<p><strong>Background:</strong> One of the strategies to improve access to eye care services in low- and middle-income countries (LMICs) is to integrate such services into primary health care (PHC). This can be achieved by implementing sustainable and equitable services across all levels of the health care system.<br /><strong>Aim:</strong> This study assessed the provision of primary eye care services among children in the Ashanti region of Ghana from the perspective of district health directors.<br /><strong>Setting:</strong> This study was done in the Ashanti region of Ghana.<br /><strong>Methods:</strong> A purposive sampling technique was employed to select 10 district health directors for a one-on-one interview guided by the eye care service assessment tool (ECSAT). It focused on the provision of primary eye care services, current policies and programmes and efforts to support integration of eye care services for children into the PHC system.<br /><strong>Results:</strong> The district health information management system (DHIM) was the major source of information on child eye health. Basic eye care services were available and covered by the national health insurance scheme (NHIS). School screenings and outreach programmes were organised for underserved communities. There were limited resources and knowledge on diagnostic and treatment procedures.<br /><strong>Conclusion:</strong> To address the gaps, policymakers and stakeholders should prioritise the development of sustainable and equitable eye care strategies.<br /><strong>Contribution:</strong> This study is the first in Ghana to comprehensively assess eye care services among children from the perspectives of district health directors. It provides findings to guide policy formulation and clinical practice for quality primary-level eye care services for children.</p>