Women's Health Plan 1996 - 1998 The current SWSAHS Women’s Health Plan 1996 – 1998 is being reviewed and a revised plan is due to be developed by June 1999. The following is a summary of the goals and policy and planning framework of the existing plan.  For a full copy of the current plan please contact Margo Moore, Women’s Health Coordinator at Bankstown CHC, Level 4 The Compass Centre Fetherstone St., BANKSTOWN 2200. Phone: 9780 2796. Fax: 9780 2888. TABLE OF CONTENTS: 1.  FOREWORD 2.  MISSION STATEMENT & GOALS 3.  INTRODUCTION 4.  PLANNING AND POLICY FRAMEWORK 5.  SUMMARY: WOMEN'S HEALTH IN SOUTH WESTERN SYDNEY 6.  SWSAHS WOMEN'S HEALTH PLAN 1996 - 1998     1. FOREWORD The development of the second South Western Sydney Area Health Service Women’s Health Plan 1995 - 98 extends the Area’s committment to improving health outcome for women. It follows an extensive review of the implementation of the first Women’s Health Plan 1991 - 1994 conducted by Marilyn Wise and Alison Boyes. The review involved wide consultation with representatives of health services and community groups about the success and limitations of the original plan. Recommendations arising from the review on future directions and outcomes for women’s health have been incorporated into the new plan. We acknowledge the expertise and critical analysis which Marilyn Wise brought to the review, and thank all the people who participated in this process. Michelle Noort (Director Health Promotion Wentworth Area Health Service) facilitated a planning workshop which set the framework for the draft plan. She also provided comment on the written draft and we would like to thank her for her input. The process of developing the new plan involved eight consultation workshops held across the Area attended by people from within the Area Health Service and the community who gave advice about priorities for women’s health and the proposed directions and goals of the new plan.Appreciation is extended to all those who participated in the consultations and commented on the draft document. The draft plan was written by Margo Moore and Jennifer Gale. 2. MISSION STATEMENT & GOALS Mission Improve the Health & Wellbeing of all Women in South Western Sydney to Be the Best in New South Wales Goal One Improve the Social & Health Status of Women to Maximise Health Gain Goal Two Develop the Capacity of South Western Sydney Area Health Service to positively impact on the Health of Women in South Western Sydney Goal Three Ensure a Strong Infrastructure for Women's Health Services Through the Development of a Skilled, Committed Workforce 3. INTRODUCTION The implementation of the first South Western Sydney Area Health Service Women's Health Plan 1991-94, and developments within the Area Health Service during this period, have resulted in significant improvements in the provision of health services to women across South Western Sydney. The first women's health plan was the subject of a comprehensive review which highlighted the influence that the plan has had on the development of an infrastructure for Women's Health services in South Western Sydney. The review found that: "the achievements of the plan demonstrate what is possible when priorities are established, roles are clearly delineated,and performance indicators provide a guide to assess progress....The Women's Health Program has a positive profile both within and beyond the Area Health Service. Strong working relationships have been established with the Non Government Women's Health Srvices and with other sectors. The program is regarded as one of the most innovative in the State, with the Domestic Violence Policy and the process which leads to it's development becoming the prototype for New South Wales." (Wise:1995) Key developments during the period of the first plan are as follows: Appointment of the Area Women's Health Coordinator which has improved planning and delivery of Women's Health Programs; Development of the South Western Sydney Area Health Service Domestic Violence Policy and Protocol; Employment of a bilingual women's health promotion worker in the Fairfield Sector; Coordination of the bilingual community education program in women's health; Development of three new bilingual community education programs for women of non-English speaking backgrounds (NESB); The establishment of Mammography Screening Services for Older Women through the Western Breast Screening Unit; The Caroline Chisholm Centre for Women and Babies at Liverpool Hospital; Karitane Residential Facility for Mothers and Babies in Fairfield; A Domestic Violence Service and a Mid to Older Women's Service at Campbelltown, as part of a service agreement with the Benevolent Society; A Post Natal Depression service linked to Karitane with support from Burdekin Mental Health Funding; Fairfield Multicultural Family Planning service with funding from the National Women's Health Program. Strategic directions for the new Women's Health Plan have been formulated taking into consideration the findings of the Review, the National and State Goals & Targets, the National Women's Health Policy, consultations with local service providers and consumers, and demographic and epidemiological data. In regard to women's health therefore, the mission of the South Western Sydney Area Health Service is "To improve the health and wellbeing of women in South Western Sydney to equal the best in NSW". The planning framework, profile of women in South Western Sydney, results of the consultation process and the goals, strategies and outcomes of the new plan are detailed in the following sections. 