As two pediatricians with a combined experience of more than 15 years working in the NT, we have been anxious to see more resources put into improving the health of Indigenous children.
We are aware of or have contributed to many reports and advice to governments about measures to improve the lives of some of the most disadvantaged young Australians. Most of the plans were not properly implemented and the advocacy went unheeded.
So we are encouraged by the current focus and commitment by Governments to improve the health of NT Aboriginal children. However, it is our very great fear that the millions of dollars spent on child health checks during phase one of the NT intervention have mostly been wasted. Time will tell, but at this stage we can see little evidence that the child health checks will make a long-term difference to improving the overall health of Aboriginal children in the NT.
It is possible that health care has been delivered to some children for ear, skin and other common problems, which may not have been delivered otherwise. But far more children could have benefited if the funds had been more wisely spent.
If the Government had paused to seek evidence for action, had sought advice and partnership with existing services and advice from health experts and Indigenous leaders with the relevant experience and expertise, a more sustainable, long-term approach to improving children’s health could have been achieved. Is there anything stopping it from doing that now?
The big problem is focusing on health checks without resourcing and developing the primary care programs needed to manage the health problems that were already well documented. Our experience is that when quality services are provided in communities, uptake from Aboriginal children and their families is actually high. Most of the health issues looked for in the checks need comprehensive continuous programs from primary health care, not once-off (or even annual) checks.
The quality of the child health checks has been enormously variable – just as you’d expect when bringing in workers who were often unfamiliar with Aboriginal culture, did not have time to establish effective therapeutic relationships and were often inexperienced in dealing with the clinical and social problems they encountered. There has been great variation in how conditions were managed and referred, and although evidence-based standard treatment protocols are in place these were not always followed.
The fact that results of child checks showed many children with ear and dental problems is not a surprise; this was already known, and reported many times and in many places.
To improve ear health, governments should support existing health services to provide comprehensive, continuous and high quality primary care programs focused on prevention of chronic ear disease and hearing impairment in young children. To only focus on surgical interventions in older children is misguided and, although this may make some difference for some children, it will in most cases be too late as the critical years for learning language have passed. And what was needed for dental health was dental services – not checks.
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The greatest deficiency of the health check program has been the lack of any stated policy objective. More than $80M after it began, still no-one can say what it is trying to achieve. All we hear about is the action.
Despite the announcement that the intervention will be reviewed in coming months, in the absence of objectives, against what criteria can such a program be evaluated?
Our other major criticism is that the intervention didn’t work alongside or with the existing health services. This meant that it often had a destructive impact upon the morale of those staff who have committed to providing longer term services to these communities. The intervention has consumed significant goodwill and human resources, and this will be felt for some time to come.
The one-year anniversary, June 21, of the bizarre announcement of compulsory child s-xual health checks will be time to reflect on what’s been done, to do more of the things that are useful and less of the things that are potentially harmful or at best, ineffective.
We do have hope that as the third phase of the intervention unfolds – a significant investment in primary care – decision makers will consider the lessons learnt from this episode.
Both the old and the new Australian Governments have made big statements about improving the health of Aboriginal children, we must hold our Government accountable for outcomes — and not just accept activity.
Dr Roseby and Dr White are pediatricians and Fellows of the Royal Australasian College of Physicians. Dr Roseby works in Alice Springs; Dr White worked in Alice Springs until recently and is now a senior lecturer in pediatrics at James Cook University in Townsville. The views expressed are their personal opinions.