Evaluating Indigenous eye health

Programs aimed at improving the health and wellbeing of Aboriginal and Torres Strait Islander people should be evaluated – both to improve program design and delivery, as well as to increase accountability for those delivering and funding such programs.

The Indigenous Eye Health (IEH) Unit, within The University of Melbourne’s School of Population and Global Health, has recently undertaken such an evaluation, looking at the progress and effectiveness of regional implementation of The Roadmap to Close the Gap for Vision (the Roadmap).

The Roadmap is a whole-of-system framework, developed in 2012, with the goal to collectively address Indigenous eye health equity and, in doing so, close the gap for vision. Annual updates have demonstrated progress against the Roadmap since 2013, but this is the first formal evaluation of the work.

The evaluation was undertaken in a collaborative partnership with ARTD Consultants and Clear Horizon, providing independence and evaluation expertise. A co-design process underpinned the project and an Aboriginal and Torres Strait Islander Reference Group was established, providing guidance and ensuring the voices of Aboriginal and Torres Strait Islander people were prioritised throughout.

Co-chair of the reference group, Shaun Tatipata, endorsed the evaluation processes and acknowledged ‘the important inputs, to both process and outcomes, achieved by privileging First Nations’ voices’.

There was a high level of remote and regional input into the evaluation, which included a national survey of people working in the Aboriginal and Torres Strait Islander eye health sector (nearly 70 per cent of survey respondents worked in regional or remote settings); eight regional case studies (six of which were based in regional or remote settings); interviews on the role of IEH as an intermediary organisation; and a scoping review of the literature.

Overall, the evaluation found that taking a collaborative, population-based approach at a regional level can be effective in improving the way services work together to plan, deliver and monitor eye health services for Aboriginal and Torres Strait Islander people. Stakeholders identified positive changes to ways of working and to service access because of regional efforts. However, many feel under-resourced to fully address identified needs.

Deputy Director of IEH, Associate Professor Mitchell Anjou said ‘the evaluation shows that change has occurred through regional efforts, and this has included positive outcomes such as increased awareness and knowledge, improved access to services and treatment, improved coordination and communication, greater collaboration and networking and better access to resources’. Professor Anjou noted that access to information varied across regions and a need to build on this was identified.

Key enablers to regional activity included Indigenous leadership, community engagement, having a credible evidence base, collaboration and partnerships, dedicated coordinator roles, access to flexible funds, and supportive tools and resources. Identified barriers included a lack of these enabling factors.

The evaluation looked specifically at the role of IEH as an ‘intermediary’ organisation through creation of an evidence base that contributed to a shared vision and plan for the sector, supporting the creation of networks at multiple levels, facilitating knowledge exchange, and contributing to policy changes and funding increases that lead to improved service delivery. A key finding is the need for greater Indigenous leadership and self-determination.

In 2022, IEH will be working with the sector to develop strategies for future focus areas identified in the evaluation, to build on the foundations already created. These include strengthening Indigenous leadership, sustaining collaborative networks, addressing cultural safety, supporting the Aboriginal and Torres Strait Islander workforce, and continuing to build the evidence base.

Professor Hugh Taylor, Director of IEH said ‘the biggest priority for us at the IEH unit this year is to develop and implement strategies for increasing Aboriginal and Torres Strait Islander leadership and self-determination of our work, and this has already commenced through changes being made to our Advisory Board’.

The need for increased leadership and community control echoes the recently released National Aboriginal and Torres Strait Islander Health Plan 2021–2031.

The evaluation reports can be found on the IEH website at www.iehu.unimelb.edu.au