CONTENTS Executive Summary Abbreviations Introduction Profile of ACT Women Profile of current health services and initiatives for women

Transcription

1 Improving women s access to health care services and information: A Strategic Framework

2 Accessibility The ACT Government is committed to making its information, services, events and venues, accessible to as many people as possible. If you have difficulty reading a standard printed document and would like to receive this publication in an alternative format such as large print or audio please telephone (02) If English is not your first language and you require the translating and interpreting service please telephone If you are deaf or hearing impaired and require the TTY typewriter service please telephone (02) , then ask for Speak and listen users phone then ask for Internet Relay Users connect to the NRS, then ask for Australian Capital Territory, Canberra July, 2010 This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part may be reproduced by any process without written permission from the Territory Records Office, Community and Infrastructure Services, Territory and Municipal Services, ACT Government, GPO Box 158, Canberra City ACT Enquiries about this publication should be directed to ACT Health, Communications and Marketing Unit, GPO Box 825 Canberra City ACT 2601 or HealthACT@act.gov.au Enquiries: Canberra 13ACT1 or

3 CONTENTS Executive Summary 1 Abbreviations 3 1. Introduction Purpose and Scope of the Framework Vision for Women s Health Key Principles Key Drivers for Change 8 2. Profile of ACT Women Demography Health Status of ACT Women Aboriginal and Torres Strait Islander Women Women from Culturally and Linguistically Diverse Backgrounds Women living with a Disability Profile of current health services and initiatives for women Health services for women in the ACT The Women s and Children s Hospital Community Based Services Maternity specific services Services for Aboriginal and Torres Strait Islander Women Local and National existing and planned health initiatives for women Planning services for women Key Strategic Objectives Implementation Plan Improving women s access to services and information Implementation Plan Examples of framework implementation from other ACT Health Plans that impact on Women s Health Outcomes Bibliography Glossary of terms 35 Appendix 1: Women s Health Framework consultation participants 40 Appendix 2: Policies and planning context 42 Appendix 3: Health Services Snapshot Facilities and programs for women 48 Appendix 4: Health services for women Profiling workforce challenges 60 Appendix 5: Challenges identified from consultations 62 Appendix 6: Proposed ACT Women s Health Advisory Network representation 65 Appendix 7: Aboriginal Health Impact Statement 66

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5 EXECUTIVE SUMMARY Women are a vital part of the ACT community. Improving the health status of ACT women is key to achieving the ACT Government s vision of the ACT as a strong, inclusive community that supports opportunities for all. Generally women in the ACT enjoy good health with ACT women achieving similar or better health outcomes than women in the rest of Australia. The Strategic Framework: Improving women s access to health care services and information informs the directions for the delivery of health services to women of the ACT up to Improving women s access to health care services and information not only benefits women but also the whole community through the different and diverse roles that women play in the community. For disadvantaged and vulnerable women, improving access to health services is a significant contributor to improved health outcomes. The vision of the Framework for 2015 is that: Women s access to and satisfaction with health care services and information allows them to maintain their health and wellbeing. The Framework provides the vision and principles for planning health services for women in the ACT and provides a process for ensuring that the distinct needs of women are addressed. Significant changes are occurring in the health sector and there is the potential for programmes and initiatives to be better planned, coordinated and delivered to maintain the higher level of health generally enjoyed by women of the ACT and improve the health and wellbeing of individual women who interact with the health system. The Framework recognises that innovative approaches are necessary to target and improve the health outcomes of women who are disadvantaged including women from Aboriginal and Torres Strait Islander backgrounds, those living with a disability and women from culturally and linguistically diverse backgrounds. The following drivers for change will affect the provision of health services for women in the future: Population growth and population ageing; Understanding and working with women s changing expectations; Changes in the organisation and delivery of services; Changes to the National Policy context; New and emerging technologies; Women and their role as carers; Supporting healthy lifestyles to enhance positive health outcomes; Preventing violence against women; The need for a sustainable workforce. The primary purpose of the Framework is to improve the health outcomes of women in the ACT by presenting a plan that health service planners and providers can utilise to improve and facilitate women s access to health care services and information. Therefore a number of high level objectives have been identified. They are: Incorporating gender mainstreaming across service delivery areas where appropriate supported by workforce development initiatives, evidence based research and the use of emerging technology. Ensuring that policies, guidelines, models of care and strategies are implemented to improve the delivery of health services to women. Improving women s access to health care services and information: A Strategic Framework 1

6 Forming effective and collaborative partnerships between ACT Health and women, other government agencies, non government organisations, General Practitioners and private health service providers to flag and address gaps in service delivery to women. Facilitating timely access to the care required by women across the continuum of care, from hospital to community based settings. Improving and integrating the coordination and roll out of health promotion, illness prevention, early intervention and health maintenance initiatives to women using a social determinants of health framework. The implementation plan outlines a number of actions for ACT Health to instigate for achieving the objectives. ACT Health has committed to collaborate with health care providers, non government organisations and consumers to ensure that all planning is directed to respond to the distinct health care needs of women of the ACT. 2 Improving women s access to health care services and information: A Strategic Framework

