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

7 Key findings and recommendations

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

Page last updated: 17 April 2012

This section synthesises the key findings of the evaluation of the CHCI and the EHSDI and sets out our main recommendations in relation to these findings. It concludes with an outline of an approach to inform the longer term monitoring and evaluation of child wellness initiatives and the program of PHC reform in the NT.

The key findings and recommendations for the CHCI align with the evaluation objectives, which also reflect the structure used in Section 4 of this report.

The key findings and recommendations for the EHSDI are organised according to the PHRG’s health systems planning framework (that is, based on the WHO’s six health system building blocks), omitting ‘access to medicines, vaccines and technology’ (which was not covered by this evaluation). The five relevant building blocks are service delivery, leadership/governance, health workforce, financing, and information. This structure is reflected in our proposed framework for informing future monitoring and evaluation of the PHC system reforms.

We have intentionally focused on a small number of high-level recommendations. We have also included a number of more specific recommendations that we feel are critical to the ongoing development of PHC services in the NT. We are aware that a few of our recommendations resonate with current or proposed approaches to particular components of the EHSDI. While the recommendations are organised under the same structure as the key findings a number of them cut across this structure, as you would expect with a complex system. Recommendations on future monitoring and evaluation are in Section 7.2.5 (the ‘information’ building block). These ‘information’ recommendations have been influenced by our experience of accessing and using data as part of the CHCI evaluation.

In line with our approach to the evaluation, the key findings and recommendations relating to the CHCI reflect a summative evaluation of the program, whereas the key findings and recommendations relating to the EHSDI reflect the formative nature of the evaluation of this emerging program.

In considering the key findings and recommendations, again we emphasise that the context of the NTER had a profound effect on each of the programs we have evaluated. This is why we include an analysis of the NTER context, in reasonable detail, in Section 3 of this report. Most immediately this context affected the design of the CHCI, the way it was implemented, the speed of implementation, and some of the initial views people had about the child health checks. But its impact went further: it affected the way key stakeholders worked with each other and the relationship between government and Aboriginal communities. This then affected the way follow-up services and the EHSDI were designed and implemented.

The capacity of the NT PHC system is limited. Since July 2007 it has implemented three significant phases of NTER activity—the CHCI (Phase 1), the CHCI follow-up services (Phase 2) and the EHSDI (Phase 3)—in addition to other reform initiatives, while continuing with the core business of planning and delivering PHC services to remote Aboriginal communities. Tight and overlapping time frames made it difficult to adequately complete planning activities before moving to implementation. This has had an impact on the effectiveness and efficiency of the CHCI and the EHSDI, as one would expect.

The whole ‘system’—from government departments to Aboriginal communities—has shown remarkable strength and resilience to the shock of the NTER. Context is extremely important, particularly for the PHC system in the NT, which continually has to find ‘solutions’ to mainstream Australian Government health policy and planning initiatives. While a number of our key findings and recommendations are directly related to the context of the NTER, they are likely to be just as applicable to future more general policy interventions. The challenge remains how to bring the realities of local context into national policy initiatives.

7.1 The Child Health Check Initiative
7.2 The Expanding Health Service Delivery Initiative
7.3 Longer-term monitoring and evaluation approach
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