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workers respectively. ACCHOs reported an increase in Indigenous staffing as a result of theHealthy for Life Program sponsored by the Australian Government.There is evidence of a depletion in the infrastructure, dedicated staff, and funding in theimportant area of health promotion and prevention, as well as a reduction in the number ofprevention and health promotion programs since the development of the PCDS. This is reportedlydue to a restructuring of the NTDH&CS in 2003. The only programs identified with recurrentfunding were in the ACCHO sector, which are funded by philanthropic organisations. The nongovernmentsector indicated they were not delivering any prevention and health promotionprograms. Increasing the focus on prevention and health promotion programs is a key issue forthe future and will require genuine investment and specialised staff with diverse skills.There is evidence of a definite shift in the general awareness across the Northern Territory of theneed for dedicated and focused chronic disease programs. The NTPCD Program providesleadership for chronic disease program development, and stakeholders reported strong supportand critical input from the PCDS Director in this endeavour. Where additional resources havebeen provided dedicated staff and strategies have been implemented to address chronic diseaseissues. Since 1999 there has been an increase of 22 dedicated chronic disease staff, largelyfunded largely though the Australian Government, and an additional 13 positions have beenidentified to commence in 2007, of which 4 are renal specific. S100 funds from the Medicare poolprovided the NT Government savings in remote health, which were reinvested in chronic diseaseand quality use of medicines. Where chronic disease programs with consistent dedicated staff arenotably absent is in all remote clinics. The majority of new staff who have been employed arenurses, which is part of the solution, but what is required is an interprofessional cross culturalskills mix that includes educators, clinicians, health promotion staffing and Indigenous staff. Thekey barriers identified in achieving this is financial resources, community infrastructure and thedeclining Aboriginal Health Worker workforce numbers, which requires urgent review. Generalpractice programs are functioning across the Territory predominantly focusing on diabetes andcardiovascular disease.The NTDH&CS reportedly funds a wide variety of non-government organisations to deliverspecific preventative programs. Unfortunately, funding is often project-specific and time-limited,resulting in limited long-term benefits from some programs. ACCHOs are largely funded from theAustralian Government and those participating in the Healthy for Life program reported that therewere dedicated chronic disease activities occurring, supported by a systems approach to care.There has been some growth in community control of health services through funds pooling withEvaluation of the NT Preventable Chronic Disease Strategy 2007xii
the establishment of the Sunrise Health Service in Katherine and the establishment of governingboards in the Primary Health Care Access Program (PHCAP) regions. Issues of Indigenousgovernance are paramount to addressing the underlying causes of chronic disease, and to tacklethe social determinants of health. Hence it is vital to ensure that strategies developed arerelevant and workable in the environment that will be applied.Assessment against NTPCDS key result areasThere are six key result areas in the NTPCDS where there is strong evidence to supportintervention. Between 1999-2002 in the Northern Territory there was a reduction in lowbirthweight in Indigenous and non-indigenous babies and an increase in the mean birthweight ofboth groups (3) . Breast feeding rates at discharge from hospital were unchanged from 1993-2003(3) , however breast feeding rates at 3 months and 6 months post birth fell between 1993-2003.This fall was largely due to a decrease in breast feeding rates in the urban non-Indigenouspopulation. By six months of age, the proportion of NT rural Indigenous infants who were stillbreastfed was above the national average (3) . The childhood immunisation coverage for the NThas improved significantly between 1999-2005, and data suggests that NT children haveimmunisation coverage that is as good as, or better, than the rest of Australia (3) . Timeliness ofvaccine delivery is reportedly still not optimal.Rates of malnutrition are measured by rates of stunting, wasting and anaemia, which between2001-05, have not changed. Overall Indigenous children in remote communities experience highlevels of underweight – 15 per cent, stunting – 11 per cent, and wasting – 9 per cent (3) .Anaemia rates of children under 5 years remain extremely high in remote areas ranging from 23per cent in the Darwin rural district to 44 per cent in the Barkley district. The proportion of NTurban children who are overweight lowered slightly at 12 per cent compared with SouthAustralian children at 14.4 per cent. The number of NT urban Indigenous children who are obeseis double the non-indigenous urban rate. The availability and cost of healthy food in remote areascontinues to be poor and extremely expensive despite several inquiries during this time. Theissue of poverty is critical to the success of improving all of these key indicators yet NTIndigenous households continue to receive only 59 per cent of non-indigenous households (5) .Results of the 2007 Indigenous Community Housing Survey reveal poor environmental healthconditions especially in discrete remote communities, where there continues to be a lack of basichousing maintenance, overcrowding, unsafe water supply, lack of rubbish disposal, and thehighest national sewerage overflow rate (6) .Evaluation of the NT Preventable Chronic Disease Strategy 2007xiii
