Academic journal article Australian Health Review

Tensions in Maternal and Child Health Policy in Victoria: Looking Back, Looking Forward

Academic journal article Australian Health Review

Tensions in Maternal and Child Health Policy in Victoria: Looking Back, Looking Forward

Article excerpt

Abstract

Since the late 1980s, Maternal and Child Health Services (MCHS) in Victoria have undergone significant change. This paper provides an historically-informed analysis of the complex intersection of policy, administrative restructuring and stakeholder interests. It draws on and extends the authors' previous research into MCH Service policy directions and administration, including the impact of Compulsory Competitive Tendering (CCT) on MCH nurses in the 1990s. Historically there has been little explicit debate about either organisational arrangements, or the policy objectives of the MCHS. The dominant focus on health surveillance of infants never adequately reflected nurses' wider role in the community and was not consistent with a wider social model of health. Tensions between professional, consumer and administrative stakeholders became heightened by the implementation of the 1990s neoliberal political agenda. During this period, when restructuring linked funding to service delivery through tendering arrangements, a political and policy settlement further institutionalised surveillance as the basis of the MCHS. The restructured Service has remained constrained by the dominance of health surveillance as the primary program goal even after more varied contracting arrangements replaced CCT. Although recent initiatives indicate signs of change, narrow surveillance-based guidelines for Victorian MCH Services are not consistent, we argue, with recent early years of life policy which calls for approaches derived from socio-ecological models of health.

Introduction

International health policy is increasingly attentive to the importance of maternal health and of early childhood in establishing the basis of health and well-being. In the last fifteen years, Victoria's long-established Maternal and Child Health Services (MCHS) have undergone significant change. This paper explores these developments in light of the emerging wider policy concerns, and provides an historically-informed analysis that shows how administrative restructuring, policy objectives and stakeholder interests intersect in complex ways. 1 lie paper draws on the authors' previous research on MCH history, policy and administration that is reported fully elsewhere (Reiger, 1985, 2001; Keleher, 2000; Reiger & Keleher, 2002, 2004). Here we extend our analysis in light of evidence from literature on the social determinants of health which has demonstrated convincingly that education, literacy and healthy early years of life establish the foundations for health.

In the Victorian MCHS, we argue, a longstanding tension over the orientation of the Service towards a medical or social model of health can be ttaced. In the neoliberal political context of the mid-1990s, political and professional agendas produced administrative arrangements that settled this tension in favour of a medicallyoriented health surveillance rather than a socio-ecological approach. An emphasis on child health surveillance was not only established in MCH program guidelines, but became embedded in specifications for tendered services and in state-local government funding formulas based on 'key ages and stages' of child development. Although the policy agenda is now moving away from a narrow surveillance approach to the early years of life, this objective remains compromised by the 1990s 'settlement' with regard to organisational and program structures that are still oriented to health surveillance. We suggest that the draft framework and guidelines (DHS 2003a, 2003b) for Victorian MCH Services remain narrowly cast as what Turrell, Oldenburg, McGoffin & Dent (1999) describe as 'downstream' intervention approaches, and are not yet consistent with the more 'upstream' socio-ecological potential of emerging early years of life policy.

Historical context of MCH policy

The paradigm of child health surveillance in relation to mothers and their infants has a long policy history. …

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