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A protocol for a qualitative evidence synthesis

In 2021 WHO revised its Eye Care Situation Analysis Tool (ECSAT), which has 178 individual questions across 31 Items organised across six health system building blocks7. This report is based on responses to each of these ECSAT questions. To develop this report, between November 2021 and January 2022 we undertook a document review involving scholarly work (e.g. scientific peer reviewed publications), official documents (e.g. policy and policy directives), implementation documents (e.g. clinical protocols, training manuals, and evaluation reports), legal documents (e.g. regulations), working documents (e.g. PowerPoint presentations), and media communications (e.g. newspaper and magazine articles, newsletters, and webpages). We then engaged in a series of key informant interviews with members of the Technical Working Group or other colleagues (listed in acknowledgements) to verify information obtained and fill in any knowledge gaps. This draft report was shared with the Technical Working Group with a request for feedback, and further discussions took place until consensus on responses were reached. This report provides a summary of the key aspects of the eye health situation in 2022. However, we recognise there may be some activities that were not readily available online and were unknown to our key informants and are therefore not reflected here. We welcome additional information being shared with us. This report summarises the Eye Care Situation in Aotearoa New Zealand (hereafter referred to as New Zealand or NZ) in Q1 2022, according to the 178 individual questions across 31 Items in WHO’s Eye Care Situation Analysis Tool (ECSAT). These questions in the tool are numbered from (a) up to (j) for each Item, and we have added these letters at the end of each statement for ease of cross-reference to the ECSAT tool. In ECSAT, most questions call for a yes/no response. In this report, we have rephrased the question to be a statement, with elaboration where we felt this was warranted. The tool also includes a series of statements to summarise the ‘maturity level’ of each of the 31 Items, from “Level 4 Needs no immediate action” down to “Level 1 Needs establishing”. We have made our assessment of the maturity level of eye care services in New Zealand based on the evidence we could identify for each Item (evidence statements are summarized in the blue box for each Item). For each of these statements, we include the level at which WHO has placed the situation (e.g. L1, L4). Where the statements outlined by WHO did not reflect our situation, we have added statements, and these are shown with (*). We have collated and visualised the maturity level for all 31 Items on the following page. The tool also includes a series of possible actions for each Item. We have included what we consider to be the priority actions for each Item (shown in the green box for each Item). Where the actions outlined by WHO did not reflect what was needed in New Zealand, we have added actions, and these are shown with (*). We have collated the possible actions for all Items at the end of the report. References are included to support our statements where these were available. If no citation is provided, the information was obtained from key informant interviews or knowledge of the Technical Working Group.

Equity in health has risen in prominence in recent decades. Within eye health, The World Health Organization’s (WHO) World Report on Vision and the Lancet Global Health Commission on Global Eye Health both highlighted that in all parts of the world, there are population groups underserved by existing services, such as rural dwellers, women, Indigenous/First-Nations and non-dominant ethnicity groups, and people living in areas of high deprivation. These reports also called for more evidence and action to address inequity, including better monitoring of inequality. Population-based eye health surveys (including those employing the Rapid Assessment of Avoidable Blindness (RAAB) methodology) can be used by governments to strengthen eye health services to meet the needs of the population. These surveys assess and/or report the eye health needs of underserved groups in a range of ways, for example by intentionally recruiting communities with large unmet needs, or by conducting surveys in the general population and disaggregating the outcomes by different population groups. Future approaches to enhance inequality monitoring may include increasing the sample size so that it is adequately powered for subgroup analysis, adapting recruitment strategies to ensure they are appropriate for the target population groups, and finding ways to include traditionally ineligible population groups (e.g. people without housing / a fixed address). These modifications may allow surveys to be as equity-relevant as possible. We wish to identify the extent to which underserved population groups have been considered by researchers in the design, implementation, and reporting of population-based eye health surveys, and which strategies have been described. Our aims are to summarise: 1. The proportion of eye health surveys that have considered underserved groups in their design, implementation, and reporting; and 2. How and in what ways eye health surveys have considered underserved groups in their design, implementation, and reporting. In addition to identifying the range of strategies that have been implemented to date, the findings of this review will form a baseline from which the field can develop.