In 2007, the Northern Territory Emergency Response (NTER) was developed as the complex of programs and services implemented in the Northern Territory for the Aboriginal people to improve the health state of children within the communities and protect them from different kinds of abuse. Later, the focus of the programs was shifted to health questions. In 2011, the evaluation report concerning the programs’ implementation and success was presented.
There is the part in the report which focuses on the effectiveness of specific initiatives for improving children’s health in the Northern Territory. To evaluate the appropriateness and efficiency of such programs like Child Health Check Initiative (CHCI) and its later variant the Expanding Health Service Delivery Initiative (EHSDI), it is necessary to concentrate on such important elements of the programs as the staff and to develop the effective evaluation questions regarding the aspects of the programs’ implementation and impact on the situation within the region.
To evaluate the definite program or initiative, it is important to develop the evaluation questions. Evaluation questions are worked out to frame the whole process of evaluating the program (Rossi, Lipsy, & Freeman 2004). Focusing on the objectives of the program or initiative, it is possible to develop relevant evaluation questions to reflect the main aspects and points of the program (Hawthorne 2000). Answering the reasonable evaluation questions, the evaluator can concentrate on the complex picture of the process and its effectiveness according to the definite set criteria.
To evaluate the staff about the programs’ delivery and provision as one of the main elements of the project, it is possible to develop eight evaluation questions associated with the factors of the programs’ implementation and impact on the health of children in the Northern Territory. The evaluative criteria and the indicator of performance are based on the data provided in the report on the statistics of positive changes in the health of children in the region (Overveit 2002).
The delivery and provision of CHCI and EHSDI were based on the appropriately organized staff team. After checking the health conditions of the Aboriginal children, the team decides whether follow-up services, primary health care and medical help or preventive measures should be provided. To implement the program, overcome the problematic situations and make the right decisions, the staff should be experienced and professional (Additional information on Stronger Futures Legislation 2012). Thus, the first question is
- How appropriate is the number of team members participating in CHCI and EHSDI to cope with the set tasks?
The teams for CHCI are organized to provide the basic checking procedures. Thus, a doctor, three nurses, and the representatives of the administrative staff participate in the team. Nevertheless, the teams are expanded to provide the necessary immediate help for the EHSDI program (Northern Territory Emergency Response n.d.). On the one hand, the initial number of the staff members can be discussed as appropriate for realizing the checking procedures. On the other hand, the team lacks the staff to deliver and provide the definite follow-up services which were later proposed with the EHSDI program.
- How accessible is the help of the specialists concerning the cases which need referrals?
To expand services, it is necessary to recruit additional staff. However, staff recruitment is a challenge for the programs. That is why all the cases associated with the necessity to provide the help of specialists are not resolved immediately.
- How does the need for staff influence the progress of the program and its implementation?
The problem is in the fact that the recruitment of the professional staff for implementing the program remains to be a challenge during CHCI as well as EHSDI. It is impossible to rely on the effectiveness of the programs’ implementation when the permanent staff rejects working and professionals reject participating in the programs (Northern Territory Emergency Response: evaluation report 2011).
- To what extent can the staff’s interest in the program contribute to the project’s implementation and development?
The focus of the strategy regarding the staff is on attracting the Aboriginal workers according to the principles of the Aboriginal Health Workers program. Nevertheless, the Aboriginal health workers do not reveal a real interest in joining the CHCI or EHSDI despite the significant investment (Richardson & Hawthorne 2000). Thus, the strategies to attract the staff to implement the programs successfully are ineffective.
To discuss the impact of the programs on the health of the Aboriginal children, it is necessary to refer to the additional four evaluation questions associated with the role and impact of the staff on the programs’ realization.
- To what extent can the lack of staff influence the CHCI or EHSDI programs’ outcomes?
The CHCI and EHSDI programs are oriented to the factual improvement of the Aboriginal children’s health with the help of checking, diagnosing, and treating oral, hearing, and dental problems. The provision of the services is based on the provision of immediate help and follow-up services along with the help of the specialists. The lack of staff influences the programs’ outcomes negatively because of the impossibility to help all the patients.
- What is the role of the staff in the delivery and provision of services that improve the state of the Aboriginal children’s health?
According to the evaluation evidence, the majority of the Aboriginal children is checked, and the diagnosed health problems are treated successfully if they are checked during the first wave of monitoring. Thus, the work of the staff is directly connected with the positive results of the programs (Owen 2006).