Page 1 and 2: Pty LtdABN 82 147 637 101AN EVALUAT
Page 3 and 4: TABLE OF CONTENTSList of figuresLis
Page 5 and 6: 6.6 Indigenous workforce 996.7 Prev
Page 7 and 8: List of AbbreviationsABCDACCHOsACIC
Page 9 and 10: ACKNOWLEDGEMENTSWe would like to ac
Page 11: However the extraordinary number of
Page 15 and 16: RECOMMENDATIONSGeneral recommendati
Page 17 and 18: Exploration of joint funding arrang
Page 19 and 20: CHAPTER 1. INTRODUCTION1.1 Backgrou
Page 21 and 22: Choosing the 5 chronic conditionsTh
Page 23 and 24: Table 1.1Key Result Areas + Best Bu
Page 25 and 26: prior to the launch of NTPCDS, such
Page 27 and 28: Year * Action Outcome1999 S NT Prev
Page 29 and 30: Year * Action Outcome2005 P Aborigi
Page 31 and 32: CHAPTER 2.EVALUATION METHODOLOGYThe
Page 33 and 34: 2.2 Evaluation StagesThe NTPCDS eva
Page 35 and 36: chronic disease activities funded t
Page 37 and 38: internal project team. It was very
Page 39 and 40: Situation at Baseline1. The Guideli
Page 41 and 42: 3.1.2 Patient information and recal
Page 43 and 44: Ferret Miwatj, Numbulwar, Marngarr,
Page 45 and 46: Medicare information is not for pub
Page 47 and 48: was in place in Central Australia i
Page 49 and 50: What orientation and ongoing traini
Page 51 and 52: programs focus on chronic disease p
Page 53 and 54: The information collected as part o
Page 55 and 56: Assessment against objectiveMost se
Page 57 and 58: career development, and retention i
Page 59 and 60: are. Indigenous employment is NTDH&
Page 61 and 62: NTDH&CS Programs that encourage Hea
Page 63 and 64:
2002 Aboriginal and Torres Strait I
Page 65 and 66:
delivering any prevention and healt
Page 67 and 68:
The Community Services Division - A
Page 69 and 70:
1 x AHW Central Australia 2001 S100
Page 71 and 72:
One clinic stated it had no care pl
Page 73 and 74:
Identifies priority practices to in
Page 75 and 76:
There has been a significant growth
Page 77 and 78:
about 25 per cent of the hospital b
Page 79 and 80:
The level of funding provided by th
Page 81 and 82:
Central Australia and two zones cur
Page 83 and 84:
The diabetes education teams at HLN
Page 85 and 86:
maintenance group for people with l
Page 87 and 88:
Rebates for participating or arrang
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Use of Medicine Programmes. Althoug
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CHAPTER 4. CLINICAL OUTCOMES OF THE
Page 93 and 94:
improvements have been made to serv
Page 95 and 96:
A recent ten-year follow-up of a co
Page 97 and 98:
The NTDH&CS also collect birthweigh
Page 99 and 100:
Figure 5.3 Vaccination coverage for
Page 101 and 102:
It is also important to note that k
Page 103 and 104:
eported that 50 per cent of the Ind
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The current action plan identifies
Page 107 and 108:
The availability and cost of health
Page 109 and 110:
Hoy et al in 1995-2000 (100) , and
Page 111 and 112:
5.6 Best practice management5.6.1 P
Page 113 and 114:
disease care in urban areas regardi
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PCIS was developed by NTDH&CS as th
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emote staff can access training and
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In the Top End there appeared to be
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APPENDIX 1EVALUATION OF THE NT PREV
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2.10 Generally speaking, on a scale
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4.4 Briefly recount any anecdotes y
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5.9 Generally speaking, on a scale
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Section 8 • Summary questions8.1
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Preventable Chronic Disease Program
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Year Type Background What is it? /
Page 135 and 136:
Year Type Background What is it? /
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An important background to this stu
Page 139 and 140:
New beliefs do not replace the old,
Page 141 and 142:
Other services are provided to the
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ecame the main priority in many peo
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to be healthy, how to get rid of di
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(Draft Version - © August 2006 Jan
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References1. Dunham, H., Ministeria
Page 151 and 152:
35. Smith, J.D., Progress report fo
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Research Centre for Aboriginal Heal
Page 155:
114. Senior, K., 'A Gudbala Laif? h
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