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At least 19 recordsLinked to original sources
PubMed1997

Outcomes-based resource allocation for indigenous health services: a model for northern Australia?

Wide differentials continue to exist in mortality rates and other health outcomes between Aboriginal and non-Aboriginal Australians. In the Northern Territory (NT), where Aborigines make up 24% of the population, the all-causes age-adjusted Standardised Mortality Ratio for Aborigines compared to non-Aborigines has remained above 3 since the late 1970s, with significant regional variations. During 1995 an expenditure analysis was undertaken for primary health care (PHC) services in different regions of the NT and compared to mortality ratios. At the same time a method for needs-based funding was being developed which could replace the existing historical funding arrangements. In the first instance, the application of a simplified version of this Resource Allocation Formula (RAF) resulted in a significant shift of resources for new prevention program funding to regions of relatively high mortality and low per capita PHC expenditure. However, developing RAFs to redistribute at the margin within the NT is likely to generate further inequities between losing NT programs and counterparts in other states. If outcomes-based resource allocation is to be meaningful nationally, the reference point for the RAF should be national average PHC expenditure rather than existing state averages. There is a need for a combined approach to outcomes-based planning which takes into account both the equity arguments of resource allocation models and efficacy arguments to maximise health gains. Some of these arguments are explored in this paper.

Australia↗
PubMed2006

Cervical smear participation and prevalence of sexually transmitted infections in women attending a community-controlled Indigenous health service in north Queensland.

OBJECTIVE: To increase Pap smear participation and to assess the prevalence of sexually transmitted infection (STI) in urban Indigenous women in Townsville. DESIGN: Convenience sample of women attending Townsville Aboriginal and Islanders Health Services (TAIHS) for health care participating in the Trichomonas vaginalis (TV) project, coordinated by an Aboriginal Health Worker (AHW) trained in women's health and cervical screening. PARTICIPANTS: 198 women, aged 20-69 years of age, attending TAIHS between March 2002 and 31 January 2004. MAIN OUTCOME MEASURES: Pap smear participation and prevalence of STIs. RESULTS: Pap smear participation among eligible women at TAIHS increased from 20.9% pre TV project to 28.6% during the project and 35.6% in the 12 months post completion of the TV project (p<0.0001), an increase of 70.3%. Of 196 smears performed during the study, 20 (10.6%, 95% CI 6.2-15) were abnormal; abnormality was more common in non-Indigenous 8/50 (16.0%) than in Indigenous women 12/139 (8.6%), but did not reach significance (p=0.180). The prevalence of Chlamydia trachomatis was low, with no differences between the Indigenous and non-Indigenous groups, and highest in younger women: 6/44 (13.6%) in women less than 25 years; Trichomonas vaginalis was more common in the Indigenous group. CONCLUSION: An AHW trained to perform and advocating for Pap smear participation has significantly increased the smear participation at TAIHS. The overall prevalence of STI was low.

Adult↗
PubMed2006

Aboriginal mental health workers and the improving Indigenous mental health service delivery model in the 'Top End'.

OBJECTIVES: This article reviews the changing Aboriginal mental health service delivery model of Top End Mental Health Services, and highlights the importance of Aboriginal mental health workers in improving communication with Aboriginal patients. The Australian Integrated Mental Health Initiative Northern Territory Indigenous stream (AIMHI NT) is introduced. METHOD: Baseline measures of AIMHI NT in 2003, and findings from two clinical file audits (1996 and 2001) at Royal Darwin Hospital inpatient unit are presented. The files were audited for a range of assessment and treatment interventions. RESULTS: The audits reveal significant improvements in Aboriginal inpatient care between 1995 and 2001. CONCLUSION: Aboriginal mental health workers provide essential services as cross-cultural brokers in the setting of Aboriginal mental illness. The improvements in care found in this file audit coincide with the commencement of employment of Aboriginal mental health workers in the inpatient unit. The AIMHI consultation reveals broad support for employment of more Aboriginal mental health workers in the Top End.

Communication↗
PubMed1989

Access to health care in urban areas of developing societies.

Emphasis on rural health problems has led to a relative neglect of urban health issues in developing societies. Yet the fact that a large proportion of the limited financial and human resources is allocated to urban health care makes it imperative for researchers and health planners to evaluate the effectiveness of the urban health care system. This paper examines data on health care utilization from a sample survey of 1500 households conducted in three areas of Accra, Ghana in 1982. The factors that influence the use of three types of health care services (clinics, drug vendors, and traditional healers) are examined. Suggestions are made for increasing the effectiveness of the health care system in Accra, with the aim of making medical care more accessible to all families.

Community Health Services↗
PubMed2000

Asthma management in indigenous children of a remote community using an indigenous health model.

