**Background:** Integrated health systems are considered essential for achieving universal health coverage (UHC). The East, Central, and Southern Africa Health Community (ECSA-HC) passed a resolution in 2020 to integrate eye health into the wider health system. However, the term 'integration' is loosely defined and may vary across contexts. This scoping review aimed to describe the state of eye health system integration in the ECSA-HC region, using the WHO health system building blocks framework (leadership/governance, financing, workforce, medical products, service delivery, and health information systems).
**Methods:** The review followed PRISMA-ScR guidelines and was registered on Open Science Framework. Four electronic databases (MEDLINE, EMBASE, Global Health, Africa-Wide Information) were searched from 1946 to July 2020. Inclusion criteria were any intervention/observational studies, reports, or policy papers on eye health systems or integration in ECSA-HC countries (Eswatini, Malawi, Mauritius, Kenya, Lesotho, Tanzania, Uganda, Zambia, Zimbabwe), with no time restriction. Exclusion criteria included papers not presenting data on eye health systems or integration, those describing vertical eye health systems exclusively, and studies not involving a health system building block. Two reviewers independently screened titles/abstracts and full texts, achieving 90% inter-reviewer agreement after a pilot phase. Data were charted into a preformatted form on Google Sheets, and narrative synthesis was performed using thematic analysis.
**Key Results:** The search yielded 812 articles; after deduplication and screening, 110 full texts were assessed, and 30 articles met eligibility criteria. Most were observational studies (60%, n=18) and from Tanzania (43%, n=13). Publication years ranged from 1980 to 2020, with 18 articles published between 2013 and 2020. No explicit definition of integration was found in any included article. Eye health was prioritized at national level in some countries (Kenya, Uganda, Zambia) but failed to cascade to lower levels; for example, in Tanzania, government dispensary health workers with primary eye care training saw only three eye patients per month on average. Eye health data documentation was inadequate, with data often not entering health management information systems (HMIS). Service delivery integration was the most common focus, with primary eye care delivered by community members and primary health workers. In Malawi, between 1999 and 2006, those with blinding cataract who accessed surgery increased from 1 in 7 to 4 in 5 due to referrals from trained community case finders. Workforce integration involved training general health cadres (e.g., junior doctors, nurses) and creating multidisciplinary teams for conditions like diabetes and retinoblastoma. However, concerns about quality of care were noted; one Malawi study found trained community members were more effective at identifying blind children than trained primary health workers. Government funding for eye care was limited, with no designated budget lines in some countries, relying on NGOs and user fees. No studies discussed specific government funding mechanisms for integration.
**Clinical Implications:** The review highlights that eye health integration in the ECSA-HC region has been in progress for about four decades but remains primarily focused on service delivery at the primary level, with significant gaps in financial integration, data documentation, and quality assurance. The lack of a universal definition of integration hinders measurement and comparison. To achieve UHC, comprehensive integration across all health system building blocks is needed, particularly dedicated government funding and inclusion of eye care in essential health packages. The diabetes care model and retinoblastoma multidisciplinary teams offer examples of incremental integration that could be expanded. Improved data collection and electronic medical records could enhance monitoring and decision-making. The findings underscore the need for sustained political commitment, standardized protocols, and publication of integration efforts to reflect the true state of eye health systems in the region.