The Fred Hollows Foundation's

Indigenous Australia Strategy 2020-2024

We are determined to keep Fred’s vision alive by preventing blindness and restoring sight. We’re working to close the eye health gap so that Aboriginal and Torres Strait Islander Peoples can exercise their right to sight, good health, and self-determination. 

Through the 2020-2024 Indigenous Australia Strategy, The Fred Hollows Foundation will be making its biggest ever investment in Aboriginal and Torres Strait Islander eye health, contributing to the Strong Eyes, Strong Communities plan.

Read on for a summary, or download the full report for a deep-dive.
In the late 1970s, Professor Fred Hollows saw for himself the appalling disparities in eye health between Aboriginal and Torres Strait Islander Peoples and the rest of Australia.

Fred channelled his outrage into action and led the National Trachoma and Eye Health Program, bringing relief and good eyesight to thousands. 

Much of the program’s success was thanks to the direct involvement of Aboriginal and Torres Strait Islander Peoples in delivering these services. 

Fred knew that the only way to deliver eye health services in Aboriginal communities was to have community members at the heart of that work. 

We’re following in Fred’s footsteps even today to close the gap in eye health by working with Aboriginal and Torres Strait Islander Peoples to design and deliver effective services. 
 
In Fred’s day, Aboriginal and Torres Strait Islander Peoples were 10 times more likely to be blind than other Australians. 

By working with our partners and their communities, we have seen this rate gradually reduce, and now Aboriginal and Torres Strait Islander Peoples are three times more likely to be blind than other Australians. 

That’s real progress. But much more needs to be done to close the gap.



 

A NATIONAL PLAN FOR ABORIGINAL AND TORRES STRAIT ISLANDER EYE HEALTH

Strong Eyes, Strong Communities is a five-year plan for Aboriginal and Torres Strait Islander eye health, developed by members of Vision 2020 Australia, the peak body representing Australia’s eye and vision care sector. The national plan charts a course to Close the Gap for vision and create a world-class system of eye health and vision for Aboriginal and Torres Strait Islander Peoples.

Four key strategic areas are set out in the national plan:
 

1. Enhance service delivery by expanding current eye health and vision care services
2. Strengthen regional partnerships and local supports to ensure local and regional systems work effectively for Aboriginal and Torres Strait Islander Peoples
3. Embed eye health in Aboriginal Community Controlled Health Services (ACCHSs) and other primary care services through a combination of workforce and system development and awareness-raising activities
4. Eliminate trachoma, with a sustained focus on full implementation of the Surgery, Antibiotic, Facial Cleanliness and Environmental Health (SAFE) strategy, including targeted efforts to enhance environmental health and embed ongoing screening in primary health care.

Through the 2020-2024 Indigenous Australia Strategy, The Fred Hollows Foundation will be making its biggest ever investment in Aboriginal and Torres Strait Islander eye health, contributing to the Strong Eyes, Strong Communities plan.

By working in collaboration with ACCHSs, governments and the eye health and vision care sector, The Foundation commits to ensuring that a world-class eye health system is in place and accessible to Aboriginal and Torres Strait Islander Peoples. 

Together, we can and will finally close the eye health gap.

OUR GOALS

Goal 1: Effective cataract treatment is accessible to all Aboriginal and Torres Strait Islander Peoples

Cataract is the leading cause of blindness for Aboriginal and Torres Strait Islander adults.

Aboriginal  and Torres Strait Islander Peoples who need cataract surgery face challenges in accessing treatment and typically wait longer than other Australians. Those living in underserviced locations across Australia face particular challenges accessing cataract surgery.

The Foundation is committed to addressing the structural barriers to accessing cataract surgery experienced by Aboriginal and Torres Strait Islander Peoples.

In collaboration with our partners, The Foundation will work to:
 

• Close the gap in the rates of blindness and vision loss from cataract 
• Close the gap in cataract surgery rates and coverage 
• Close the gap in wait times for cataract surgery

 

Goal 2: Trachoma, the world’s leading infectious cause of blindness, is eliminated from Australia

Australia remains the only developed country with endemic trachoma, which is found predominantly in very remote Aboriginal communities. Rates of trachoma are falling, but there are many communities still at risk.

The Foundation is committed to eliminating trachoma and to ensuring effective and sustainable mechanisms are established to reduce the risk of trachoma re-emerging.

In collaboration with our partners, The Foundation will work to:
 

• Eliminate trachoma from Australia
• Establish effective trachoma post-elimination surveillance and response systems across all at-risk regions
• Establish effective environmental health programs across all at-risk regions 
• Establish effective healthy living practices promotion programs across all at-risk regions

 

Goal 3: Effective refractive error prevention and treatment is accessible to all Aboriginal and Torres Strait Islander Peoples

Uncorrected refractive error is the leading cause of vision loss for Aboriginal and Torres Strait Islander adults. Aboriginal and Torres Strait Islander Peoples are not accessing eye care at rates high enough to address this growing problem.

The Foundation is committed to ensuring Aboriginal and Torres Strait Islander Peoples have access to regular eye examinations and glasses when they need them.

In collaboration with our partners, The Foundation will work to:

• Close the gap in the rates of vision loss due to uncorrected refractive error 
• Close the gap in the rates and coverage of eye examinations
• Close the gap in the coverage of glasses

 

Goal 4: Effective and timely treatment for diabetic retinopathy and other eye conditions is accessible to all Aboriginal and Torres Strait Islander Peoples

Diabetes is a significant health problem for Aboriginal and Torres Strait Islander Peoples. It is recommended that people with diabetes receive an eye examination every year so diabetic retinopathy (DR) can be detected and treated before it causes permanent vision loss or blindness. 

