Burns C B, Clough A R, Currie B J, Thomsen P, Wuridjal R
Clinical Unit, Menzies School of Health Research, Darwin.
Aust N Z J Public Health. 1998 Feb;22(1):133-9. doi: 10.1111/j.1467-842x.1998.tb01157.x.
In 1994 the Commonwealth funded studies to establish and develop Aboriginal health services. One such study was undertaken in 1995 at Maningrida, Northern Territory: to identify the health-service needs of the population and consider community management structures; to identify Northern Territory expenditure for primary health care; and to provide a three- to five-year development budget. Approximately 2100 Aboriginal residents in the region used the service, including 750 living on 24 outstations within 75 km. Nearly 40 per cent were aged under 15 years. Childhood morbidity was high, with children under two averaging 1.4 hospital admissions per year. The age pyramid reflected premature adult mortality from the third decade of life. Service providers identified inadequate staffing and infrastructure as barriers to service development. Community consultations emphasised the need for resident doctors, improved outstation services and aged and respite care, local training for Aboriginal health workers and housing for staff. These developments would require per capita primary health care expenditure ($872) to be doubled. Aboriginal people in remote areas are disadvantaged through Commonwealth Grants Commission funding formulae and lack of Medicare access. As the sole funding source, the Northern Territory spends over $1.83 million per year providing health services at Maningrida. Additionally, the study proposed that the Commonwealth spend $1.96 million a year over five years on staffing and infrastructure. Local Aboriginal organisations also agreed to allocate resources for health service development. Ineffective implementation, lack of clarification of government responsibilities and funding shortfalls remain barriers to developing remote Aboriginal health services.
1994年，英联邦资助了多项研究，以建立和发展原住民健康服务。1995年在北领地的曼宁里达进行了一项此类研究：确定当地居民的健康服务需求并考虑社区管理结构；确定北领地在初级卫生保健方面的支出；并提供一份三到五年的发展预算。该地区约2100名原住民居民使用了这项服务，其中包括居住在75公里范围内24个偏远居民点的750人。近40%的人年龄在15岁以下。儿童发病率很高，两岁以下儿童平均每年住院1.4次。年龄金字塔反映出从成年第三十年起就出现的过早成人死亡率。服务提供者认为人员配备不足和基础设施不完善是服务发展的障碍。社区协商强调需要驻院医生、改善偏远居民点服务以及老年护理和临时护理、为原住民卫生工作者提供当地培训以及为工作人员提供住房。这些发展将需要人均初级卫生保健支出（872澳元）翻倍。偏远地区的原住民因联邦拨款委员会的资金分配公式和缺乏医疗保险而处于不利地位。作为唯一的资金来源，北领地每年花费超过183万澳元在曼宁里达提供卫生服务。此外，该研究提议联邦政府在五年内每年花费196万澳元用于人员配备和基础设施建设。当地原住民组织也同意为卫生服务发展分配资源。实施不力、政府责任不明确以及资金短缺仍然是发展偏远原住民卫生服务的障碍。
