Beyond Coverage: A Pragmatic Path to Effective Eye-Care Coverage in Low-Resource Settings

The global eye‑health agenda has shifted from service volume to effectiveness care that restores usable vision and function. This commentary proposes a pragmatic eye-care playbook for resource-limited settings: (1) complete screening‑to‑spectacles pathways for children with on‑site refraction, timely delivery, and a three‑month wear review; (2) expand cataract access while protecting outcomes by tracking a small bundle of indicators and reporting effective cataract surgical coverage (eCSC); and (3) close workforce gaps via competency‑based task‑sharing and asynchronous tele‑ophthalmology. Aligning with WHA73.4 and the WHO 2030 effective coverage targets (eCSC/eREC), the approach is human‑centered, feasible at district scale, and designed to deliver faster, fairer gains in vision. Somalia‑specific evidence illustrates unmet need (school‑age refractive error and adult blindness profiles) and real‑world delivery via outreach eye camps.