World Health Organization · 1st edition, 2022 · 40 pages
Step-by-step guidance for adapting the global eye care competency framework to local workforce planning, curriculum development, and service delivery.
- Issuer
- World Health Organization
- Edition
- 1st edition, 2022
- Audience
- Policy-makers, regulatory authorities, eye care service providers, NGOs, education and training institutions, professional associations, human resource development leaders
- Evidence
- Expert consensus and pilot case studies from four international sites (Aravind India, Québec Canada, IJCAHPO/LVPEI, Singapore National Eye Centre)
- Reviewed
- 23 Oct 2026 · GMJ
What this guideline says
GMJ summary
This technical guide provides a practical, staged approach for applying the WHO Eye Care Competency Framework (ECCF) to local contexts. It is designed for diverse users: policy-makers and regulators planning the eye care workforce, service providers developing employment guidelines and performance appraisals, non-governmental organizations advocating for workforce development, and education institutions designing competency-based curricula.
The guide describes six stages: Planning (forming stakeholder working groups, defining objectives), Understanding the context (conducting situation analysis using tools such as ECSAT), Using the ECCF (extracting and adapting relevant competencies, activities, tasks, knowledge and skills across four proficiency levels), Developing a competency framework, Developing a competency-based curriculum (optional, for training institutions), and Disseminating. Four pilot case studies illustrate application in hospital workforce review (Aravind, India), professional regulatory framework development (Québec Optometrists), AOP curriculum alignment (IJCAHPO and L V Prasad Eye Institute), and training programme benchmarking (Singapore National Eye Centre).
The guide emphasizes that the ECCF is a ‘menu’ from which appropriate components are selected and adapted, not a prescriptive template. It provides practical tools including competency framework templates, alignment tables, and step-by-step checklists. The approach promotes stakeholder engagement throughout, ensuring local ownership and relevance while maintaining alignment with the global ECCF structure and its six domains: Practice, Professionalism, Management and leadership, Community and advocacy, Education and learning, and Evidence.
Key points
For clinicians — doses and thresholds as stated in the guideline
- Six-stage process: Planning → Context analysis → Using ECCF → Framework development → Curriculum development (optional) → Dissemination; estimated 12–18 months for framework, longer for full curriculum.
- ECCF is a 'menu': select relevant competencies and activities; not all activities or tasks need be included; entire activities may be excluded if not contextually appropriate.
- Four proficiency levels in ECCF (Introductory, Intermediate, Advanced, Expert); frameworks may address single or multiple levels depending on target workforce.
- Conduct situation analysis using WHO Eye Care Situation Analysis Tool (ECSAT) covering workforce availability, training, competencies, regulations, and population needs before adapting ECCF.
- Form key stakeholder working group including human resource leaders, academics, service providers, professional associations, regulatory bodies, patient groups, and decision-makers early for buy-in.
- Competency-based curricula require defining learning outcomes aligned to ECCF behaviours and tasks, planning learning experiences (clinical placements prioritized), sequencing content, and multiple assessment formats (formative and summative).
- Validation through wide stakeholder review and modified Delphi survey recommended to confirm readability, accuracy, applicability, and acceptability before finalization.
- Case studies show ECCF applications: workforce gap analysis identified need for structured leadership training in non-clinical domains (Evidence, Community, Professionalism) and patient-centred practice integration.
Example of identifying relevant ECCF competencies for an ophthalmic nurse (Case study extraction table)
Table extracted from the guideline
| Proficiency Level | Behaviour (Competency PC1: People-centred practice) | Knowledge | Skills |
|---|---|---|---|
| Introductory (Level 1) | Demonstrates understanding of people and communities, their care needs, contextual influences and how their own identity, values and behaviour can affect care provision | Knowledge of: diversity in population demographics; professional code of ethics and conduct; therapeutic communication skills | Skills in: therapeutic and effective communication; engaging people and communities |
| Intermediate (Level 2) | Integrates understanding of people's lived experiences, priorities and capabilities to form a shared care plan. Demonstrates cultural humility and safety, including addressing unconscious bias | Knowledge of: cultural humility; unconscious bias and structural determinants of health; communication skills in context of cultural diversity | Skills in: communication with diverse people; creating culturally safe environments; applying communication skills across different contexts |
Source: World Health Organization, Guide to applying the WHO Eye Care Competency Framework. Reproduced in summary form.
From the guideline
Verbatim
“Consider the ECCF as a menu, where items that are appropriate for the setting can be chosen.”
