Assessing Eye-Care Systems in a Fragile Context: A District-Level Situational Analysis from Northwest Cameroon

Abstract

Background: Visual impairment and blindness remain major public health challenges in low- and middle-income countries, particularly in fragile and conflict-affected settings. In Cameroon’s Northwest Region, prolonged armed conflict since 2016 has disrupted health services and intensified pre-existing inequities in access to eye care. Evidence on system-level capacity and equity gaps remains limited. Methods: We conducted a cross-sectional, mixed-methods situational analysis between July and November 2025 across all 21 health districts of the Northwest Region of Cameroon. The assessment was guided by the Christian Blind Mission (CBM), District Eye Care Situational Analysis Tool (DECSAT) and informed by the WHO Health System Building Blocks framework. Data sources included facility assessments, structured surveys with district and facility leaders, documentary review, and extraction of routine service statistics from District health information system 2 (DHIS2) and facility registers. Quantitative data were analyzed descriptively and triangulated with qualitative findings using an equity lens. Results: 11 of 21 (52.4%) districts had fixed eye care services, with facilities and specialist staff concentrated in urban and semi-urban areas. Rural and conflict-affected districts relied on basic care, irregular outreach, or referrals, often requiring travel of 20–50 km. Governance and coordination were weak, with most districts lacking eye-health focal persons. Financing relied largely on out-of-pocket payments, creating major affordability barriers. Health information systems showed inconsistent reporting and limited disability-disaggregated data. Community outreach and rehabilitation activities were fragmented and frequently disrupted by insecurity. Conclusion: Eye-care delivery in the Northwest Region of Cameroon is constrained by conflict-related disruption, weak governance, limited financial protection, and inequitable service distribution. Conflict-sensitive, equity-focused system strengthening is required to improve access, inclusion, and continuity of eye care in this fragile setting.