Academic literature on the topic 'Medical care Australian Capital Territory'

This paper presents an outline of the socio-demographic features of the Australian Capital Territory (the ACT) and of its health care system. I describe how health care resources are allocated in the government sector, present a moredetailed description of the way that hospital services are purchased, and summarise the government's policy directions for health. I argue that the main directions are sensible, and particularly those that support more integrated care that is largely based in the community. There appear to be no major weaknesses in the budget-share output-based funding model used in the purchase of hospital services, although the rationale for some of the components might be clarified.In total, the ACT government appears to be on the right track. However, I argue that more rapid progress might bepossible if there were greater collaboration between the Territory health authority and the relatively powerful private medical profession.

Objective This study asks ‘Is capital investment in Australian public hospitals effectively funding patient access to efficient hospital care?’ Methods The study drew information from semistructured interviews with senior health infrastructure officials, literature reviews and World Health Organization (WHO) reports. To identify which systems most effectively fund patient access to efficient hospitals, capital allocation systems for 17 Organisation for Economic Cooperation and Development (OECD) countries were assessed. Results Australian government objectives (equitable access to clinically appropriate, efficient, sustainable, innovative, patient-based) for acute health services are not directly addressed within Australian capital allocation systems for hospitals. Instead, Australia retains a prioritised hospital investment system for institutionally based asset replacement and capital planning, aligned with budgetary and political priorities. Australian systems of capital allocation for public hospitals were found not to match health system objectives for allocative, productive and dynamic efficiency. Australia scored below average in funding patient access to efficient hospitals. The OECD countries most effectively funding patient access to efficient hospital care have transitioned to diagnosis-related group (DRG) aligned capital funding. Measures of effective capital allocation for hospitals, patient access and efficiency found mixed government–private–public partnerships performed poorly with inferior access to capital than DRG-aligned systems, with the worst performing systems based on private finance. Conclusion Australian capital allocation systems for hospitals do not meet Australian government standards for the health system. Transition to a diagnosis-based system of capital allocation would align capital allocation with government standards and has been found to improve patient access to efficient hospital care. What is known about the topic? Very little is known about the effectiveness of Australian capital allocation for public hospitals. In Australia, capital is rarely discussed in the context of efficiency, although poor built capital and inappropriate technologies are acknowledged as limitations to improving efficiency. Capital allocated for public hospitals by state and territory is no longer reported by Australian Institute of Health and Welfare due to problems with data reliability. International comparative reviews of capital funding for hospitals have not included Australia. Most comparative efficiency reviews for health avoid considering capital allocation. The national review of hospitals found capital allocation information makes it difficult to determine ’if we have it right’ in terms of investment for health services. Problems with capital allocation systems for public hospitals have been identified within state-based reviews of health service delivery. The Productivity Commission was unable to identify the cost of capital used in treating patients in Australian public hospitals. Instead, building and equipment depreciation plus the user cost of capital (or the cost of using the money invested in the asset) are used to estimate the cost of capital required for patient care, despite concerns about accuracy and comparability. What does this paper add? This is the first study to review capital allocation systems for Australian public hospitals, to evaluate those systems against the contemporary objectives of the health systems and to assess whether prevailing Australian allocation systems deliver funds to facilitate patient access to efficient hospital care. This is the first study to evaluate Australian hospital capital allocation and efficiency. It compares the objectives of the Australian public hospitals system (for universal access to patient-centred, efficient and effective health care) against a range of capital funding mechanisms used in comparable health systems. It is also the first comparative review of international capital funding systems to include Australia. What are the implications for practitioners? Clinical quality and operational efficiency in hospitals require access for all patients to technologically appropriate hospitals. Funding for appropriate public hospital facilities, medical equipment and information and communications technology is not connected to activity-based funding in Australia. This study examines how capital can most effectively be allocated to provide patient access to efficient hospital care for Australian public hospitals. Capital investment for hospitals that is patient based, rather than institutionally focused, aligns with higher efficiency.

