Current Projects and Activities

International projects
Consultancy work
Australian projects
Research for Department of Health and Community Service

International projects

China ARC Linkage Grant (begun 2005)

This research studies the complex relationships between the policy, health systems and birth outcomes in contemporary China where macroeconomic reforms have been accompanied by new evidence of stark and growing disparities in health. Decisions about resource allocation, education of health workers and the introduction of technologies around birth, made within national priorities, are often based on 'modern' assumptions and policies are based in ideas accepted as fact without empirical information. Contemporary health systems in many countries are now re thinking provision of birthing services. Recent technically dominant 'modern' assumptions about birth have proved to be problematic. They have ignored 'social context', the influence of policies both beyond and within the health sector and disparities in health status and economic capacity across nations. This study seeks to bring these understandings together.

China Minorities Project

An internal grant gained funding from Charles Darwin University (CDU) in July 2005 - General and Equities Grant Program.

This project is linked to the larger Indigenous birth: Pathways and people for healthy families, mothers and babies. ARC project. This is aimed at improving health services and access for women disadvantaged by remoteness and social and linguistic factors. Chinese academics, health professionals and the literature identify minority groups as having particularly poor obstetric outcomes. In Sichuan Province there are several minority groups identified as non-Han Chinese, who are culturally and linguistically unique. This study aims to not only identify factors which facilitate or hinder minority group's maternal health outcomes and access to health care, but also to identify flexible and responsive maternal health models of care. It will add theoretical depth and complexity to research that has already begun in collaboration with the West China Second University (Chengdu) on policy, state and professional interactions relating to birth outcomes with Han Chinese. It will strengthen Chinese colleague's capacity to design multi-option health care systems that meet the needs of diverse groups in society.

Reproductive Health Research in China

In response to a request from our project colleagues in Shanxi Province, China, we are seeking to fund a joint research project with other bodies that will explore the potential for greater coordination between family planning and maternal health care services. For several decades levels of funding for reproductive health have been disproportionately weighted in favour of Family Planning. This area continues to be heavily subsidised and supported by government while MCH services struggle to provide the most basic amenities, particularly in poorer rural areas. Moreover, funding for Family Planning alone has continued to rise steadily since the early 1970s. The literature to date reports ongoing problems associated with the current system including gaps in services such as inadequate follow up on contraceptive use resulting in unnecessary morbidity, poor coordination and communication between services and instances of replication of services. Preliminary research under the Improving Birth Outcomes in China project suggests that recent changes evidence increasing government attention to MCH, and attempts at greater coordination between bureaucracies and other organisations. The goal of this study is explore the potential for delivering better maternal and child health care through an expanded role for village level Women's Federation representatives that more effectively and efficiently bridge and build on existing MCH and Family Planning services.

Status - application for funding underway with Chinese partners identified.

Quality Improvement Study

We have, through our current research clearly identified specific areas of health services that are not based on international evidence and which could, potentially, be improved in ways that are cost-effective, evidence-based and appropriate to local social and political context. We have also identified potential for achieving real changes in service delivery through a potential for action research in health facilities at all levels of the health care system. In this project, we aim to apply our findings through operations research in a broader, more targeted way to achieve measurable and sustainable improvements in health service quality.

The objectives would be to:

Introduce the concepts of evidence base maternity care for consideration within Sichuan
Establish and test the effectiveness of a mechanism for continued quality improvement led by established Chinese leaders within existing systems
Improve morbidity outcomes through a process of local data collection, analysis, goal setting and review of performance using clinical data currently collected
Reduce costs and increase effectiveness for hospitals and patients, particularly in rural settings.

Status - application for funding underway with Chinese partners identified.

East Timor

Research on maternal mortality in East Timor – funded by CDU and UNFPA

Timor has one of the highest fertility rates in the world and related deaths due to pregnancy and childbirth. The Ministry of Justice and the Office for Promotion of Equality is concerned at the level of maternal deaths and requires quality data from which to promulgate law and policy which will benefit the women of East Timor. The East Timorese women’s NGO Alola Foundation will be collaborating with the researchers to implement this study. The study will provide preliminary data and establish relationships forming a base from which to apply for substantial research funding to reduce maternal deaths.

Research areas to be investigated:

Legal constraints to providing safe, reliable, low-cost modern contraceptives to Timorese families
Social constraints to safe fertility regulation for Timorese families
Health workers' current procedures for recording maternal deaths
Social, economic and health system implications of early pregnancy loss and frequent maternal deaths
An examination of the personal and institutional supports for a larger study to assess maternal mortality

Indonesia

There is strong interest in work with CDU from Indonesia. One project is aimed to help up-grade nurses and midwives for international work, building a project with Indonesian government support as well as business in Indonesia. Our first program will be conducted in this program in 2006. Please contact Professor Barclay if you are interested in further details of other work on Safety and Quality of Health care and support we provide to higher education of health workers in Indonesia.

Transition Program

To mark the 60th anniversary of Indonesia’s independence the NT Government has generously provided $295,000 as a gift to the Government of Indonesia. This gift will provide 20 university trained Indonesian nurses the opportunity to undertake a transition program to be run from April to September 2006 which will cover three months English language and three months supervised clinical theory and practice. On successful completion of the program and registration with the NT Nurses and Midwives Board the nurses will be offered positions in Northern Territory hospitals to combat the shortage of Australian nurses.

