Evaluating an innovative model in Aboriginal health
: the review of the Lower Western Sector Agreement

  • Robert William Griew

    Student thesis: Coursework Masters - CDU


    In 1995, an innovative model of Aboriginal involvement in health care began in the far west of NSW. The local Aboriginal leaders interested in establishing peak health council for the far west of NSW decided not to establish a parallel service structure but to engage with the mainstream Area Health Services. An Agreement was signed between the new organisation, which later became Maari Ma, and the Far West Area Health Service, under which Maari Ma provided a management service for remote health services that would remain Area services.

    This Review was commissioned to evaluate the Agreement, through its various iterations, ten years on, and to make recommendations for the future. The Agreement was due to come to an end at 31 December 2006 and its parties wanted to know what has been achieved and seek recommendations about any future agreement. There had been several changes in the institutional structures surrounding the Agreement over the last ten years. There was no longer any shared sense of clarity about the purpose of the Agreement.

    The Review took place in two phases. The first phase, timed to provide advice for the decision that Maari Ma and GWAHS needed to make at the end of 2006, involved an extensive exploration of the historical record and in depth interviewing with key players from the inception of the Agreement and since. The aim was to provide to new players a clear understanding of what the Agreement had been trying to achieve, both in health service reform and in response to the political aspirations of local Aboriginal leaders. Thus the first phase of the Review produced an analysis of the implicit governance model.

    Also included in the first phase of the Review was an evaluation of results achieved under the Agreement based on documentary and file searches, interviewing and visits and the analysis of health information that could be accessed during the necessarily compressed timeframe. An evaluation framework was adopted that assessed results under the Agreement against a tiered set of objectives from a Health Performance Framework previously endorsed by the Australian Health Ministers’ Council. The tiers included:
    • Financial and management obligations;
    • Aboriginal workforce development;
    • Access to services for Indigenous and non-Indigenous residents;
    • Improved Aboriginal community engagement in health;
    • Health service reform; and
    • Health outcomes.

    The first Report was accepted by Maari Ma and GWAHS in late 2006. At a briefing of the Director-General of NSW Health at that time she agreed that it would be useful for further, more rigorous, analysis to be undertaken of the last objective relating to health outcomes. This would use data not available at the time, with the support of the Centre for Epidemiology and Research in NSW Health.

    The second stage of the evaluation of health outcomes has been undertaken during 2007. To achieve this four sources of potential data were considered, including: health behaviour from the NSW Health Surveys (which turned out not to be useful); pregnancy related indicators from the Midwives Collection; and mortality and hospitalisation data from administrative collections. Data were compared for the specific LGAs served under the Agreement with Indigenous and non-Indigenous comparator populations in a selected group of similar LGAs in neighbouring parts of NSW. A more detailed data analysis allowed a number of useful results to be added to the first phase analysis.

    Significant improvements have been achieved in both access to antenatal care in the first 20 weeks of pregnancy and for vaccine preventable hospitalisations for the Indigenous population covered by the Agreement. Encouraging trends were also identified for premature and low birth weights, and in the rate of acute ambulatory care preventable hospitalizations, for Indigenous people covered by the Agreement.

    The Review Team concluded that the Agreement has been effectively implemented and has been an essential part of an impressive and encouraging record of health reform in the Remote Cluster, over ten years. It recommended a new Agreement be negotiated. The Review also considered a number of key issues arising for the parties to the Agreement in the negotiation of any new Agreement and made a number of recommendations as a result.
    Date of AwardJul 2007
    Original languageEnglish
    SupervisorJonathan Carapetis (Supervisor)

    Cite this