1.Background Primary health care in Tanzania is provided at two types of health units, the dispensary and the health centre. Tanzania’s experience in providing effective primary care is similar to most Sub Saharan African countries.Problems identified so far include a weak referal system, shortage of basic supplies, poor skills and lack of proper supervision. To meet the goals of VISION 2020, it is possible that primary eye care (PEC) will play an important role, however the exact role has not been clarified in Africa. Theoretically, primary health workers (with knowledge of PEC) are ideally placed to identify people in need of eye care services. To do so, primary health care workers need to be well trained and supervised in order to provide the basic eye care services. In Tanzania,they are expected to be able to identify, treat ,or correctly refer a number of eye conditions including cataract, trauma, presbyopia, and the“red eye”. They are also expected to be able to measure visual acuity correctly and to educate the community about prevention. Current evidence suggests that primary health care workers do not possess these skills. 2.Objectives The objective was to determine the effect of enhanced supervision on eye care on the knowledge and skills of primary health care workers in Kilimanjaro region of Tanzania. 3.Methodology Study design: This was an interventional study, of two supervisory methods Participants: All government health workers having the primary responsibilities in health care services at dispensaries in Mwanga District of Kilimanjaro Region were included in the study. Dispensaries were randomly allocated to either “intervention” or no “intervention”. All health workers previously surveyed (n=49) were included. Intervention: The intervention comprised an enhanced supervision focusing on improved skills and service delivery. Data collection: Participants were interviewed pre (2008) and post (2010) intervention and the information were recorded using a standardized pre-tested questionnaire form. 4. Results: High level of attrition (24%) within 1 year from the time of baseline survey. Absenteeism was also quite high, especially amongst clinical officers (44%). The mean score of respondents was higher 6.43 (80.4%) among the enhanced group than among the routine group 4.71 (58.9%). Mean improvement in ability to describe and demonstrate vision testing was better 1.8 (SD1.47) in the enhanced supervision dispensary group than in the routine 0.88(0.93), p=0.015. The overall pass rate in vision testing, diagnosis and management of cataract and presbyopia was better 15 (71.4) with enhanced supervision compared to routine supervision 6 (35.2); p=0.048. 5. Conclusion: It was observed in this study that knowledge and skills in vision testing improved with enhanced supervision. However, it is unclear if knowledge and skills in recognizing and managing cataract or presbyopia improved with enhanced supervision. Attrition and absenteeism was quite high especially amongst clinical officers. We cannot guarantee how much knowledge and skills acquired during enhanced supervision will be maintained. 6. Recommendations: The curriculum and training in PEC needs revision and should be practicum based. Supervision guidelines need to be revised and expectations of PEC needs to be re-emphasized in order to improve quality of eye care services. There is need to improve on accountability of health workers to reduce attrition and absenteeism.