IntroductionThere are little published data on the long-term psychological outcomes in intensive care unit (ICU) survivors and their family members in Australian ICUs. In addition, there is scant literature evaluating the effects of psychological morbidity in intensive care survivors on their family members. The aims of this study are to describe and compare the long-term psychological outcomes of intubated and non-intubated ICU survivors and their family members in an Australian ICU setting.Methods and analysisThis will be a prospective observational cohort study across four ICUs in Australia. The study aims to recruit 150 (75 intubated and 75 non-intubated) adult ICU survivors and 150 family members of the survivors from 2015 to 2018. Long-term psychological outcomes and effects on health-related quality of life (HRQoL) will be evaluated at 3 and 12 months follow-up using validated and published screening tools. The primary objective is to compare the prevalence of affective symptoms in intubated and non-intubated survivors of intensive care and their families and its effects on HRQoL. The secondary objective is to explore dyadic relations of psychological outcomes in patients and their family members.Ethics and disseminationThe study has been approved by the relevant human research ethics committees (HREC) of Australian Capital Territory (ACT) Health (ETH.11.14.315), New South Wales (HREC/16/HNE/64), South Australia (HREC/15/RAH/346). The results of this study will be published in a peer-reviewed medical journal and presented to the local intensive care community and other stakeholders.Trial registration numberACTRN12615000880549; Pre-results.

The Canberra Clinical School is attached to Woden Valley Hospital, the principalhospital in the Australian Capital Territory. The clinical school arose out of amemorandum of understanding signed between the University of Sydney and theACT Department of Health (as it then was) in March 1993. One of theaspirations of those who negotiated the memorandum of understanding was thatthe creation of the clinical school would lead to a cultural shift in attitudes towardschange within the health care system. This paper looks at the management structureof Woden Valley Hospital and at what the development of a clinical school inCanberra can achieve, particularly in relation to hospital and health servicemanagement.

Aged care is a growing issue in Australia and other countries. There are significant barriers to meeting the health needs of this population. Current services have gaps between care and lack communication and integration between care providers. Research was conducted in the Australian Capital Territory to investigate the potential role of the aged care nurse practitioner in health service delivery in aged care settings. A multimethod case study design was utilised, with three student nurse practitioners (SNP) providing care to aged care clients across three sectors of health service delivery (residential aged care facilities, general medical practices and acute care). Data collection consisted of in-depth interviews and journal entries of the SNP, as well as focus groups and surveys of multidisciplinary staff and patients over the age of 65 years in the settings frequented by the SNP. The aged care SNP were found to cross professional and organisational boundaries, cross intra- as well as interorganisational boundaries and to contribute to more seamless patient care as members of a multidisciplinary aged care team. The aged care nurse practitioner role consequently has the potential to function in a networked rather than a hierarchical manner, and this could be a key element in addressing gaps in care across care locales and between disciplines.

The extraordinary (unplanned) review of clinical privileges is the means by which an organisation can manage specific complaints about individual practitioners’ clinical competence that require immediate investigation. To date, the extraordinary review of clinical privileges for doctors and dentists has not been the subject of much research and there is a pressing need for the evaluation and review of how different legislated and non-legislated administrative processes work and what they achieve. Although it seems a fair proposition that comprehensive processes for the evaluation of the clinical competence of doctors and dentists may improve the overall delivery of an organisation’s clinical services, in fact, little is known about the relationship between the safety and quality of specific clinical services, procedures and interventions and the efficiency or effectiveness of established methodologies for the routine or the extraordinary review of clinical privileges. The authors present a model of a structured approach to the extraordinary review of clinical privileges within a clinical governance framework in the Australian Capital Territory. The assessment framework uses a primarily qualitative methodology, underpinned by a process of systematic review of clinical competence against the agreed standards of the CanMEDS Physician Competency Framework. The model is a practical, working framework that could be implemented on a hospital-, area health service- or state- and territory-wide basis in any other Australian jurisdiction. What is known about the topic?In Australia, there is a national standard for credentialing and defining the scope of clinical practice for doctors working in hospital settings. However, there are no published reports in the national arena on established processes for the extraordinary review of clinical privileges for doctors or dentists and, despite the major inquiries investigating health system failures in Australian hospitals, the effectiveness and adequacy of existing processes for the extraordinary review of clinical privileges has not yet been prioritised nationally as an area for improvement or reform. Internationally, health care organisations have also been slow to establish frameworks for the management of complaints about doctors or dentists. What does this paper add?This paper makes a significant contribution to the national and international safety and quality literature by presenting an exposition of a working model for the extraordinary review of clinical privileges of doctors and dentists. The authors describe a methodology in the public health sector that is territory-wide (not hospital-based), peer-reviewed, objective, fair and responsive. Because the model is a practical, working framework that could be implemented on a hospital-, area health service- or state- and territory-wide basis in any other Australian jurisdiction, this paper provides an opportunity for policy makers and legislators to drive innovative change. Although incursions into the provision of care by other health professionals have been avoided, the model could be readily adopted by clinical leaders from the nursing and allied health professions. What are the implications for practitioners?An organisation dedicated to investigating serious complaints with a real sense of urgency, objectivity and transparency is far less likely to fester a climate of disquiet or anger amongst staff, or to trigger concerns of a ‘cover-up’ or disregard for accountability than an organisation not adopting such an approach. Anecdotal experience suggests the model has the potential to minimise, if not prevent, the occurrence of the kinds of complaints that become much-publicised in the media. This is positive because these types of damaging high profile cases often have the effect of diminishing community confidence in the health care system, in particular, confidence in the medical profession’s ability to self-regulate. Often, they also lead to a misrepresentation of the medical profession in the media, which is unfair since the overwhelming majority of doctors do meet the standards of their profession.

