Due to changes in disease burden and population dynamics, the World Health organization has acknowledged that attention must be given to integration and coordination of care and delivery of specialized health care service (World Health Organization 2012). Specialized health care service are those type of service that is suitable to treat a unique disease condition or health problem which requires specific experience and skills to manage particular health problem. Apart from disease management, these type of health services act as up-to-date knowledge center for patients and families too (Lal et al. 2015). Reproductive health services is one of the types of specialized health service where the main focus of group of health workers are to educate and professionally train people in in sexual and reproductive health. It can be given in several forms such as early intervention to eliminate risk of expecting mothers, counselling services and contraceptive services. Each specialized health care program works on the basis of set goals and mission and certain ethical considerations, risk management plan and quality and safety standards guides the specialized health services 9). The main purpose of this report is to evaluate the system underpinning the specialised program ‘New Directions Mothers and Babies Services Program’. The program is relevant to reproductive health service and the analysis of the system gives an idea about the effectiveness of the program.
The New Directions Mothers and Babies service (NDMBS) is a program implemented by the government in 2008 to meet the specific needs of Aboriginal and Torres Strait Islander women. It was a five year program (2007-2008) and the main goal of the program was to improve the health and well-being of Aboriginal and Torres Strait Islander children and their mothers. The key objectives of the program was to improve access to antenatal care, provide practical information about breastfeeding, parenting and baby care, analyse immunization status, monitor developmental milestones and conduct health checks for indigenous children (Australian Indigenous HealthInfoNet 2014). Based on the review of goals and objectives of the program, it can be said that the program looked at solving the problem of gap in mortality rates between indigenous and non-indigenous children and poor access to mental health services.
The NDMBS is an initiative that was implemented as part of the Commonwealth Government commitment to half the gap in mortality rate between indigenous and non-indigenous children. It aimed to reduce the gap in indigenous children health and achieve the target set by Council OF Australian Government (COAG). There was a need for this program because of excess burden of mortality carried by the indigenous population. In 2005, the indigenous child mortality rate was 225.4 per 100, 000 in Queensland. Compared to the statistics for indigenous children, the figure is almost double. In addition, 80% of deaths you children under age five years were recorded for Indigenous children (Khalidi 2008). This figure signifies the importance of infant health during the early years on the overall health and mortality rate for children under age of five. Realising the need for improvement in perinatal outcomes for infant and pregnant women, improving health outcome for the target group was prioritized. For more recent statistics, the infant deaths represented 4.25 of deaths for indigenous people compared to 0.8% for non-indigenous people between the year 2008 to 2012 (Australian Institute of Health and Welfare 2015). Hence, such figure was the trigger behind the development of programs like the New Directions.
Another issue that the program aimed to address is improving access to maternal health for indigenous women. Variations in access to maternal health service for indigenous women are understood by the gaps in health of aboriginal children before birth compared to non-indigenous babies due to low birthweight and pre-term birth ((Australian Institute of Health and Welfare 2015). Focusing on addressing this issue is important because unless it is addressed, the problem of inequalities will continue through early childhood and this would upset reduction in mortality rate targets. The program aimed to address this issue by focussing on maternal health as maternal factors like maternal behaviours, social determinants and access to health services have a major impact on health outcomes of infant (Department of Health and Ageing 2013). Indigenous women fail to maintain continuity of care during pregnancy because of distance issues, language barrier and the need to negotiate with unfamiliar health system (Lowell et a. 2015). Hence, the NDMBS staffs have workers to address these issues through different modes of delivery of services.
Activities and resources:
As specialized health care services require specialized expert with specials skills, staffs like midwife, aboriginal health workers and aboriginal health workers were included in the program. They took the step to encourage women to receive antenatal care through transport assistance, home visits, reminders, referrals and health promotion. Apart from parental advice, before school screening, housing support and domestic violence screening also promoted continuity of care for indigenous women and children. Antenatal education and health promotion for pregnant women was also considered by means of groups sessions and consultation (Department of Health and Ageing 2013).
Ethical consideration has a strong influence over the health care practices that are provided to the patients. The health care facility providing a varied range of services to the patient population needs to orient their service delivery system according to four overarching principles of health acre ethics, beneficence, non-maleficence, justice and respect (Pelletier et al. 2015). Beneficence can be defined as the principle of helping or benefiting others. On a more elaborative note, this is the principle which relates to providing supportive assistance to patients and engaging in activities that benefit the patient and promotes their best interests. For the indigenous population, the neonatal and child mortality has been a grave concern. The child mortality rates among the indigenous populations have always been considerably high when compared to non-indigenous populations. It has to be mentioned in this context that the rate of child mortality among the indigenous populations by the year of 2016 had been 146 deaths per 100000 people. The antenatal and child health services provided by this program had been able to provide extreme benefits to the aboriginal communities and have provided enough support to reduce the child mortality rates. Furthermore, the integration of NDMB in to the care services has also provided extreme benefits to the aboriginal mothers and children (Health.gov.au 2018).
