title: The quality of health services provided to remote dwelling aboriginal infants in the top end of northern Australia following health system changes: a qualitative analysis.
abstract: In Australia the health outcomes of remote dwelling Aboriginal infants are comparable to infants in developing countries. This research investigates service quality, from the clinicians' perspective and as observed and recorded by the researcher, in two large Aboriginal communities in the Top End of northern Australia following health system changes.
  
  
  
  Data were collected from semi-structured interviews with 25 clinicians providing or managing child health services in the two study sites. Thirty hours of participant observation was undertaken in the 'baby-rooms' at the two remote health centres between June and December 2012. The interview and observational data, as well as field notes were integrated and analysed thematically to explore clinicians' perspectives of service delivery to infants in the remote health centres.
  
  
  
  A range of factors affecting the quality of care, mostly identified before health system changes were instigated, persisted. These factors included ineffective service delivery, inadequate staffing and culturally unsafe practices. The six themes identified in the data: 'very adhoc', 'swallowed by acute', 'going under', 'a flux', 'a huge barrier' and 'them and us' illustrate how these factors continue, and when combined portray a 'very chaotic system'.
  
  
  
  Service providers perceived service provision and quality to be inadequate, despite health system changes. Further work is urgently needed to improve the quality, cultural responsiveness and effectiveness of services to this population.
authors.affiliation: University Centre for Rural Health Sydney School of Public Health, University of Sydney, Sydney, NSW, 2480, Australia. djosif6@bigpond.com.
authors.forename: Cathryn M
authors.initials: CM
authors.lastname: Josif
authors.affiliation: School of Nursing Midwifery and Social Work, The University of Queensland (UQ), Brisbane, 4010, Australia.
authors.forename: Sue
authors.initials: S
authors.lastname: Kruske
authors.affiliation: School of Nursing Midwifery and Social Work, The University of Queensland (UQ), Brisbane, 4010, Australia.
authors.forename: Sue V
authors.initials: SV
authors.lastname: Kildea
authors.affiliation: University Centre for Rural Health Sydney School of Public Health, University of Sydney, Sydney, NSW, 2480, Australia.
authors.forename: Lesley M
authors.initials: LM
authors.lastname: Barclay
mesh_terms: D001291:Attitude of Health Personnel; D005260:Female; D006303:Health Services, Indigenous / Q000458:organization & administration / Q000592:standards*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007407:Interviews as Topic; D008297:Male; D015876:Northern Territory; D036301:Qualitative Research; D011785:Quality Assurance, Health Care; D058996:Quality Improvement; D012189:Retrospective Studies; D019035:Rural Health Services / Q000458:organization & administration / Q000592:standards*
keywords: Aboriginal; Anaemia; Australia; Child Health; Growth faltering; Indigenous; Infant; Remote