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

1.2 The NTER: the CHCI and EHSDI

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

Page last updated: 17 April 2012

On 15 June 2007 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 was publicly released (Anderson and Wild 2007). The report was commissioned by the NT Government and investigated the incidence of sexual abuse and suggested ways to prevent Aboriginal children from exposure to abuse. It offered a range of recommendations to address the social and economic conditions which have placed Indigenous communities at a disadvantage within Australian society.

On 21 June 2007 the Australian Government announced the Northern Territory Emergency Response (NTER) in response to the report, and specifically in response to concerns about widespread sexual abuse of children in Aboriginal communities.

The NTER specified the immediate implementation of a number of initiatives in Aboriginal communities in the NT. Specific aims of the NTER included tackling child sexual abuse and neglect, making communities safer, and developing the long-term infrastructure to support strong communities. The NTER was implemented in prescribed areas4 throughout the NT which had been identified for intervention. This covered over 600,000 square kilometres and included 73 remote towns as well as Aboriginal communities, camps, town camps and outstations. Census data from 2006 indicates that an estimated 41,130 people live in the prescribed areas, of whom around 87 per cent are Indigenous Australians and around 16,000 are children under 16 years of age.

The CHCI and EHSDI are part a range of initiatives that make up the NTER. The main areas of activity are:

  • welfare reform and employment
  • law and order
  • enhancing education
  • improving child and family health (including the CHCI and the EHSDI)
  • housing and land reform
  • coordination of service delivery.
A 2008 review of the NTER examined the first 12 months of the intervention and assessed its progress on improving the safety of children and stabilising Indigenous communities (NTER Review Board 2008). The findings indicated that although there was some support for aspects of the intervention, the way in which the measures were imposed had failed to engage Aboriginal people. The report did note, however, that there was support for certain measures, including those intended to increase access to housing, advance educational opportunities and reduce alcohol-related violence. The review report also observed that if the NTER was modified and improved there might be less resistance from Aboriginal communities.

In October 2008 the Australian Government announced that the intervention would continue, but committed to a series of consultations with Indigenous people about improving the NTER. From June–August 2009 more than 500 consultations were held with communities included in the NTER, culminating in the November 2009 release of a policy statement that outlined changes to enhance the long-term effectiveness of the NTER (FaHCSIA 2009a). These included the reinstatement of the Racial Discrimination Act 1975 and the redesign of certain NTER measures to comply with this Act.

The current evaluation covers only the CHCI and the EHSDI. Other components of the NTER have been, or are being, evaluated in separate projects. The context of the wider NTER set of initiatives is, however, an important factor in setting the scene for the evaluation of the CHCI and EHSDI.

Both the NT Government and the Australian Government have policies on addressing the disadvantages suffered by Indigenous people. The budget for Closing the Gap—Northern Territory Indigenous Health and Related Services Measure includes $131.1 million over three years beginning 2009–10. The bulk of the funding is allocated for the continued regional reform of remote Indigenous PHC under the EHSDI and, therefore, has an impact on this evaluation. Top of page

1.2.1 The CHCI

The CHCI was one of the first NTER measures to be implemented (from July 2007). The program provided free health checks and follow-up care for all Aboriginal and Torres Strait Islander children 15 years of age 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 of 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 (DoHA et al 2009).
The CHCI was generally delivered by teams made up of 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. In some communities, the local health services used their own teams to deliver the checks.

The checks involved a series of tests and questions for the child and/or parent or caregiver, focusing on aspects of health and wellbeing including height, weight, haemoglobin, hearing and vision testing, previous medical history and vaccination status. The health checks also gathered contextual information about the child’s determinants of health and social networks such as education, housing situation, smoking and parental wellbeing. Checks for adolescents aged 12–15 years included questions on drug and alcohol use. All health checks were voluntary.

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 hearing and ear, nose and throat conditions was then extended for an additional year. Follow-up dental services will continue until mid-2012, an additional three years. 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. Further detail on these costs, and other costs associated with planning and implementing the program is included in Section 4.1.
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1.2.2 The EHSDI

The EHSDI is about expanding and reforming PHC in remote Aboriginal communities in the NT, and is an ongoing program. The EHSDI aims to strengthen regionalised approaches to the delivery of health services for a more efficient, coordinated and community-controlled PHC system. The original objectives of the EHSDI and a more recent set of program goals are included in Appendix A. The main elements of these objectives and goals 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 delivery PHC services
  • increasing Aboriginal community control and participation in regional health service planning and delivery.

The EHSDI has five component parts working to achieve its objectives and goals. These are:
  • expanded PHC services
  • development of regions (regionalisation) and a move 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 Northern Territory Aboriginal Health Forum (NT AHF) had been working on before the NTER. In addition to the elements above, the process is supported by other system-wide reforms in the NT. These include agreement on a set of core PHC services, continuous quality improvement (CQI), NT Aboriginal Health Key Performance Indicators (NT AHKPIs) and the development of leadership and governance frameworks.

These elements aim to improve the quality of services at a local, regional and NT-wide level. A more comprehensive description of reform processes in the NT remote health system is included in Section 5.2. The EHSDI officially began on 1 July 2008 with a planned time frame of two years. Funding was later extended for an additional two years to July 2012. 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. Further detail on these costs and budgets is included in Section 5.2.

4 - Prescribed areas are defined in the Northern Territory National Emergency Response Act 2007 and include:
- Aboriginal land defined under the Aboriginal Lands Rights (Northern Territory) Act 1976
- roads, rivers, streams, estuaries or other areas on Aboriginal land
- areas known as Aboriginal community living areas (a form of freehold title issued to Aboriginal corporations by the Northern Territory Government)
- town camps declared by the Minister for Families, Housing, Community Services and Indigenous Affairs under the Northern Territory National Emergency Response Act 2007.
- any other area declared by the Minister to be a prescribed area.
The Minister for Families, Housing, Community Services and Indigenous Affairs has the power to make a legislative instrument to include or exclude areas as prescribed areas.

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