Evaluating the Integration Model of a Standalone Eye Centre Into Provincial Government Hospital

Worldwide there are 36.0 million blind and 216.6 million visually impaired. Of these, the majority of cases are preventable or treatable. With most eye care being delivered through secondary and tertiary levels of the health system, initial access to services remains a barrier to addressing visual impairment. A key approach to improving access is the integration of eye care into primary health care to provide treatment and referral at the lowest population level to identify those in need of eye health services.2 Visual impairment remains a significant public health concern in Nepal, particularly in rural and peri-urban regions where access to specialized eye care is limited. District-level hospitals represent the primary point of care for substantial segments of the population; however, these facilities frequently lack the ophthalmic infrastructure, skilled personnel, and diagnostic capacity required to address the growing burden of ocular morbidity. Standalone eye centers, often operated by non-governmental or semi-autonomous entities, have historically supplemented government services and played a critical role in delivering specialized ophthalmic care. Despite their strengths, these centers commonly function in parallel to the public health system, resulting in fragmented service delivery, inconsistent referral pathways, and challenges in long-term care coordination.3 This study aims to undertake a comprehensive academic evaluation of the integration of a standalone eye centre into the Provincial Government Hospital in Kalaiya, Bara District, Nepal. The initiative seeks to merge the specialized clinical capabilities and equipment resources of the Kalaiya Eye Centre (KEC) with the infrastructural capacity, patient volume, and administrative governance of the Provincial Government Hospital. This type of integration model represents an innovative approach to strengthening district-level eye care by enhancing system cohesion and optimizing resource utilization. Rigorous assessment of this model is necessary to determine its feasibility, operational efficiency, scalability, and potential contribution to strengthening Nepal's eye health system.4 The primary objectives of the study are to Compare patient service utilization (outpatient visits, follow ups, referrals) before and after integration. Secondary objectives include, to assess patient and community perceptions of accessibility, convenience, and quality of eye care services following integration.

A mixed-method research design will be employed to enable a holistic understanding of the integration process. Quantitative data will be extracted from electronic and paper-based service statistics, hospital records, and patient registries. This dataset will include indicators such as patient volume, follow ups and referrals. Statistical analyses will be undertaken to compare pre-integration and post-integration performance across these parameters, with the aim of identifying measurable improvements or persistent gaps.

Qualitative data will be obtained through semi-structured interviews, focus group discussions, and direct observational assessments involving ophthalmologists, optometrists, administrative personnel, and patients. The qualitative component will enable an in-depth examination of staff perceptions, workflow adaptations, communication pathways, patient experiences, and broader contextual factors influencing the success of the integration.

The integration will be examined not only in terms of structural reorganization but also as a dynamic process requiring alignment of institutional cultures, adaptation of workflows, and development of collaborative mechanisms. This perspective is critical for understanding integration as a multifaceted intervention that extends beyond infrastructural consolidation and entails significant organizational transformation.

The expected outcomes of the study include evidence on the extent to which integration improves patient access to timely ophthalmic evaluations, reduces unnecessary delays, and strengthens continuity of care.

This evaluation aligns with Nepal's broader commitments to Universal Eye Health and the national objective of reducing avoidable blindness. Strengthening eye care at the district level is central to achieving equitable service distribution and ensuring that underserved and marginalized populations receive timely, high-quality ophthalmic care. Findings from this study have the potential to inform policy decisions, guide health system strengthening efforts, and contribute to the development of evidence-based models for integrating specialized eye services into public hospital settings.

By providing a rigorous academic assessment of the integration model at Kalaiya, this study aims to contribute to the global discourse on health system integration and collaborative service delivery in low- and middle-income countries. The results are expected to offer transferable insights relevant to other regions seeking to harmonize parallel service structures, improve care coordination, and build more resilient and efficient eye health systems.