This section presents a broad implementation plan which ranks the recommendation by priority (as determined by the evaluation team), assigns a time frame for the commencement of action and suggests an order of responsibility (D = DoHA; J= Jurisdictional health authorities; N = NTSRU; PH = Public health units or equivalents; P = local primary health care staff) for implementation.

Table 6.1: Implementation priorities for improved and enhanced national trachoma surveillance system

Priority Level

Recommendation

Order of responsibility*

Short-term – enhancements – action to commence within six months R1: Within NT, WA and SA all communities located in remote and very remote locations should be included in the screening program at least once in a five year cycle using the rapid assessment method. A decision to continue ongoing annual screening in these communities should depend on the estimated prevalence of active trachoma found within the community.
J/PH/P
R5: The CDNA Guidelines which require annual screening in trachoma endemic communities until prevalence is less than 5% for five consecutive years should be enforced in funding and performance agreements between the Commonwealth and the jurisdictions relating to the allocation of additional funds under the new trachoma eradication initiative.
D/J/PH
R6: The target screening coverage rate of 80% (i.e. the number of children aged 5-9 years screened as a proportion of the estimated number of children aged 5-9 years present in the community at the time of screening) stated in the National Framework for Delivery of Trachoma Control Programs should be enforced to ensure that screening coverage is sufficient to provide a reasonable estimate of trachoma prevalence.
D/J/PH
R7: The denominator used in calculating the screening coverage rate should be estimated locally at the time of screening, based on a discussion between screening staff and local school and/or health clinic staff using a list of school enrolees or local resident children within the specified age ranges.
D/J/PH
R8: Jurisdictions in collaboration with the NTSRU develop guidelines to be followed by screening staff in estimating the number of children in the target age group in the community at the time of screening.
J/N
R12: National Form 1 should be amended to capture data on the total number of children screened who received azithromycin for active trachoma by age group (including those who received treatment outside the two week period).
N/D/J/PH
R13: National Form 3 should be amended to capture codified information related to the nature of health promotion strategies implemented under the facial cleanliness and the health promotion/education categories. A set of codes describing the range of health promotion/education programs should be developed through an analysis of programs currently reported in textual form through National Form 3.
N/D/J/PH
R18: OATSIH should consider allocating resources to assist with the development of a web based system for capturing surveillance and treatment data and allowing access to standard reports.
D
R19: The lag in the preparation of the national report should be reduced through the jurisdictional and regional co-ordinators identifying and addressing the factors that contribute to late provision of data to the NTSRU; the implementation of web based data collection mechanisms (see R18) that facilitate earlier resolution of data quality issues; and the NTSRU examining opportunities to more rapidly produce the final report.
D/J/N/PH
R20: A flexible set of reports/pivot tables should be made available to jurisdictional and regional coordinators through the existing Access database or the new web based system.
N/J/PH
R22: The national trachoma surveillance system should be enhanced through the development of training materials/packages (including web-based training modules) for training of local staff in trachoma screening and control activities.
D/N
R23: Quality of the national trachoma surveillance data should be enhanced through the development of a training package or session with staff that collect and/or enter the data. The training package/session would involve being taught to use the Access database or its replacement as well as understanding the uses of the data at the national level.
D/N
Short-term – expansion – action to commence within six months R2: Active trachoma screening activities should be extended, at least on a once off basis, to remote and very remote communities in NSW and Queensland using the rapid assessment method. A decision to continue ongoing annual screening in these communities should depend on the estimated prevalence of active trachoma found within the community.
D/J/PH/N
R3: Jurisdictions should consider screening ‘at risk’ communities that are not located in remote and very remote areas) at least on a once off basis every five years using a rapid assessment method. A decision to continue ongoing annual screening in these communities should depend on the estimated prevalence of active trachoma found within the community.
J/PH/D/N
R4: Jurisdictions should be able to exercise some discretion in choosing not to screen communities in which there is good local evidence that active trachoma is no longer present. However, the reasons for a decision not to screen a community located in remote and very remote locations at least once in a five year cycle should be conveyed to the NTSRU.
J/PH/D/N
Long Term – enhancement - action to commence within six months to two years R14: Arrangements should be made at the national level to allow relevant data from the Community Housing and Infrastructure Needs Survey (CHIN) by the year (2006 and 2011 when available) to be integrated into the national Access database on trachoma surveillance (or its replacement).
D
R15: Jurisdictional trachoma coordinators continue to explore opportunities to improve data collection systems and mechanisms for extracting data from local clinical systems for trachoma surveillance reporting.
PH/N/J/D
R21: Following the implementation of recommendation R14, the national surveillance report should include analyses of the relationships between housing and environmental factors and trachoma prevalence.
N/D/J/PH
Long Term – expansion - action to commence within six months to two years R9: Surveillance data on the prevalence of active trachoma and trichiasis should be supplemented by conducting a national eye health survey of Indigenous people about once every five years using a randomised cluster sampling method, similar to that used for the recent National Indigenous Eye Survey.
D
R10: Trichiasis surveillance should be enhanced by pursuing integration of screening for trichiasis with the provision of annual influenza vaccinations to Aboriginal adults and/or ‘healthy adult checks’ in at risk communities in the Northern Territory and South Australia.
D/J/PH/N
R11: The current approach to monitoring antibiotic resistance should be retained. The national trachoma surveillance system should be enhanced by the NTSRU seeking agreement from PathWest to contribute annual data on azithromycin resistance to the system.
N/D/J/PH
R16: Jurisdictional trachoma coordinators should seek to establish arrangements with ophthalmologists designed to capture relevant information on Aboriginal persons provided with trichiasis surgery.
PH/N/J/D
R17: The Department of Health and Ageing should consider the development of a specific MBS code for trichiasis surgery.
D/J/PH/N

* D = DoHA; J= Jurisdictional health authorities; N = NTSRU; PH = Public health units or equivalents; P = local primary health care staff

Many of the recommendations have been allocated to the short term enhancement and expansion categories so that the additional and higher quality data that will flow from their early implementation will be available to allow a timely assessment of the impact of the trachoma surveillance and control component of the Australian Government’s Improving Eye and Ear Health Services for Indigenous Australians for Better Education and Employment Outcomes measure. Naturally, it will be important that DoHA and the jurisdictions allocate sufficient resources to allow timely and effective implementation of the recommendations. top of page