Safety and Quality Short Course

In December 2005 GSHP and Royal Darwin Hospital hosted seven participants from the Jogjakarta Health Care Quality Council (Badan Mutu) for a week long course in Hospital Safety and Quality. The course included a tour of Royal Darwin Hospital and covered:

Accreditation, standards and credentialing
National medication chart
Waste management and infection control
Managing, implementing and maintaining change
Quality improvement programs - tools, approaches, governance, leadership and organisational structure.

Presenters included staff from Charles Darwin University, Royal Darwin Hospital, Northern Territory Government and Quality works Pty Ltd and was funded by the World Bank. The course was very highly commended - please see the evaluation form.

Off Shore Masters Education for Nurses YAKKUM Project

This Master of Nursing offshore course will be held in Central Java over two years. The course will be held in intensive mode so that students will attend in short blocks with guided study materials between attendances. The course will presume an IELTS 6.5 or above and S1 bachelor level qualification in a relevant program of study.

Status - funding has been obtained for this initiative and the course will commence in 2007.

Consultancy work

Samoa and Pacific

In collaboration with Dr Caroline Homer, University of Technology Sydney.

WHO funded consultancy. This work has examined, and recommended strategies to redress the consequences of applying western maternity care models in cross-cultural contexts. Work continues to support systems change by building a regional postgraduate school for nurses and midwives with the support of pacific islands Governments and WHO.

Papua New Guinea

AusAID PNG Health Project

Evaluation of a program to improve the interaction between community and health systems in Papua New Guinea: Its impact on improved maternal child health. This is led by PhD student Ms Helen Ashwell supported by Professor Lesley Barclay.

This research examines the process involved in design, implementation and the outcomes of an international development aid project in Papua New Guinea between 1998 and 2004. The design and delivery of a village-level maternal and child health promotion program within the context of health volunteer programs in Papua New Guinean communities is critiqued. This research, supported by AusAID funding, explores the expansion of the village health volunteer program, alongside the development of policy, standards, training and materials. AusAID is funding the collection of outcomes data and fieldwork in Papua New Guinea in 2006.

PNG Midwifery Education Review Retrospective analysis of program documentation and outcome data (to be collected in 2006) will be used to analyse the impact on communities and the health system at national, provincial, district and health facility levels.

PNG Midwifery Education Review

In December 2006 Dr Sue Kruske undertook a WHO consultancy to review the midwifery education in Papua New Guinea. A total of four midwifery programs were reviewed across the country and included field trips to Port Moresby, Madang and Goroka. Health facilities were also visited and included tertiary level (Port Moresby General Hospital), regional (Goroka and Modillon Hospitals), rural health centres and remote aide posts. 30 recommendations were provided in the report and ranged from strengthening cirriculae, teaching resources, health facilities and regulatory processes.

Mongolia

World Health Organisation review of midwifery services in Mongolia

WHO review of midwifery services in Mongolia Sue Kildea, with Dr Margareta Larrson (WHO consultant Geneva), participated in a comprehensive review of midwifery education and services in Mongolia in 2006. The review was conducted on behalf of WHO and the Mongolian Ministry of Health. The terms of reference (TOR) included reporting on the current coverage and competency of midwives, pre-service and in-service training, recruitment and career path, deployment and retention of midwives in rural and remote areas, and attractiveness of midwifery as a profession.

A rapid appraisal approach working with a local advisory committee and utilising WHO Making Pregnancy Safer Draft Guidelines was used. The team travelled several thousand kilometres to visit health and medical education facilities in rural and remote areas. Further feedback was received from a key stakeholder meeting when the preliminary findings were presented.

The findings were also presented at The First Mongolian Midwifery Conference held at Government House, Ulaan Baatar, Mongolia on the 7-8th December, 2006.

While the primary focus of the review was on the Mongolian situation, reviewers were asked to provide comparisons and develop conclusions and recommendations based on regional and international best practices. The final report provides clear recommendations against each of the TORs for consideration by the Ministry of Health.

Australian projects

1+1 = A Healthy Start to Life: Targeting the year before and the year after birth in Aboriginal children in remote areas

Grant awarded May 2007 ($528,000 funded by the NHMRC, $45,000 from the NT Government Research and Innovation Board).

This research project is a three stage baseline, intervention and post-intervention study which is designed to improve maternal and infant health for remote dwelling Aboriginal families in the Top End of the NT. it is based around initial scoping work with women from our field sites Maningrida and Wadeye health workers and policy makers who confirmed the feasibility and importance of the study. We have also tested our patient journey modelling framework and gained support for our approach to the study which will use participatory action research to research and introduce change simultaneously. Consultation has suggested and evidence confirms that health service re-design, our intervention, will be based on 'women centred' continuity of care, and proactive, intensive and focused support for mothers, infants and families. Further consultation, baseline data and evidence will be used to design the specifics of service improvement. This will be evaluated post-intervention against baseline data from our two field sites and aggregated data already routinely collected from similar Top End communities. Data collected will include organisational data for example costing and workforce utilisation, outcomes of women and families with the health system pre and post intervention generated using ethnographic methods.

