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

5. 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).

Page last updated: 10 June 2011

The health needs of Aboriginal people living in remote NT communities remain critically high, as does the need for significant improvement in the ability of health services to meet these needs. The evaluation of the CHCI and the EHSDI has identified 17 recommendations which will support the development of a PHC system that can meet the needs of remote Aboriginal communities.

Recommendation 1—Before developing and implementing child health screening programs or other initiatives to improve child health, the responsible agency must develop a program logic and implementation plan to establish links between the health problem, the target population, the health system and social determinants of health.

The analysis should include identification of the strengths and weaknesses (including bottlenecks) within the current system and its interfaces (such as between primary and secondary care), to ensure effective and timely follow-up of referrals and to avoid duplicating services or exacerbating existing gaps. Planning should include a thorough analysis of the costs and benefits of new programs, initiatives and processes, measured against the costs and benefits of continuing or enhancing existing systems (including systems for providing routine care outside formal programs). An analysis of the acceptability of the program to local populations should also be undertaken. Actions to positively influence the social determinants that give rise to health conditions should be an integral part of any program. top of page

Recommendation 2—Child health screening programs should monitor and report on service use and outcomes of both the population that accesses the program and the eligible population that does not access it.

This information will allow ongoing assessment of the needs of all children in the eligible population and enable assessment of the effectiveness of program implementation and the capacity of the system to respond to these needs.

Recommendation 3—Ensure that the elements of improved referred service provision gained through the CHCI can be sustained with adequate funding and a sufficient workforce.

Rather than relying on short-term special program funding, the Australian Government and the NT Government need to agree on core, long-term funding for providing these services (especially for paediatrics, hearing and dental health). This funding needs to be coordinated to enable provision over the full care pathway from primary care to secondary and other referred services and specialist care. In the short term, there is a need to develop and implement transition plans for each type of CHCI follow-up service for which there are any outstanding referrals that still require follow-up at the end of the current funding arrangements. This may require reviewing all the outstanding referrals with PHC providers to ensure that transition plans apply only to children who still have a clinical need for follow-up services.

Recommendation 4—Develop a national policy and accompanying guidelines on child health screening specific to remote Aboriginal communities, in consultation with these communities and drawing on the experience of the NT health sector in delivering relevant programs (such as the CHCI, GAA/Healthy Under 5 Kids and HSAK) before implementing any new child health screening programs.

Recommendation 5—The NT AHF should develop an accurate costing model for delivering core PHC services to remote areas.

The costing model should incorporate regular reviews to ensure that it remains valid, accurate and appropriate. These reviews should be linked to reviews of national health funding systems, such as the MBS, to ensure that NT remote health funding increases in line with mainstream health funding. The model needs to include measures of funding equity, both between the NT and the rest of Australia and between NT regions. To be equitable, the model will need to correct for the costs associated with service delivery to geographically remote Aboriginal communities and the magnitude of improvement in health status that would be needed for people in remote Aboriginal communities to achieve the same health outcomes as other Australians.top of page

Recommendation 6—The Australian Government and the NT Government should agree to a financing model that:

  • provides a funding pathway that enables the provision of core PHC services in all proposed HSDAs on the basis of the costing model (recommendation 5) within five years
  • commits to ongoing funding for three to five years to enable health providers to plan for the longer-term provision of core PHC services.

    Recommendation 7—The NT AHF partners should review current governance and leadership arrangements focusing on the need to bring coherence to functional areas including policy and funding. As part of this review, we recommend:
  • that the governance function, which should continue to be provided by the NT AHF, focus on providing strategic leadership across the health sector including primary and secondary care and monitoring the reform process
  • considering mechanisms for strengthening consumers’ voices (such as the Health Complaints Commission) to act as vehicles for communicating consumers’ experience of health services. The NT AHF should formally consider the Health Complaints Commission’s reports as a means of consumer input into its decisions, outside the interests of provider organisations
  • increasing policy capacity in the NT to sustain the pace and effectiveness of the reform agenda and to effect the intended changes.This might involve establishing a combined AMSANT, DHF and DoHA capacity or increasing the capacity of individual partners in the NT with strong inter-agency protocols and processes for efficient and effective policy development
  • implementing the NT AHF communications strategy.This will support a more consistent and coherent approach between partners so consistent messages are communicated to stakeholders about the reforms.

    Recommendation 8—In further reforming the NT remote health system, the NT AHF partners should consider:
  • further expanding the scope of PHC to include a wider range of services
  • taking responsibility for linking health development with the wider social determinants of health
  • adopting a stronger focus on people-centred care and the patient journey through the health system.
    Future reforms need to be consistent with current Australian Government health reforms.

    Recommendation 9—Under the direction of the NT AHF, re-scope the regionalisation process and the NT AHF partners’ expectations to more clearly identify:
  • the tasks involved
  • the actions and resources required
  • who should undertake the work
  • a delivery time frame that is consistent with the communities’ wishes.
    This exercise should consider the following components of regionalisation:
  • the merger of ACCHOs and building community capacity to contribute to the planning and governance of health services
  • decentralisation and a move to community control of DHF clinics
  • establishing and supporting new regional structures
  • repositioning the system’s policy capacity to focus on the issue of implementation.top of page

    Recommendation 10—Develop a comprehensive workforce strategy for the NT remote PHC sector including strategies to increase Aboriginal employment in the PHC sector. The strategy will need to reflect new and proposed regional service delivery models, including the responsibilities of regional ACCHOs.

    Recommendation 11—Address the current inadequacies within the system for recruiting, training and supporting AHWs.

    Recommendation 12—The future of the RAHC model should be considered by the three NT AHF partners within the context of the wider workforce issues in the NT to ensure a coordinated approach to workforce issues across the system (such as for DHF/ACCHO sectors, short-term/permanent and clinical/non-clinical) and within the context of the future recruitment needs of the 14 proposed regionally-based Aboriginal controlled PHC services.

    Recommendation 13—Consideration should be given to establishing a health service purchasing body that funds all health services in the NT and consolidates PHC funding so that providers only report to a single program funding source.

    This will address issues associated with the inefficiencies of multiple contracts and funding sources.

    Recommendation 14—Continue to invest in CQI, giving priority to providing training for all levels of health service staff, developing resources and tools for supporting its use and undertaking a formative evaluation of the CQI program to determine future development and investment.

    Recommendation 15—Once the integrity of the NT AHKPI data at the system level can be assured, the NT AHF should use the data to supplement a more contextualised description (including of the likely impact of any other factors on service activities and health outcomes), to report to decision makers on the population health needs of remote Aboriginal communities and the progress of services in responding to these needs.

    This is in addition to the primary use of the data to report to health boards and communities.

    Recommendation 16—Ensure there is sufficient capacity at all levels of the PHC system (centrally, regionally and locally) to enable the effective use of data.
    This should take into account:
  • developing data access protocols in partnership with ACCHOs
  • refocusing the orientation of data collections to enable and promote the use of data at all levels of the PHC system
  • supporting health services to use data on a broad range of PHC and social support services (not only clinical data) for planning and reporting.

    Recommendation 17—The NT AHF partners should engage with key stakeholders across the NT PHC system to identify the purpose of, and priority questions for, future monitoring and evaluation of the different elements of the system reform.

    This should take into account:
  • the existing EHSDI goals and objectives, the PHRG’s health systems planning framework and this report’s evaluation findings
  • stakeholders’ current expectations of program success criteria and anticipated program outcomes
  • establishing specific indicators to monitor the progress of key elements of the reform program (such as efficiency indicators for regionalisation and workforce and funding indicators).top of page