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BMC Pediatrics
Published in: BMC Pediatrics 1/2017

Open Access 01-12-2017 | Research article

The quality of health services provided to remote dwelling aboriginal infants in the top end of northern Australia following health system changes: a qualitative analysis

Authors: Cathryn M. Josif, Sue Kruske, Sue V. Kildea, Lesley M. Barclay

Published in: BMC Pediatrics | Issue 1/2017

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Abstract

Background

In Australia the health outcomes of remote dwelling Aboriginal infants are comparable to infants in developing countries. This research investigates service quality, from the clinicians’ perspective and as observed and recorded by the researcher, in two large Aboriginal communities in the Top End of northern Australia following health system changes.

Methods

Data were collected from semi-structured interviews with 25 clinicians providing or managing child health services in the two study sites. Thirty hours of participant observation was undertaken in the ‘baby-rooms’ at the two remote health centres between June and December 2012. The interview and observational data, as well as field notes were integrated and analysed thematically to explore clinicians’ perspectives of service delivery to infants in the remote health centres.

Results

A range of factors affecting the quality of care, mostly identified before health system changes were instigated, persisted. These factors included ineffective service delivery, inadequate staffing and culturally unsafe practices. The six themes identified in the data: ‘very adhoc’, ‘swallowed by acute’, ‘going under’, ‘a flux’, ‘a huge barrier’ and ‘them and us’ illustrate how these factors continue, and when combined portray a ‘very chaotic system’.

Conclusion

Service providers perceived service provision and quality to be inadequate, despite health system changes. Further work is urgently needed to improve the quality, cultural responsiveness and effectiveness of services to this population.
Appendix
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Footnotes
1
There is no consistent terminology applied to nurses who provide community based services in the 0–5 population. In the Northern Territory (NT) these nurses are called child and family health nurses; throughout Australia though, the terminology varies. For example, maternal and child health nurse is used in Victoria.
 
2
Central Australian Rural Practitioners Association CARPA Standard Treatment Manual – a clinic manual for primary health care practitioners in remote and rural communities in Central and Northern Australia. Remote Health Atlas available online and in hard copy to provide governance and information for staff. It sets standards and provides guidance regarding the DoH remote health branch, policy and protocol.
 
3
A term referring to non-Aboriginal people in the TE of Australia.
 
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Metadata
Title
The quality of health services provided to remote dwelling aboriginal infants in the top end of northern Australia following health system changes: a qualitative analysis
Authors
Cathryn M. Josif
Sue Kruske
Sue V. Kildea
Lesley M. Barclay
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Pediatrics / Issue 1/2017
Electronic ISSN: 1471-2431
DOI
https://doi.org/10.1186/s12887-017-0849-1

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