Review of Aboriginal child health services in remote Western Australia identifies challenges and informs solutions

Philippa J Dossetor,Alexandra Lc Martiniuk,John Boulton,Elizabeth J Elliott,Maureen Carter,Jane Latimer,June Oscar,James Fitzpatrick,Carol Bower,Kathryn Thorburn,Emily Fitzpatrick

doi:10.1186/s12913-019-4605-0

Abstract

BackgroundDespite a national focus on closing the gap between Aboriginal and non-Aboriginal child health outcomes in Australia, there remain significant challenges, including provision of health services in very remote communities. We aimed to identify and map child health services in the very remote Fitzroy Valley, West Kimberley, and document barriers to effective service delivery.MethodsIdentification and review of all regional child health services and staffing in 2013. Verification of data by interview with senior managers and staff of key providers in the Western Australian Country Health Service, Kimberley Population Health Unit, Nindilingarri Cultural Health Services and non-government providers.ResultsWe identified no document providing a comprehensive overview of child health services in the Fitzroy Valley. There were inadequate numbers of health professionals, facilities and accommodation; high staff turnover; and limited capacity and experience of local health professionals. Funding and administrative arrangements were complex and services poorly coordinated and sometimes duplicated. The large geographic area, distances, extreme climate and lack of public and private transport challenge service delivery. The need to attend to acute illness acts to deprioritise crucial primary and preventative health care and capacity for dealing with chronic, complex disorders. Some services lack cultural safety and there is a critical shortage of Aboriginal Health Workers (AHW).ConclusionsServices are fragmented and variable and would benefit from a coordinated approach between government, community-controlled agencies, health and education sectors. A unifying model of care with emphasis on capacity-building in Aboriginal community members and training and support for AHW and other health professionals is required but must be developed in consultation with communities. Innovative diagnostic and care models are needed to address these challenges, which are applicable to many remote Australian settings outside the Fitzroy Valley, as well as other countries globally. Our results will inform future health service planning and strategies to attract and retain health professionals to work in these demanding settings. A prospective audit of child health services is now needed to inform improved planning of child health services with a focus on identifying service gaps and training needs and better coordinating existing services to improve efficiency and potentially also efficacy.

Highlights

Despite a national focus on closing the gap between Aboriginal and non-Aboriginal child health outcomes in Australia, there remain significant challenges, including provision of health services in very remote communities
Identification and description of child health services In 2014, we approached the regional department of health, child health workers, and searched health department websites to identify child health services operating in the Fitzroy Valley in 2013
Interviews were conducted with four service managers and 13 practitioners from 17 services including: six from the Western Australian Country Health Services (WACHS); six from the Kimberley Population Health Unit (KPHU); two from Boab Health; two from the Department of Education; and one from the Royal Flying Doctor Service (RFDS)

Summary

Introduction

Despite a national focus on closing the gap between Aboriginal and non-Aboriginal child health outcomes in Australia, there remain significant challenges, including provision of health services in very remote communities. An 8-year old child living 150 km from the very remote service town is seen in the paediatric clinic in Fitzroy Crossing and suspected to have fetal alcohol spectrum disorder (FASD). The disparity in child health and developmental outcomes between Aboriginal and non-Aboriginal children living in remote Australian communities is well described [1, 2]. Few population-based studies are available [1, 3] data consistently demonstrate a high burden of health needs and demand for services for Aboriginal children. One retrospective cohort study of Aboriginal infants in remote Northern Territory communities reports high rates of hospital admission and visits to remote primary health centres beginning in early childhood and notes the inadequacy of services to meet demand [3]

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