7 ABBREVIATIONS ABS AHMAC AHP AHS AIHW ALP ALWHS AMAP AMWAC BOS CADP CALD CEDAW CF&YH CH CHI CJJH CMP CYWH DoHA ED EMR FGM FTE GIS GSAHS HDA HPV IMU MaCH MAP MAPU MSC NCPH NHPAC NHS PHRC RANZCOG SAHS SHFPACT TCH TFR USC W&CH WCHM WHO WHP Australian Bureau of Statistics Australian Health Ministers Advisory Council Allied Health Professional Aboriginal Health Service Australian Institute of Health and Welfare Australian Labor Party Australian Longitudinal Women s Health Survey Aboriginal Midwifery Access Program Australian Medical Workforce Advisory Committee Birth Outcomes System Capital Asset Development Plan Culturally and Linguistically Diverse Convention on the Elimination of Domestic Violence against Women Child, Family and Youth Health Calvary Hospital Community Health Intake Calvary John James Hospital Canberra Midwifery Program Child, Youth and Women s Health Department of Health and Ageing Emergency Department Electronic Medical Records Female Genital Mutilation Full Time Equivalent Gender Impact Statement Greater Southern Area Health Service Health Direct Australia Human Papilloma Virus Information Management Unit Maternal and Child Health Midwifery Access Program Medical Assessment and Planning Unit Maternity Shared Care National Capital Private Hospital National Health Priority Action Council National Health Service (UK) Population Health Research Centre Royal Australian and New Zealand College of Obstetricians and Gynaecologists Southern Area Health Service Sexual Health and Family Planning ACT The Canberra Hospital Total Fertility Rate Usual Source of Care Women s and Children s Hospital Women s Centre for Health Matters World Health Organisation Women s Health Plan Improving women s access to health care services and information: A Strategic Framework 3

8 SECTION 1: ACT WOMEN S HEALTH FRAMEWORK 1 Introduction ACT Health recognises the importance of a social view of health and wellness. This view is supported by the World Health Organisation (WHO), defining health as a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity. 1 The health issues experienced by women and girls are different to those experienced by men and boys. There are specific health related conditions and issues where females (girls and women) are uniquely affected or disproportionately affected compared to males (men and boys). Each planning process within ACT Health addresses the impact of services on the community, but to date plans have not systematically addressed the inequalities arising from gender differences and diversity and between different groups of women. Some health issues experienced by women require different approaches to the way health services are currently organised and delivered. Consequently, ACT Health will adopt a gender specific planning framework to ensure that women s and men s experiences are accounted for in planning, facilitating access to services and information and improving delivery of health services. Initially, the principles in this framework are being implemented alongside the ACT Government s Capital Asset Development Plan (CADP) that includes the establishment of a dedicated women s and children s hospital, enhanced and generalist community health centres serving the local catchment area, supported by developing innovative models of care. A framework devoted to men s health will also be developed. The concept of gender specific frameworks notes that women and men have different life experiences, needs, levels of power, access to information from varied sources to assist decision making and ways of expressing illness. Those differences impact on the way that men and women interact with health services. Consequently these define what are considered appropriate interventions for women and men. ACT Health proposes to work in collaboration with the ACT Office for Women to pilot a Gender Impact Statement (GIS) in an area of ACT Health. GIS is about assessing ways in which ACT Health can better understand and respond to the distinct needs of women and men. The development of the Framework has been overseen by a steering committee. The Framework incorporates the perspectives and expertise of relevant service professionals, non government organisations, consumers and carers as well as a reference network (see Appendix 1). Two rounds of consultation were undertaken. The information gathered together with available data and research, has led to the creation of the ACT Women s Health Framework. The title of the Plan was subsequently changed from a Plan to a Strategic Framework to reflect the overarching directions adopted. Women s health outcomes are impacted by local and national initiatives (refer to Chapter 3). The initiatives will continue to evolve during the implementation of the Framework. ACT Health will establish the Framework s advisory network to monitor the development of those initiatives, adapt and adopt new strategies and respond to evolving local and national directions to enhance women s health outcomes. 1 World Health Organisation (1988) From Alma Ata to the year Reflections at the midpoint, WHO, Geneva 4 Improving women s access to health care services and information: A Strategic Framework

