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BackgroundMozambique has high maternal mortality which is compounded by limited human resources for health, weak access to health services, and poor development indicators. In 2011, the Mozambique Ministry of Health (MoH) approved the distribution of misoprostol for the prevention of post-partum haemorrhage (PPH) at home births where oxytocin is not available. Misoprostol can be administered by a traditional birth attendant or self-administered. The objective of this paper is to examine, through applying a human rights lens, the broader contextual, policy and institutional issues that have influenced and impacted the early implementation of misoprostol for the prevention of PPH. We explore the utility of rights-based framework to inform this particular program, with implications for sexual and reproductive health programs more broadly.MethodsA human rights, health and development framework was used to analyse the early expansion phase of the scale-up of Mozambique's misoprostol program in two provinces. A policy document review was undertaken to contextualize the human rights, health and development setting in Mozambique. Qualitative primary data from a program evaluation of misoprostol for the prevention of PPH was then analysed using a human rights lens; these results are presented alongside three examples where rights are constrained.ResultsStructural and institutional challenges exacerbated gaps in the misoprostol program, and sexual and reproductive health more generally. While enshrined in the constitution and within health policy documents, human rights were not fully met and many individuals in the study were unaware of their rights. Lack of information about the purpose of misoprostol and how to access the medication contributed to power imbalances between the state, health care workers and beneficiaries. The accessibility of misoprostol was further limited due to dynamics of power and control.ConclusionsApplying a rights-based approach to the Mozambican misoprostol program is helpful in contextualising and informing the practical changes needed to improve access to misoprostol as an essential medicine, and in turn, preventing PPH. This study adds to the evidence of the interconnection between human rights, health and development and the importance of integrating the concepts to ensure women's rights are prioritized within health service delivery.

The lower rates of participation in higher education of people from remote areas, together with the under-representation of Aboriginal and Torres Strait Islander students in higher education, make it less likely that students from remote Indigenous communities will aspire to attend university. Educators and community must develop working relationships and act early to raise students' aspirations through an awareness of wider possibilities within and beyond their own community. One initiative taken to accomplish these aims is the UniCamps program run by the University of South Australia's (UniSA) Centre for Regional Engagement (CRE) in partnership with Mimili Anangu School. (Anangu is the name that Indigenous people from that region use for themselves.) By showing learning pathways through the tertiary sector, leading to a range of careers, either within their community or through pursuing their own interests, this program seeks to capture and maintain Anangu students' interest in diverse educational opportunities. Beginning in 2010, groups of Mimili secondary students have been visiting Whyalla, living in student accommodation and experiencing university study and life in a large regional centre. While raising aspirations and developing tertiary experience are priorities, students also develop skills to assist them with living away from home and their remote community, acquire and refine communication skills, and learn to build relationships with unfamiliar non-Anangu people--a supportive environment is important. The planning and initiation of the first UniCamp required full commitment from all involved--school leaders, family and community members, the students themselves and university staff--to provide optimal learning experiences and opportunities for the young people. For successful transition from secondary schooling in a remote community to a tertiary environment, students need significant literacy and numeracy skills, along with confidence to seek assistance in an unfamiliar setting. At times, the young people immersed themselves in the experience, supporting each other. On subsequent visits, through a widening range of activities--academic sessions, living skills, recreational activities, and engaging in the wider community--the students have grown more familiar with the campus and regional city environment. Students who before the program did not aspire to tertiary study now see this, including university, as one possibility for their future. Relationship-building--between communities, educational institutions and within the university--takes time, but is a crucial foundation for implementing such a program. Support from the CRE Director and wider UniSA connections have contributed to making the program a reality. Collaboration with different areas of the University and community allows for an enriched educational experience. UniCamps is an opportunity for students to engage in career-related experiences which may be unfamiliar to them. As such, participation and learning opportunities should be targeted to achieve this goal. As the students' first language is not English, program content must be delivered in an appropriately scaffolded way, while still challenging and extending the students. What has been learned from the Mimili-UniSA partnership will guide current plans to extend UniCamps opportunities to other rural and remote students.