Almost half of Aboriginal and Torres Strait Islander Peoples with diabetes are not currently having the recommended annual diabetes eye examinations and only one-third of those requiring treatment have received it.

The Foundation is committed to ensuring Aboriginal and Torres Strait Islander Peoples have access to culturally-safe and high-quality eye examinations and treatment for diabetic retinopathy.

In collaboration with our partners, The Foundation will work to:
 

• Close the gap in the rates and coverage of eye examinations 
• Close the gap in rates and coverage of treatment for diabetic retinopathy

OUR OBJECTIVES

Objective 1: Strengthen regional eye health services

The health system is not meeting the eye health and vision care needs of Aboriginal and Torres Strait Islander Peoples.

To ensure sustained access to high quality, culturally-safe, patient-centred eye care for Aboriginal and Torres Strait Islander Peoples there must be expanded services and pathways to treatment. 

Working together, government and nongovernment eye health stakeholders can strengthen local service delivery and integration. Regional planning is key to ensure resources are allocated and there is continuous quality improvement in eye health.

The Foundation expects that by strengthening regional eye health service delivery models, more Aboriginal and Torres Strait Islander Peoples will receive high-quality, culturally-safe eye care.

We will:

• Improve patient access to high quality, culturally safe, patient-centred eye care through collaboration and cooperation
• Support the development of Regional Hubs and eye health coalitions to enable the necessary scale up of eye care services to communities

 

Objective 2: Train and strengthen the eye health workforce

There is a shortage of Aboriginal and Torres Strait Islander Peoples employed in eye health roles.

Greater investment is needed to ensure more trained and culturally-competent eye health professionals are available to ensure Aboriginal and Torres Strait Islander Peoples receive high-quality, culturally-safe eye care, as close to home as possible.

By 2024 we aim to see:

• 50 additional Aboriginal or Torres Strait Islander health professionals trained in eye health
• 30 additional service delivery coordinators employed to increase uptake of eye health services
• Two additional Aboriginal or Torres Strait Islander doctors enrolled in ophthalmology
• Five additional Aboriginal or Torres Strait Islander people training to be optometrists
• 50 ophthalmologists and optometrists with enhanced skills in the provision of culturally responsive services to Aboriginal and Torres Strait Islander Peoples
• 100 percent of target regions are resourced with the staff required to deliver effective eye health care
• Annual dissemination of at least two new insights.

 

Objective 3: Strengthen eye care in Aboriginal Community Controlled Health Services

Aboriginal Community Controlled Health Services (ACCHSs) are best-placed to provide localised, culturally-responsive primary eye care to Aboriginal and Torres Strait Islander Peoples.

ACCHSs need greater support to embed eye care within primary health care and to address widespread equipment shortages.

The Foundation expects that by strengthening the provision of eye health care within ACCHSs, more Aboriginal and Torres Strait Islander Peoples will receive eye examinations, gain access to glasses when they need them and be actively supported to access cataract surgery and treatment for diabetic retinopathy.

We aim to:

• understand and address the challenges faced by ACCHSs to meet the needs of their communities;
• and pilot innovative projects to ensure ACCHSs have the equipment, systems and staff they need to deliver eye care

 

Objective 4: Finally eliminate trachoma

Australia has almost eliminated trachoma.

Effective post-elimination trachoma surveillance and response systems and strong environmental health and hygiene promotion programs within remote and very remote communities are needed to achieve and sustain elimination efforts.

The Foundation expects that investments in these strategies will ensure trachoma is finally eliminated from Australia.

We will:
 

• work with health and housing departments, non-government organisations and the Aboriginal community-controlled sector to identify and test local solutions to address the determinants of trachoma transmission;
• work nationally to strengthen knowledge exchange, workforce capacity and the monitoring and evaluation of environmental health and hygiene promotion programs
• contribute to the development of post-elimination trachoma surveillance and control strategies, and advocate for government investment in evidence-based environmental health and hygiene promotion programs.

By 2024 we aim to see:

• Trachoma eliminated from all at-risk communities
• Effective post-elimination trachoma surveillance and response systems operating across all at-risk regions
• Annual dissemination of at least two new insights relating to the impacts, costs, or effectiveness of new tools or models for delivery of environmental health and healthy living practices promotion programs.

 

Objective 5: Ensure governments adopt The Strong Eyes, Strong Communities national plan

The gap in eye health for Aboriginal and Torres Strait Islander Peoples has been halved over the past decade as a result of the collective efforts of many individuals, organisations and governments.

Despite these investments, only 60 percent of the need is being met and access to culturally-safe treatment is still lacking.

If funded by governments, the Strong Eyes, Strong Communities plan will enable the necessary scale-up of the clinical and non-clinical services required to meet population need and support Aboriginal Community Controlled Health Services to play a greater role in designing and delivering culturally-responsive models of eye health care.

We will:

• work in collaboration with Vision 2020 Australia and members of its Aboriginal and Torres Strait Islander Committee to push for governments to adopt the recommendations set out in the Strong Eyes, Strong Communities plan;
• champion greater Aboriginal and Torres Strait Islander leadership and control in the eye health sector;
• and ensure that there is meaningful and substantive engagement with and participation of Aboriginal and Torres Strait Islander leaders, organisations and community members in implementing the plan.

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