4. PLANNING & POLICY FRAMEWORK The revised Women’s Health plan is set within the priority framework of the National and State health goals and targets which incorporate the following principles: All Australians should have access to a comprehensive range of health care services regardless of financial status and place of residence; Health services should be of a consistently high quality across Australia; There should be continuity of care across the health system, with appropriate higher level services; and Major causes of ill health and premature death including environmental and lifestyles factors should be identified and addressed, and cooperative strategies to reduce them developed and implemented (CDHS&H 1994). The National Health Goals & Targets define health outcomes within four broad categories: Healthy Environments Health Literacy and Health Skills Lifestyles and Risk Factors Mortality and Morbidity Goals and strategies within the SWSAHS Women's Health Plan have been structured around this approach and incorporate the broader framework of the National Health Goals & Targets which are: Social Justice Access & Participation Intersectoral Action Healthy Lifestyles The three principle goals for the New South Wales (NSW) Health System are to: ensure better health for people enable equity of access to comprehensive health services improve the quality of service. An integral part of improving the health status of the whole community is an increased emphasis on consultation processes and social justice strategies aimed at ensuring equity and improving the health of specific population groups including Aboriginal people, women, NESB communities and older people (NSW Health 1995). The SWSAHS Corporate Plan emphasises the importance of implementing an outcomes approach to the plan, provision and evaluation of services. The mission of the SWSAHS Women’s Health Plan is consistent with the broader mission of the Area Health Service and support the three goals of the SWSAHS Corporate plan which are to: Work with the residents of South Western Sydney to improve their health status to the highest in NSW. Ensure the quality constantly improves and that people’s needs and choices inform all aspects of the health system. Ensure services are delivered at world standards by highly trained and motivated staff using modern facilities, technologies and information systems. These principles and goals, in conjunction with the principles and priorities of the National Women's Health Policy, have been identified as being the basis for the new priorities for women's health to achieve better health outcomes in South Western Sydney.The principles of the National Women's Health Policy are as follows: 1. “The National Women’s Health Policy is based on an understanding of health within a social context as emphasised by the World Health Organisation and endorsed by the Australian Government in its National Policy on 'Health for all Australians'. This view recognises that: health is determined by a broad range of social, environmental, economic and biological factors; differences in health status and health outcomes are linked to gender, age, socioeconomic status, ethnicity, disability, location and environment; health promotion, disease prevention, equity of access to appropriate and affordable services and strengthening the primary health care system are necessary, along with high quality illness treatment services; and information, consultation and community development are important elements of the health process. 2. Women’s health policy must encompass all of a woman's lifespan, and reflect women's various roles in Australian society, not just their reproductive role. 3. Women’s health policy must aim to promote greater participation by women in decision making about health services and health policy, as both consumers and providers. 4. Women’s health policy must recognise women's rights, as health care consumers, to be treated with dignity in an environment which provides for privacy, informed consent and confidentiality. 5. Women’s health policy must acknowledge that informed decisions about health and health care require accessible information which is appropriately targeted for different socioeconomic, educational and cultural groups. 6. Women’s health policy must be based on accurate data and research concerning women's health, women's views about health, and strategies which most effectively address women's health needs." (National Women's Health Policy 1989) The National Women’s Health Policy identifies the following as priority issues for women’s health: Reproductive health and sexuality Health of ageing women Women's emotional and mental health Violence against women Occupational health and safety Health needs of women as carers Health effects of sex role stereotyping on women 5. SUMMARY: WOMEN'S HEALTH IN SOUTH WESTERN SYDNEY In 1994 the female population of the South Western Sydney Area Health Service was in excess of 345,00 persons. The Area Health Service covers the Local Government Areas (LGAs) of Bankstown, Camden, Campbelltown, Fairfield, Liverpool, Wollondilly and Wingecarribee. It has the third largest population of any Area or District in New South Wales with the greatest cultural diversity within its community. The Area is characterised by high birth rates and high rates of population