A government-funded service to provide forensic and medical care to survivors of sexual assault was established in the Australian Capital Territory (ACT) in 2001. Doctors employed by the service lacked the specific skills required to care comprehensively for survivors. Our aim was to develop, implement and evaluate a sexual assault medical education program. It consisted of an `in-house' education program, and external university course and incorporated team-building, networking activities and protocol development. Core elements were: forensic evidence collection, assessment and management of injuries, prevention of sexually transmissible infections and pregnancy, counselling and emotional support. Participant satisfaction and knowledge acquisition were evaluated using a semi-structured interview and a questionnaire. Seven doctors participated in a 16-session program conducted by the director and nurse coordinator with help from local forensic, legal and medical experts. All doctors successfully completed the Certificate in Forensic Medicine, and reported satisfaction with the program and their increased knowledge, particularly associated with collection of forensic evidence and court procedures. A compete set of protocols was developed and cohesive networks established. We have designed an effective education program for doctors working in the field of sexual assault and offer it as a template to other health professionals working in this area.

OBJECT Time-critical neurosurgical conditions require urgent operative treatment to prevent death or neurological deficits. In New South Wales/Australian Capital Territory patients’ distance from neurosurgical care is often great, presenting a challenge in achieving timely care for patients with acute neurosurgical conditions. METHODS A protocol was developed to facilitate consultant neurosurgery locally. Children with acute, time-critical neurosurgical emergencies underwent operations in hospitals that do not normally offer neurosurgery. The authors describe the developed protocol, the outcome of its use, and the lessons learned in the 9 initial cases where the protocol has been used. Three cases are discussed in detail. RESULTS Nine children were treated by a neurosurgeon at 5 rural hospitals, and 2 children were treated at a smaller metropolitan hospital. Road ambulance, fixed wing aircraft, and medical helicopters were used to transport the Newborn and Paediatric Emergency Transport Service (NETS) team, neurosurgeon, and patients. In each case, the time to definitive neurosurgical intervention was significantly reduced. The median interval from triage at the initial hospital to surgical start time was 3:55 hours, (interquartile range [IQR] 03:29–05:20 hours). The median distance traveled to reach a patient was 232 km (range 23–637 km). The median interval from the initial NETS call requesting patient retrieval to surgical start time was 3:15 hours (IQR 00:47–03:37 hours). The estimated median “time saved” was approximately 3:00 hours (IQR 1:44–3:15 hours) compared with the travel time to retrieve the child to the tertiary center: 8:31 hours (IQR 6:56–10:08 hours). CONCLUSIONS Remote urgent neurosurgical interventions can be performed safely and effectively. This practice is relevant to countries where distance limits urgent access for patients to tertiary pediatric care. This practice is lifesaving for some children with head injuries and other acute neurosurgical conditions.

