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

G - Social determinants of health assessment tool

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

Page last updated: 17 April 2012

Table A: Water supply
Very poor
Poor
Satisfactory
Good
Excellent
0 1
2 3 4
5 6 7
8 9 10
11
Delivery systemUnprotected source, serious breakdowns with no preventative monitoring and maintenance program in place.Basic monitoring and maintenance takes place but responsible local staff have poor skills and knowledge. No planned monitoring and maintenance program is in place.System well monitored and maintained. Local staff have satisfactory skills and knowledge. Water supply system can sometimes be maintained and serviced locally.Protected source, system well monitored and maintained, responsible local staff have good skills and knowledge, water supply system can usually be maintained and serviced locally.Well-protected source. Formal monitoring and maintenance plan in place and in progress. Local responsible staff have excellent skills and knowledge and maintain and service the system locally.
Drinking waterWater quality does not meet Australian Drinking Water Guidelines (ADWG) values (e.g. microbiological failures occur or no regular disinfection process in place); boil water alerts may be regular.Water quality almost meets ADWG values; some boil water alerts occur.Water quality mostly meets ADWG values, i.e. occasionally some individual samples do not meet guidelines by marginal amounts. Drinking water is accessible and available to every house and at schools.Water quality always meets ADWG values and drinking water is accessible and available to every house and at schools.Water quality easily and consistently meets ADWG values. A water management plan is in place. Drinking water is accessible and available in public places.
Rate of supplySystem unable to provide quantity required for community all year round.Intermittent unplanned interruptions in supply occur.Intermittent planned interruptions in supply occur.System consistently delivers at least the minimum water quantity requirements; no interruptions to supply.System consistently delivers well above minimum water quantity requirements with no interruptions to supply. Supply plans take account of future needs.
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Table B: Sewerage system
Very poor
Poor
Satisfactory
Good
Excellent
0 1
2 3 4
5 6 7
8 9 10
11
Sewerage systemSerious breakdowns in day-to-day monitoring and maintenance may occur. Effluent overflows and leakages may be regular. Responsible staff do not have the skills and knowledge to effectively maintain the system. Sewerage system cannot be maintained and serviced locally. Effluent/waste stabilisation ponds are not secured, allowing public access. System capacity not coping with current flows. Basic day-to-day monitoring and maintenance takes place. Some leakages may occur. Responsible staff do not have sufficient skills and knowledge to effectively maintain the system. Sewerage system can rarely be maintained and serviced locally. Blocked drains, equipment failure, design and installation problems may occur. Effluent/waste stabilisation ponds are not secured, allowing public access.Day-to-day monitoring and maintenance done locally. No problems with day-to-day running of the system. System capacity coping with current flows. Minimum distance from sewerage treatment facility to housing is met. System meets all established standards. Effluent/waste stabilisation ponds secured to prevent public access.Conditions met as for ‘satisfactory’. In addition, system well monitored and maintained. Local staff have a good level of training.Conditions met as for ‘good’. System consistently delivers well above minimum requirements for the community. Formal infrastructure monitoring and maintenance plan in place. Sewage treatment management plan in place. Responsible staff have a high level of skills and knowledge and can deal with all day-to-day issues concerning the running of the system. Water-saving devices are in place to reduce overall sewage volume. All septic tank lids, manhole and pump station covers in place. System capacity over-designed, allowing for future flows.
