’s dedicated eye care professionals whilst making quality vision care accessible to millions who currently go without. 

What We Need: 

We seek guidance from Ghana’s eye care community to ensure we operate as trusted, compliant partners. Specifically, we require guidance on regulatory requirements, alignment with professional standards, and integration pathways that enhance existing eye care delivery systems. 

Our vision is systematic integration within Ghana’s existing eye care infrastructure. Expanded access can enhance professional service delivery, particularly for those who are most in need. 

With appropriate guidance and partnership, we can create sustainable solutions that honour professional standards whilst making quality vision care accessible to all Ghanaians. Stories of transformation should become standard outcomes rather than exceptional cases.