Progressing Aboriginal and Torres Strait Islander eye health and vision care. Policy and funding proposal

Progressing Aboriginal and Torres Strait Islander eye health and vision care Policy and funding proposal March 2013

Contents 1 Executive Summary 1 1.1 Purpose 1 1.2 Key recommendations 2 1.3 Vision 2020 Australia Aboriginal and Torres Strait Islander Committee members: 2 2 Introduction 4 2.1 Vision 2020 Australia 4 2.2 National Framework 4 2.3 WHA Action Plan 5 2.4 National Framework Implementation Plan 5 2.5 Roadmap to Close the Gap for Vision 6 3 Why eye health is important 7 3.1 Aboriginal and Torres Strait Islander eye health 7 3.2 National Indigenous Eye Health Survey 7 3.3 National Framework and Aboriginal and Torres Strait Islander eye health 8 4 Recommendations 13 4.1 Links to Vision 2020 Australia s Progressing eye health and vision care in Australia proposal 13 4.2 Linking recommendations with the four conditions responsible for 94 cent of vision loss in Aboriginal and Torres Strait Islander people 13 5 In summary 16 6 Contact 17

1 Executive Summary 1.1 Purpose This proposal seeks an additional capped funding commitment of $67.13 million over three years to close the gap in Aboriginal and Torres Strait Islander eye health and vision care. Importantly, this figure is sought within the context of a five year funding requirement of $90.75 million as outlined in The Roadmap to Close the Gap for Vision, 2012 (The Roadmap). 1 Addressing the four conditions responsible for 94 per cent of vision loss can be achieved by strengthening current programs such as the Medical Specialists Outreach Assistance Program (MSOAP) and Visiting Optometrists Scheme (VOS) and integrating eye health into broader health infrastructure such as Medicare Locals and Local Hospital Networks. A focus on coordination through Aboriginal Community Controlled Health Services (ACCHS) and between programs is imperative to strengthen partnerships, enhance referrals and maximise efficiencies. Australia s international obligations establish a mandate for further investment in eye health and vision care. They also require a greater emphasis on adopting a systemsbased approach, improving the evidence base and monitoring and evaluation. Importantly, this proposal supports the recommendations of The Roadmap 2 and is complementary to Vision 2020 Australia s mainstream Progressing eye health and vision care in Australia, 2013 submission. Inclusion of Indigenous eye health in the plan to implement the National Framework for Action to Promote Eye Health and Prevent Avoidable Blindness and Vision Loss (National Framework) is important particularly through the identification of a national suite of eye health indicators including those specific to the Aboriginal and Torres Strait Islander population. Vision 2020 Australia works closely with the National Aboriginal and Community Controlled Health Organisation (NACCHO). NACCHO is the peak body representing over 150 ACCHS across the country on Aboriginal health and wellbeing issues. Both organisations recognise eye health has a significant role to play in closing the gap in Indigenous health and ACCHS are well poised to coordinate eye health services as part of this proposal. This submission has been prepared by members of Vision 2020 Australia s Aboriginal and Torres Strait Islander Committee which is chaired by the CEO of NACCHO, Ms Lisa Briggs. A list of member organisations is provided below. 1 The $67.13 million figure is sought for a three year period within the context of the five year funding requirement of $90.75 million outlined in The Roadmap to Close the Gap for Vision, 2012. 2 Roadmap to Close the Gap for Vision (2012). Published by the Indigenous Eye Health Unit, The University of Melbourne: Melbourne. 1 Progressing Aboriginal and Torres Strait Islander eye health and vision care Policy and funding proposal

