Process and Outcome Evaluation of Integrating Primary Eye Care into Primary Healthcare: A Quasi-Experimental Study in Rural China

Introduction: Visual impairment is a critical issue in low- and middle-income countries (LMICs), where unmet eye care needs are significant. The WHO’s 2019 World Report on Vision recommends integrating primary eye care (PEC) into primary healthcare (PHC). This study evaluates the integration of PEC into PHC within County-wide Tight Medical Alliances (CTMAs) in rural China. Methods: From 2021 to 2023, we implemented the Eye CARE Model, focusing on Capacity building, Awareness raising, and Referral system Establishment (CARE). We used the Medical Research Council (MRC) process evaluation framework and a quasi-experimental difference-in-differences (DID) method to assess the impact on eye care utilization in three pilot counties in Yunnan Province. Results: The Eye CARE Model increased primary and secondary eye care visits by 76 and 52 per 10,000 people, respectively. It also improved community-based eye health education and established a three-tiered referral system. The intervention had high fidelity and reach, supported by local government and CTMAs, though challenges in sustaining incentives and integrating PEC indicators into health systems were noted. Conclusions: The Eye CARE Model successfully increased eye care utilization and demonstrated the feasibility of integrating PEC into PHC in rural China, emphasizing the importance of contextual factors in LMICs.