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disease would result in leaving the community with a fatal condition. Taking of blood for some ofthe older members of the community was seen as a cultural infringement and they were criticalof the lack of respect clinic staff demonstrated in taking and handling blood. Throughout thediscussion on screening techniques, there was a general lack of knowledge of why theseparticular tests were necessary and a perception that tests that involved taking blood wereinferior to other possible methods of screening (such as x-rays). There is the need for moreeducation about some of the methods that the chronic disease strategy uses, so that peopleknow why their blood is being taken and what purposes it will be used for.It must be acknowledged that in both communities, there were many barriers to people takingresponsibility for their own health. Sorcery was considered to be an important cause of illnessand death in both communities, and there was the attitude that there was very little an individualcould do to protect themselves from it. In such an environment, changing one‟s lifestyle (andenduring the possibly negative quality affects to life quality) may not be seen as worth the effort.It is also clear that many of the current health problems are considered to be caused by outsiders(Munanga or Europeans) and therefore the responsibility of outsiders to deal with. Finally, thereis the lasting legacy of the Mission, and some people‟s active resistance to the values instilled bythe Missionaries.The chronic disease strategy is an innovation which has a specific focus on the health centres.People‟s view of health in both communities does not centre around this single institution, ratherhealth is influenced by a wide range of interrelated factors such as employment, education andpeople‟s feelings of self worth. It is too late to investigate these factors before implementing thestrategy, but it is important that the chronic disease strategy is not seen as entirely “clinicbusiness” and to foster involvement of other key institutions, particularly the schools.Education is a keystone of the strategy, but it should not be assumed that information can besimply provided and that people will take up and apply this knowledge to change their own lives.For innovations to be accepted they must be seen to be effective and they must also haveaccordance with peoples‟ own understandings of how things work (in this case the causation ofillness and effective treatment).It is also important to investigate how knowledge of innovations is disseminated around thecommunity, what gives this knowledge legitimacy and who takes up and applies this knowledge.Addressing these factors requires a thorough understanding of the dynamics of communities anda realisation that these factors may be locally specific.Appendix 4: Ethnographic Field Study – Evaluation of the NT Preventable Chronic Disease Strategy 2007 128
(Draft Version – © August 2006 Jane Lloyd)APPENDIX 5. How Policy is ImplementedHow Aboriginal Health Policy Is Implemented: Initial Findings BriefTO:PURPOSE:the Steering Committee for the Evaluation of the Northern Territory PreventableChronic Disease Strategy (PCDS)to consider the potential contribution of research, on how PCDS was implemented, tothe evaluation of PCDSCONTENT:This brief includes initial findings arising from research into the implementation of PCDS. Theresearch involved 35 in-depth interviews with service providers and administrators across urban andremote areas of the Northern Territory. Participants were asked to comment on: 1) supports andbarriers to the implementation of PCDS; and 2) how to determine whether or not PCDS is a success.Responses have been organised into common themes: workforce; funding; relationships; leadershipand management; commitments and culture.Initial findings reveal that there were major changes to the PCDS as it was implemented. Thisdemonstrates that policy evolves as it is implemented (as opposed to emerging complete and readyfor adoption); and implementation occurs through a process of collective negotiation.Results can be presented to the Evaluation Committee in two formats: either as initial findings byNovember 2006 or collated responses by September 2006. Initial findings pertaining to the workforcetheme are outlined below. A draft list of collated responses are attached as appendix one.The composition of the workforce influences what is implemented. There have been substantialimprovements in the management of chronic disease and to a lesser extent, early detection. This ispartly attributable to the strength of the workforce, doctors and nurses are trained to treat patients,therefore emphasis has been placed on better management rather than primary prevention.What is implemented affects the workforce. The focus on better management has directed furthertraining in this area, and has supported the development and use of recall systems and best practiceguidelines. These are important strategies that build the capacity of the clinical workforce. Meanwhileprimary prevention receives less attention and therefore develops less capacity.Sufficient numbers of the right mix of staff and a process for inclusive decision making are needed toimplement policy. The right mix of staff includes professions such as doctors, nurses, managers, andAboriginal health workers. But having the right mix of staff also includes values, beliefs, andattributes e.g. a commitment to community engagement. The right mix of staff might include a set ofvalues, or innate qualities, and this is where staff recruitment and selection become important, orthey might include skills that can be learnt, and this is where training is important.Appendix 5: How Policy is Implemented – Evaluation of the NT Preventable Chronic Disease Strategy 2007 129
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Pty LtdABN 82 147 637 101AN EVALUAT
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TABLE OF CONTENTSList of figuresLis
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6.6 Indigenous workforce 996.7 Prev
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List of AbbreviationsABCDACCHOsACIC
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ACKNOWLEDGEMENTSWe would like to ac
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However the extraordinary number of
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the establishment of the Sunrise He
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RECOMMENDATIONSGeneral recommendati
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Exploration of joint funding arrang
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CHAPTER 1. INTRODUCTION1.1 Backgrou
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Choosing the 5 chronic conditionsTh
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Table 1.1Key Result Areas + Best Bu
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prior to the launch of NTPCDS, such
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Year * Action Outcome1999 S NT Prev
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Year * Action Outcome2005 P Aborigi
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CHAPTER 2.EVALUATION METHODOLOGYThe
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2.2 Evaluation StagesThe NTPCDS eva
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chronic disease activities funded t
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internal project team. It was very
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Situation at Baseline1. The Guideli
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3.1.2 Patient information and recal
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Ferret Miwatj, Numbulwar, Marngarr,
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Medicare information is not for pub
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was in place in Central Australia i
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What orientation and ongoing traini
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programs focus on chronic disease p
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The information collected as part o
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Assessment against objectiveMost se
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career development, and retention i
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are. Indigenous employment is NTDH&
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NTDH&CS Programs that encourage Hea
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2002 Aboriginal and Torres Strait I
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delivering any prevention and healt
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The Community Services Division - A
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1 x AHW Central Australia 2001 S100
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One clinic stated it had no care pl
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Identifies priority practices to in
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There has been a significant growth
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about 25 per cent of the hospital b
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The level of funding provided by th
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Central Australia and two zones cur
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The diabetes education teams at HLN
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maintenance group for people with l
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Rebates for participating or arrang
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Use of Medicine Programmes. Althoug
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CHAPTER 4. CLINICAL OUTCOMES OF THE
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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
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Page 103 and 104: eported that 50 per cent of the Ind
Page 105 and 106: 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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Page 117 and 118: emote staff can access training and
Page 119 and 120: In the Top End there appeared to be
Page 121 and 122: APPENDIX 1EVALUATION OF THE NT PREV
Page 123 and 124: 2.10 Generally speaking, on a scale
Page 125 and 126: 4.4 Briefly recount any anecdotes y
Page 127 and 128: 5.9 Generally speaking, on a scale
Page 129 and 130: Section 8 • Summary questions8.1
Page 131 and 132: Preventable Chronic Disease Program
Page 133 and 134: Year Type Background What is it? /
Page 135 and 136: Year Type Background What is it? /
Page 137 and 138: 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
Page 143 and 144: ecame the main priority in many peo
Page 145: to be healthy, how to get rid of di
Page 149 and 150: References1. Dunham, H., Ministeria
Page 151 and 152: 35. Smith, J.D., Progress report fo
Page 153 and 154: Research Centre for Aboriginal Heal
Page 155: 114. Senior, K., 'A Gudbala Laif? h
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