Three groups of health care professionals were canvassed for their views on euthanasia - student nurses, practising nurses and doctors. The aim of the research was to make a possible contribution to a formalised health policy on this issue for the ACT. The following forms of euthanasia were covered by the research: (i) voluntary active euthanasia: (ii) voluntary passive euthanasia: (iii) involuntary active euthanasia: (iv) involuntary passive euthanasia. Passive forms of euthanasia were found to be the most acceptable. Voluntary forms of euthanasia were not found, in general, to be more approved of than involuntary forms of euthanasia. However, active forms of euthanasia were much less acceptable than passive forms. In order to adapt the research findings to a methodology for policy use. Allison's models (1971) of public policy development were modified into a single model. This provided an application of the research results in such a way as to allow for the development of a possible formalised policy on euthanasia, and practical applications. The conclusions drawn from the research findings and the subsequent recommendations are supportive of law reform and the implementation of a new policy on the issue of euthanasia.

The study reviewed the provision of childbirth and parenting education in the ACT for indicators of effectiveness and needs. Users (n = 207) and providers (n = 7) were surveyed for information on educational and administrative aspects of the service. An original design questionnaire was based on the PRECEDE framework (predisposing, reinforcing and enabling factors in educational diagnosis and evaluation) and the social model of health. Items were drawn from the relevant literature, concerning individual, social and service delivery elements of the health fields concept interpreted for pregnancy, childbirth and parenting. Individual factors were related to Maslow's hierarchy and the valuing approach to health education. The provider survey covered information on organisational elements, comprising inputs, processes, products, outputs and outcomes of childbirth education. The study comprised a literature review, cross-sectional non-experimental surveys of users and providers, and a needs assessment combining information from each of the three sources. Descriptive statistical techniques, analysis of variance and valuing analysis were used to extract information on effectiveness indicators and needs from the user data. Comparisons were made between present and past users, and between women of different ages, experience of pregnancy and preferences for public or private methods of education for childbirth. No evidence was found of individual differences in the women's attitudes, beliefs and values that could be attributed to education. However, users expressed strong approval and positive views of the service and its providers. The level of personal health skills, confidence and emotional preparatiqn they achieved through childbirth and parenting education did not fully meet their expectations. The survey also found that the organisation of childbirth and parenting education has not developed professionally like other health services. Service goals and objectives are ill-defined; planning and coordinating are inadequate for an integrated maternal health care system. The service's main resources are its highly motivated and dedicated teachers and clients. Several recommendations are made for educational and administrative measures to enhance service effectiveness within present organisational constraints, based on the needs identified by the study.

The increased demand for Out of School Hours Care (OSHC) has been linked to changes that have occurred in the family structure and work habits. OSHC programs operating on school sites under the management of a committee of parents and school representatives provide parents with one option to meet the needs for care of primary age children. This study examined the issue of OSHC from the perspectives of workers involved in the provision of services in government school sites in the ACT. Data were gathered by way of semi-structured interviews with nineteen coordinators from sixteen After School Care (ASC) centres. The data were analysed to find similarities in the experiences of workers interviewed. Extracts from the interviews are presented in the findings to illustrate the perceptions care givers have about their work and areas where changes can be made to improve the quality of ASC services. The study provides information on the factors affecting the provision of quality services and suggests possible directions for future planning and research in this area. The findings indicate that the care givers interviewed perceived their role as a positive influence in the lives of children and families. Care givers sought to provide relaxed environments for children after the school day. Many centres operated with the strong support of parents, schools and management committees. The findings suggest that ASC centres can and do operate successfully on school sites in the ACT and that care givers were generally happy with the level of service provided. However, variability in the facilities and support provided to centres was noted. The study concludes that real improvement to the quality of programs and support of workers is dependent on the introduction of nationally recognised standards in the provision of ASC.