- How can the expansion of the health services affect the programs’ outcomes?
The number and quality of health checks and delivery of the necessary procedures depends on the number of staff members available (Shadish, Cook, & Leviton 1991). That is why the expansion of the health services based on the additional recruitment affects the programs’ outcomes positively with references to the improvement of the Aboriginal children’s health.
- How important is the strong connection between the checking procedure, follow-up services, and referrals to the specialists?
The role of the team participating in the program is to provide high-quality service appropriate for the definite cause. Thus, receiving the necessary check, the child should be treated appropriately concerning the necessary follow-up services or provision of the effective specialist’s help (Conley-Tyler 2005; Patton 2008). The identification of the problems during the first period of checking can increase the percentage of effective treatment. The implemented programs with references to professional staff also contribute to the decrease of the mortality rates within the Northern Territory (Stronger Futures in the Northern Territory Act 2012).
The Northern Territory Emergency Response was developed to protect the interests of the Aboriginal children and to provide the possibilities for the improvement of these children’s health state which is worse in comparison with the health state of the non-Aboriginal population of the territories. The factor of equality is the first ethical point that should be discussed with the question. Despite the fact the above-mentioned programs are developed to meet the issue of the unequal health care system for the aboriginals and the other population of the territories, the implemented programs cannot be discussed as successful enough to overcome the gap between the health care systems and approaches and to meet the needs of the Aboriginal people (Kelaher et al. 2006; Krass, Hourihan, & Chen 2003).
Furthermore, the problem is in the attitude of the Aboriginal people to the provided programs because of their unwillingness to participate in the check procedures. Thus, initially, the mentioned programs were worked out to find the cases of family abuse of children within the Aboriginal territories. The controversial ethical question was discussed (Scougall 2006). Later, the programs’ priorities were changed. However, many parents prevent their children from checking and treating because of the fear to be accused of an inappropriate attitude toward the children and their health.
In addition, there are many ethical and cultural limitations associated with the programs. It is possible to focus on respect for persons and the interests of children, on confidentiality and privacy, but the particular features of the territories’ culture and ethics make the programs’ designers concentrate on selecting the Aboriginal health workers who often reject the proposals to cooperate. This fact provokes the decrease of the programs’ effectiveness concerning the ethical challenges.
Reference List
Additional information on Stronger Futures Legislation 2012. Web.
Conley-Tyler, M 2005, ‘A fundamental choice: internal or external evaluation?’, Evaluation journal of Australia, vol. 4 no. 1-2, pp. 3-11.
Hawthorne, G 2000, Introduction to health program evaluation, Centre for Health Program Evaluation, West Heidelberg.
Kelaher, M, Dunt, D, Taylor-Thomson, D, Harrison, N, O’Donoghue, L, Barnes, T, & Anderson, I 2006, ‘Improving access to medicines among clients of remote area Aboriginal and Torres Strait Islander Health Services’, Australian and New Zealand Journal of Public Health, vol. 30 no. 1, pp. 177-183.
Krass, I, Hourihan, F, & Chen, T 2003, ‘Health promotion and screening for cardiovascular risk factors in NSW: a community pharmacy model’, Health Promotion Journal of Australia, vol. 14 no. 2, pp. 101-108.
Northern Territory Emergency Response (NTER) n.d. Web.
Northern Territory Emergency Response: evaluation report 2011, NTER, Australia.
Overveit, J 2002, Action evaluation of health programmes and changes: a handbook for a user-focused approach, Radcliffe Publishing, Australia.
Owen, JM 2006, Program evaluation: forms and approaches, Allen & Unwin, St Leonards.
Patton, M 2008, Utilization-focused evaluation, Sage Publications, Australia.
Richardson, J, & Hawthorne, G 2000, Health program evaluation, Center for Health Program Evaluation, Australia.
Rossi, P, Lipsy, M, & Freeman, H 2004, Evaluation: a systemic approach, Sage Publications, Housand Oaks.
Scougall, J 2006, ‘Reconciling tensions between principles and practice in Indigenous evaluation’, Evaluation journal of Australia, vol. 6 no. 2, pp. 49-55.
Shadish, W, Cook,T & Leviton, L 1991, Foundations of program evaluation: theories of practice, Sage Publications, Australia.
Stronger Futures in the Northern Territory Act 2012. Web.