1.2 Key recommendations Vision 2020 Australia, as a national peak body for the eye health and vision care sector, working in collaboration with NACCHO, makes the following key recommendations: Recommendations 2014-17 Governments must honour the Close the Gap Statement of Intent As part of this commitment, a funding allocation must be dedicated to eye health Improved coordination of eye care services and enhanced referral pathways Improved accessibility to ophthalmology and optometric services to address diabetic retinopathy and cataract $36.63 million* $13.56 million* Eliminate trachoma $13.5 million* Governance $3.44 million* Total figure sought for the next three years: The National Framework Implementation Plan with focus on Aboriginal and Torres Strait Islander eye health must be funded and developed *Source: The Roadmap to Close the Gap for Vision, 2012. $67.13 million Note: The $67.13 million figure is sought for a three year period within the context of the five year funding requirement of $90.75 million outlined in The Roadmap. 1.3 Vision 2020 Australia Aboriginal and Torres Strait Islander Committee members: Aboriginal Health and Medical Research Council of NSW Aboriginal Health Council of South Australia Australian College of Optometry Brien Holden Vision Institute Centre for Eye Research Australia Indigenous Eye Health Unit, The University of Melbourne National Aboriginal Community Controlled Health Organisation OneSight Foundation Operation Eyesight Australia Optometric Vision Research Foundation Optometrists Association Australia Queensland Aboriginal and Islander Health Council Queensland Vision Initiative Inc 2 Progressing Aboriginal and Torres Strait Islander eye health and vision care Policy and funding proposal

Retina Australia The Fred Hollows Foundation The Royal Australian and New Zealand College of Ophthalmologists The Royal Victorian Eye and Ear Hospital Victorian Aboriginal and Community Controlled Health Organisation 3 Progressing Aboriginal and Torres Strait Islander eye health and vision care Policy and funding proposal

2 Introduction 2.1 Vision 2020 Australia Established in October 2000, Vision 2020 Australia is part of VISION 2020: The Right to Sight, a global initiative of the World Health Organisation and the International Agency for the Prevention of Blindness. Vision 2020 Australia is recognised by the Australian Government as the national peak body for eye health and vision care, representing more than 60 member organisations involved in local and global eye care, health promotion, low vision support, vision rehabilitation, eye research, professional assistance and community support. Our vision is the elimination of avoidable blindness and vision loss by the year 2020 and ensuring that blindness and vision impairment are no longer barriers to full participation in the community. Vision 2020 Australia and NACCHO are two peak bodies working together through consistent messaging and strategic alignment a powerful collaboration when addressing the gap between Indigenous and non-indigenous eye health. 2.2 National Framework In 2005 Australian health ministers endorsed the National Framework for Action to Promote Eye Health and Prevent Avoidable Blindness and Vision Loss (National Framework). This strategic platform represents Australia s response to World Health Assembly (WHA) resolution WHA56.25 the elimination of avoidable blindness. It aims to provide a blueprint for nationally coordinated action by governments, health professionals, non-government organisations, industry and individuals to work in partnership. 3 The National Framework does not focus on any one specific condition, but outlines five key areas for action. They include: Reducing the risk of eye disease and injury Increasing early detection Improving access to eye health services Improving the systems and quality of care Improving the underlying evidence base While the National Framework does not include a specific key area for action dedicated to Aboriginal and Torres Strait Islander eye health, there are actions throughout the document that have this focus. 3 National Framework for Action to Promote Eye Health and Prevent Avoidable Blindness and Vision Loss, 2005, page 1. 4 Progressing Aboriginal and Torres Strait Islander eye health and vision care Policy and funding proposal

2.3 WHA Action Plan In 2009, Australia supported WHA62.10 Action Plan for the Prevention of Avoidable Blindness and Visual Impairment 2009-13. This plan set out a host of challenges for Member States including: strengthen advocacy to increase Member States political, financial and technical commitment in order to eliminate avoidable blindness and vision impairment develop and strengthen national policies, plans and programs for eye health and prevention of avoidable blindness and vision impairment increase and expand research for the prevention of blindness and vision impairment improve coordination between partnerships and stakeholders at national and international levels for the prevention of blindness and vision impairment monitor progress in elimination of avoidable blindness at national, regional and global levels. In 2012 the Executive Board of the WHO instructed the Director-General to develop a revised plan for the period 2014-19. The WHO Secretariat subsequently prepared the Zero Draft Universal Access to Eye Health: A Global Action Plan 2014-19 (WHA Action Plan 2014-19) and Member States have been invited to comment. The Australian Government and Vision 2020 Australia have participated in this consultation process. The Secretary of the Australian Government Department of Health and Ageing has championed eye health and vision care by keeping it on the international agenda in her capacity as a member on the Executive Board of the WHO. Indeed in January 2013, the WHO Executive Board endorsed the WHA Action Plan 2014-19 and Australia co-sponsored the Resolution. 2.4 National Framework Implementation Plan Australia s first national eye health platform is now seven years old and Vision 2020 Australia is advocating for a plan to strengthen and implement the National Framework (Implementation Plan). Unfortunately at the time of its development the National Framework did not include indicators, despite the document forecasting that: It is envisaged that during the implementation phase a comprehensive evaluation strategy based on performance indicators will be developed in collaboration with key stakeholders, including states and territories, to inform and guide the continuous improvement of avoidable blindness and vision loss prevention activities under the [National] Framework. Indeed the AIHW flagship report Australia s Health 2012 notes due to limitations in the availability and completeness of eye health data, it is not currently possible to measure Australia s progress towards eliminating avoidable blindness. 4 What is needed is a focus on outcomes. Vision 2020 Australia proposes the development of an Implementation Plan aligned with the Global Action Plan, embedded with national indicators, including stronger links to low vision and rehabilitation and a greater focus on Aboriginal and 4 Australia s Health 2012, Australian Institute of Health and Welfare, 2012, page 310. 5 Progressing Aboriginal and Torres Strait Islander eye health and vision care Policy and funding proposal