BACKGROUND: In response to demographic changes, increasing rates of chronic disease and demand for primary health care services, since the early 2000’s Australia has increased the number and roles of general practice nurses (GPNs). There is a scarcity of evidence establishing whether the increased availability and use of nursing care in general practice has resulted in improved patient outcomes. Two key quality outcomes – patient satisfaction and enablement – have been examined extensively as outcomes of general practitioner care; however an evidence gap exists regarding these outcomes in relation to GPN care. The aim of this study was to examine the relationship between general practice and GPN consultation characteristics, and patient satisfaction and enablement. METHODS: A concurrent mixed methods study was conducted. The quantitative component consisted of a cross-sectional study of 678 patients (response rate = 41%) receiving GPN care in 21 general practices in the Australian Capital Territory. Patient Enablement and Satisfaction Surveys were distributed to these patients between September 2013 and March 2014. Multilevel mixed effect models were used to analyse these data. The qualitative component took a grounded theory approach to in-depth interviews with GPNs (n=16), patients (n=23) and practice managers (n=9) from these same general practices. Data generation and analysis were conducted concurrently using constant comparative analysis and theoretical sampling. After the separate quantitative and qualitative analyses, findings were integrated. This involved quantification of selected qualitative variables for inclusion in multilevel analyses and a secondary integration of findings. FINDINGS: The results of this study provided evidence of: ● a significant association between patient satisfaction and Nursing scope of practice and autonomy, Continuity of GPN care, Patients making appointments to see a particular GPN, Consultation type and Duration of consultation; ● a significant association between patient enablement and Nursing scope of practice and autonomy, Consultation type and Duration of consultation;● behaviours that characterise ‘the just right nurse’; ● an interconnection between patient satisfaction and enablement. This evidence is presented in the form of a theoretical model called, developing a positive patient experience with nurses in general practice: an integrated model of patient satisfaction and enablement. This process-based model includes general practice and GPN consultation characteristics underpinning actions and interactions that support the triggering of health care partnerships between patients and GPNs, and tailoring care to meet each patient’s unique needs. The effectiveness of this model is contingent on the general practice context in which it operates. Examination of characteristics that support broad scopes of nursing practice coupled with high levels of autonomy facilitated an understanding of ‘enabling’ and ‘less-enabling’ general practices. CONCLUSION: This integrated model of patient satisfaction and enablement is a practical tool to inform education and training for GPNs and other clinicians, particularly in relation to the management of patients with chronic and long-term conditions. This evidence provides impetus to deepen our insight into general practice models of care that facilitate enhanced nursing scope of practice and autonomy, continuity of care and adequate time for nursing consultations. Integral to patient-centred care, these interprofessional models are the key to optimising GPN roles and the associated quality patient outcomes.

This thesis examines the arts of care in an asylum in New South Wales (NSW) and a mental health community in the Australian Capital Territory in twentieth-century Australia, and describes and compares a range of governmental responses for responding to persons deemed to be in need of care. The thesis explores similarities between twentieth-century Australian care techniques and the key principles underpinning a ‘care system’ that was developed over 200 years ago. It proposes three twentieth-century care regimes, each one characteristic of a certain period: Herd Care, set in an asylum era that emphasised custodialism and confinement (1925-1958); Therapeutic Community, a period during which the asylum was reconfigured into a facilitative community (1959-1983); and Community Care, beginning around 1983, when NSW asylums were ‘rationalised’, their care techniques fragmented and outsourced in diverse settings generally referred to collectively as the mental health community. Some of the dynamics, continuities and ruptures in twentieth-century care regimes are analysed. Chapters describe the landscapes of care. They explore how environmental settings have been designed to reinforce the care regimes in which they are mobilised and how they ‘make up’ the possibilities for action of the subject of care. The dynamics of care between care providers and their recipients are examined. Some of the continuities and discontinuities of meanings associated with ‘family’ and ‘community’ in each of the care regimes are observed. Fieldwork findings are combined with the cultural narrative of psychiatric primitivism to consider why subjects have been deemed in need of care, at times in need of protection and training and at other times in need of discipline and restraint. The new possibilities for action that have emerged in Australian twentieth-century mental health governance are considered, when subjects of care have been encouraged to learn how to be free

