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Updated: Jun 11, 2026

$Subjective Refraction Test Using a Smartphone for Vision Screening$

Subjective Refraction Test Using a Smartphone for Vision Screening

Published on: October 18, 2024

Service users' perspectives on primary eye care services following performance-based financing in Rwanda: an

Thierry Claudien Uhawenimana^1,2, Stella Matutina Umuhoza³, Jean Bosco Ndayambaje⁴

¹School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda. tcuhawenimana@gmail.com.

International Journal for Equity in Health

|June 10, 2026

Summary

Decentralizing eye care in Rwanda improved access but financial and systemic barriers persist. Addressing these is crucial for equitable eye health services for all.

Keywords:

Eye care services Performance-based financing Primary healthcare Qualitative study Rwanda

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Last Updated: Jun 11, 2026

$Subjective Refraction Test Using a Smartphone for Vision Screening$

Subjective Refraction Test Using a Smartphone for Vision Screening

Published on: October 18, 2024

Area of Science:

Public Health
Ophthalmology
Health Services Research

Background:

Visual impairment is a global health issue, especially in low- and middle-income countries (LMICs).
Rwanda integrated eye care into its Performance-Based Financing (PBF) framework in 2019 to enhance service accessibility and quality.
Service user perspectives on this integration are largely unexplored.

Purpose of the Study:

To investigate service users' perceptions of eye care accessibility, quality, affordability, and satisfaction.
To identify challenges encountered by users accessing eye care at primary healthcare facilities in Rwanda.

Main Methods:

An exploratory qualitative study involving 72 participants across six health centers in Rwanda.
Data collected via focus group discussions (FGDs) exploring user experiences.
Inductive analysis of transcribed and translated data using Dedoose software, ensuring trustworthiness through multiple methods.

Main Results:

Decentralization improved geographical access and reduced travel times.
Financial barriers (eyeglasses, medications) and inconsistent service quality (stock-outs, limited equipment/personnel) were significant challenges.
Users reported satisfaction with provider attitudes but dissatisfaction with systemic inefficiencies (long waits, understaffing).

Conclusions:

Decentralization enhanced geographic access and responsiveness but faces persistent financial and systemic barriers.
Recommendations include expanding service packages, strengthening supply chains and human resources, improving insurance coverage, and enhancing community education for equitable eye care.