Theoretical Frameworks for Universal Eye Health Coverage in a Low-Middle Income Country: Developing a Nigeria-Specific Model

Universal health coverage frameworks increasingly acknowledge eye health as an integral but insufficiently integrated component of primary health care, yet no Nigeria-specific theoretical model for universal eye health coverage exists to guide policy and resource allocation. This study develops and validates a Nigeria-specific theoretical framework for universal eye health coverage, drawing on health systems science, political economy analysis, and implementation science. A qualitative theory-building research design will be adopted across three phases. Phase one involves systematic review of existing global frameworks including the WHO eye health framework and IAPB Universal Eye Health coverage paradigm, identifying adaptable elements and critical gaps for the Nigerian context. Phase two conducts 60 in-depth interviews with ophthalmologists, health policymakers, patient advocates, development partners, and community representatives across all six geopolitical zones. Phase three uses a Delphi consensus process with a 30-member expert panel to validate and refine the emergent framework. The resulting model will specify the structural determinants, system-level inputs, governance mechanisms, and equity considerations unique to Nigeria's federated health architecture, diverse epidemiology, and complex socio-cultural environment. Existing frameworks imported from high-income or generic low-income country contexts fail to account for Nigeria's federalism, informal sector dominance, pluralistic healthcare market, and ethno-religious diversity. This study makes an original theoretical contribution to global eye health policy science. Recommendations will inform the next iteration of Nigeria's National Eye Health Policy and provide a replicable framework development methodology for other low-middle income countries. Keywords: universal eye health coverage, theoretical framework, health systems, Nigeria policy, primary health care