Eye care: what’s the situation in Aotearoa New Zealand?

Eye care: what’s the situation in Aotearoa New Zealand?

by | 27 Jul, 2022 | Resources

ecsat coverIn 2022, researchers from the Community Eye Health team (Pushkar Silwal, Renata Watene, Jacqueline Ramke) were commissioned to prepare a detailed report that summarises the state of eye care services in Aotearoa New Zealand. The report highlights that while New Zealand has a solid foundation for good quality eye care services, there is room for improvement in the way we plan and deliver eye care services to ensure all New Zealanders can access the services they need. Eye Care in Aotearoa New Zealand (2022) uses the World Health Organization’s Eye Care Situation Analysis Tool (ECSAT) to summarise the performance of our eye care services. The tool consists of 31 items (grouped into six ‘building blocks’) that each assess a different component of New Zealand’s eye care services.

Read the published report and download the plain language summary of the findings. 

Why did we undertake an ECSAT?

Globally, more than a billion people live with vision impairment and the negative effects this can have on their lives. To reduce this problem, in its inaugural World report on vision, the World Health Organization called for eye health to be part of efforts to achieve universal health coverage (UHC) through implementing Integrated People-centred Eye Care across the spectrum of promotive, preventative, curative and rehabilitative services. In 2020, this call was adopted by 194 countries at the 73rd World Health Assembly (including Aotearoa). To improve our eye care services, we must first understand the strengths and weaknesses of current services. This understanding is enabled by ECSAT, which is the first of four tools in the Guide for Action developed by WHO to support countries to strengthen integration of eye care into the health system.

The ECSAT report was commissioned by Eye Health Aotearoa to support New Zealand’s policy makers to develop integrated people-centred eye care, and ensure that all New Zealanders can access quality care.

How did we prepare the report?

To prepare the report, we established a Technical Working Group that included members with experience in optometry, ophthalmology, primary care/general practice, rehabilitation and Māori health. We used information gathered from published documents, which we augmented by interviewing with people with detailed knowledge of eye care services. The report can be downloaded from the Open Science Framework.

The report was launched by Eye Health Aotearoa at Parliament on 27 July 2023.

What are the major findings of the report?

The report identified that components of our eye care services in Aotearoa that are generally “strong” or only “need minor strengthening”, include:

  • Service delivery: The quality of eye care services.
  • Workforce & infrastructure: Ensuring that workers are trained and available to provide eye care services.

In contrast, the components of our eye care services that had aspects that “need major strengthening” include:

  • Leadership & governance: Planning, integrating and coordinating services, with appropriate policies in place.
  • Financing: How services are funded, including reducing out-of-pocket costs for population groups who are less able to afford services.
  • Access to services: Availability of the range of services throughout the country, as well as whether all population groups can access them.
  • Information: How service performance is monitored, and whether evidence is used to inform how services operate.

The report provides a detailed list of 81 recommended actions that may help strengthen eye care services in New Zealand.

Citation: Silwal P, Watene R, Cowan C, Cunningham W, Harwood M, Korau J, Sue W, Wilson G, Ramke J. Eye care in Aotearoa New Zealand 2022: Eye care situation analysis tool (ECSAT). Auckland: University of Auckland, 2022. Available at: https://osf.io/r75zs/

Funding: The report was prepared for Eye Health Aotearoa, with funding from Blind Low Vision New Zealand.

Vision screening in New Zealand pre-school children: is it equitable?

Vision screening in New Zealand pre-school children: is it equitable?

by | 1 Jun, 2021 | Resources

Key messages:

The B4 School Check (B4SC) vision screening service is successfully delivered to most New Zealand preschool children. However, for some groups of children, the B4SC is less accessible and more likely to deliver an incomplete test measurement. This includes Māori and Pacific children, and those living in areas of higher deprivation or in particular regions of New Zealand.

Read the published paper and download a plain language summary of the findings.

About preschool vision screening

Preschool vision screening helps to identify children with eye problems. Early treatment can then prevent permanent vision loss and difficulties at school. In Aotearoa New Zealand, all children 4 years of age are offered a free vision screening test as part of the national B4SC screening programme, and children identified for further testing are referred to eye clinics for treatment. In principle, all children in New Zealand can participate in the B4SC. However, the B4SC is inaccessible for some children, for various reasons such as difficulties in scheduling an appointment. Sometimes the vision screening test is unable to be completed (for example, due to language barriers).

Why did we do this research? 

We conducted this research to understand whether there are any inequities in the B4SC vision screening programme between children from different ethnicities, or living in areas with different levels of deprivation or in particular regions of New Zealand.

What did we do? 

Using information from the Statistics New Zealand database, we counted the number of children in New Zealand aged 4 years between 1st July 2011 and 30th June 2015. For each child, we recorded their ethnicity, and the level of deprivation of the area they lived and the health district where they live. We calculated how many of these children accessed vision screening (the screening “coverage”), and how often the screening test was performed successfully (the screening “testability).

What did we find?

Screening coverage: Nearly 90% of children could access the B4SC. The B4SC was less accessible to children of Māori, Pacific, Asian, or other minority ethnicities, or living in more deprived areas. This service was also less accessible for children in the Capital and Coast health districts than those in other regions.

Screening testability: The test was successfully completed for almost all the children who participated (97.7%). Completed testing was lowest for children of Māori or Pacific ethnicity, or living in more deprived areas. Children in the Whanganui health district were more likely to have an unsuccessful screening test compared to other regions.

What’s next? 

We need improve the way the B4SC vision screening programme is delivered so that it is equally accessible to all groups of children. In particular, this should involve consultation with Māori. Future research should examine why there are regional differences in screening rates across New Zealand.

Citation: Findlay R, Hamm L, Anstice N, et al. Vision screening in New Zealand pre-school children: Is it equitable? J Paediatr Child Health. 2021;57:1594–9. doi: 10.1111/jpc.15548.

Funding: A Better Start – National Science Challenge