National Framework for Action to Promote Eye Health and Prevent Avoidable Blindness and Vision Loss

Key Area for Action 2: Increasing early detection

Action Area: Public Awareness

In remote locations, care was delivered through the Trachoma program, school age screening, eye health and optometry team visits during the reporting period. In addition, diabetic educators and preventable chronic condition educators also delivered care through a visiting schedule. Eye health reviews were provided in local health centre consultations including the Adult Health Checks and Care Planning.
Annual trichiasis checks have been built into adult health checks in affected communities from the age of 40 years and older. Opportunistic trachoma checks were encouraged for all people presenting with sore eyes in remote Indigenous communities.

Challenges encountered during the reporting period:

• 
  There is only one NT DoH-funded diabetic educator in Central Australia. Other diabetic
  

educators are funded via NT Healthy living, Baker IDI and the Central Australian Aboriginal

Congress who also service the region.

• 
  Recruitment and retention of child health nurses, preventable chronic condition educators
  

and nursing staff.

• 
  Sporadic visits by endocrinologist and eye health teams, podiatrist and Optometrists as well
  

as addressing social determinants were additional challenges faced during the reporting period.

• 
  High rotation of remote clinical staff resulted in ongoing need for education.
  
• 
  As trachoma is only found in remote Indigenous communities, many health practitioners
  

from other jurisdictions were not familiar with trachoma and its control.

Action Area: Primary Health Care

During the reporting period, specialist optometry and eye health team visits were provided to remote community health care centres. Specialist diabetic educator, nutritionist and preventable chronic condition educators provided specialised care. Eye health reviews were provided with thorough clinical consultations through the primary health care system.
Referrals to visiting community ophthalmologists were supported by vision care coordinators, with links through to regional hospital and tertiary care as required. NT DoH with key partners and stakeholders developed new service delivery models and embraced new remote technologies (e.g: fundal cameras) to enhance the provision of eye care services to remote communities.
This was been made possible by creating an overarching, coordinated and integrated service planning and scheduling process and clinical governance structures that enable Optometrists to become a key triaging entry point for ophthalmology services and providing additional up-skilling and education sessions to local community based primary health care staff.

Action Area: Childhood Screening

During the reporting period, childhood screening, predominantly though 0-5 child health checks , the Trachoma Program and school age screening was undertaken in all remote communities.

Assisting in screening for trachoma in Aboriginal communities

The HU5K Program provided a standardised approach for the provision of routine child health care to children under five living in remote communities of NT. HU5K incorporates general eye examination of eyes at 10 days old, 4 weeks, 8 weeks, 4 months, 6 months, 9 months, 12 months, 18 months, 2 years, 3 years and 4 years of age and includes pathway for referral/recall.

Developmental screening was incorporated into the 8 week, 6 month, 12 month, 18 month, 2 year, 3 year and 4 year old schedule and includes pathway for referral/recall. Specifically:

• 
  routine eye examination for infants and children from birth to 2 years of age includes routine examination of the following: eyelids and orbits; external structures of the eyes; motility; eye muscle balance; pupils; and red reflex. The red reflex test was used to screen for abnormalities of the back of the eye and opacities in the visual axis, such as a cataract or corneal opacity; and
  
• 
  eye examination for all children from birth to 5 years of age includes observing for discharge, redness and unusual eye movement.
  

The schedule of contacts in HU5K covers key areas of anticipatory guidance (age appropriate education and support), social and emotional health, child growth and nutrition, child development and timely identification and management of common treatable health problems, such as eye disease.

Vision screening was built into the development milestones tool used in the programme - Ages & Stages Questionnaires®, Third Edition (ASQ-3™), as described in Key Area for Action 1.
Over the period 2011-2014, Aboriginal and Torres Strait Islander children living in remote communities in the NT were screened for active trachoma. In 2014, 90% of 5-9 year old Aboriginal and Torres Strait Islander children living in 30 ‘at risk’ remote communities (as per revised guidelines) were screened for active trachoma. The new guidelines can be accessed at: Department of Health | Trachoma - National Guidelines for Public Health Units.

Challenges encountered during the reporting period:

• 
  recruitment and retention of child health nurses;
  
• 
  high staff turnover in remote NT DoH clinics; and
  
• 
  competing claims on the time of busy remote NT DoH staff for HU5K.
  

Example of a successful initiative – Northern Territory
Integrated services through multi-sectoral collaboration and coordination
The significant efforts by NT Department of Health (DoH) staff bringing together and working with other Rural Health Outreach Fund outreach service stakeholders (internal and external to NT DoH) have resulted in the realisation of major enhancements to the delivery of eye health services through stronger integration and coordination of all ophthalmology providers (government, private, not for profit and the NGO sector).
These collaborations have been pivotal to negotiations that resulted in securing joint funding commencing in January 2014 for a Top End based Ophthalmology Fellow, Eye Care Coordinator and Indigenous Eye Care Liaison Officer.