A twenty-year review of human resource development for low vision care and rehabilitation in Ghana: a qualitative training evaluation using the CIPP framework

Low vision care and rehabilitation (LVCR) in Ghana has developed through a small number of training initiatives, but the extent to which training translates into sustained practice remains unclear. This study explored how LVCR training programmes were organized and experienced by training organizations and trained optometrists, and how training-related factors interacted with service-level barriers to continued practice, using the Context–Input–Process–Product (CIPP) framework. A qualitative training evaluation was conducted among representatives of five organizations involved in LVCR training and 22 optometrists trained between 2004 and 2024. Semi-structured interviews explored training objectives, content, delivery, support, post-training experiences and barriers to practice. Training histories were cross-checked against institutional records. Interviews were conducted face-to-face, by telephone, or through online video conferencing according to participant preference. Verbatim transcripts were coded and synthesized into categories and themes using QDA Miner Lite v3.0.6. Themes were developed inductively, then mapped to CIPP domains; CIPP was applied after data collection as an analytic, not design, framework. Within the period reviewed, five organizations have been involved in LVCR training, with six training programmes involving 35 optometrists. Training responded to programme objectives and an undergraduate skills gap (context), used short, donor-funded practical courses with equipment support (input, process) and improved skills (product); both groups reported service-level barriers limiting sustained practice. NGO-supported programmes provided practical training, equipment, outreach support and, in some programmes, refresher or mentorship opportunities. However, training duration, donor/project priorities, access to devices and space, workload, remuneration, patient awareness and staff transfers constrained sustained practice. Among the 22 interviewed trainees, the proportion reporting current LVCR practice was 13.6% (3/22) before training and 31.8% (7/22) at interview, an increase of 18.2% points. Training initiatives have contributed to developing LVCR skills among participating optometrists, but training alone has not ensured continued practice. A more coordinated workforce-development approach that links training with equipment, protected service capacity, supportive deployment, continuing professional development and institutional recognition may improve the translation of training into sustained LVCR provision in Ghana. Sustainability of outcomes depended largely on post-training service conditions.