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The aim of this situational analysis was to assess the feasibility of implementing a pediatric ophthalmology fellowship at Addis Ababa University with support from the University of Toronto, modeled by successful postgraduate medical education within Toronto Addis Ababa Academic Collaboration. The study assessed the needs, staff expertise, equipment and infrastructure compared to International Council of Ophthalmology fellowship guidelines. Patient volumes and local training were documented too. The analysis revealed the following findings: The faculty consisted of 11 ophthalmologists. Fourteen thousand six hundred twenty-seven medical and three thousand six hundred forty-one surgical pediatric cases were seen in the previous year. A 2-year fellowship incorporating anterior segment, retinoblastoma, strabismus, and retinopathy of prematurity modules was developed. Research collaborations, didactic teaching, and surgical supervision were identified as priorities requiring support. Quality standard indicators included faculty feedback, case log review and formal examination. Telemedicine, development of a larger eye hospital and partnerships to support equipment maintenance were identified as strategies to manage implementation barriers. This situational analysis provided a way forward for the development of a pediatric ophthalmology fellowship, the first of its kind in Eastern Africa. Learning outcomes are feasible given high patient volumes, qualified staff supervision and sufficient equipment.