9 1.1 Purpose and Scope of the Framework The Strategic Framework: Improving women s access to health care services and information is an overarching planning document that outlines the strategic directions (long term objectives) and initiatives (local actions listed in Chapter 5) to be adopted by ACT Health for enabling and enhancing women s access to and satisfaction with health care services and for providing clear information about health services. The target group for this framework is females aged 12 years and over. Research has demonstrated that the health needs of women differ through stages of their lifecycle. These needs are being addressed through various ACT Health service planning processes such as the Mental Health Services Plan Four life stages developmental model, Rehabilitation and Aged Care Services Plan and will be considered in the development of Gender Impact Statements. Currently health services for women are delivered in a range of settings. Some services are provided only for women, by women, and these services will continue to be provided. This Framework does not provide for additional health services exclusively for women but rather presents a gender sensitive planning process to better understand the distinct needs of women so that health service planners and providers can respond appropriately and effectively. Specific illnesses, medical conditions, services and facilities are not the primary focus of this framework as they are the subject of other planning processes across ACT Health (see Chapter 3.6). Similarly, children s and neonatal services are not included in the scope of this Framework even though these services overlap with services for women. These areas warrant their own plan development to adequately meet the diverse needs of people they affect. The Health Status of Women in the ACT 2 profiled the current demographic status and health issues relevant to women in the ACT. The analysis of other key policy and planning documents has informed the development of the Framework (see Appendix 2). A number of key drivers for implementing change were identified to guide decisions on how services should be planned in the future. This planning framework contains a set of key principles and objectives which will assist service providers to develop a more inclusive, gender sensitive and ACT wide approach to the planning of health services for women. An implementation/action plan (refer to Chapter 5) articulates some preliminary initiatives and actions to achieve the overall vision of the framework. This Framework will evolve in response to: A better understanding of the changing needs of women of the ACT; Emerging evidence based practice and new models of care; Capital infrastructure (building) redevelopment; and Improved understanding and monitoring of health issues and risk factors affecting the health status of women. Implementation of the Framework will be monitored and evaluated by ACT Health through the establishment of a Women s Health Advisory Network with membership from across representative groups. 2 ACT Health (2008) Health Status of Women in the ACT, Health Series no.46, ACT Government, Canberra. Improving women s access to health care services and information: A Strategic Framework 5

10 1.2 Vision for Women s Health The vision for women s health is that: Women s access to and satisfaction with health care services and information allows them to maintain their health and wellbeing. 3 To achieve this vision, the Framework: Promotes the recognition of the gender specific (distinct) needs of women; Highlights the need to develop effective and responsive policies, programs and services to meet the distinct needs of women; Encourages participation of women in making decisions about their own health care; Facilitates discussion on topics relevant to the planning of services for women; Articulates a long term (principles and objectives) and short term (actions) plan to improve health services for women; Provides a coordinated framework that can easily be adopted by all service delivery areas across ACT Health that provide services for women; Communicates the importance of health literacy 4 and finding clear health care service related information; Recognises and responds to the impact of violence against women; and Recognises and responds to the social determinants of health. Through the Framework and other ACT Health planning and implementation processes, ACT Health will work to ensure that appropriate health services are accessible to women, at all stages of their life. ACT Health will promote and facilitate collaboration and partnerships with external providers, services and organisations including General Practice. ACT Health is committed to improving and facilitating women s access to basic health services in safe environments when and where they need the services. ACT Health services may be delivered at home, through community health centres, child health services or hospitals. 3 Vision adapted from the ACT Women s Plan (2004). 4 Health Literacy Glossary of terms (Chapter 7) 6 Improving women s access to health care services and information: A Strategic Framework

11 1.3 Key Principles The Framework is based on a gendered approach that is inclusive of a social view of health and accounts for the diversity in women s experiences. As gender is a major determinant of health and wellbeing, this framework will help service planners and providers to improve women s access to services and information. The delivery of safe and quality services for women will be guided by the following principles supporting a sustainable and modern health system of the future. Women centred services will be responsive to gendered psychosocial and cultural differences and individual needs. Services will be provided by a competent workforce in an integrated multidisciplinary and multi-agency setting. (The principles of multidisciplinary care include team work, communication and accountability, best practice standards of care and involvement of the patient and their carers). Professional, innovative and evidence based services will be supported by the latest research findings and emerging technologies and provided in a patient oriented service environment. (Evidence-based practice is an approach to decision-making that integrates the best available evidence with clinical expertise. Guided by their expertise, and in consultation with patients and their families, clinicians use the best information from research to choose the most appropriate care for each patient). Safe and quality services are provided in an appropriate care environment. (The health system delivers safe and effective care to large numbers of patients each year. However it is not risk free. A safe and quality service encourages open and honest communication and encourages developing a culture of continuous quality improvement). Services will utilise care pathways to facilitate access to and continuity of care for all women who require care while maintaining flexibility in service provision. (Coordinated linkages and communication pathways are required across all levels and types of services). Services will facilitate equitable access and reduce inequalities in health for all women. Provision of affordable health services that seek to eliminate economic or demographic discrimination. Improving women s access to health care services and information: A Strategic Framework 7