Torres Strait Islander eye health. It is positive the Standing Council on Health has endorsed the second progress report against the National Framework and the Minister for Health has instructed the Department of Health and Ageing (DoHA) to develop an Implementation Plan. Vision 2020 Australia and its members participated in a sector-wide consultation with cross-portfolio Australian Government in March 2013 to progress the plan. As part of this consultation the sector has identified specific indicators relevant to Aboriginal and Torres Strait Islander eye health and vision care. The WHO Executive Board s endorsement of the WHA Action Plan 2014-19 at its meeting in January 2013, has provided further impetus for the inclusion of indicators within the domestic Implementation Plan. 2.5 Roadmap to Close the Gap for Vision The Roadmap to Close the Gap for Vision (The Roadmap) prepared by the Indigenous Eye Health Unit, The University of Melbourne, following extensive consultation with the sector, provides 42 recommendations across nine key areas. These include: Primary eye care as part of comprehensive primary health care Indigenous access to eye health services Co-ordination Eye health workforce Elimination of trachoma Monitoring and evaluation Governance Health promotion and awareness Health financing There are many linkages between The Roadmap and the National Framework and Vision 2020 Australia is advocating for these linkages to be incorporated in the Implementation Plan. 6 Progressing Aboriginal and Torres Strait Islander eye health and vision care Policy and funding proposal

3 Why eye health is important 3.1 Aboriginal and Torres Strait Islander eye health There is significant disparity between the eye health of Aboriginal and Torres Strait Islander people and mainstream Australians. Four conditions are responsible for 94 per cent of vision loss in Aboriginal and Torres Strait Islander communities. These include: Uncorrected refractive error Cataract Diabetic retinopathy Trachoma The terrible irony is that Aboriginal and Torres Strait Islander children have better vision than mainstream children, so early preventive vision care as well as a focus on overall health and well-being in life is essential to the preservation of eye sight and long term good health. 3.2 National Indigenous Eye Health Survey Published in 2009, the National Indigenous Eye Health Survey (NIEHS) has helped inform an understanding of the extent, causes and impact of vision loss in Aboriginal and Torres Strait Islander peoples. Closing the gap for vision will require the elimination of the known differences in the standard of eye health between Indigenous and non-indigenous Australians. 3.2.1 Key findings Some of the key findings of this report and other leading research 5 are captured below: Blindness rates in Indigenous adults are six times the rate in mainstream Australians Vision loss was the most commonly reported health problem according to the Australian Institute of Health and Welfare (AIHW) 94 per cent of vision loss is preventable or treatable but 35 per cent of Indigenous adults have never had an eye exam Vision loss in Indigenous children is five times less common than in mainstream children Blinding cataract in the Indigenous population is 12 times more common, yet surgery is seven times less Eleven per cent of years of life lost to disability for Indigenous people is due to vision loss Vision loss represents the equal third leading cause of the gap after heart disease and diabetes, but ahead of trauma, stroke and alcoholism 5 National Indigenous Eye Health Survey (2009). Published by the Indigenous Eye Health Unit, The University of Melbourne in collaboration with the Centre for Eye Research Australia. Roadmap to Close the Gap for Vision (2011). Published by the Indigenous Eye Health Unit, The University of Melbourne. 7 Progressing Aboriginal and Torres Strait Islander eye health and vision care Policy and funding proposal