Final effluent disposalDischarge to waterways. No valuable re-use of effluent. On-site systems fail (pooling of effluent on the surface). There is a high risk of contamination of water supplies and natural water bodies.On-site systems may fail (pooling of effluent on the surface); some overflows may occur.On-site systems do not fail but other problems are present. Informal monitoring and maintenance system in place.On-site systems do not fail. Overflows do not occur. Septic tanks are deslugged frequently and septage disposed of in designated area.Conditions met as for ‘good’. Final effluent disposed of in an approved way. There is no risk of contamination of water supplies or natural water bodies. There is valuable re-use of effluent. All health department and environmental criteria and requirements are met.
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Table C: Solid waste disposal
Very poor
Poor
Satisfactory
Good
Excellent
0 1
2 3 4
5 6 7
8 9 10
11
Delivery system(a) On-site landfill may occur on individual lots. A centralised landfill site may not exist. Burning is undertaken to manage waste volumes. Dump site may not be accessible to vehicles during wet season. There is a high risk of contamination of groundwater or water source. Community lacks plant to undertake required solid waste management. Burning at landfill site is undertaken to manage waste volumes. Dump site may not be accessible to vehicles during wet season. There is some risk of contamination of groundwater occurring. Plant to undertake required solid waste management is often not operational. No strategies in place to prevent spread of rubbish by animals and wind.Disposal site copes with current waste volume and more space is available for future disposal areas. The plant available to undertake required solid waste management is lacking or out of date and improvisation occurs. The plant available is in a satisfactory condition and suitable to undertake required waste management. All-weather access is available to the site. Regular and frequent collection of household waste. Disposal site copes with current waste volume and more space is available for future disposal areas. Site is well managed (waste regularly backfilled, free from odour and fly/vermin problems). Landfill site fenced and secured (preventing spread of rubbish by wind and dogs) Minor recycling program in place.(b)Conditions met as for ‘good’. Waste disposal site meets relevant criteria and is approved by approving body. Management plan in place for management, maintenance and monitoring (including for removal/disposal of car bodies, toxic wastes and sharp items); extensive recycling program in place; community has access to all required plant. Landfill site is lined to prevent groundwater contamination. Minimum distances to residential areas and water sources are exceeded. Landfill site capacity designed considering future waste volumes.
Household levelCommunity members responsible for disposing of own waste (e.g. by burning).(a)Households are not supplied with suitable bins for waste collection. Bins supplied are easily knocked over by dogs or other animals.Households are supplied with suitable bins for waste collection. Collection takes place at least once per week.Household outdoor waste receptacles are secured from being knocked over by animals while awaiting collection. Bins are emptied more than once per week to limit effects of putrification, flies, maggots and rats. Limited education is provided about the correct ways to dispose of waste.Conditions met as for ‘good’. A system is in place to check and replace damaged bins as necessary. Education is provided on how to maintain bins in a hygienic condition and about the correct ways to dispose of household waste.
Community levelNo bins provided in public areas. Bins provided but there is no regular emptying system. Bins overflow or are knocked over regularly by dogs or other animals. Litter regularly blown about the community by the wind.Some bins provided but not suitable for the purpose (e.g. do not hold sufficient volume or not child friendly). Community may experience problems with wind-blown litter. Bins not routinely emptied. Little compliance to dispose of litter correctly.Clearly visible bins in public places that are emptied regularly. Overflow does occur on occasions but the problem is remedied quickly. Some compliance with disposal of litter appropriately.Community free from problems with wind-blown litter; bins available in litter drop zones (e.g. store, school, health centre). Good compliance with disposal of litter appropriately. Education programs and deterrents to littering (e.g. people who litter are fined).Conditions met as for ‘good’. There is a high level of awareness of and compliance with appropriate disposal of litter. Strategies and incentives are in place to promote the correct disposal of litter and pride in the appearance of the community (e.g. refundable bottles and health promotion activities).

