Barriers to the implementation of the SAFE strategy to combat hyperendemic trachoma in Australia

Ophthalmic Epidemiol. 2010 Dec;17(6):349-59. doi: 10.3109/09286586.2010.528135.


Objective: Australia is the only developed country in the world that still has endemic levels of blinding trachoma. The SAFE (Surgery, Antibiotics, Facial cleanliness, Environmental improvement) strategy is an effective public health intervention that has been successfully used to eliminate blinding trachoma in some of the poorest countries of the world. Yet the SAFE strategy has not been systematically implemented in Australia. We undertook semi-structured interviews to identify some of barriers to the implementation of the SAFE strategy within remote indigenous communities of Australia.

Methods: Health care professionals who were responsible for delivering trachoma control programs throughout the Northern Territory were asked to participate in a semi-structured interview. Quantitative analysis was performed using an existing strategic management framework.

Results: Fourteen individuals were interviewed. Responses were grouped into 19 categories; 12 from the existing strategic management framework and 7 additional categories that were created for ideas unique to the trachoma control program in Australia.

Conclusions: A number of key themes emerged from the interview and are presented in a literary style. From these key themes critical success factors for the implementation of a sustainable trachoma control program were identified. With the election of the Rudd government there has been a renewed interest in "closing the gap" between the health of indigenous and non-indigenous Australians. A federal government funding package of $58 million over four years has just been announced to tackle trachoma. It is hoped that the findings of this research can assist in making sure that money achieves its goal.

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Blindness / prevention & control
  • Detergents
  • Endemic Diseases*
  • Health Knowledge, Attitudes, Practice
  • Health Personnel
  • Health Plan Implementation / statistics & numerical data*
  • Health Services Accessibility / statistics & numerical data*
  • Humans
  • Hygiene
  • Northern Territory / epidemiology
  • Ophthalmologic Surgical Procedures
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Rural Population
  • Surveys and Questionnaires
  • Trachoma / epidemiology*
  • Trachoma / prevention & control*


  • Anti-Bacterial Agents
  • Detergents