Vision loss increases mortality rates in the Indigenous population by at least two-fold Spending on vision loss is cost effective every $1 spent on eye care yields a $5 return Australia currently spends $1.39 on Indigenous health for each $1 spent on mainstream as there is three times morbidity (and vision loss) there is a need to spend more. 94 per cent of vision loss is preventable or treatable but 35 per cent of Indigenous adults have never had an eye exam 3.3 National Framework and Aboriginal and Torres Strait Islander eye health While Aboriginal and Torres Strait Islander communities are not specifically identified in the National Framework, the following areas are particularly relevant to Aboriginal and Torres Strait Islander eye health and vision care: Key Action Area Three Improving access to eye health and vision care services which seeks to ensure that all Australians have equitable access to eye health and vision care services when required Key Action Area Four Improving the systems and quality of care which seeks to ensure that eye health and vision care is safe, affordable, well-coordinated, consumer focused and consistent with internationally recognised good practice Many Indigenous communities could benefit from a greater full-time presence of optometrists and ophthalmologists, as well as increased coordination between visiting eye teams, local service providers, Aboriginal Medical Services, and Regional Surgical Centres. Helen Johnstone, Indigenous Research and Evaluation, AIHW 3.3.1 Access The Medical Specialists Outreach Assistance Program (MSOAP) and the Visiting Optometrists Scheme (VOS) are two important programs that have facilitated access to ophthalmological and optometry services for people living in rural and remote Australia. Access however, remains significantly lower in some remote and very remote areas. It is important that the most vulnerable, many of whom live in these communities and include Aboriginal and Torres Strait Islander people, have access to these important services. Furthermore, while remoteness is an issue, even in urban and regional areas many Aboriginal and Torres Strait Islander people are not utilising services that are available. A 2010 report by Siggins Miller 6 assessing the MSOAP and VOS identifies a number of barriers to access eye health and vision care services by Aboriginal and Torres Strait Islander people. These include: limited service availability 6 Siggins Miller report 2010 8 Progressing Aboriginal and Torres Strait Islander eye health and vision care Policy and funding proposal

workforce distribution remote nature of many communities access to cataract surgery and eye examinations affordability cultural insensitivity access to transport public awareness eye health literacy in the community perceived cost of spectacles perceived cost of cataract surgery 3.3.2 Coordination The Roadmap places significant emphasis on coordination at the local and regional levels. Coordination refers to case management and support of the patient journey, service delivery, and enhanced referral pathways. With the establishment of Medicare Locals and Local Hospital Networks it is important that mechanisms for the coordination of eye care be established by these entities in a collaborative, integrated and multidisciplinary manner with ACCHS within its footprint. The ACCHS network, which is both community-based and community-controlled, is integral to ensuring the best clinical and cultural outcomes for Indigenous Australians. Similarly, local referral pathways need to be in place for all eye care services and made known to service providers. Vision 2020 Australia supports the third recommendation of the recent Close the Gap Campaign Steering Committee submission in response to the 2012 National Aboriginal and Torres Strait Islander Health Plan (NATSIHP) discussion paper which recommends that the NATSIHP recognise NACCHO, NACCHO affiliates and ACCHS as the preferred provider and vehicle for the delivery of comprehensive primary care. It also recognises that practices by these organisations in delivering culturally appropriate comprehensive primary health care reflect a holistic definition of health. Studies show that there is a strong correlation between good coordination and positive eye health outcomes and it is something that should be supported throughout the referral pathway from primary through to tertiary eye care. By integrating the visiting optometry and ophthalmology services, less primary health care is performed by ophthalmologists, which improves the surgical case rate. There are increased levels of clinical activity and reduced waiting time without any additional costs. 7 7 Turner, A., Mulholland, W., and Taylor, H. (2011) Coordination of outreach eye services in remote Australia in Clinical and Experimental Ophthalmology, RANZCO. 9 Progressing Aboriginal and Torres Strait Islander eye health and vision care Policy and funding proposal

