Table 5 Key strategies for improving quality of remote infant health care

Service organization and delivery

• Implement a culturally appropriate model of service delivery based on community development principals and continuity of care.

• Provide flexibility in service delivery: times/location: home visiting, community based care

• Increase delivery of community based health care interventions.

Workforce

• Staffing for health services based on patterns of service use, workload, and community health care needs

• Scale up of designated child health nurses and community based family support workers.

• Ensure effective integration and increase leadership of AHW staff in the health service.

Education and training

• Mandatory cultural security training undertaken by all clinicians prior to commencement of employment in remote communities. Inclusion of a component on Aboriginal child rearing practices.

• Introduction of a minimum set of core competencies in child health for all clinicians that are assessed on an annual basis.

• Ensure clinicians working with children are appropriately qualified to do so or be working towards obtaining a child health qualification.

• Provide clinicians with opportunities to undertake distance education modules to build skills and knowledge directly relevant to remote area practice.

• Ensure all clinicians have access to designated ‘specialist’ mentors or preceptors within and external to their workplace that can provide mentoring and opportunities for knowledge and skills refresher training in the workplace.

• Ensure Aboriginal Health Workers and other community workers have a larger role in health education and health promotion activities or community-based interventions, such as for growth faltering.

Clinical governance and leadership

• Management to ensure all new and existing clinicians are orientated to the health service and trained in the use of the local guidelines, primary care manuals, referral practices and documentation. Ensure regular refresher training on use of guidelines and patient information systems.

• Regular supervision of health care practice and auditing of documentation.

• Establish key targets for health outcomes and service delivery performance specific to the needs of individual health facilities.

• Implementation of local systems for regular monitoring and evaluation of child health outcomes and health system performance with action plan for facilitating improvements.