The New Directions: Mothers and Babies Services program, funded by the Australian Government, aims to increase access to, and use of, child and maternal healthcare services for Aboriginal and Torres Strait Islander families. There were 85 health organisations across Australia funded to implement the program in five waves over 5 years, beginning in 2007-08.
The Department of Health was interested in gaining insights into how well the program was performing. No data collection had been set up specifically to monitor the New Directions program, nor to collect baseline information. There is, however, an existing national Key Performance Indicators (nKPIs) data collection that includes child and maternal health indicators. The nKPIs collect six-monthly data on a range of primary health care indicators from Aboriginal and Torres Strait Islander health organisations, including most of the organisations that receive New Directions funding.
The 8 maternal and child health measures included in the nKPIs are: antenatal care provided before 13 weeks of pregnancy; birthweight recorded; birthweight result; health assessment for 0-4 year olds; health assessment for women; and 3 immunisation measures (whether 1, 2 and 5 year olds were recorded as fully immunised). The AIHW compiled data on the 8 measures, and compared the results for the 77 nKPI organisations that received New Directions funding in waves 1 to 4 with 123 other broadly comparable nKPI organisations.
At the time of this analysis, the nKPI data for the maternal and child health measures were available for either two reporting periods (June 2013 and December 2013) or three reporting periods (December 2012, June 2013 and December 2013), depending on the measure. The available data therefore only covered a relatively short time period, and it was anticipated that improvements in process rather than outcome measures were more likely to be observed in the early years, as organisations have more direct influence over these.
The two groups of organisations were assessed in relation to whether they achieved a particular measure for more than half of their clients. For example, for antenatal care, the measurement criterion was the proportion of organisations where more than half of women attended their first antenatal visit before 13 weeks of pregnancy, while for immunisation it was whether more than half of children were recorded as being fully immunised.
The data analyses show that there was an improvement in 7 out of 8 of the maternal and child health measures for New Directions organisations, compared with 4 out of 8 measures for non-New Directions organisations. The 7 measures where New Directions organisations improved were all 'process-of-care' indicators such as child health check and immunisation recorded. The only measure where New Directions organisations did not improve was for birthweight result, a health outcome measure influenced by a wide range of factors, including behavioural and lifestyle factors.
Although the nKPI data can provide useful information on the performance of organisations who receive New Directions funding compared with those who do not, the nKPI data cannot be used to evaluate program effectiveness. The improvements in New Directions organisations cannot be directly attributed to the program, as they could be due to a range of other factors not controlled for in the analyses. As more organisations participate in New Directions, baseline data will be available and analyses can be undertaken over a longer time frame, which should provide better information for program monitoring.