The Intensive Eye Surgery Week (IESW) program was instigated in 2007 in order to reduce the backlog of people awaiting eye surgery in Central Australia and the Barkly. IESWs are conducted over a five day period, with a target of 50 procedures to be performed. In order to maintain an average of ten patients per day for five consecutive days, additional medical and support personnel are provided, many of whom are brought in from other parts of Australia. The majority of patients have usually been residents of remote Indigenous communities, with priority for other places being given to Indigenous residents of Alice Springs including Town Camp residents. Transport, accommodation and meals are arranged and funded for all remote patients, most of whom stay in Alice Springs for 2-4 nights. The IESW program has utilised strategies and methodologies which are not practised in the regular eye surgery program, which are designed to overcome or mitigate many of the barriers that reduce access to eye surgery, especially for patients from remote communities. These can be summarised into four key principles: a. Provision of patient support b. Flexible and opportunistic approach c. Effective engagement of community clinics d. Centralised coordination Notably, the Coordinator s role improves the efficiency and effectiveness of IESWs, and is a key enabler of the application of the first three principles. The Coordinator is responsible for planning, booking and monitoring of all patient travel and accommodation, and also for targeting communities and patient groups, liaising with all relevant stakeholders (e.g. community clinics, Aboriginal Medical Services, medical staff, Aboriginal Liaison Officers, transport providers, patients and carers) and most importantly general troubleshooting. Having oversight for all non-medical aspects of the program allows the Coordinator to plan in a way which ensures that services and processes are wellintegrated and aligned, and address any issues which arise with a sound understanding of context and content. Having a focus on and responsibility for maximising access to eye procedures ensures an efficient use of resources. The IESW model achieved an attendance rate of around 80% of initially scheduled patients, in an environment where a 50% 10 Progressing Aboriginal and Torres Strait Islander eye health and vision care Policy and funding proposal

cancellation rate is common. A total of eleven IESWs have now been conducted, with the most recent being held in November 2012. Over this time, 568 procedures have been performed on 546 patients. Source: Fred Hollows Foundation, 2013 The Regional Eye Health Coordinator (REHC) is one example of a professional cadre, trained in coordinating patients along the pathway of care. This workforce however, is stretched and under-resourced and not available in all areas of Australia. The flow-on effect of the recent expansion in VOS servicing has significantly impacted on REHC workload creating a reduced capacity to fulfil regional eye health coordination role. Furthermore, the shift of allocated eye health funding for these posts to pooled funding for chronic disease management following a 2003 review saw a focus on eye care evaporate. 8 A dedicated investment and focus on coordination will seek to improve service delivery and enhance referral pathways between Medicare Locals, Local Hospital Networks and ACCHS. This will support the recommendations of the Roadmap which includes a focus on ensuring that those with a high need for eye care, such as diabetes, receive the necessary examinations and treatment required. Vision 2020 Australia notes diabetes is an identified priority area of the Aboriginal and Torres Strait Islander Chronic Disease Fund. It is anticipated enhanced funding will demonstrate the impact appropriately resourced structures can have in leveraging partnerships and enhancing referral pathways. 3.3.3 Trachoma Australia is the only developed country where trachoma still exists. It is a highly preventable blinding infectious eye disease which occurs in areas with poor hygiene and living conditions. Blinding endemic trachoma occurs in 60 per cent of Australian outback communities. 9 Vision 2020 Australia and members commend the Australian Government for its 2009 funding commitment of $58.3 million over four years towards the Improving Eye and Ear Health Services for Indigenous Australians for Better Education and Employment Outcomes. This initiative has seen significant inroads in the elimination of trachoma. 10 In particular, there has been a significant expansion of trachoma-control activities in the Northern Territory, Western Australia and South Australia. 11 New South Wales and Queensland however, are just starting to address the issue. As a result of the measure, 150 communities across 16 rural and remote communities have been screened and if necessary, treated. 12 Analysis of data indicates there has been a reduction in trachoma owing to heightened levels of screening. 8 Ibid 9 The Roadmap to Close the Gap for Vision, page 6. 10 Closing the Gap: Prime Minister s Report, 2013. 11 Ibid 12 Ibid 11 Progressing Aboriginal and Torres Strait Islander eye health and vision care Policy and funding proposal

