In what ways does the mandatory nature of Victoria's municipal public health planning framework impact on the planning process and outcomes?

BACKGROUND: Systems for planning are a critical component of the infrastructure for public health. Both in Australia and internationally there is growing interest in how planning processes might best be strengthened to improve health outcomes for communities. In Australia the delivery of public health varies across states, and mandated municipal public health planning is being introduced or considered in a number of jurisdictions. In 1988 the Victorian State government enacted legislation that made it mandatory for each local government to produce a Municipal Public Health Plan, offering us a 20-year experience to consider. RESULTS: In-depth interviews were undertaken with those involved in public health planning at the local government level, as part of a larger study on local public health infrastructure and capacity. From these interviews four significant themes emerge. Firstly, there is general agreement that the Victorian framework of mandatory public health planning has led to improvements in systems for planning. However, there is some debate about the degree of that improvement. Secondly, there is considerable variation in the way in which councils approach planning and the priority they attach to the process. Thirdly, there is concern that the focus is on producing a plan rather than on implementing the plan. Finally, some tension over priorities is evident. Those responsible for developing Municipal Public Health Plans express frustration over the difficulty of having issues they believe are important addressed through the MPHP process. CONCLUSION: There are criticisms of Victoria's system for public health planning at the local government level. Some of these issues may be specific to the arrangement in Victoria, others are problems encountered in public health planning generally. In Victoria where the delivery structure for public health is diverse, a system of mandatory planning has created a minimum standard. The implementation of the framework was slow and factors in the broader political environment had a significant impact. Work done in recent years to support the process appears to have led to improvements. There are lessons for other states as they embark upon mandated public health plans

Australian public health policy in 2003 – 2004

In Australia, compared with other developed countries the many and varied programs which comprise public health have continued to be funded poorly and unsystematically, particularly given the amount of publicly voiced political support. In 2003, the major public health policy developments in communicable disease control were in the fields of SARS, and vaccine funding, whilst the TGA was focused on the Pan Pharmaceutical crisis. Programs directed to health maintenance and healthy ageing were approved. The tertiary education sector was involved in the development of programs for training the public health workforce and new professional qualifications and competencies. The Abelson Report received support from overseas experts, providing a potential platform for calls to improve national funding for future Australian preventive programs; however, inconsistencies continued across all jurisdictions in their approaches to tackling national health priorities. Despite 2004 being an election year, public health policy was not visible, with the bulk of the public health funding available in the 2004/05 federal budget allocated to managing such emerging risks as avian flu. We conclude by suggesting several implications for the future

Communicable Diseases Epidemiology

In March 2017 I commenced the Master of Applied Epidemiology program, hosted in the Communicable Diseases Branch at Health Protection New South Wales (NSW). Presented in this bound volume are four research projects: an epidemiological study, data analysis study, outbreak response, and an evaluation of a public health surveillance system. I was also heavily involved in routine public health work including on-call, outbreak investigations and follow-up of laboratory notifications. The epidemiological study was an audit that estimated true immunisation coverage of NSW children at one year of age on the Australian Immunisation Register (AIR), and explored reasons associated with under-reporting. Our estimate of true coverage was 96.2% with a 95% Confidence Interval 95.9%-96.4%; 2.1% higher than AIR reported coverage of 94.1%. The under-reporting was mainly due to data errors at the provider level and duplicate records. Included is a peer-reviewed article that I wrote and published on the subject in the Australian and New Zealand Journal of Public Health. The data analysis project investigated the over-representation of Aboriginal people diagnosed with Q fever in NSW, particularly in Western NSW. Following indirect standardisation, we found that Aboriginal people across Western NSW were notified with Q fever almost 35% more often as non-Indigenous people living in the same area. Aboriginal people reported working in occupations such as shearing at a much younger age than non-Indigenous people. Aboriginal community governance over the public health actions that arose from this analysis is provided in detail. I led an investigation into a large protracted outbreak of Salmonella Typhimurium with a novel multi-locus variable number tandem repeat analysis type profile that affected 235 people in the Australian Capital Territory, NSW and Queensland from 10 October 2018 to 31 May 2019. The chapter describes the outbreak investigation including epidemiological, environmental and laboratory components, and control actions taken. I evaluated the NSW Acute Rheumatic Fever (ARF) and Rheumatic Heart Disease (RHD) Surveillance System, including the RHD Register. Using open ended and closed question surveys, network consultation and analysis of data, the system was found to be useful in improving the management of ARF/RHD. Recommendations for improving attributes were made based on the Updated Guidelines for Evaluating Public Health Surveillance Systems by the United States Centers for Disease Control and Prevention. I had the opportunity to teach and present my research during the MAE and through concurrent employment as an academic tutor. I delivered presentations at local, state, national and international conferences throughout the placement, and produced a Lesson from the Field competency with the Gamilaraay title 'nginda MAE waala wiitha' (throwing the MAE into the fire); an acknowledgement of the feeling many peers felt undertaking data linkage projects with inconsistent or missing data. I saw an opportunity to start a conversation about reasons why Aboriginal and Torres Strait Islander identity data may be missing in datasets, which prompted the group to explore why an individual may identify in one place and not another

Improving the identification of Aboriginal and Torres Strait Islander people in mainstream general practice

The project aim was to identify promising strategies to improve identification processes in mainstream general practice. To achieve this aim, the project explored three primary research questions. • What strategies to improve the identification of Aboriginal and Torres Strait Islander people in mainstream general practice have been trialled before and what is worth trialling (feasible and acceptable) in the future? • How can mainstream general practice be encouraged to improve identification processes for Aboriginal and Torres Strait Islander people? • What are the links between improved identification and quality of care?The research reported in this paper is a project of the Australian Primary Health Care Research Institute, which is supported by a grant from the Australian Government Department of Health and Ageing under the Primary Health Care Research, Evaluation and Development Strategy

Attitudes and attributes of pharmacists in relation to practice change - a scoping review and discussion

Multiple barriers and facilitators to the uptake of cognitive services in pharmacy practice have been identified. Pharmacists' attitudes and attributes have been described as barriers and facilitators in relation to the uptake of extended pharmacy services, in addition to those of a more systemic nature.To systematically scope and review the literature describing pharmacists' attitudes and attributes in relation to the implementation of cognitive services or role extension and to critically analyze and discuss their relevance as barriers or facilitators.A scoping review of the literature on attitudes and attributes of pharmacists in relation to pharmacy practice was performed, including 47 articles on attitudes and 12 on attributes, forming the basis for a critical analysis within theoretical frameworks.Pharmacists' attitudes toward role extensions and new pharmacy service models are generally positive and their personal attributes and personality traits appear favorable for roles as health professionals. Pharmacists perceived a number of barriers to the uptake of extended roles.Pharmacists' attributes, including personality traits, and attitudes favor the implementation of cognitive and patient-focused health care services and should not be regarded as major barriers to the uptake of extended pharmacy practice roles. Framing their attitudes and attributes within the theories of planned behavior and personality trait theories indicates that individual motivation needs to be underscored by systemic support for pharmacy practice change to succeed on a wide scale

Applying a system dynamics modelling approach to explore policy options for improving neonatal health in Uganda

Description of variables. (DOCX 31 kb

Transformational change in health systems: a road strewn with obstacles.

This research study assesses the impact on primary health care of the reform changes in the South Australian health system from 2005 to 2007. The research follows a pilot study conducted in one of the newly created health regions in 2005 to 2006 and reported in: Governance change in the southern metropolitan Adelaide health region: implications for Primary Health Care (Baum et al. 2006). Both studies were intended as scoping exercises to contribute towards the development of an evaluation framework for primary health care