This thesis is a comparative demonstration study, using a novel approach to mental health systems research, to: (i) analyse the pattern of care provision in an Australian health jurisdiction; (ii) compare it with that of other health districts in Australia, Europe and South America; and (iii) demonstrate its usability as a decision support aid for mental healthcare planners. Background. The outcomes of policy interventions in mental health systems are shaped not only by the intervention, but also by the characteristics of systems themselves. Knowledge of the local context is critical to enable planners to identify gaps and pathways in the system, to inform modelling, and to guide resource allocation. However, current services research and planning is based on a limited, component-based approach, with service provision at local level often informed by data aggregated at national level. In Australia, this has resulted in a system of mental healthcare delivery described as fragmented, with gaps in key areas and disproportionate investment in others, poor interaction between the different sectors of care, and confusion about accountability between different levels of responsibility. A new approach has been developed--the mental health ecosystems research approach (MHESR). MHESR provides an analysis of the whole system of care delivery at small area level, allowing identification of patterns of care and gaps in service provision, and providing more reliable data for local planning and modelling. In this thesis, I demonstrate the usability of an innovative tool based on this approach-- The Integrated Atlas of Mental Healthcare--in an analysis of the mental health system in the Australian Capital Territory, and a comparison with eight other health districts in Australia, Europe, and South America. Method. Integrated Atlases (Atlases) of Mental Healthcare provide an analysis of the whole system of care delivery in a defined region. Data, including service availability, capacity, and diversity, is collected at local level using a standardised, multiaxial service classification instrument, the Description and Evaluation of Services and Directories for Long Term Care (DESDE-LTC). Atlases also include key socio-demographic indicators and other local context information and present data using visualisation tools including Geographic Information Systems (GIS). Results. My research identified gaps in service provision in key areas in the ACT common to the Australian, but not to the international regions; as well as patterns in service provision of some types of care, particularly community care, where the ACT more closely resembled the international regions than it did its national comparators. I found that some types of care were absent or lacking in all regions of the study. ACT showed a unique difference to all other regions in its balance of psychiatrists and psychologists. The Atlas has had a moderate impact on planning agencies in the ACT. Conclusion: Integrated Atlases using a MHESR approach provide more comprehensive and reliable information about the whole system of care delivery, and are useful tools to support decision makers to improve mental healthcare planning in Australia.

Risky alcohol consumption is responsible for seven per cent of all Indigenous deaths in Australia and is a precursor to many diseases. Despite high rates of risky consumption, screening is not routine practice in primary health care and the validity of screening instruments (other than the Indigenous Risk Impact Screen) have not been performed for Indigenous peoples. Enquiring about risky alcohol use can cause discomfort for health practitioners and clients. One way of overcoming this is to create an environment free from a number of social contexts. My first aim was to assess the reliability and validity of commonly used alcohol screening instruments. This then provided an opportunity to assess the level of risky alcohol use in the study population, my second aim. My third aim was to assess whether a culturally mediated alcohol screen could improve reporting of risky alcohol consumption. It involved starting the interview with questions about the participant's 'mob and country'. My fourth aim was to determine whether the socio-cultural factors or acculturation stress reflected determinants of drinking for the study population. My final aim was to examine facilitators and moderators of risky drinking. I conducted a computer-assisted cross-sectional survey of Indigenous people (n=121) in the primary survey and 45 participants completed a re-test survey (for test re-test reliability). The surveys were conducted among Aboriginal and Torres Strait Islander people living in the Australian Capital Territory (ACT) region from July 2010 to August 2011. Participants were randomised into a 'mob-ask' screening group (n=53) and a 'screening as usual' group (n=69). Five alcohol screening instruments were administered. A modified Vancouver Index of Acculturation (VIA) were used to examine how Indigenous people viewed their participation in heritage and dominant society cultures, the Drinking Motives Questionnaire (DMQ) to examine motives for drinking and the Kessler 10 (K10) to examine psychological distress. All alcohol screening instruments were reliable, but shorter screening instruments were as reliable and valid as existing instruments. Half the participants were drinking above recommended guideline limits and the mean age of initiation to alcohol was 14 years, 13 years for males and 15 years for females. Being male, living in a dependent household situation and being excluded from education were associated with risk-taking behaviour and risky alcohol consumption. Alcohol screening instrument mean scores were higher in the 'mob-ask' screen group compared to the control group. Participants were highly integrated (had a positive association with both heritage and dominant society culture) and, as anticipated, socio-cultural factors, rather than acculturation stress, predicted risky alcohol use. Health gains achieved through reducing consumption and drinking in specific situations (particularly around children and family members) moderated drinking. Family members were also identified by participants as facilitators to drinking and risk-taking behaviour. Screening approaches for risky drinking do not require major modification but do need to be focused on younger people (from 13 years) and screening needs to be routine.