(a) - In very small communities where no waste disposal service is available (e.g. outstations or homeland communities consisting of two or three houses), burning of rubbish will be the most feasible and appropriate solution to waste disposal. However, this must be done in a way that does not put at risk personal safety, infrastructure or the wider environment.
(b) - In remote and rural areas a recycling program may be considered best practice, as opposed to a minimum standard as in urban areas, due to logistics and cost.

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Table D: Electricity supply
Very poor
Poor
Satisfactory
Good
Excellent
0 1
2 3 4
5 6 7
8 9 10
11
Access to electricityNot all houses are supplied with electricity. System may be overloaded. Regular (more than 20 times per year) interruptions may occur due to equipment breakdown. Consumers frequently report damage to electrical goods because of interruptions or voltage fluctuations in power supply.Not all houses are supplied with electricity. Regular interruptions due to storms and equipment breakdown (more than five per year) may occur. Time taken to restore power can be lengthy. Day-to-day monitoring and maintenance cannot be completed by local staff. All houses are supplied with electricity. The voltage delivered to households is constant. Interruptions may occur occasionally and are likely to be due to planned maintenance outages. Power is restored with minimal delay if unplanned outage does occur (e.g. due to storm). Day-to-day monitoring and maintenance can sometimes be done by local staff. All households and other community buildings are provided with electricity. The voltage delivered to households is constant. Interruptions to supply are generally planned. Day-to-day monitoring and maintenance is done by local staff. Few complaints from consumers.Conditions apply as for ‘good’. Community has a good supply of electricity 24 hours per day throughout the whole community all year. This may involve the use of back-up systems such as solar power or auxiliary generators. Level of consumer satisfaction is high.
SafetyLow and/or faulty power lines present. Electricity-related accidents may occur. Day-to-day safety aspects of the supply system cannot be maintained locally. Basic day-to-day safety monitoring and maintenance of supply occurs but responsible staff have poor skills and knowledge. Basic day-to-day safety monitoring and maintenance of supply occurs. Responsible staff have satisfactory skills and knowledge. Electrical-related deaths, injury and property damage are prevented. All houses have safety switches.Conditions apply as for ‘satisfactory’. Tall trees are planted well away from power lines. Power poles and lines are inspected regularly and tree pruning occurs.Conditions apply as for ‘good’. Supply source is well maintained. There is a monitoring and maintenance program in place to ensure safe supply.
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Table E: Healthy housing
Very poor
Poor
Satisfactory
Good
Excellent
0 1
2 3 4
5 6 7
8 9 10
11
Personal hygieneLack of privacy or non-functional health hardware forces people to leave their own home and go elsewhere to shower or bathe their children.Lack of privacy or non-functional health hardware forces people to improvise to wash (e.g. to use a bucket because not all the health hardware needed to shower or wash children is working in the house). Members of households have easy access to health hardware and are assured of privacy when showering in their home. Functioning health hardware is available to meet children’s hygiene needs. Health hardware needs minor repairs or maintenance. Hygiene education provided on a one-to-one basis only.Members of households can easily access and are comfortable in washing or showering in their own home. The health hardware available provides alternatives for washing children. A responsive and effective health hardware repairs and maintenance service operates. Some hygiene education provided at community level.Conditions apply as for ‘good’. The community offers a proactive and responsive health hardware repair and maintenance service. Good hygiene promoted on a number of levels in the community via a number of different means (e.g. school programs, social marketing).
LaundryFew houses have functional washing machines and clothes lines. There is no functioning community laundry facility. Most houses offer no shelf or other storage facility in the laundry. Few houses have functional washing machines. There is a functional community laundry in the community which is affordable but not within easy walking distance from all houses. Few houses have functional clothes lines. Most houses offer no shelf or other storage facility in the laundry.Many houses have functional washing machines. There is an affordable community laundry within easy walking distance from all houses. Many houses have functional clothes lines. The laundry in most houses has limited storage facilities (e.g. a shelf only). Hygiene education provided on a one-to-one basis only.Most houses have functional washing machines. There is a functioning community laundry within easy walking distance from all houses. Most houses have functional clothes lines. The laundry has good storage facilities (e.g. shelf and cupboards). Limited hygiene education provided at the community level.All the houses have functional washing machines or there is a functioning community laundry within easy walking distance. All the houses have functional clothes lines. The laundry has good storage facilities (e.g. shelf and cupboards).

Good hygiene promoted on a number of levels in the community via a number of different means (e.g. school programs, social marketing).

The ability to safely store and prepare healthy foodIn most houses the kitchen health hardware and kitchen infrastructure is generally poor. It is not easy to hand wash before preparing food. Kitchen utensils and food cannot be easily washed at the kitchen sink. Bench tops are in poor repair. No functional refrigerator. No cupboards to safely and securely store food. No hot plates available to cook food. When first occupying new or renovated houses training is not provided in using and maintaining kitchen fixtures and fittings.In many houses the kitchen health hardware and kitchen infrastructure is generally poor. It is not easy wash hands. Bench tops are in poor repair. No functional refrigerator. Cupboards to store food are in poor condition. Only some hot plates work. New tenants are provided with a brief ‘handover’ only.Most houses have functional health hardware and the kitchen infrastructure and fittings and fixtures are generally good. Hand washing is easy. Bench tops can be maintained in a hygienic condition. A functional refrigerator. Cupboards are available to store food. All hot plates work. When first occupying new or renovated houses training in using and maintaining kitchen equipment, and ongoing support, is provided.Kitchen health hardware and infrastructure is functional and easy to maintain in a clean condition. Hand washing is easy. Bench tops are in good repair and easy to maintain. A functional refrigerator. Cupboards available to safely and securely store food. All hot plates and oven work. Ongoing education and skills training is provided in using kitchen equipment and maintaining the kitchen environment in good order and a clean state.Conditions apply as for ‘good’. Hardware and infrastructure are of appropriate design and made of superior/durable materials and easy to clean. Additional safety features to prevent accident and injury are presented. Easy to clean cupboards available to safely and securely store food. Ongoing nutrition and hygiene promotion program in place.

Source: MSHR (2006).



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