12 1.4 Key Drivers for Change Planning for health services is based on a projected demand for services, the priorities of the local community and the context of the system in which it will be delivered. The following are drivers for change in the provision of health care services for women of the ACT. Population growth and population ageing In 2006, there were 164,379 women living in the ACT. 5 This figure is projected to grow to close to 186,000 by The ACT and surrounding population is also ageing with significant increase in the over 65 age group, primarily the result of the larger baby boom cohorts gradually shifting into the older age groups. Understanding and working with women s changing expectations The Australian Longitudinal Women s Health Study (ALWHS) which began in 1995 found that there are changes in women s expectations and those of the general population about the health services they receive and use. 6 In general, women are more likely to use health care services throughout their lives, yet have lower incomes and fewer resources than men. Women nowadays have better access to birth control, post-school education and a greater variety of paid work. These changes have a significant impact on the role of women. 7 Women s roles as carers and advocates for family members also impacts on their expectations in the planning, design and the delivery of health services. Changes in the organisation and delivery of services The redesign of healthcare systems provides new ways of organising services to facilitate continuity of care for women and in assisting their return to the community after hospitalisation. 8 Women want client focussed service delivery and ease of access to services when and where they need them. Changes to the national policy context The Australian Government has committed to ensure that the planning and delivery of health services better meets the needs of Australian women through the development of gender focussed national health policies. The National Women s Health Policy which will be released in 2010 will focus on prevention, health inequalities in our society and the social determinants of health inequalities. A national review of maternity services was completed in A strategy from the recommendations of the Report resulted in the budget package, Providing More Choice in Maternity Care Access to Medicare and PBS for Midwives. 9 5 ACT Health (2008) Health Status of Women in the ACT. Health Series Number 46. Population Health Research Centre, Population Health Division. (Source, 2006 Census Tables ACT) 6 The Australian Longitudinal Study on Women s Health. Reports downloaded on 7 Australian Bureau of Statistics Australian Social Trends, People in their 20 s: Then and now, ABS, Canberra. 8 ACT Health (2007) access health healthcare for all in the ACT, ACT Government, Canberra 9 *Australian Government (2008) Developing a women s health policy for Australia Setting the scene. *Providing more choice in maternity care access to Medicare and PBS for Midwives. 8 Improving women s access to health care services and information: A Strategic Framework

13 New and emerging technologies Advances in technology have improved longevity and are driving major changes in the delivery of health care services. Technologies in the areas of diagnoses, treatment, remote monitoring and communication are improving access, knowledge, client involvement, satisfaction and other benefits to clients. Electronic Medical Records (EMR) and Electronic Health Records are on the health agenda. EMR will support fast clinical decision-making, reduce re-testing and support communication between women and their health professionals. 10 Health literacy differs amongst women. Increased access to information at specific decision milestones, through a range of media as well as improved commitment from clinicians to use emerging technologies should make a difference in health literacy. The challenge for service providers is to seek new ways in which they engage women to use emerging technologies and be more involved in decision making. Women and their role as carers As care is shifted from hospitals to the community and in people s homes, women are particularly affected as they make up a large proportion (estimated close to 70%) of family caregivers. 11 The caring role of women is expanding; it does not only include children, but also ageing parents and significant others. 12 Access to flexible health services (when, where and by whom the service is provided) will better enable women to meet these increasing demands. Supporting healthy lifestyles Greater emphasis is being placed on health promotion and illness prevention across the health sector to: Improve the management of several health risk factors; 13 Prevent avoidable health conditions; Address the increased incidence of chronic (long term) conditions; and Improve the health and wellbeing of the community. 14 ACT Health recognises that not all health conditions can be prevented but many people can be supported to self manage the risks that may lead to chronic conditions. 10 Centre for Connected Health (2008). Growing evidence of the benefits of technology to improve patient satisfaction and empowerment downloaded on 11 *Bereck.J, Lucke.J, Hockey.R, Dobson.A (2008) Transitions into informal care and out of paid employment of women in their 50 s: A study of cause and effect, Social Science and medicine, (1): *Lee.C, Gramotnev.H (2007) Transitions into and out of caregiving: Health and social characteristics of midage Australian women, Psychology and health (2007); 22 (2): Carers ACT (2008) The Australian Capital Territory in A glimpse of the future for Carer, Carers ACT, Canberra. 13 Lucke.J, Waters.B, Hockey.R, Spallek.M, Gibson.R, Byles.J, Dobson.A (2007) Trends in women s risk factors and chronic conditions: Findings from the Australian Longitudinal Study on Women s Health, Women s Health, 2007: 3 (4) *Chief Minister s Department (2004) ACT Women s Plan, ACT Government, Canberra. *ACT Health (2006) The ACT Primary Health Care Strategy , ACT Government, Canberra. *Australian Government (2007) The Australian Government Policies on Women s Health. *ACT Health (2008) ACT Chronic Disease Strategy , ACT Government, Canberra. Improving women s access to health care services and information: A Strategic Framework 9