Background Plasmodium falciparum malaria during pregnancy poses a substantial risk to mother and foetus. In recent years, convincing evidence has shown that preventive methods such as the use of insecticide treated bed nets (ITNs) and intermittent preventive treatment (IPT) in pregnancy with sulphadoxine-pyrimethamine (IPTp-sp) can greatly reduce the adverse effects of malaria during pregnancy. Purpose The main purpose of the study was to assess the knowledge and use of Intermittent Preventive Treatment of Malaria among pregnant women receiving Antenatal Care at the primary health centers of the Federal Capital Territory, Abuja Nigeria. Methods A quantitative, descriptive, cross-sectional study was conducted Structured questionnaires were administered to 300 pregnant women aged between 18 and 49 years. Data was analysed using Statistical Package for Social Sciences (SPSS) 22. Results The results revealed that most of the respondents had knowledge about IPT, majority of the respondents had received IPT drugs, in the clinic, but unfortunately none of them were supervised by a health worker during taking of the drug. Few of the respondents did not take the drugs at all for fear of complication, some of them did not know exactly how many tablets were given to them and there was poor adherence to the Directly Observed Therapy (DOT) scheme. Conclusion Knowledge of malaria and IPT was good and many pregnant women received the drugs and used it, but some of them had challenges and did not use the drugs.
Health Studies
M.P.H.

