Health services for aboriginal and Torres Strait Islander children in remote Australia: A scoping review

Abstract

In Australia, there is a significant gap between health outcomes in Indigenous and non-Indigenous children, which may relate to inequity in health service provision, particularly in remote areas. The aim was to conduct a scoping review to identify publications in the academic and grey literature and describe 1) Existing health services for Indigenous children in remote Australia and service use, 2) Workforce challenges in remote settings, 3) Characteristics of an effective health service, and 4) Models of care and solutions. Electronic databases of medical/health literature were searched (Jan 1990 to May 2021). Grey literature was identified through investigation of websites, including of local, state and national health departments. Identified papers (n = 1775) were screened and duplicates removed. Information was extracted and summarised from 116 papers that met review inclusion criteria (70 from electronic medical databases and 45 from the grey literature). This review identified that existing services struggle to meet demand. Barriers to effective child health service delivery in remote Australia include availability of trained staff, limited services, and difficult access. Aboriginal and Community Controlled Health Organisations are effective and should receive increased support including increased training and remuneration for Aboriginal Health Workers. Continuous quality assessment of existing and future programs will improve quality; as will measures that reflect aboriginal ways of knowing and being, that go beyond traditional Key Performance Indicators. Best practice models for service delivery have community leadership and collaboration. Increased resources with a focus on primary prevention and health promotion are essential.

Aboriginal children with cancer: The patient and healthcare worker perspective

“…Many Aboriginal Australians do not seek healthcare due to challenges with transport, poor access to services, financial constraints, unavailability or lack of trained staff, particularly in the Aboriginal workforce, poor communication and cultural safety 6,9 . Similar themes have been explored with Aboriginal children, with communication, financial constraints and cultural issues highlighted as barriers to care, 12,13 further risking delayed diagnosis due to discomfort in seeking medical treatment 14,15 …”

“…A culturally safe workplace requires clinician engagement with Aboriginal communities and inclusion of Aboriginal HCW 9 . Other strategies to improve cultural sensitivity include continuous quality improvement models, 14 formal training and employment of Aboriginal HCW, 14 and staff self‐reflection and training in cultural competency 6 . Better identification of Aboriginal status could improve the linkage with Aboriginal HCW, 16 who not only act as a liaison with tertiary medical centres, but also promote understanding of cultural differences 12 …”

“…There is a higher burden of disease 1,2 and poorer health outcomes [2][3][4][5][6] amongst Australian Aboriginal children compared to their non-Aboriginal counterparts. Aboriginal children with leukaemia have reduced clinical trial enrolment rates and increased loss to followup rates, and a trend towards inferior survival.…”

A community-embedded approach to increasing the health literacy of Aboriginal children in a regional area: processes of co-design and local implementation

“…Australian Aboriginal communities experience significant health inequities, similar to those of other Indigenous peoples in colonised nations ( 3 , 4 ). These inequities are evident from childhood.…”

Racism and access to maternal health care among garo indigenous women in Bangladesh: A qualitative descriptive study

“…Although extensively studied in prior research [ 2 , 4 , 5 ], the specific effects of racism on Indigenous women’s access to maternal healthcare have received limited attention within Indigenous women’s health studies [ 6 ]. Research from various countries indicates higher rates of maternal morbidity and mortality associated with racism [ 7 – 9 ]. Instances of racial discrimination against Indigenous women by healthcare providers are evident in both India, the United States, and Mexico [ 10 – 14 ].…”