increase, a large NESB population (over 30% speak a language other than English at home), significant numbers of newly arrived migrants and refugees and 25% of Sydney's urban Aboriginal population. There are high rates of unemployment, especially amongst some ethnic communities and the Aboriginal community. Large numbers of single parent families and low income households, and poor levels of educational attainment, especially amongst women, mean that the population in South Western Sydney experiences considerable socio-economic disadvantage relative to the rest of NSW. Rapid population expansion in new release areas, poor public transport, lack of social support facilities, and language difficulties mean that many women are socially isolated and have significant difficulty accessing health and social services. Poor socio-economic status is correlated with poor health outcomes. Women generally earn less than men and they are more likely to be heads of single parent families. Their role as a carer can have a significant negative impact on their physical and mental health. They have higher rates of unemployment and are more likely to be employed part time or to depend on social security as their sole source of income. Awareness of risk factors and the adoption of preventive health practices such as Pap tests and mammography are significantly lower among women of lower socio-economic status and for women from non- English speaking backgrounds. Women's mental health is affected by dislocation and loss following migration, social isolation, discrimination, violence and sexual assault. A detailed profile on women's health is contained in the Demographic profile following the Goals & Strategies. Description of Current Designated Women's Health Services in SWS Designated Women's Health Services within SWSAHS, ie Women's Health Nurses and Women's Health Promotion Workers, are funded through Community Health. Women's health promotion projects have been supported with funding through Health Promotion. The National Women's Health Program has provided resources allowing the employment of specialist Women's Health promotion workers. Sector Services Sectors Women's Health Nurse Consultant Specialist Women's Health Promotion Worker Non Government Services Bankstown 0.3 0.5 Bankstown Women's Health Centre Older Women's "Wellness" project* Liverpool 0.3 0.5 Liverpool Women's Health Centre Fairfield 0.3 1* Immigrant Women's Health Information Service Multicultural Family Planning Camden / Wollondilly 0.5 0.5**   Campbelltown 0.5   WILMA Women's Health Centre*** Benevolent Society:*** Domestic Violence Mid to Older Women's Health Service Wingecarribee 1 0.5**   Area Services Area Coordinator Women's Health Bilingual Community Education Coordinator 0.5* Bilingual Community Education Training Project Worker 0.5* Bilingual Community Education Research Worker 0.5** Karitane Child & Family Services *Funded through the National Women's Health Program ** Temporary Positions funded through the National Women's Health Program *** Also covers the Camden / Wollondilly Area All positions are expressed as Full Time Equivalent The limited number of designated women's health services within SWSAHS relative to the size and diverse needs of the population needs means that the ability of the Area Health Service to adequately address women's health issues is severely restricted. In some cases, for example, Women's Health Nurses and Health Promotion Workers are responsible for services in two or three very large sectors. The need to ensure a strong infrastructure for women's health within SWSAHS is addressed in Goal 3 of the Women's Health Plan. Priorities Identified in the Consultation Process The importance of consultative processes in formulating effective health plans which reflect the interests and priorities of the community are stressed in the National Women's Heath Policy the NSW Vision Paper "Caring Health" and the policies of the South Western Sydney Area Health Service. Improving the health of populations is best achieved through cooperation and commitment from a broad range of Government and Non Government organisations and the community as a whole. To determine priority issues for Women's Health eight consultation workshops were held across the Area. Approximately 100 people representing local councils, women's health centres, migrant services, community organisations, consumer groups and health services within SWSAHS attended the workshops during which a number of priority issues were identified. These are arranged in order of frequency of response: Access to appropriate services and information about services and health issues in particular the need for: Increasing access for NESB women by providing: adequate interpreter services in all Sectors (particularly a local pool of interpreters for Campbelltown); more bilingual staff; and linguistically and culturally appropriate resources and programs Increased dissemination of information about available health services and women's health issues Increased involvement of consumers, especially immigrant women in health services planning Increasing staff knowledge and skills in cross-cultural issues Increased provision of appropriate health services. Violence and sexual assault: Provision of counselling for women suffering from domestic violence Implementation of public awareness campaigns against violence Improving public safety. Emotional and mental wellbeing: Improved response to post-natal