Avoiding the activities that can lead to harm to the patients has also provided better control at child and maternal health of the aboriginals. The program follows a strict policy against protecting the health and welfare of the children, mothers and pregnant women that come to their aid. The organization also has associated with various policies and protocols that protects the mothers and children from any harm not just in the care setting but also providing advocacy to the scenario providing supportive care and education against different social stresses. Considering the aspects of respect and justice, the most important aspect addressed by the organization is closing the gap between the service availability for natives and service availability for non-natives (Kendall and Barnett 2015). The Children, Youth and Women’s Health Service program has incorporated the Aboriginal Cultural Consultants which has provided the assistance that improved help seeking behaviour and accessibility to maternal and child health services. The aid of culturally safe care services provided to the patients with collaboration of aboriginal or indigenous community experts and peer workers, the program has attempted to provide services that are respectful to the cultural identity and dignity of the aboriginals. Elaborating further, the aid of respect to cultural identity and tradition of the aboriginals and most importantly providing adequate cultural safety to the professionals have enhanced help seeking behaviour drastically among the target group that it ids serving and also has improved the child mortality rates. With the aid of these culturally safe and easily accessible services has helped the organization achieve and address the ethical considerations of respect and treating people fairly and equally. The equal start of life for indigenous children is one notable initiative by this program which has helped the organisation address these ethical concerns (Healthinfonet.ecu.edu.au 2018).
Risk and hazards in relation to target population or program objective is a common issue faced while implementing any specialized health program. However, good critical insight and the ability to foresee and prepared for the risk helps to overcome such issues in care. By the analysis of the NDMBS program, it has been found the involved parties took steps to mitigate patient safety and any future policy related risk. As the indigenous people were the targets of the NDMBS program, there was a possible of risk due to language gaps and cultural gaps between health promotion staffs and the indigenous women. Waterworth et al. (2018) emphasized that to eliminate health risk behaviours in indigenous people, it is necessary that care staffs have the skills to retain cultural identity and distinctiveness of indigenous people. Many indigenous people regard fear of losing traditional values as one of the reasons for not visiting health care clinics. NDMBS program eliminated such form of risk and its impact on well-being outcomes of for indigenous women by referral to translators to understand issues or problems for indigenous women. In addition, aboriginal health workers have been recruited to provide different types of services. They can work to empower indigenous women and promote activities like knowledge sharing. However, many women may not wish to contact health service because of past experience (Conway, Tsourtos and Lawn 2017). There is no evidence regarding any racism prevention related strategies taken by the NDMBS. This is a major limitation which needs to be addressed in future.
Racism is one of the determinants of social and emotional well-being for Aboriginal people. It may exist in the form of stereotypes, discrimination and prejudices against the Aboriginal and Torres Strait Islander community. It undermines health and well-being because of impact on emotional outcomes such as anxiety, stress level and depression. Hence, when looking to address the issue of poor accessibility to antenatal care, it was necessary that the program took steps to assess inequalities in power and resource for indigenous women. Although the Racial Discrimination Act 1975 protects Australians against any unfair treatment and racism experience, however focusing on identifying racism would have helped to challenge current policy and pave way for stricter policies for Aboriginal people (Bielefeld & Altman, 2015).. However, NDMBS did not took extra steps to focus on impact of racism on health of indigenous women and their interest in visiting antenatal care. Equity should have been prioritized in response to the high likelihood of prevalence of discrimination against the indigenous Australians in health care setting.
As per the National Safety and Quality Health Service Standards (NSQHS), it is necessary to protect the public from harm and improve the quality of health service provision. The NSQHS provides evidence based improvement strategies to provide quality assurance mechanism and increase the quality of care. By looking at the actions of the NDMBS, it can be said that the program workers to address standard 1 and standard 2. The program itself was a quality control initiative. The standard 2 of the NSQHS states that leaders of a health care system should implement systems to partner with patients and consumers and reduce mortality rate and adherence to treatment regimen by focusing on providing better patient experience (Australian Commission on Safety and Quality in Health Care 2012). The program activities which indicated fulfilment of standard 2 included implementation of several enhancement strategies to partner with indigenous women and encouraging them to visit antenatal service. The strategy of home visits was an effective step taken by the program which helped to enter into direct communication with indigenous women and explain them the importance of visiting ante-natal services. Organization of playgroup sessions and immunisation clinics also played a role in developing relationship between antenatal care and child health nurse (Department of Health and Ageing 2013). Hence, it was a strategy that paved way for increasing indigenous women participation in care and decision making.