Objective: The aim of this study was to identify an Aboriginal community's aspirations for health service improvement during implementation of the Commonwealth's Health Care Homes (HCH) reform. Methods: This study was a qualitative study consisting of Aboriginal-controlled phenomenological enquiry in a large Aboriginal community in north-central Arnhem Land. Results: A representative sample of 60 Aboriginal health service users identified shortcomings in their current experience of primary health care, including low cultural security. These shortcomings reduced access to care. Participants described several ways that care could be reorientated to match their needs during HCH implementation. Principally, patients voiced the need for: (1) restructuring care teams to foster culturally secure relationship-based care; and (2) reorientating the Aboriginal Health Practitioner role from acute care to strength-based competencies as the focal point of care continuity: self-management support, care coordination and navigation, health coaching and cultural mentorship for non-Aboriginal staff. Conclusions: For HCH to be successful, service providers need to engage with service users to identify and implement patient-centred strategies to improve access, acceptability and patient activation. What is known about the topic?: Success of the Commonwealth's HCH reform is contingent on improving care access and patient activation to better manage chronic conditions What does this paper add?: This is the first opportunity that this Aboriginal community has had to articulate their aspirations for high quality healthcare. Beyond the strong alignment with the HCH building blocks, their care preferences posit practical and achievable workforce and delivery system reforms that may improve primary health care in other remote Aboriginal communities. What are the implications for practitioners?: The long-term success of the HCH reform will require iterative engagement with service users to identify and implement patient-centred strategies to improve access and acceptability of care. Service model alignment with patient care preferences will improve patient activation and is particularly important when working with vulnerable populations. [ABSTRACT FROM AUTHOR]

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Background: The postpartum period is a critical time to improve health outcomes for Aboriginal women, particularly for those who have chronic conditions. Aims: To assess enhanced support methods (for women following diabetes in pregnancy (DIP)) to improve completion rates of recommended postpartum health checks. Materials and Methods: Fifty‐three Aboriginal women in the Northern Territory (NT) were contacted in the postpartum period to encourage medical check‐ups. Messages were delivered through phone (call or text messages) or other methods (Facebook or email). The primary outcome was postpartum blood glucose testing (oral glucose tolerance testing (OGTT), random or fasting glucose and HbA1c). Results: Establishing contact with women was difficult. Of 137 messages sent to 52 women, 22 responded (42%). Phone was the most common contact method with successful contact made from 16 of 119 (13%) attempts. Rates of postpartum OGTT completion were higher in the group successfully contacted (32% vs 7%). However, for any postpartum glucose testing (including OGTT and HbA1c) rates were 25 of 42 (60%) and neither success in making contact nor the contact method was associated with higher rates. Conclusions: The small sample size limits our conclusions; however, results highlight that engaging remote women postpartum is difficult. While rates of postpartum OGTT completion differed according to successful contacts, rates of any postpartum blood glucose testing did not. Further research is needed to explore feasible intervention methods to improve postpartum screening after a pregnancy complicated by diabetes. [ABSTRACT FROM AUTHOR]

Models of care that include a prominent role for Aboriginal workers are fundamental to improving the health of Aboriginal Australians. However, tension arises when these models co-exist with mainstream models, contributing to difficulties sustaining an Aboriginal workforce. The ‘ideal worker’ theory is drawn on to explore whether historical workplace norms undermine the roles of Aboriginal workers in an Australian hospital setting. In-depth interviews were conducted with 30 staff and clients of an innovative maternity service, featuring Aboriginal Maternal Infant Care (AMIC) workers caring for Aboriginal women in partnership with midwives. A phenomenological methodology highlighted that unrealistic and inappropriate assumptions embedded in the ideal worker notion underpin many challenges facing AMIC workers. These workers have deep ties to their communities, with extensive responsibilities beyond the workplace. Although the hospital system relies on these ties to engage clients, this time commitment and the unbounded ways in which AMIC workers provide care are not acknowledged. Findings illustrate how the ideal worker concept has a cultural and gender dimension, which undermines AMIC workers and does not value culturally relevant care. This work has implications for ingraining cultural competence into health care, suggesting the wide-ranging contributions of Aboriginal workers must be recognised to achieve sustainable reform. [ABSTRACT FROM AUTHOR]