14 Preventing violence against women Every Australian woman, man and child has the right to live free from violence in a safe and supportive home and community. These rights are clearly outlined in the Convention on the Rights of the Child and the International Convention on the Elimination of all Forms of Discrimination against Women (CEDAW) 15, to which Australia is a party. Violence affects women from all cultural and socioeconomic backgrounds across all life stages. Violence against women takes many forms including physical, sexual, financial, emotional and psychological abuse and can occur in the home, community or in institutions. The health impacts can be severe and long lasting. 16 Women who have been exposed to violence have a greater risk of developing a range of health problems including stress, anxiety, depression, pain syndromes, phobias, somatic and medical symptoms. 17 There must be capacity in the health sector to screen for, respond to and treat cases of domestic violence, gender-related violence and rape to minimise the health impacts and long term negative health outcomes. The need for a sustainable workforce Sustaining levels of healthcare provision at current levels, further expanding some services and introducing new services will require substantial workforce redesign and modernisation. A workforce that is fit for purpose, ie one that meets the healthcare needs of the population, is skilled to provide the services required and implements safe and effective models of care, needs to be planned well in advance. At the end of June 2008, women comprised 78% of ACT Health s workforce of which 63% were nurses and other health professionals. 59% of ACT Health s female workforce were 40 years and over. 18 In many areas, access to female providers is an important determinant of women s health service utilization patterns. A workforce profile for specific services for women in the ACT has been completed and work has begun on projecting a workforce of the future based on the models of care review and redesign of ACT Health service delivery. 19 A major review of the ACT GP workforce was completed in 2009 and the recommendations are being addressed by the ACT Government. 15 Commonwealth Office of the Status of Women (2003) Australia s combined fourth and fifth reports to the United Nations on the Convention on the elimination of all forms of discrimination against women. 16 *Taft.A, Watson.L (2008) Depression, pregnancy termination and births among young Australian Women: The confounding effect of partner violence. Australian Longitudinal Study Women s Health Australia BMC, Public Health (2008) 8 (1):75. *Australian Women s Health Network (2008) Women s Health: The New National Agenda. *Astbury, J et al (2000) The impact of domestic violence on individuals, Medical Journal of Australia 2000; 173: Victorian Dept of Health (2004) The health costs of violence. Measuring the burden of disease caused by intimate partner violence. Department of Human Services, Melbourne. 18 ACT Health (2008) ACT Health Annual Report , ACT Government, Canberra 19 Appendix 5 Workforce Profile of women services. ACT Health Workforce Policy and Planning Unit. 10 Improving women s access to health care services and information: A Strategic Framework

15 2. PROFILE OF ACT WOMEN 2.1 Demography In 2006 there were just over 164,000 women living in the ACT, an average increase of 0.9% per annum since Women comprised 50.7% of the total ACT population in 2006 with 140,317 women and girls aged 12 years and over, representing 85.4% of the female population. 20 Analysis of data from the Health Status of Women in the ACT shows that: The ACT female population is increasing most rapidly in the 50 to 69 year age group. From 1996 to 2006 the size of this age group increased by 5.3% per annum compared with an overall population increase of 0.9% per annum. The ACT fertility rate has increased in recent years. There is a trend towards older women giving birth. Women are traditionally over-represented in the lower socio-economic groups (low wages, single parents). In May 2007, ACT women had lower average earnings than men. One in ten ACT females reported that they encountered times when food ran out and there was no money to buy more. The most common causes for female mortality were heart disease and cerebrovascular disease (stroke). For younger women aged years the most common causes of death were intentional self-inflicted injury and accidental injury. For women aged years, the most common causes of death were breast and lung cancers and for women aged 65 years and over the most common causes of death were heart disease and cerebrovascular disease. The ACT has the highest life expectancy at birth of all other states and territories. Life expectancy for ACT females for the period rose slightly from previous projections to 84 years. 21 By 2015, life expectancy at birth is projected to be 86.5 years for females. 22 Changes to the size and composition of the ACT female population over time will have implications for health service planning. The female ACT resident population is expected to grow from the projected 171,475 persons in 2007 to 185,875 persons in Over this period, most of the growth is expected to continue in older age groups consistent with the current age structure and women will represent 50.4% of the population. The ageing of the population impacts on health care provision and health care utilisation. 2.2 Health Status of ACT Women Whilst the health of women in the ACT is generally good and their life expectancy has increased, major health risk and issues still exist. Figure 1, from the Health Status of Women in the ACT, outlines issues and demographic and health status characteristics that will contribute to their health service needs ABS, 2006 Census Tables, Cat. No , ACT 21 ABS, Life Tables, Australian Capital Territory, ACT Health (2008). ACT Chief Health Officer s Report Population Health Division. 23 ACT Government (2009) ACT Population Projections for suburbs and districts 2007 to Chief Minister s Department. 24 ACT Health (2008) Health Status of Women in the ACT, Health Series no. 46, ACT Government, Canberra Improving women s access to health care services and information: A Strategic Framework 11

