Hub and Spoke: Building a Unique Model in Western Australia

A unique hub and spoke model initiated and supported by the University of Western Australia (UWA) is creating “very rich rural and remote and cultural experiences” for optometry students and helping to meet key recommendations set out in the Vision 2030 report.1

The model has been led by Professor Garr y Fitzpatrick , Head of UWA’s Doctor of Optometry program with Associate Professor Khyber Alam, and Senior Lecturers Shaun Tatipata and Neilsen De Souza.

Eye health centres that are the model’s ‘hubs’ are led by local Aboriginal Community Controlled Health Organisations ( ACCHOs) and community optometrists, with an onsite academic clinician at each hub employed by UWA in association with the region’s University Department of Rural Health (UDRH). The presence of a local clinician provides continuous community engagement, delivers ongoing eye care services, conducts research, builds relationships with local stakeholders, delivers health promotion campaigns, and leads groups of final year UWA Doctor of Optometry students who visit for four blocks of six-week placements.

The ‘spokes’ are the remote areas that are serviced by these hubs, providing education, health promotion and clinical services that are led by the regional ACCHOs.

Sounds simple, but in practice there could be nothing further from the truth. As Mr Tatipata explained, every community has different aspirations and strengths, and therefore it requires a different approach to suit those local contexts and to overcome the key challenges. This could include, “infrastructure, the lack of critical space and equipment, and the ability to maintain those pieces of equipment”.

FACILITATING THE MODEL

Mr Tatipata said UWA’s role is to facilitate service delivery by providing support and advice. “These mob, they ’re leading the way in effective primary healthcare services, and so we’re certainly not coming in as experts... we’re just trying to facilitate the journey and through that we have the development of these strong partnerships and the creation of unique learning experiences for our students.”

One of the key contributors to the model is Mr De Souza, who has been involved in the development of over 400 public eye health centres worldwide.

“When the School of Optometry started in WA, I could see a tremendous opportunity to provide access to eye health across a large geographic area by introducing some of the models I had helped deliver for public health globally,” he explained.

Mr De Souza said the hub and spoke model makes sense because resources are developed and centralised at UWA, then distributed and adapted to hubs to ensure quality and consistency of care, and allow scalability.

“We work to fulfil service and education gaps and consult with practitioners to ensure our model does not undermine existing local service providers,” he said.

A UWA objective of the optometry program is to build “socially conscious students” by allowing them to experience optometry in rural and remote areas.

“We aim to provide a supported and immersive experience that provides our students exposure to diverse patients, in diverse settings. At the same time, we don’t want to go to an ACCHO and leave patients without essential eye care services when there are no students there.

“An ongoing presence means eye care services aren’t intermittent; patients can access preventative eye care services in a culturally safe environment, rather than finding themselves at the point where they are living with blinding eye conditions that were avoidable but are now end stage and irreversible,” Mr De Souza said.

UWA is currently recruiting motivated and passionate optometrists to start work as academic clinicians in the Bunbury and Broome hubs in 2024 and in the Goldfields hub in 2025.

A HOLISTIC APPROACH

At a holistic level, Mr Tatipata said the benefit of the hubs goes well beyond an interesting student experience and the delivery of eye care.

“It allows students to develop and define what their role is as part of the broader primary healthcare service delivery landscape. And this leads to better clinicians and better care, particularly for Aboriginal communities. We also know that clinicians and specialists that spend time in rural and remote areas while training are more likely to return and contribute once qualified, whether it’s periodic outreach work or whether they ’re basing themselves in rural or remote locations.

“But this is also a way to support local capacity, to build capability in our clinicians, and to do it in a way that really elevates the voices and aspirations of the communities we’re working with… We can also bring in other providers like ophthalmology and start to look at how we can move beyond reforming the health system across that region, to completely transform it.

“So, it’s Aboriginal community led and it’s servicing the needs, but also empowering the local community. Through this, we hope to see more Aboriginal and Torres Strait people entering into optometry as a profession.

“We understand that not ever yone wants to be a clinician or work in a clinical environment; there’s certainly a lot of opportunity in the peripheral support industry to be able to engage Aboriginal and Torres Strait people to work in and to support their communities in that space as well,” Mr Tatipata said.

As the founding Director of Australia’s first Aboriginal-owned optical and eye care provider, Deadly Vision, Mr Tatipata’s company supplies prescription frames and lenses to the ACCHOs involved in the hub and spoke models, and he works with the Aboriginal staff involved to strengthen their capacity. He trains local people to edge and fit lenses onsite with the intent of manufacturing as much of Deadly Eyewear in community as possible, enabling glasses to be dispensed in a culturally safe environment.

“It’s more than just getting Aboriginal people the eye checks and the treatment that they need… we are building the workforce, building representation in the eye care sector. I mean, how good is it when you’re an Aboriginal person and you walk into a service, and you’re being greeted by and supported by the local community members as well?

“It’s such a special feeling and what that does for our communities and our younger ones, it’s hard to describe, but it’s heartwarming and truly inspiring,” Mr Tatipata said.

EXPANDING REACH

UWA Optometr y now has eye health hubs in Darwin (led by Deadly Vision); Geraldton (in partnership with Geraldton Regional Aboriginal Medical Services, and the local WA Centre for Rural Health ( WACRH)); Broome (in partnership with Lions Outback Vision and Majarlin, Notre Dame University); Bunbury (in partnership with

South West Aboriginal Medical Services and UDRH South West, Edith Cowan University); and Karratha (in partnership with WACRH and local community optometrists). In all locations, hubs work with local optometrists and ophthalmologists and services are integrated into local systems.

Taking the next step, UWA is now engaging state government departments to support children’s vision and aged care programs in rural areas to expand the footprint and contribution of its hubs. In 2025, the aim is to establish a sixth hub in the Goldfields. On a broader level, Mr De Souza hopes that other states and territories of Australia will replicate the model, enabling the delivery of sustainable eye care services and unique student experiences throughout regional and remote areas of the country.

In Western Australia, the hub and spoke model is funded by UWA Optometry, Rural Health West, University Departments of Rural Health with philanthropic support from The Fred Hollows Foundation and the Perth Eye Foundation. The optical industry continues to supply subsidised equipment and expertise.

The UDRHs, which have a remit to support the development of workforce in allied health in rural remote locations, have come on board to support students during placements with accommodation and pastoral care. Assoc Prof Alam said the aim is to ensure the program is financially sustainable to ensure its long-term viability.

“Everyone’s on board, everyone’s into it… when good work happens, you want that good work to continue. And so, we want to strengthen the relationships we have developed; we don’t want to be a burden to the local champions or the local people driving this change… Our original focus was on the students’ learning and teaching; we wanted them to have a really rich clinical experience. But it’s more than just the students, it’s about the social impact… and ensuring that the program continues for the next few decades.”

Reference 1. Shukralla H., Tatipata S., Fonua, L., Alam, K. Vision 2030. Key findings of a workshop of First Nations people working in First Nations eye health, held at the National Aboriginal and Torres Strait Islander Eye Health Conference 2022.

Staff and students from the UWA Doctor of Optometry program.