Evaluation of the Child Health Check Initiative and the Expanding Health Service Delivery Initiative - Final Report

6.4 Sustainability

Evaluation of the Child Health Check Initiative and the Expanding Health Service Delivery Initiative - Final Report

Page last updated: 17 April 2012

For many of the agencies and people involved in planning and implementing the CHCI and the EHSDI, sustainability has been a central consideration from the start of the NTER, with an eye on building on the CHCI to secure increased funding for the NT PHC system. The NT PHC system has certainly demonstrated resilience, a key characteristic of a sustainable system, in responding to the ‘shock’ of the NTER.

With regards to the CHCI, the key issues affecting the future sustainability of services and outcomes are the need for ongoing resourcing (both funding and staffing) of the models of follow-up service delivery that have evolved from the program in order to complete all outstanding referrals that still require follow-up and to provide for new referrals, and the need to address the poor social conditions that limit longer term impacts. Future funding of follow-up delivery of ENT/hearing services needs to address the complex and recurrent nature of ear disease in Aboriginal children (often requiring multiple referrals and interventions over the long term). The sustainability of these new service delivery models will also be enhanced by integrating them with PHC and health promotion.

At the system planning and policy level there is a need to sustain the benefits of the CHCI in increasing understanding of the health needs of the population and increasing the ability of services to meet these needs. Measures to ensure that this increased awareness is not lost need to be incorporated in further development and implementation of the NT AHKPIs, and in data collection and reporting on individual programs such as the GAA/Healthy Under 5 Kids.

The evaluation identified a number of areas of ongoing system reform through the EHSDI to focus on to enhance sustainability. In particular, continued focus on building strong relationships and partnerships within and between agencies (including the three key partner agencies: DoHA, DHF and AMSANT), service providers, health consumers and communities will enhance the sustainability and continued development of the remote PHC sector.

There is also a need for a viable long-term resourcing solution, including for the health workforce. The lack of long-term funding for the EHSDI is a concern, as the gains made through the reform process cannot be sustained without continued financial investment. As well as financial resources, additional policy capacity will need to be directed towards implementing the reforms if the pace of change is to be sustained.

Other aspects of sustainability that should be considered in relation to the EHSDI include the need to engage more directly with other sectors to address social determinants of health. Any improvements to remote health services under the EHSDI will have limited long-term impact without explicit engagement with wider determinants of health, particularly in housing. The EHSDI will be more sustainable if the reforms link health development with wider social conditions.

Finally, there is a need to manage risks by planning for failures (such as service providers collapsing) to ensure that the system does not fail as a result; and the system needs to be adaptive and able to learn from both successes and failures.
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