Australia is part of the international alliance which forms the Global Elimination of Trachoma by 2020 (GET 2020). GET 2020 is committed to implementing the SAFE strategy which stands for surgery for trichiasis (inturned eyelashes), antibiotics, facial cleanliness and environmental improvement. Given Australia s commitment to GET 2020 it is important eye health initiatives which address trachoma. The evidence certainly points to a strong correlation between funding commitment and positive outcomes for Aboriginal and Torres Strait Islander people. 12 Progressing Aboriginal and Torres Strait Islander eye health and vision care Policy and funding proposal

4 Recommendations 4.1 Links to Vision 2020 Australia s Progressing eye health and vision care in Australia proposal Vision 2020 Australia provides the following overarching recommendations in relation to Aboriginal and Torres Strait Islander eye health and vision care. These recommendations stand alongside Progressing eye health and vision care in Australia, Vision 2020 Australia s 2013 mainstream policy proposal which also contains the following high level key recommendations. 4.1.1 Governments must honour the Close the Gap Statement of Intent If governments commit to this then the positive macro (general) to micro (condition specific) health outcomes will be achieved. Vision 2020 Australia supports the Close the Gap Campaign Steering Committee proposal which includes the need for long term goals, a shared sense of ownership by Aboriginal and Torres Strait Islander people, the need for genuine partnerships and policy commitments and investment. 4.1.2 As part of this commitment, a funding allocation must be dedicated to eye health With government funding for Aboriginal and Torres Strait Islander health secured by upholding the Close the Gap Statement of Intent, Vision 2020 Australia and members believe a sizeable portion must be dedicated to eye health in keeping with the holistic definition of health as advocated by the Closing the Gap Steering Committee proposal. 4.1.3 The National Framework Implementation Plan with focus on Aboriginal and Torres Strait Islander eye health must be developed and funded The Implementation Plan, embedded with national eye indicators, can provide a mechanism through which the current National Framework can focus on outcomes. This will give life to the National Framework and support the Australian Government in fulfilling its international obligations. 4.2 Linking recommendations with the four conditions responsible for 94 cent of vision loss in Aboriginal and Torres Strait Islander people From the above broad recommendations specific recommendations linked with the four conditions responsible for 94 per cent of vision loss in Aboriginal and Torres Strait Islander people have been identified. It is proposed awareness raising of Indigenous eye health and vision care issues will be heightened through the Aboriginal and Torres Strait Islander component of the proposed national social marketing campaign in Vision 2020 Australia s mainstream proposal, activity which will be supported by programs of activity in selected states and territories. It is important to note Vision 2020 Australia members are undertaking activity in line with the Roadmap recommendations and endorsement of these recommendations will be complementary to the collective sector effort. 13 Progressing Aboriginal and Torres Strait Islander eye health and vision care Policy and funding proposal

4.2.1 Improved coordination of eye care services, case management and enhanced referral pathways Coordination of eye health services, case management and the successful navigation of referral pathways are keys to creating efficiencies through best use of existing services and to addressing Indigenous eye health. Qualitative evidence indicates coordination services are currently overstretched and that there is a need for retention of personnel and improved succession planning to better support the patient journey and improve service delivery. 13 It is recommended that funding be provided to improve coordination of services, case management and enhance referral pathways between Medicare Locals, Local Hospital Networks and ACCHSs. Vision 2020 Australia proposes the latter are best placed to coordinate services. Endorsement of ACCHS echoes Vision 2020 Australia s advocacy of a holistic, systemsbased approach to Aboriginal and Torres Strait Islander health. Given the close links between vision loss and chronic disease, for example between diabetes and diabetic retinopathy, it is also important for eye health to be integrated within chronic disease and diabetes plans. Additional funding sought: $36.3 million over three years 4.2.2 Increase access to eye health and vision care services Vision 2020 Australia supports the Roadmap recommendations under domain 4 eye health workforce to increase availability and improve distribution of eye health workforce. In particular, it notes that the eye health workforce and funding are allocated according to population needs with consideration of existing local services and contracting of VOS and MSOAP be restructured to provide simple, flexible, co-ordinated and transparent operation and management of these services. Vision 2020 Australia also supports the recommendation of the Evaluation of the Medical Specialist Outreach Assistance Program and Visiting Optometrists Scheme which notes that better mechanisms are required to assess levels of need and gaps in access; and take into account the cost of service delivery in more remote locations. There is strong consensus in the sector on the importance of shared planning and close cooperation between MSOAP and VOS programs. Members support the need for more close alignment, organisation and coordination between the two. Engagement of both programs with Medicare Locals, Local Hospital Networks and ACCHS is also very important. 13 Regional Eye Health Coordination, Final Report, Vision 2020 Australia submission to the Australian Government Department of Health and Ageing, June 2010. 14 Progressing Aboriginal and Torres Strait Islander eye health and vision care Policy and funding proposal

