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Poor collaboration between health districts and local governments, the control of certain resources by the state and the health districts constrain the implementation of health resources and skills transfer policy at grassroots level. Careful attention should be given to the country's political context and institutional design.Background Limbal stem cell deficiency (LSCD) is a refractory ocular surface disorder characterized by progressive corneal epithelial degeneration, conjunctivalization, and neovascularization, potentially leading