ANZSOG’s John L. Alford Case Library contains almost 300 examples of public policy challenges, to be used in the development of public managers. This article highlights a case on how one determined advocate shifted government policy on Indigenous health and helped save thousands from blindness.
Ten years ago, Australia was the only OECD country where the preventable eye disease trachoma remained active in its population. While it was a hundred years since the disease had been seen in non-Aboriginal Australia, in Aboriginal communities, children were still being infected, and adults blinded, at rates equal to the worst in the world.
Professor Hugh Taylor had taken part in Australia’s first national survey of Indigenous eye health in the mid-1970s. He was frustrated by the lack of progress in addressing trachoma in remote Aboriginal communities and was determined to do something about it.
Seizing the momentum created by the Close the Gap targets and Kevin Rudd’s apology to the Stolen Generations, Professor Taylor used a combination of philanthropic donations and government funding to put together a pilot program that has led to Australia being on track to eliminate endemic trachoma by 2020.
ANZSOG’s Case Library details the full story of the role of Professor Taylor and the Centre for Eye Research Australia (CERA) in building political support and coordinating the fight against trachoma.
As of 2006, only fragmented regional programs against trachoma were being conducted by publicly funded public health services and Aboriginal controlled health services. Different jurisdictions had different programs, despite national treatment guidelines.
This was a major problem in the fight against a disease which spread easily, and effectively required an entire community to be cured to ensure the disease was unlikely to return.
Professor Taylor recalled that the programs were “rapidly devolved” to the states, so the responses varied resulting in a lack of accountability.
“They put trachoma people or trachoma teams in place until 1997, but these were just visiting people with inadequate resources, no oversight and no real skills in terms of a systems approach. In the end, they were actually a block for taking activities to scale.”
CERA developed, what was at the time, a ground-breaking analysis of the cost to society of preventable vision loss: $9.85 billion annually.
The critical finding was that this dramatic “vision gap” could be almost completely closed. Nearly all vision loss in Indigenous people – about 94 per cent – could be prevented or treated.
In the run-up to the 2007 election, Taylor spent time with politicians from both main parties, including federal Labor members Jenny Macklin and Nicola Roxon, who went on to become the Minister for Indigenous Affairs and Minister for Health and Ageing respectively, as well as Senator Trish Crossin, who was a strong advocate for reform through the Senate Estimate Committee process. After the election, he delivered a three-minute pitch to Prime Minister Kevin Rudd at an event in Tasmania, detailing why trachoma should be a priority.
He formed the Indigenous Eye Health Unit in 2008, to drive the elimination of trachoma in Indigenous Australia. It prepared a plan costing $25 million over four years to set up regional implementation teams, with national coordination, monitoring and support. They even made an uninvited submission to Rudd’s Australia 2020 Summit, arguing that the eradication of trachoma was now an achievable goal, which Australia should take on, if only to salvage its international reputation. The resulting report contained two mentions of trachoma in its wide-ranging recommendations.
In February 2009, the first anniversary of his historic apology to the Stolen Generations, Prime Minister Rudd announced $58.3 million for Indigenous eye and ear programs over four years, of which $16 million was allocated to the elimination of trachoma. By then, Professor Taylor and the IEHU team were already considering how to galvanise philanthropic support for an estimated $70 million in public funding needed to implement the plan over four years – soon to be named the ‘Road Map to Close the Vision Gap’.
By 2011, the IEHU could report significant progress in identifying weaknesses in the current system and in developing successful solutions.
They had identified a lack of access to eye services in remote communities, and a lack of accountability in providing them. In addition, a trial in the remote communities in Western Australia, funded by the Christian Blind Mission and philanthropists David Middleton and (later) Greg Poche, had shown that the holistic SAFE program ( Surgery, Antibiotics, Cleanliness, Environmental improvements) could reduce trachoma rates in a short time.
Professor Taylor and IEHU remained firm that it was a governmental responsibility to expand the funding and implement a national program.
“Sustainable funding means it has to come from the usual budgets,” Professor Taylor said.
“Also, the scale of a national program requires the support of government – not only for funding but to ensure adoption.”
Funding at federal and state levels has continued since then, and trachoma is close to being eradicated.
Professor Taylor’s role shows the importance of building a strong case for action, giving a disjointed health sector a vision to work towards, and seizing every opportunity to build political momentum to deliver a long-overdue change.
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