These main messages are the key lessons from this evaluation for decision makers. Section 5 of this report has a set of specific recommendations.
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). These needs remain critically high and there is a significant need for improvement in the health system to meet these needs.
Expanding and reforming health services is complex with many challenges and risks. The overall message is that the program is heading in the right direction. The partnership between the governments and the Aboriginal community controlled health sector is critical. There has been significant progress to date which, given sufficient time and adequate resourcing, is likely to bring improvements in health service delivery and outcomes.
The Child Health Check Initiative
- Before developing and implementing child health screening programs the responsible agency needs to develop rigorous policies which fully engage with existing programs, initiatives and processes.
- Setting up new programs is expensive. The costs and benefits of new programs, initiatives and processes need to be thoroughly weighed up against the costs and benefits of continuing or enhancing existing initiatives.
- Child health initiatives should first identify gaps in existing service delivery and target these areas for development. In the CHCI the gap that became visible was at the primary care–referred services interface. Regardless of the initiative, the patient’s experience of the health system is a critical consideration.
- Continued resourcing, including initiatives to overcome workforce barriers, is essential for sustaining and expanding CHCI successes—such as efficient service delivery models for dental, hearing and ear, nose and throat (ENT).
- Child health initiatives need to include specific measures to address the underlying social determinants of health including housing, education and poverty.
- The CHCI made the health needs of Aboriginal children in remote areas of the NT more visible at a political and administrative level. Ongoing policy, planning and delivery of child health initiatives would benefit from having access to regular and comprehensive information on the needs of Aboriginal children and the capacity of the system to respond to these needs.
The Expanding Health Service Delivery Initiative
- The EHSDI was based on engaging with existing processes in the NT and through building effective partnerships between the Australian Government, NT Government and Aboriginal community controlled sectors. This is in contrast to the approach taken with the CHCI.
- While the EHSDI has added significantly to the remote health workforce in the NT, there are still ongoing difficulties with recruitment, Aboriginal Health Worker training, staff accommodation shortages and high staff turnover. A comprehensive workforce strategy is required to address these concerns at a system level.
- A long-term funding pathway is essential for continued expansion and reform of the remote NT primary health care (PHC) system. This should be based on an accurate costing model for providing core PHC services in the NT.
- The NT Aboriginal Health Forum partners need to reconfirm their agreement on the aims, purposes and goals of changing to regional health services under Aboriginal community control, as a central component of the EHSDI. The regionalisation process then needs to be re-scoped to clarify the tasks involved, the resources required and who is most appropriate to undertake the tasks.
- Policy capacity in the NT needs to be enhanced to give full effect to the intended reform agenda under the EHSDI and to ensure that the pace of implementation can be sustained.
- Further reform of the remote NT PHC system should consider broadening the scope of primary care to include a wider range of services and a stronger link with social determinants of health. top of page