Background and Objective:
The World Health Organisation (WHO) recommends reorienting health systems towards primary health care (PHC), as a foundation for achieving universal health coverage (UHC). Sierra Leone is integrating some previously vertical programmes, Neglected Tropical Diseases (NTDs) and Primary Eye Care (PEC), into its PHC services. In this study, we explored the experiences and capacities of PHC staff trained in eye care; investigated the readiness of the PHC facilities and staff to deliver NTD services; and sought to understand how PHC can deliver essential eye care and NTD services to all.

Methods:
We employed a mixed-method approach, including desk review of key documents. We interviewed 57 purposively sampled health care personnel, and we conducted facility-based surveys in 32 PHC facilities. Drawing on the WHO health systems building blocks, we used a framework analysis approach to analyse all data. Ethics were obtained from the Sierra Leone Ethics and Scientific Review Committee. Empirical data was collected from 4 districts in Sierra Leone between December 2021 and February 2022.

Results:
Trained staff are now able to treat basic eye diseases, provide on spot services for communities in hard-to-reach areas, and conduct outreach programmes to educate communities on eye care and NTD management. Despite the successes, multiple shortcomings and challenges across the health system continue to hinder efficacy of the training and its potential to improve eye care services. Challenges include lack of basic infrastructure including electricity and water; insufficient paid staff; shortages of basic drugs; lack of infrastructure to support digitalised data management; lack of funds for outreach programmes; and lack of accessible facilities for women and people with disabilities. Recommendations included pre- and in-service training modules for all PHC staff.

Conclusion:
Training PHC workers without the accompanying system strengthening is not enough to provide the successes that these trainings envisage.