National Prescribing Service Reaching Niche Groups: Program delivery partnerships to increase participation of new and emerging prescribers in quality use of medicines activities

Grant awarded March 2007 ($200,000 funded by the National Prescribing Service). Partner Organisations: Charles Darwin University, Australian Nurse Practitioner Association, Northern Territory's Department of Health and Community Services, Clinical Learning Branch, Australian Nursing and Midwifery Council.

Prescribing is no longer the sole province of medical practitioners and dentists. Extension of prescribing rights to other healthcare professionals is now seen as a way to improve the quality of services to clients, whilst maintaining client safety, increasing client choice and improving access to healthcare. With this expansion comes many challenges for health professionals, in particular the impact of demographic shifts, biomedical advancements, information technology, changing healthcare delivery systems, migration, refugees and changing disease patterns. Clearly there is a need for wider access to flexible ongoing education to ensure standards of practice that maintain quality of client care, access, continuity and effective care, while delivering positive health outcomes. To achieve these goals health professionals need to adhere to the principles of Quality Use of Medicine (QUM) viz judicious selection of management options, appropriate choice of medicines, where medicine is considered necessary and safe and effective use. Ongoing education is clearly an important tool for achieving the quality use of medicines.

The objectives of the grant are:

to increase uptake of NPS activities and information by new and emerging prescribers, specifically nurse practitioners;
to collaborate with leading organisations and personnel in program implementation and capacity building in the QUM sector;
to develop interventions tailored to nurse practitioner practice settings and needs to optimise their effectiveness;
to follow QUM principles and ensure all products are accurate, balanced and evidence-based; and
to develop and test new web based strategies to enhance user uptake, learning and behavioural change.

Quality Use of Medicines for Nurse Practitioners Program

Indigenous Birth: Pathways and people for healthy families, mothers and babies ARC

Girl and child Linkages Grant awarded July 2006 ($373,000 funded by the ARC and $150,000 from Linkage partners NT Department of Health and Community Services and Danila Dilba Health Service).

The project will generate knowledge, health promoting-behaviours, social and institutional change and inform systems and service development and delivery that improves social, emotional and physical outcomes of antenatal care, birth and early parenting for Aboriginal families in selected sites in Darwin and remote settings. The project team is a partnership of academics, Aboriginal women, organisation leaders, health practitioners and government policy makers. The project includes a community development approach to health promotion led by investigator and PhD student Lorna Murakami-Gold , a study through time and place on contemporary experiences of Aboriginal families accessing health and welfare services led by investigator and PhD student Terry Dunbar and an exploratory ethnography charting women's journeys through the maternal health systems led by Research Associate Suzanne Belton.

Developing and testing processes to improve continuity of care in primary health care maternity services for Indigenous women

Partners: A number of Aboriginal communities and their health boards and UNSW, AIHW, Menzies, UTS, UWS, DHCS

The goal of this project is to improve maternity care within a Primary Health Care framework though implementing continuity of care and Indigenous partnerships and leadership. It is being carried out in a variety of ways - for one example, see below:

Scoping workshops

The Cooperative Research Centre for Aboriginal Health (CRCAH) funded the team to convene a scoping workshop in Darwin with Aboriginal women from Maningrida and Wadeye and key staff from DHCS and Danila Dilba. Participants have recommended research strategies. A further workshop will be held in Alice Springs later in 2006 again bringing together Aboriginal women and key staff from Government and Aboriginal organisations.

Research for Department of Health and Community Services

Self discharge

Project completed August 2005 with a related study to be completed by March 2006. The project aimed to establish why Aboriginal people self discharge prematurely, and more often than non-Aboriginal patients, and the consequences of this behaviour for their health and the health system. The goal is to identify the antecedents of discharge and its consequences for the individual, the professionals and services involved. The study also examines the costs of this to the health system, so that remedial action can be taken and the rate and consequences reduced.

An investigation of the effects of distanced management on retention of remote area nurses (RANs) employed by non-Indigenous organisations as perceived by the nurses themselves in three remote areas of Australia

This project aimed to investigate the effects of distanced management on the retention of RANs in three remote areas of Australia as perceived by the nurse respondents. This will be achieved through a survey questionnaire, targeted stakeholder interviews, semi-structured interviews and documentary and record analysis. The purpose of this study is to provide information that can be used by professional organisations, employers and policy makers in improving conditions of employment and the capacity to both attract and retain this crucial workforce. The researchers are all experienced RANs themselves who work in NT, WA and SA. The study is being informed and supported practically (not funded) by CRANA who are also providing an expert Steering Committee. The GSHP is assisting with this project in collaboration with the Centre for Remote Health.

Child protection

Research undertaken by Marie Land for NAPCAN investigating child health, paediatric and other nurses' capacity to be effective in child protection. A report has been submitted to funding body and to DHCS and was well received. This work constitutes the first study in her PhD, which will move into an action research project designed to improve the effectiveness of this resource and strengthen links with FAC services in this field.