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

6. Conclusions

The Child Health Check Initiative (CHCI) and the Expanding Health Service Delivery Initiative (EHSDI) were designed to address the health needs of people living in remote Aboriginal communities in the Northern Territory (NT).

Page last updated: 10 June 2011

Although the CHCI is largely complete, child wellness checks are part of the core PHC services in the NT. Many of our key findings and recommendations for the CHCI may be relevant to other existing or future child screening programs.

There was a lack of policy development at the federal level during the design phase of the CHCI due to the ‘urgency’ of the NTER. Consequently there was inadequate consultation with communities and health workers in the NT, the checks did not follow international guidelines for screening programs and inadequate attention was given to the existing strengths and weaknesses of the NT PHC system. Before developing and implementing child health screening programs there should be thorough policy development and this needs to fully engage with existing programs, initiatives and processes.

The CHCI brought constructive attention and resources to the NT remote health system. A large number of children were checked and received treatment and/or follow-up services; however, the NT health system did not have the capacity to provide follow-up services to many of children who were referred through the health checks. The number of children who did not receive follow-up care ranged from 19.6–57.4 per cent depending on the type of referral. The interface between primary care and referred services in the NT health system needs to be strengthened to facilitate efficient patient flow through the system from PHC to specialist follow-up care.

The CHCI funding has enabled the development of new service delivery models for dental and hearing/ENT. These models have the potential to contribute to more efficient and effective service delivery, providing these services continue to be funded and are developed within the context of a comprehensive PHC approach.

The time-limited ‘blitz’ nature of the CHCI is unlikely to be effective in addressing the chronic nature of the health needs identified among Aboriginal children. Future child health initiatives need to have a long-term focus on the underlying social determinants of health including housing, education and poverty.

In contrast to the approach taken to the CHCI, the EHSDI was premised on engagement with existing processes in the NT. The initiative built on earlier reform efforts and made use of established governance frameworks and partnerships. This cooperative approach built on existing developments such as the introduction of system-wide NT AHKPIs and the Pathways to Community Control framework.

The EHSDI has added significantly to the remote health workforce in the NT. The RAHC has provided health professionals for short-term placements while expanded service funding has enabled the creation of a range of additional positions across the health system. There are ongoing difficulties with recruitment, AHW training, staff accommodation shortages and high staff turnover. A comprehensive approach is required to address these concerns at a system level.

The EHSDI has substantially increased financial inputs into the NT remote PHC system and enabled it to partially address the inequitable distribution of funding across the NT. A long-term, realistic funding pathway is essential for the continued development of services. Increased efficiency could be achieved by consolidating multiple funding streams to bring greater coordination in program delivery thereby relieving the administrative burden on community health services.

The regionalisation component of the EHSDI has been under-scoped and under-resourced and the partners are not currently united about the reform and its aspirations. The process of regionalisation, and the partners’ expectations of the process, need to be re-scoped so that the principles of regional Aboriginal community control of health services, equity of access and quality of services are sustained.

Policy capacity within the NT PHC system is currently insufficient to address the implementation of the EHSDI reform agenda, or not enough capacity is being directed to support the reforms. This will need to be enhanced if the pace of reform is to be sustained.

Further reform of the NT remote health system should consider a stronger emphasis on people-centred health care. This approach emphasises people as partners in the pursuit of health and broadens the scope of PHC to be seen not as a ‘layer’ of a health system but as a comprehensive and continuous set of services which people are guided through. The approach also supports more explicit engagement by the health system with the social determinants of health. top of page