OBJECTIVE: To describe the management of asthma in children in a remote indigenous community and the delivery of subspecialist service through the indigenous health-care model. METHODOLOGY: Children referred by indigenous health-care workers were evaluated prospectively by paediatric respiratory physicians, based on a standardized protocol, at a primary health care setting at Thursday Island, Queensland. RESULTS: Forty of the 54 children referred with a provisional diagnosis of asthma did have asthma, with 30% having persistent asthma. Only 59% of parents knew the dose of the medication prescribed and 80% had minimal knowledge of the medications. In 88% of children, the management of asthma was improved by introduction of an appropriate spacer device and changing the dose and type of medications. CONCLUSIONS: The management of children with asthma in the Torres region can be improved substantially by the use of age appropriate delivery devices and medications, and improving knowledge of asthma. Specialist delivery service to remote indigenous communities can be effectively delivered in partnership with the indigenous health service. The high proportion of persistent asthma in the Torres Straits community in comparison to urbanised Australia raises issues of inequity of appropriate medical service delivery to remote indigenous communities.

Adolescent↗
PubMed2006

Building service capacity within a regional district mental health service: recommendations from an Indigenous mental health symposium.

CONTEXT: In response to recent developments within the mental health services of south-east Queensland, the Toowoomba District Mental Health Service (TDMHS) has developed a Model of Service Delivery, which outlines the range of services provided for consumers across their lifespan. Indigenous consumers of the TDMHS come from a wide area of communities in the surrounding shires (Rural, remote and metropolitan areas (RRMA) 4-7). It was recognised by the service that Indigenous mental health consumers have unique needs and, because of these needs, this area of service delivery required greater attention and further development. In December 2004, a symposium was organised by the service to bring together a range of speakers and delegates working in the area of Indigenous mental health to discuss issues and work towards developing strategies to enable the service to better meet the needs of Indigenous consumers in this region of south-east Queensland. ISSUES: The symposium program consisted of keynote speakers and invited papers and culminated with an afternoon workshop that collated the symposium's main issues and themes around building service capacity for Indigenous mental health consumers. The objective of the workshop was 'Identifying ways to meet Indigenous mental health needs'. This workshop gave the delegates a chance to reflect, discuss and brainstorm the major issues of concern relating to this question. A group facilitator guided the discussion and organised the delegates into groups to evaluate, debate and propose recommendations for each of the major issues that emerged. LESSONS LEARNED: The feedback and discussion arising from the workshop is presented. Sixteen major themes emerged from the workshop. Seven of these were voted by the participants as being dominant and in greatest need of discussion: (1) communication; (2) cultural respect; (3) culturally appropriate clinical tools; (4) supportive management; (5) patient compliance; (6) career structure; and (7) empowerment. These seven themes are discussed and recommendations arising from the workshop are noted.

Community Mental Health Services↗
PubMed1985

Pregnancy, childbirth, mother and child care among the indigenous people of Zimbabwe.

Even in areas of Zimbabwe with easy access to Western-type delivery care, the majority of women are cared for and delivered by traditional birth attendants who are members of their extended family. To understand the social, cultural context of pregnancy, childbirth and subsequent maternal and child care and to use this information for the improvement of maternal and child-health care an anthropological investigation was conducted in an area near Harare, Zimbabwe from June 1983 to the end of 1984. Certain aspects of childbirth such as primagravida deliveries and the origins of peripartum complications, are intimately linked to the religious beliefs and values; other aspects such as the relationship of nutrition and pregnancy are not so linked. An understanding of the traditional concepts of pregnancy, delivery and child care is invaluable if not essential for the upgrading of pregnancy and delivery care, the elimination of harmful practices and the building of supportive links between the traditional and the formal health system.

Female↗
PubMed1991

Developing community mental health services for indigenous people of northern Ontario.

Inadequacies of three common models of mental health service delivery have been presented but each of these can contribute to an adequate system if the approach aims at the totality of mental health care. The key to service delivery and the provision of services in the local community by adequately trained and supervised mental health workers familiar with the culture and language and who are involved with other community workers in an inter-agency process. A major and the most important part of the work occurs in this level. This front line work must have the back-up and support of the system which has three roots. The clinical root is that of a support team of professionals, the local nursing station, hospital and the tertiary institutions. The second root is in training and education by recognized courses and other resources and the third in an adequate administration in which the indigenous population has been put in control.

Adolescent↗
PubMed1985

Traditional birth attendants.

In many countries 60-80% of deliveries are assisted by traditional birth attendants (TBAs). Over the last several decades efforts have been made to regulate, upgrade through training or replace the TBA. The strength of the TBA stems from the fact that she is part of the cultural and social life of the community in which she lives. Her weakness lies in the traditional practices which may have dangers for her clients. With suitable training and supervision these dangers can be minimized and her potential used to improve the health of mothers and babies. Increasingly countries are recognizing that the TBA will represent a major resource where women do not have access to services for either cultural or geographic barriers. The effective use of this resource will require an understanding and appreciation of the TBA's role and contribution by all health authorities, flexibility in the development of training programs and the co-operation of the TBAs themselves.

Age Factors↗
PubMed1986

Childbearing among the Igbos of Nigeria.

Traditional Obstetric care among women of the Igbo tribe in Nigeria is described. The role of traditional birth attendants, antenatal care, management of delivery complications, postnatal care and traditional community practices surrounding birth are discussed.

Delivery, Obstetric↗