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

3.1 Context

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

This report presents the findings of an evaluation of two programs implemented as part of the Northern Territory Emergency Response (NTER)—the CHCI and the EHSDI. These programs were contrasting approaches to improving the health status of Aboriginal and Torres Strait Islander people in the NT.

On 21 June 2007 the NTER was announced by the Australian Government in response to concerns about widespread sexual abuse of children in Aboriginal communities. Central to the NTER was the release of the report of the Northern Territory Board of Inquiry into the Protection of Aboriginal Children from Sexual Abuse, known as Ampe Akelyernemane Meke Mekarle—Little Children are Sacred (Anderson and Wild 2007). The NTER comprised a range of measures intended to protect children, stabilise communities, normalise services and infrastructure, and provide longer-term support to communities. The CHCI and EHSDI are part of the ‘improving child and family health’ component of the NTER. top of page

3.1.1 The Child Health Check Initiative

The CHCI was one of the first NTER measures to be implemented. The program, which began in July 2007, provided free health checks and follow-up care for all Aboriginal and Torres Strait Islander children aged 15 years and under who were living within the remote communities covered by the NTER. The specific objectives of the CHCI were to:
  • provide medical teams to conduct voluntary health checks and follow-up health care for Indigenous children 0–15 years of age living in the areas prescribed under the NTER
  • deliver a broad range of follow-up services including primary health care, allied health and specialist services to Indigenous children 0–15 years of age living in the areas prescribed under the NTER.
The child health checks involved a series of health assessments and questions for the child and/or parent or caregiver, focusing on a range of aspects of health and wellbeing including height, weight, haemoglobin level, hearing and vision, previous medical history and vaccination status. The health checks also gathered information about the child’s determinants of health and social wellbeing such as education, housing, smoking and parental wellbeing. In addition, checks for adolescents aged 12–15 years included questions on drug and alcohol use. All health checks were voluntary.

The child health checks were generally delivered by teams comprising a doctor, up to three nurses and administrative staff. The teams were placed in Aboriginal communities and worked alongside local services for up to three weeks at a time. In some communities the local health services used their own teams to deliver the checks.

Initially the program only included the health checks and was scheduled to take place from 1 July 2007 to 30 June 2008—known as Phase 1 of the CHCI. Later it was extended to 30 June 2009 and expanded to include follow-up care. Follow-up treatment for ENT conditions was then extended until 31 December 2010. Follow-up hearing and dental services will continue for an additional three years until 30 June 2012. The extension of the child health checks and the expansion to include follow-up services is known as Phase 2 of the CHCI.

Up to 30 June 2010, $75.688 million was allocated for the child health checks and follow-up services, and actual expenditure totalled $54.469 million.

3.1.2 The Expanding Health Service Delivery Initiative

The EHSDI is about expanding and reforming PHC in remote Aboriginal communities in the NT. The main objectives and goals of the EHSDI can be summarised as:
  • expanding PHC to improve access to core health services
  • improving the quality of remote PHC services
  • developing regional approaches to planning and delivering PHC services
  • increasing Aboriginal community control and participation in regional health service planning and delivery.
The EHSDI has the following five components for achieving these objectives and goals:
  • expanded PHC services
  • development of regions (regionalisation) and movement towards Aboriginal community control
  • the Remote Area Health Corps (RAHC)
  • capital and infrastructure
  • evaluation.
The EHSDI builds on and extends a long-term reform agenda for the remote NT PHC system that the NT AHF had been working on before the NTER. The process is supported by other system-wide reforms in the NT. These include agreement on a set of core PHC services, CQI, NT AHKPIs and developing leadership and governance frameworks.

The EHSDI officially began on 1 July 2008 with a planned time frame of two years. Funding was later extended to June 2012 (an additional two years). Elements of the wider NT PHC reform process were progressing before July 2008 and have continued alongside the specific components of the EHSDI.

As at 30 June 2010, $181.688 million had been allocated to the EHSDI for the period 1 July 2008 to 30 June 2012. Expenditure to 30 June 2010 was $88.572 million.top of page

3.1.3 Purpose of this evaluation

DoHA commissioned this evaluation to better understand the process of developing and implementing the CHCI and EHSDI, their outcomes and, where possible, the impact the CHCI and EHSDI have had and continue to have on Aboriginal and Torres Strait Islander people in the NT.

The purpose of the evaluation, as established by DoHA, is to provide a formative and summative assessment of the performance of the CHCI and EHSDI on the following aspects of the programs:
  • effectiveness—to improve the health of remote Aboriginal and Torres Strait Islander people in the NT
  • efficiency—to deliver the services in a cost-effective manner
  • appropriateness—to ensure the right services are delivered in the right way to the target population in a timely manner and in accordance with Australian Government priorities and policy.
A set of evaluation objectives for both the CHCI and EHSDI were established before Allen and Clarke was engaged to undertake the evaluation. These objectives are included in Appendix A. In addition to these objectives, we were asked to develop theoretical models for PHC system reforms and for future child wellness checks and/or services to guide future monitoring and evaluation of such initiatives.

3.1.4 Governance of the evaluation

In implementing the evaluation, Allen and Clarke has reported to the MoU Management Committee and its Indigenous Advisory Group. Box 1 shows the main agencies and inter-agency groups that have a role in the programs and/or this evaluation.top of page