This implementation research evaluates whether an integrated model of school eye health delivery is more cost-effective than a traditional vertical approach in Zanzibar. The study compares the costs, service outputs, and operational efficiencies of delivering eye health activities through existing school health systems versus stand-alone outreach programmes. It also explores the feasibility and practical challenges of integrating eye health into routine school health services within a low-resource setting. The findings aim to inform policymakers and programme implementers on sustainable and efficient approaches for scaling school eye health programmes in Zanzibar and similar contexts.

This qualitative health systems study explores the contextual and health system factors influencing the integration of eye health into school health programmes in Zanzibar. Using interviews and stakeholder engagement across the education and health sectors, the study examines how governance, workforce capacity, referral systems, financing, intersectoral collaboration, and community perceptions shape programme implementation. The research highlights both enabling factors and systemic barriers affecting the sustainability and effectiveness of integrated school eye health services. The findings provide evidence to inform policy, strengthen health system integration, and support the development of scalable and contextually responsive school eye health programmes in low-resource settings.

This non-randomised interventional comparative implementation study examines whether an integrated school eye health delivery model performs better than a conventional vertical approach in a real-world setting in Zanzibar. The study compares programme performance indicators including screening coverage, referral uptake, service delivery efficiency, and implementation feasibility, between the two models. It further explores how integration within existing school health systems influences operational sustainability, coordination, and resource utilisation. The findings provide practical evidence to guide policymakers and implementers on effective strategies for scaling school eye health services in low-resource contexts.

This programme evaluation study assessed the reach, effectiveness, adoption, implementation, and maintenance of a school eye health programme in Petauke district, Zambia, using the RE-AIM framework. The programme screened over 53,000 children through teacher-led vision screening and demonstrated improvements in teachers’ eye health practices and children’s quality of life following intervention. Despite strong programme reach and effectiveness, challenges such as low spectacle compliance and poor referral uptake highlighted important contextual barriers including parental misconceptions, seasonal activities, and community perceptions. The study emphasises that sustainable school eye health programmes require not only effective screening systems, but also stronger community engagement, follow-up mechanisms, and long-term integration into routine school health structures.