16 Figure 1: Issues from the Health Status of Women in the ACT (2008) Women Breast cancer was the most common cancer diagnosed in ACT followed by colorectal cancer and skin melanoma. The most common causes of death from cancer among women were breast cancer, colorectal cancer and lung cancer. Notification rates of chlamydia infections for women have increased since The rate of notifications in the ACT has been higher than the Australian rate since Half of female ACT Aboriginal and Torres Strait Islander residents reported being current smokers (49.4%). Almost half of ACT Aboriginal and Torres Strait Islander women reported that they smoked during pregnancy (42.9%). The percentage of low birth weight babies was significantly higher for Aboriginal and Torres Strait Islander women compared with non-aboriginal women. Participation of ACT women in the National Cervical Screening Program in was 65.5%, significantly higher than the Australian participation rate. THE HEALTH STATUS OF WOMEN IN THE ACT (2008) BreastScreen Australia aims to achieve 70% participation in breast screening for women aged 50 to 69 years. The participation rate for ACT women in was 55.2% (Australia 56.2%). Women were more likely than men to report having a mental health condition such as depression and anxiety. They were also more likely to report high to very high levels of psychological distress. An ACT study found that one in ten women had postnatal depression at eight weeks post partum and 17.3% had postnatal depression over a six months post partum follow-up. Arthritis, asthma, chronic obstructive pulmonary disease and cardiovascular disease were the most prevalent chronic health conditions reported by ACT women. Almost one third of people with a disability had problems accessing service providers, compared with 14.2% of ACT residents without a disability. This includes problems accessing transport. ACT women were most likely to require hospitalisation for obstetrics, gynaecology and orthopaedics than for other causes. Almost one third of outpatient occasions of service provided to women were for obstetrics in , followed by radiology, oncology and endocrinology. The proportion of caesarean sections was higher in private hospitals than in public hospitals (40.3% versus 27.1%). The rate of caesarean section births has increased from 21.7% in 2000 to 28.9% in However, the ACT percentage remains lower than that of Australia (30.3%) as a whole. Women were less likely to smoke or consume alcohol at risky levels than men. However, women were more likely to be obese and to have insufficient levels of physical activity. Only one in ten women consumed sufficient vegetables to meet nutritional guidelines. 12 Improving women s access to health care services and information: A Strategic Framework

17 Other relevant Australia wide statistics pertaining to women s health: The National Health Survey 25 indicated that 88% of children aged 0 3 years had been breastfed, a similar proportion to 2001 and 1995 (87% and 86%, respectively) (AIHW 2007b). The National Health and Medical Research Council dietary guidelines 26 suggest that it is an achievable goal to have 80% of Australian mothers still breastfeeding their child at 6 months (NHMRC 2003a). In 2001, less than half (48%) of all infants were receiving any breast milk at the age of 6 months, and none were being fully breastfed that is, receiving only breast milk (and not breast milk substitutes or solids). 27 Domestic violence is a major factor contributing to homelessness in Australia, particularly for women. Female SAAP clients and children escaping domestic and family violence reports that in , approximately 33% or 32,700 of the 100,200 clients accessing the Supported Accommodation Assistance Program (SAAP) were women escaping domestic violence. Aboriginal and Torres Strait Islander women make up 2% of the female Australian population but indigenous women made up 24% of the female SAAP clients escaping domestic violence in The development of the Health Status of Women in the ACT profile highlighted that there are difficulties in accessing ACT health service utilisation data about specific population groups in our community such as women in same sex relationships, women living with disabilities and women who have experienced violence. The absence of data poses a challenge for adequate responding and planning services to meet the distinct needs of specific population groups. A recommendation from this planning process is that gendered analysis should be undertaken across all services provided and funded by ACT Health to support future decision making. 25 Australian Institute of Health and Welfare (2007b) National Health Survey. 26 NMHRC (2003a) Dietary Guidelines. 27 Australian Institute of Health and Welfare (2008) Australia s Health 2008, no index.cfm/title/ Female SAAP clients and children escaping domestic and family violence Improving women s access to health care services and information: A Strategic Framework 13