Immunisation is a cost-effective public health intervention that contributes to the attainment of the Sustainable Development Goals (SDGs). About 40% of children under the age of five years die from vaccine-preventable diseases in Nigeria. Routine immunisation has been quite low in Nigeria, where national coverage is estimated to be 33%, according to a 2016–2017 survey. This empirical research was aimed at determining the key socio-economic and gender determinants of immunisation in the Federal Capital Territory (FCT), identifying gaps and proffering solutions. Mixed methods of data collection and analysis were used. Data were gathered from several secondary sources and from 11 key informants using semi-structured interviews and 501 household and 26 health-facility surveys using questionnaires mounted on Open Data Kit. Lot quality assurance sampling and probability to population size methodology were used to size the samples and identify survey locations. Odds ratio analysis and logistic regression analysis were conducted to gauge the statistical association between the determinants and the coverage of immunisation. The main finding that was reached on the basis of the documents reviewed and the feedback received from the key informants was that they were gender blind at worst and gender neural at best. Most of the current strategies give little attention to socio-economic and gender barriers. Over 40 immunisation variables were identified. The analysis, particularly using the 2x2 odds ratio, yielded mixed results. The majority of the variables exhibited a close statistical association as far as immunisation indices were concerned. These variables included urban residency, married couples, literacy, birth at a health facility, antenatal care experience, vaccination card possession, immunisation knowledge, child health information, non-farming earnings, socio-economic status and tolerance of spouse beating. On the other hand, variables that were found to have no statistical significance included sex, marital status, marriage type, age, religion, tetanus toxoid (TT) vaccination and adequacy of income. Immunisation and gender are intertwined, particularly because of mothers’ biological and social attachment to their children. At the same time, conducting vaccination avails the opportunity to access almost all households. Moreover, it is important to recognise that socio-economic and gender determinants are not totally in control of one ministry. Single agenda interventions will not produce the desired result. A paradigm shift and the concerted effort of various sectors and partners are required. Therefore, the Nigerian government should galvanise the relevant stakeholders to bring gender and socio-economic variables into the mainstream throughout the immunisation ecosystem and to implement integrated development initiatives by prioritising vulnerable communities.
Ugonyo yindlela engcono yokungenela kwezempilo yabantu engathela esivivaneni ekufinyeleleni izinhloso zentuthuko eqhubekela phambili ezaziwa ngelokuthi yi- Sustainable Development Goals (SDGs). Cishe izingane ezifinyelela ku 40% ezingaphansi kweminyaka emihlanu zibulawa yizifo ezivimbelekayo ngomgcabo emitholampilo eNigeria. Ukugonya njalo kusezingeni eliphansi eNigeria, laphokhona ukwengamela kuzwelonke kulinganiselwa ku 33%, ngokuya kocwaningo olwenziwe phakathi kuka 2016-2017. Ucwaningo lokuthola ubufakazi lwalunenhloso yokubona imithelela yezesimo sabantu nomnotho (socio-economic) kanye nobulili ngokugonya kwi-Federal Capital Territory (FCT) ukubona amagebe kanye nokutholakala kwezixazululo. Amamethodi axubene okuqokelela ulwazi kanye nohlaziyo kwasetshenziswa. Ulwazi lwaqokelelwa ngokufunda imithombo yemibhalo (secondary sources) kanye nakubantu ababalulekile abanolwazi (key informants) abangu 11 ngokusebenzisa ama-semi-structured interview kanye nemizi engu 501 kanye namasurvey amafasilithi ezempilo angu 26 ngokusebenzisa uhla lwemibuzo yamaquestionnaire ebifakelwe kwi-Open Data Kit. Kwasetshenziswa nemethodi ye-Lot quality assurance sampling ne-probability, ngemethodoloji yobuningi babantu, ukwenza usayizi wamasampuli kanye nokubona izindawo okumele kwenziwe kuzo ama-survey. Kwenziwa nohlaziyo lwe-Odds ratio analysis kanye ne-logisic regression analysis ukubona ukuhambelana kwamastatistiki phakathi kwezinto eziwumthelela kanye nokunaba kongamelo lokwenziwa kogonyo. Okukhulu okutholakele ngokulandela amadokhumende okufundwe kuwo, kanye nezimpendulo ezivela kulabo abanolwazi ababalulekile (key informants) kube wukuthi bekungaboneleli ubulili (gender blind) kanti futhi bekungachemile ngokulandela ubulili (gender neutral) ngezinga elibi nangokungcono kakhulu. Amasu amaningi amanje awanakekeli kakhulu izihibe ezimayelana nabantu nezomnotho kanye nezobulili. Kwaphawulwa cishe izinto ezehlukene zama-variable ezingu 40 mayelana nogonyo. Uhlaziyo, ikakhulukazi ngokusebenzisa i 2x2 odds ratio, lwaveza imiphumela exubene. Ezinto zama-variable ehlukene eziningi zikhombise ukuhlobana phakathi kwamastatistiki mayelana namaindices ogonyo. Lama variable, abandakanye ukuhlala emadolobheni, abantu abashadile, ikhono lokubhala nokufunda, ukuzalwa kwezingane kumafasilithi ezempilo, izipiliyoni zonakekelo lwengane ngaphambi kokuzalwa, ukuba nekhadi lomgcabo ix wasemitholampilo, ulwazi ngogonyo, ulwazi ngempilo yengane, ukuthola imali ngemisebenzi engeyona eyokulima, isimo sabantu mayelana nezomnotho, kanye nokuqinisela ukuhlukunyezwa ngokushaywa kwabesimame. Kanti ngakolunye uhlangothi, ama-variable atholakale engenakho ukubaluleka ngokwamastatistiki, abandakanya ubulili, isimo ngokomendo, inhlobo yomendo, iminyaka yobudala, inkolo, umgcabo we-tetanus toxoid (TT), kanye nokwenela kwengeniso lemali. Ugonyo kanye nobulili kuyangenelana nokuhambelana, ikakhulukazi ngenxa yokusondelana komama kanye nezingane zabo. Ngaso leso sikhathi, ukwenziwa kogonyo kuhlinzeka ngethuba lokufinyelela cishe kuwo yonke imizi eminingi. Nangaphezu kwalokho, kubalulekile ukwamukela ukuthi isimo sabantu mayelana nezomnotho kanye nobulili kuyizinto ezinomthelela, azinalo ulawulo oluphelele kumnyango kangqongqoshe owodwa. Ungenelo ngento eyodwa ngeke kwaveza imiphumela efiswayo. Ukugudluka ngokomqondo (paradigm shift), kanye nemizamo eqhubekela phambili yemikhakha ehlukene kanye nabasebenzisani kuyadingeka. Ngakho-ke uhulumeni waseNigeria, kumele agqugquzele ababambiqhaza abafanele ukuhlanganisa nokufaka emkhakheni ofanele izinto ezimayelana nabantu nomnotho kanye nobulili, kuyo yonke inqubo yokusebenzisana kwemikhakha okumele isebenzisane nehlangene ukusebenza ngokulandela inqubo yentuthuko ehlangane ngokubonelela imiphakathi ekwizimo ezibucayi
Development Studies
D. Phil. (Development Studies)

This chapter examines the ethical issues related to the practice of health care in an environment where human rights are absent, specifically relating to the conditions for refugees and asylum seekers who arrive by sea in Australian territory. The ethical considerations of working within the offshore detention environment are discussed. Health-care workers in these harsh environments often have divided loyalties, when duties to their patients conflict with duties to their employer or to the state. The author draws on published accounts and interviews with health-care providers who have worked on Manus Island and Nauru and Christmas Island, the sites used by Australia for offshore detention of asylum seekers.