In addition, The NSQHS standard 1 mentioned about the need to implement governance systems that monitors and tracks performance of the organization. To comply with this standard, it was necessary that the NDMBS developed strategies monitor and track progress of each activities too (Australian Commission on Safety and Quality in Health Care 2012). The review of the activities of the program revealed compliance with standard 1 as the program monitored developmental milestones, immunisation status and infections in indigenous children. This was predictive of the presence of governance structure in the specialized health program (Department of Health and Ageing 2013). However, difficulties with the use of IT and data collection was one of the issue for the staffs and taking approach to include technologies that enhance data collection was important.
Conclusion:
The report gave an insight into the analysis of the specialized health care system of the NDMBS in relation to ethics, risk, quality and safety. The main goal of the program was to address the issue of infant mortality rate and poor accessibility to maternal care for indigenous women. The review of ethics revealed the program had adequate system in place to address cultural gaps in care and promote beneficence of the target group through reducing accessibility issues for indigenous women. The risk analysis revealed consideration of patient safety issues by preserving cultural identity. However, lack of consideration of policy related changes in the areas of racism and discrimination against the indigenous women was one limitation of the program. The program also took vital steps to increase partnership with women which are vital to reduce health gaps for indigenous people.
References:
Australian Commission on Safety and Quality in Health Care 2012. National Safety and Quality Health Service Standards Retrieved from: https://www.safetyandquality.gov.au/wp-content/uploads/2011/09/NSQHS-Standards-Sept-2012.pdf
Australian Indigenous HealthInfoNet. (2018). Programs – Promote and practice – Australian Indigenous HealthInfoNet. [online] Available at: https://healthinfonet.ecu.edu.au/key-resources/programs-and-projects/?id=2389 [Accessed 7 Oct. 2018].
Australian Indigenous HealthInfoNet. 2014. New Directions: Mothers and Babies Services. Retrieved from: https://healthinfonet.ecu.edu.au/key-resources/programs-and-projects/?id=2389
Australian Institute of Health and Welfare (2015). The health and welfare of Australia’s Aboriginal and Torres Strait Islander peoples: 2015. Retrieved from: https://www.aihw.gov.au/reports/indigenous-health-welfare/indigenous-health-welfare-2015/contents/life-expectancy-and-mortality-key-points
Bielefeld, S., & Altman, J. (2015). Australia’s First Peoples–Still Struggling for Protection Against Racial Discrimination.
Conway, J., Tsourtos, G., and Lawn, S. 2017. The barriers and facilitators that indigenous health workers experience in their workplace and communities in providing self-management support: a multiple case study. BMC Health Services Research, 17, 319. https://doi.org/10.1186/s12913-017-2265-5
Department of Health and Ageing. 2013. Descriptive Analysis of New Directions Mothers and Babies Services Program. Retrieved from: https://www.health.gov.au/internet/main/publishing.nsf/Content/6004A632C0A1429DCA257F37000AE260/$File/Final%20Report%20-%20New%20Directions%20%20Mothers%20and%20Babies%20Services%20Program%20Descriptive%20Analysis.pdf
Descriptive Analysis of New Directions Mothers and Babies Services Program. (2018). Retrieved from https://www.health.gov.au/internet/main/publishing.nsf/Content/6004A632C0A1429DCA257F37000AE260/$File/Final%20Report%20-%20New%20Directions%20%20Mothers%20and%20Babies%20Services%20Program%20Descriptive%20Analysis.pdf
Kendall, E. and Barnett, L., 2015. Principles for the development of Aboriginal health interventions: culturally appropriate methods through systemic empathy. Ethnicity & health, 20(5), pp.437-452.
Khalidi. N. 2008. Closing the Gap in Mortality Rates for Indigenous Children Under Five in Queensland. Retrieved from: https://www.health.qld.gov.au/__data/assets/pdf_file/0016/361420/statbite45.pdf
Lal, S., Dell’Elce, J., Tucci, N., Fuhrer, R., Tamblyn, R. and Malla, A., 2015. Preferences of young adults with first-episode psychosis for receiving specialized mental health services using technology: a survey study. JMIR mental health, 2(2).
Lowell, A., Kildea, S., Liddle, M., Cox, B. and Paterson, B., 2015. Supporting aboriginal knowledge and practice in health care: lessons from a qualitative evaluation of the strong women, strong babies, strong culture program. BMC pregnancy and childbirth, 15(1), p.19.
Pelletier, C., Stevenson, F., Chrysikou, V., Park, S. and Gibson, W., 2015. Reconsidering ‘ethics’ and ‘quality’in healthcare research: the case for an iterative ethical paradigm. BMC Health Services Research.
Waterworth, P., Pescud, M., Braham, R., Dimmock, J. and Rosenberg, M., 2015. Factors influencing the health behaviour of indigenous Australians: Perspectives from support people. PloS one, 10(11), p.e0142323.
World Health Organization, 2012. Modern health care delivery systems, care coordination and the role of hospitals. Copenhagen: WHO.
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