stress and depression Increasing women's self esteem, confidence and assertiveness Increased access to counselling services Support programs for women suffering grief and loss, in particular NESB women, older women, and women who have had abortions or experienced stillbirths or neo-natal deaths. Social status issues: Increased access to child care Poverty Employment Education Sex role stereotyping Discrimination on the basis of race, age, sex, ethnicity, social class. Isolation and transport issues: Outreach services Increased access to transport Building networks among socially or geographically isolated women. Target populations: NESB women Older women Disabled women Young women Women who are carers Aboriginal women Childbirth and parenting issues, in particular the need for: Improving links between hospital and community health services for pregnant and post-partum women Increased provision of family support services especially in the Wingecarribee and Camden/Wollondilly Sectors Provision of programs especially addressing the needs of young women with children. Sexual and reproductive health issues: Safe sex Information on sexual and reproductive issues for young women and women in the middle years. Increasing women's participation in screening for breast and cervical cancers. Other priorities including: Support services for disadvantaged groups eg carers Increased emphasis on developing public policy to promote women's health and creating environments which are conducive to good health Nutrition Improved access to exercise Prevention and treatment of Drug & Alcohol related problems Occupation health and safety for NESB women. These priority issues, identified during the consultations, formed the basis of the final goals and strategies of the Women's Health Plan. In formulating the goals of the Women's Health Plan other Area wide strategic plans were taken into consideration. Some of the specific issues raised in the consultation process will be addressed as part of local implementation plans or have been referred to other Area Plans. These issues and the relevant Area Plan are detailed in Appendix 1. 6. THE SWSAHS WOMEN'S HEALTH PLAN 1996 - 1998 The SWSAHS Women’s Health Plan 1996 - 1998 incorporates a social view of health and aims to promote gender equity in ensuring optimum health status for women in South Western Sydney. The mission and goals for women’s health in SWSAHS are: Mission: To improve the health and wellbeing of all women in South Western Sydney to be the best in New South Wales. Goal 1: To improve the social and health status of women to maximise health gain. Goal 2: Develop the capacity of Souwth Western Sydney Area Health Service to positively impact on the health of women in South Western Sydney. Goal 3: Ensure the develoment of a strong infrastructure for Women’s Health Services through the development of a skilled, committed workforce. These goals set the broad strategic directions for Women's Health in SWSAHS over the next three years. The objectives and strategies which flow from all three goals may relate to: Healthy environments physical, transport, housing, workplaces, health care systems, schools, for example Goal: 1.14 Increase the level of community awareness of, and support for, a culture of non violence in the public and private domain. Health knowledge & skills, health literacy personal knowledge and positive attitudes, ability to act on knowledge, knowledge of the health system, for example Goal: 1.13 Enhance women’s sense of well being and understanding of their rights within the community and as health consumers. Social justice reducing social and health inequalities in Australia, for example Goal; 2.19 Research, develop and publicise appropriate evaluation tools for use in NESB women’s mental health promotion programs. Intersectoral action coordinated action across agencies to promote healthy public policies and healthy environments, for example Goal: 1.9 Establish stronger lnks with local councils, schools, TAFE colleges and non government organisations to increase understanding and collaboration around women’s social and health issues. Access and participation improving access and addressing barriers of race, culture, language, physical isolation, transport, for example Goal 1.7 When recruiting staff within service delivery areas increase the proportion of bi lingual staff in key services for women through identifying positions, both existing and new, as requiring skills in relevant community languages. Healthy lifestyles promote preventive practices and reduce risk factors, for example Goal 1.5 Work with local government to ensure that recreation facilities are appropriate, accessible and safe for women. Outcome indicators have been developed to enable evaluation of the plan. These indicators are not exhaustive, but provide a guide to the outcomes we would expect to see when the goals are achieved. More detailed outcome indicators will be developed within service and program plans. The Area Health Service is responsible for addressing the health needs of all women in South Western Sydney. The SWSAHS Women's Health Program will support this responsibility through a specific focus on social justice strategies to improve the health of identified groups including: Aboriginal Women Women of Non English Speaking Background Older Women Disabled Women Socially Isolated Women Geographically Isolated Women Young Women Socially Disadvantaged Women Women as Carers Women as Parents