18 2.3 ABORIGINAL AND TORRES STRAIT ISLANDER WOMEN There were 1,942 women who identified as Aboriginal and Torres Strait Islander in the 2006 Census, representing 1.2% of the ACT female population. Aboriginal and Torres Strait Islander people living in the ACT continue to experience poorer health outcomes and shorter life expectancy than non-aboriginal ACT residents. 29 Just over half (51.6%) of Aboriginal people who responded to the National Aboriginal and Torres Strait Islander Health Survey reported three or more long term conditions. 30 The most frequently reported long term conditions were eyesight problems (37.9%) and asthma (18%). At a national level it has been noted that social conditions associated with Aboriginal and Torres Strait Islander pregnancy include high rates of smoking, alcohol ingestion, domestic violence and teenage pregnancy. 31 These issues often occur with medical problems including hypertension, gestational diabetes and rheumatic heart disease. During , 240 Aboriginal and Torres Strait Islander women in the ACT gave birth to 246 babies. Aboriginal and Torres Strait Islander women are giving birth at younger ages and the percentage of low birth weight babies (less than 2,500 grams) born during 2000 to 2004 was significantly higher when compared with birth weights of babies of non-aboriginal and Torres Strait Islander women. Aboriginal and Torres Strait Islander people are more likely to require hospital treatment for many conditions at significantly younger ages than non-aboriginal and Torres Strait Islander people in the ACT. The most frequent reasons for hospitalisation of ACT Aboriginal and Torres Strait Islander people are pregnancy and birth, digestive system disorders, injury and poisoning, mental and behavioural disorders. An Aboriginal Health Impact Statement was completed in accordance to ACT Health s Policy. A copy is attached as Appendix ACT Health (2007) The Health of Aboriginal and Torres Strait Islander People in the ACT , Population Health Research Centre Health Series Number ACT Health (2008) Health Status of Women in the ACT, ACT Government, Canberra. 31 Australian Institute of Health and Welfare (2008) Australia s Health 2008, no index.cfm/title/ Improving women s access to health care services and information: A Strategic Framework

19 2.4 WOMEN FROM CULTURALLY AND LINGUISTICALLY DIVERSE BACKGROUNDS The 2006 ABS census showed that 21.7% of ACT residents were born overseas. 32 Table 1 indicates the core countries of origin and most common languages spoken. Table 1: Diversity of residents in the ACT in 2006 Countries of Origin England 4.0% New Zealand 1.2% China 1.1% India 0.8% Vietnam 0.7% Common languages spoken other than English Mandarin 1.1% Italian 1.1% Vietnamese 0.9% Cantonese 0.9% Greek 0.8% Women from Culturally and Linguistically Diverse (CALD) communities cannot be considered as one homogenous group. ACT Health recognises the specific needs of women from CALD background as they attempt to adjust to new social and health care structures. The health care needs of older women who came to Australia following World War II and the needs of humanitarian entrants over the past decade are quite different. Their health needs and expectations are based upon from their pre-arrival experiences, their country of origin, cultural background and availability of supportive networks. Their health care needs and services available have been further explored and documented in Appendix Australian Bureau of Statistics (2006) Census of Population and Housing: Media Releases and Fact Sheets, ABS, Canberra. Improving women s access to health care services and information: A Strategic Framework 15

20 2.5 WOMEN LIVING WITH A DISABILITY Some form of disability affects about one in five Australians. In the context of health experience, disability may refer to impairments, activity limitations and participation restrictions. ACT Health recognises that women with disabilities are another marginalised group of women. ABS data suggests that in 2003, around 6% of ACT women (9,600 women) had a profound or severe core activity limitation. In terms of service access, 8.4% of people with a core activity limitation could not, or had difficulty, in getting to the places they needed to go, compared with 1.4% of the population without a disability. Additionally, 29.3% of people with a core activity limitation had problems accessing service providers, compared with 14.2% for ACT residents without a disability or long term health condition. Issues in terms of transport, social isolation and income poverty are significant for women living with a disability. 16 Improving women s access to health care services and information: A Strategic Framework

21 3. PROFILE OF CURRENT HEALTH SERVICES AND INITIATIVES FOR WOMEN 3.1 Health services for women in the ACT ACT Health currently offers a diverse range of programs which provide services to women through its service delivery divisions as illustrated in Figure 2. Services are also provided in partnership with other government and non-government organisations through contractual arrangements (See Appendix 3). Due to the number of departments and organisations which deliver services to women, it was felt that a framework to guide all activities across ACT Health would be a stepping stone to target women s health issues and improved health outcomes for women of the ACT. Figure 2: Key Service Delivery Divisions ACT Health Clinical Operations Population Health The Canberra Hospital Capital Region Cancer Services Calvary Hospital Aged Care and Rehabilitation Service Community Health Mental Health ACT There are different practical, functional and operational benefits and challenges to the ways that a health service organises its services. It is not only the organisational aspect of services that facilitates or impedes access to its services. Anecdotal evidence suggests that information and education (health literacy) on services, well articulated and documented links and referrals, collaborative partnerships, and effective communication and interventions contribute to women s enhanced access and satisfaction with services. These factors underpin the objectives of this framework. Clear pathways, linkages and communication are required to assist women who need to navigate the health system for themselves and their significant others. They need to understand the words used by health professionals to describe different levels (primary, secondary and tertiary) and types of services (prevention, diagnostic, treatment). Women should be engaged and empowered to actively participate in decisions about their health management plan. Improving women s access to health care services and information: A Strategic Framework 17