Editor’s perspective
Why this matters for Georgia and the region
Prof. Giorgi Pkhakadze, MD, MPH, PhD
Editor-in-Chief, Georgian Medical Journal · Chair, Public Health Institute of Georgia · WHO consultant, health and migration
As someone who has worked with WHO on health workforce standards, I see this guide as directly relevant to Georgia's ongoing efforts to align medical education with international competency frameworks under our national health strategy. The staged approach—particularly the emphasis on stakeholder working groups and situation analysis using ECSAT—mirrors best practice we have applied in other specialties at the Public Health Institute. For Georgian ophthalmology departments and the Georgian Ophthalmological Society, I would stress the importance of Stage 2 context analysis before adoption: we must honestly assess current workforce distribution (urban concentration remains a challenge), scope-of-practice regulations for optometrists and allied personnel (still evolving), and clinical placement capacity for training. The case study from Aravind identifying gaps in leadership competencies and non-clinical domains is particularly instructive—our residency programmes traditionally emphasize technical surgical skills but may underweight evidence-based practice, community advocacy, and systematic quality improvement, domains the ECCF explicitly addresses.
ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 23 Oct 2026
Applicability
Georgia and the South Caucasus
For Georgia and the South Caucasus, this guide offers a structured method to strengthen ophthalmology workforce planning amid ongoing health system reforms and the drive toward universal health coverage. National eye health programmes can use the ECCF to define competencies for ophthalmologists, optometrists, and allied ophthalmic personnel, ensuring alignment with international standards while adapting to local scope-of-practice regulations and available resources. Medical universities in Tbilisi, Yerevan, and Baku can apply Stage 5 to modernize ophthalmology residency and optometry curricula toward competency-based models. Ministries of Health can use Stage 2 (ECSAT situation analysis) to identify workforce gaps—particularly in rural areas and in non-clinical domains such as evidence-based practice, community engagement, and leadership—and use Stage 4 to develop regulatory frameworks. Regional eye care NGOs and the Public Health Institute can advocate for adoption of ECCF-aligned competency standards across the Caucasus, supporting workforce mobility and mutual recognition within the region.
Questions this guideline answers
Quick answers
What is the difference between the ECCF itself and this guide?
The ECCF is the global competency framework defining what eye care workers should know and do across six domains and four proficiency levels. This guide is the 'how-to' manual: it explains the six practical stages for adapting and applying the ECCF to your local workforce planning, regulation, service delivery, or training programme.
Do I need to include all ECCF competencies and activities in my local framework?
No. The guide explicitly states to treat the ECCF as a 'menu'—select only the competencies, activities, and tasks relevant to your context. Entire activities may be excluded, or only certain tasks within an activity included, depending on local scope of practice, resources, and population needs.
How long does it take to develop a competency framework using this guide?
The guide estimates 12–18 months to develop a competency framework (Stages 1–4 and 6), potentially longer if developing a full competency-based curriculum (adding Stage 5). Time depends on stakeholder engagement, existing resources, and validation rounds required.
What tools are recommended for understanding the local workforce context (Stage 2)?
The guide recommends using the WHO Eye Care Situation Analysis Tool (ECSAT) to assess workforce availability, training and competencies, planning and management, regulations, mobility and support, and eye care needs of the population. Also conduct desk review of existing competency frameworks, legislation, policies, curricula, and education documents.
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- Issuer
- World Health Organization
- Type
- Technical document
- Edition
- 1st edition, 2022
- Status
- Current
- Published
- 2022-10-27
- Languages
- English
- Scope
- Global; applicable to all eye care workforce cadres (ophthalmologists, optometrists, allied ophthalmic personnel) across community, primary, secondary, and tertiary levels of care
- Audience
- Policy-makers, regulatory authorities, eye care service providers, NGOs, education and training institutions, professional associations, human resource development leaders
- Pages
- 40
- Licence
- CC BY-NC-SA 3.0 IGO
- ISBN
- 9789240061422
- Evidence
- Expert consensus and pilot case studies from four international sites (Aravind India, Québec Canada, IJCAHPO/LVPEI, Singapore National Eye Centre)
- Record history
- Created 23 Oct 2026 · updated 23 Oct 2026 · next check Apr 2027
World Health Organization. Guide to applying the WHO Eye Care Competency Framework. Geneva: World Health Organization; 2022. Licence: CC BY-NC-SA 3.0 IGO.GMJ Guidelines Library records are original summaries written by the GMJ editorial team from the issuer’s published document and reviewed by a physician. They do not replace the full guideline. The document is the copyright of its issuer and is linked, not hosted. Spotted an error or a newer edition? Tell the Guidelines Desk.
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