The population-based needs estimated by the National Indigenous Eye Health Survey provides the benchmark level of optometric and ophthalmic services required for any given region and to be utilised when planning MSOAP and VOS services. Additional funding sought: $13.56 million over three years 4.2.3 Eliminate trachoma Vision 2020 Australia commends the Australian Government for its commitment of $16 million over four years towards eradication of trachoma in 2009 as part of the eye and ear measure. This funding allocation has led to inroads in the elimination of trachoma in areas identified as experiencing endemic trachoma. It is recommended that a continued funding commitment be provided to ensure continued mapping of the extent of the condition, the delivery of effective trachoma interventions such as the SAFE strategy, and provision of ongoing monitoring and evaluation activities through the National Trachoma Surveillance and Reporting Unit. Additional funding sought: $13.5 million over three years 4.2.4 Governance and evaluation In line with the WHA Action Plan 2014-19 focus on calls for greater monitoring and evaluation, governance is critical in ensuring national oversight of activity against The Roadmap and the National Framework Implementation Plan. There is significant intersect between the activity of the Australian Government, state and territory governments and Vision 2020 Australia members and it is critical all components are working together to monitor progress, adjust accordingly and avoid duplication of effort. Vision 2020 Australia endorses the call for a national oversight body to provide continuity, oversight and accountability through monitoring national progress and assessing national priorities, as outlined in the Roadmap. 14 Such a body could form part of the proposed Aboriginal and Torres Strait Islander Health Monitoring Group that is proposed by NACCHO and supported by Vision 2020 Australia. Additional funding sought: $3.44 million 14 The Roadmap to Close the Gap for Vision, page 17. 15 Progressing Aboriginal and Torres Strait Islander eye health and vision care Policy and funding proposal

5 In summary Progressing Aboriginal and Torres Strait Islander eye health and vision care supports key national priorities, anticipates emerging trends and adopts a systems-based approach. This proposal supports the domains of The Roadmap linked with the key action areas of the National Framework and the priorities outlined in the 2012 National Aboriginal and Torres Strait Islander Health Plan discussion paper. Importantly, the proposed recommendations will enhance existing systems to ensure Aboriginal and Torres Strait Islander eye care is integrated in broader health systems such as ACCHSs, Medicare Locals and Local Hospital Networks. Strengthening relevant programs in MSOAP and VOS to ensure demand is met where it is needed most and effective coordination between the two programs and new and existing health infrastructure is paramount. It is estimated that 3,300 Indigenous people are blind and more than 15,000 have low vision and this figure is set to double in the next 20 years unless further action is taken. Vision loss accounts for 11 per cent of the Indigenous health gap the difference in health status between Indigenous Australians and the remainder of the Australian population. 15 Vision 2020 Australia and NACCHO form a powerful collaboration and the eye health and vision care sector is ready and willing to continue to close the gap in Aboriginal and Torres Strait Islander eye health and vision care. 15 Vos, Theo and Taylor, Hugh R. (2012) Contribution of vision loss to the Indigenous health gap in Clinical and Experimental Ophthalmology (July 2012) 16 Progressing Aboriginal and Torres Strait Islander eye health and vision care Policy and funding proposal

6 Contact Ms Jennifer Gersbeck Chief Executive Officer Vision 2020 Australia Level 2, 174 Queen Street Melbourne VIC 3000 Phone: 03 9656 2020 Email: jgersbeck@vision2020australia.org.au 17 Progressing Aboriginal and Torres Strait Islander eye health and vision care Policy and funding proposal

18 Progressing Aboriginal and Torres Strait Islander eye health and vision care Policy and funding proposal