22 3.2 The Women s and Children s Hospital The new Women s and Children s Hospital will be built on The Canberra Hospital (TCH) campus. The facility will accommodate a range of women specific, maternity, neonatal intensive care and paediatric hospital and outpatient based services. Women will also continue to access hospital services in other parts of The Canberra Hospital, Calvary Hospital and in the community. The hospital is being planned as a centre of excellence and is underpinned by the following principles derived from clients and service providers consultations. Table 2: Guiding Principles underpinning the construction of the Women s and Children s Hospital Centre of Excellence Principles Meet projected demand for health services Implement evidence based care Achieve performance benchmarks Adopt family centred care framework Adopt developmental care frameworks Provide a suitable environment for improving clinical outcomes Build on research capacity Utilise innovative strategies to recruit, maintain and retain a professional multidisciplinary workforce through the co-location of services, staff and resources Model of Care Principles Facilitate innovation, research and translate research findings into practice Creating equal partnerships with families and collaborating with them at all stages of health care planning, delivery and evaluation Care is delivered in the context of the unique individual needs of the family The physical environment should facilitate a feeling of safety with good visibility, logical flows, comfortable waiting and patient areas Provide research and information resources for clinicians, primary care providers, patients and their carers Integrated and multidisciplinary care and treatment a system which links teams to ensure that all health professionals involved in the care of a patient can participate in the planning for their care Utilise available technologies efficiently 18 Improving women s access to health care services and information: A Strategic Framework

23 3.3 Community Based Services Community based health services are defined as all health services that do not involve admission for an overnight stay in a hospital irrespective of who funds/provides those services or whether these services are curative or preventive. The planning for community based services in ACT Health is guided by the ACT Ambulatory Care Framework which outlines the adoption of fully coordinated ambulatory care services across the ACT that are patient centred, multidisciplinary and collaborative, accessible, safe & high quality, and adopt a population health approach. Central to this framework is the notion that services should be provided as close to the community as is feasible and safe. To accommodate this framework, two enhanced community health centres at Belconnen and Phillip will have additional service capacity. Services at other Community Health Centres including Gungahlin, Dickson, Civic and Tuggeranong will be enhanced to support people in the community or in their homes. The Community Health Centres are complemented by services offered in Child and Family Centres across Canberra. The scope of services in Community Health Centres is broad and the service groups include: Health Promotion and Prevention activities Aged care and rehabilitation services Alcohol and drug counselling Continuing Care Services community nursing, allied health Child, Youth and Women s Services Dental Services for children, youth and adults Breastscreen services Mental Health services Community Chronic Disease management programs Antenatal and other medical and allied health services Renal and Diabetes Services Pathology Collection Service Medical Imaging Services Community Development Services Improving women s access to health care services and information: A Strategic Framework 19

24 3.4 Maternity specific services ACT Health continues its commitment to extending and enhancing primary maternity services. 33 Women in the ACT have access to different models of maternity care which include private obstetric care, shared care, the Canberra Midwifery Program and homebirths (small number provided by independent midwives). 34 Both public hospitals provide a range of maternity and other women specific hospital based services and will continue to do so. The QEII Family Centre provides residential programs for families with young children experiencing difficulties in the postnatal and early childhood periods. In 2008, the Canberra Midwifery Program Demand Analysis Working Group recommended that a whole of service approach should be used to address unmet demand for the Canberra Midwifery Program. 35 This work is currently being undertaken through a process of review and redesign of models of maternity care across antenatal, birthing and postnatal care. At the National Level, the Maternity Services Inter-jurisdictional Committee has recommended extending and enhancing primary maternity service models where women become the focus of the care. 36 In 2008, the Department of Health and Ageing conducted a Maternity Services Review. 37 The review will lead to the development of a national maternity services plan which will inform other strategies to be developed by the proposed Women s Health Advisory Network. 33 Primary Maternity Services Glossary of terms 34 ACT Health (2008) ACT Health Maternity Shared Care Guidelines, ACT Government, Canberra. 35 ACT Health (2008) Report of the Canberra Midwifery Program Demand Analysis Working Group, ACT Government, Canberra. 36 Australian Health Ministers Advisory Council AHMAC (2008) Primary Maternity Services in Australia A framework for Implementation. NSW Health, Sydney. Downloaded from 37 *Department of Health and Ageing (2008) Improving Maternity Services in Australia A discussion Paper from the Australian Government, Commonwealth of Australia, Canberra. *The Report of the Maternity Services Review (2009) 20 Improving women s access to health care services and information: A Strategic Framework