Background: Rates of diabetes in pregnancy are disproportionately higher among Aboriginal than non-Aboriginal women in Australia. Additional challenges are posed by the context of Aboriginal health including remoteness and disadvantage. A clinical register was established in 2011 to improve care coordination, and as an epidemiological and quality assurance tool. This paper presents results from a process evaluation identifying what worked well, persisting challenges and opportunities for improvement. Methods: Clinical register data were compared to the Northern Territory Midwives Data Collection. A cross-sectional survey of 113 health professionals across the region was also conducted in 2016 to assess use and value of the register; and five focus groups (49 healthcare professionals) documented improvements to models of care. Results: From January 2012 to December 2015, 1,410 women were referred to the register, 48% of whom were Aboriginal. In 2014, women on the register represented 75% of those on the Midwives Data Collection for Aboriginal women with gestational diabetes and 100% for Aboriginal women with pre-existing diabetes. Since commencement of the register, an 80% increase in reported prevalence of gestational diabetes among Aboriginal women in the Midwives Data Collection occurred (2011–2013), prior to adoption of new diagnostic criteria (2014). As most women met both diagnostic criteria (81% in 2012 and 74% in 2015) it is unlikely that the changes in criteria contributed to this increase. Over half (57%) of survey respondents reported improvement in knowledge of the epidemiology of diabetes in pregnancy since establishment of the register. However, only 32% of survey respondents thought that the register improved care-coordination. The need for improved integration and awareness to increase use was also highlighted. Conclusion: Although the register has not been reported to improve care coordination, it has contributed to increased reported prevalence of gestational diabetes among high risk Aboriginal women, in a routinely collected jurisdiction-wide pregnancy dataset. It has therefore contributed to an improved understanding of epidemiology and disease burden and may in future contribute to improved management and outcomes. Regions with similar challenges in context and high risk populations for diabetes in pregnancy may benefit from this experience of implementing a register. [ABSTRACT FROM AUTHOR]

Issues Addressed Methods Results Conclusions So What? In Australia, Aboriginal and Torres Strait Islander young people in remote settings are most‐affected by young onset type 2 diabetes (T2D). It is necessary to understand young people's experiences, including factors impacting on self‐management, to improve models of care.A phenomenological methodology underpinned this qualitative study in Western Australia's Kimberley region. Two Aboriginal Community Controlled Health Services supported recruitment of seven Aboriginal young people aged 12–24 with T2D, who participated in interviews. A carer and health professional of one young person in each site were also interviewed and relevant medical record data reviewed to assist with triangulation of data. De‐identified transcripts were inductively coded and a coding structure developed with oversight by a Kimberley Aboriginal researcher.Young people reported varied experiences and emotions relating to a T2D diagnosis. Most recounted this was upsetting and some reported current negative impact on emotional wellbeing. Challenges with understanding and managing diabetes were highlighted, particularly regarding healthy eating, physical activity and medication. Family are a prominent source of self‐management support, with the intergenerational impact of diabetes being evident for each participant. Positive relationships with health professionals, entailing continuity of care, were valued.There are significant emotional and medical challenges for young people with T2D and their families. Recommendations from this work will contribute to the development of local resources and initiatives to improve diabetes‐related support.Alongside broader efforts to support good health at the societal level, enhanced health education and family‐oriented support structures including Aboriginal clinical staff for young people with T2D are needed. [ABSTRACT FROM AUTHOR]

Introduction: Premature onset of type 2 diabetes and excess mortality are critical issues internationally, particularly in Indigenous populations. There is an urgent need for developmentally appropriate and culturally safe models of care. We describe the methods for the codesign, implementation and evaluation of enhanced models of care with Aboriginal and Torres Strait Islander youth living with type 2 diabetes across Northern Australia., Methods and Analysis: Our mixed-methods approach is informed by the principles of codesign. Across eight sites in four regions, the project brings together the lived experience of Aboriginal and Torres Strait Islander young people (aged 10-25) with type 2 diabetes, their families and communities, and health professionals providing diabetes care through a structured yet flexible codesign process. Participants will help identify and collaborate in the development of a range of multifaceted improvements to current models of care. These may include addressing needs identified in our formative work such as the development of screening and management guidelines, referral pathways, peer support networks, diabetes information resources and training for health professionals in youth type 2 diabetes management. The codesign process will adopt a range of methods including qualitative interviews, focus group discussions, art-based methods and healthcare systems assessments. A developmental evaluation approach will be used to create and refine the components and principles of enhanced models of care. We anticipate that this codesign study will produce new theoretical insights and practice frameworks, resources and approaches for age-appropriate, culturally safe models of care., Ethics and Dissemination: The study design was developed in collaboration with Aboriginal and Torres Strait Islander and non-Indigenous researchers, health professionals and health service managers and has received ethical approval across all sites. A range of outputs will be produced to disseminate findings to participants, other stakeholders and the scholarly community using creative and traditional formats., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)