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RURAL WOMEN’S HEALTH NEEDS PROJECT

BENALLA LOCAL GOVERNMENT AREA

(JULY-OCTOBER 2019)

FUNDED BY MURRAY PRIMARY HEALTH NETWORK (PHN)

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Contents 1 Title Page: Rural Women’s Health Needs Project – Benalla Local Government Area ..................... 3

2 Executive Summary ........................................................................................................................ 4

3 Background ..................................................................................................................................... 7

4 Summary of activity ....................................................................................................................... 11

5 Findings ........................................................................................................................................ 18

5.1 Rural Women’s Health Needs ................................................................................................... 18

5.2 Service Needs Analysis ............................................................................................................. 32

5.3 Proposed Service Model .......................................................................................................... 33

6 Recommendations ........................................................................................................................ 34

7 Achievements, challenges and key learnings ................................................................................ 35

8 References ................................................................................................................................... 36

9 Appendices ................................................................................................................................... 37

9.1 Acronyms ............................................................................................................................... 37

9.2 Murray PHN Rural Women’s Health Needs Project (RWHNP) - Action Plan .......................... 38

9.3 Letter to Stakeholders ............................................................................................................ 40

9.4 List of contacts and flyer dissemination points ....................................................................... 41

9.5 Flyer ...................................................................................................................................... 42

9.6 Murray PHN Rural Women’s Health Needs Project (RWHNP) – Survey Questions ............... 43

9.7 Proposed Service Model Indicative Costs .............................................................................. 51

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1 TITLE PAGE: RURAL WOMEN’S HEALTH NEEDS PROJECT – BENALLA LOCAL GOVERNMENT AREA

Central Hume Primary Care Partnership was funded by the Murray Primary Health Network (PHN) to

undertake this rural women’s health needs project in the Benalla Shire.

This report was compiled by the following Central Hume Primary Care Partnership (PCP) project staff:

Staff Central Hume PCP Role Project FTE

Ellie Stringer Program Coordinator: Prevention and Early Intervention 0.2

Catherine Fuller Program Coordinator: Dry Conditions Resilience 0.2

Contract Number FF-93

Project / Program Rural Women’s Health Needs

Organisation Central Hume Primary Care Partnership, auspiced by NESAY

Location of Service 56 Samaria Road, Benalla Victoria 3672

Contact Huw Brokensha

Position Executive Officer

Phone 0436690156

Email [email protected]

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2 EXECUTIVE SUMMARY

Central Hume Primary Care Partnership was funded by the Murray Primary Health Network (PHN) to

undertake one of four rural women’s health needs projects; this project was to be specifically

conducted in the Benalla Local Government Area (LGA), between July and October 2019.

The aim of this project was to determine the health and service needs of women living in the Benalla

Municipality, and propose a new service model to address the prioritised need.

3 objectives were established:

1. To leverage local relationships with health and community organisations in the Benalla LGA to

maximise service system knowledge and engagement strategies.

2. To engage with a broad range of women in the Benalla LGA using a place-based approach to

identify specific self-reported health needs and the potential service models to meet these needs.

3. To propose place-based (service model) solutions that will address the identified health needs of

the rural women in the Benalla LGA.

For expediency, the project scope was limited to women over 18 years of age living in the Benalla

LGA.

It was anticipated that the evaluation indicators would be a gained understanding of:

The enablers and barriers for women living in the Benalla LGA to accessing health and

wellbeing services;

the service gaps; and

the models that would address their health and wellbeing needs.

Key project activities, based on the objectives, included:

Using partners and established networks to identify and/or contact key stakeholders who acted

as champions to disseminate the project flyer or to help establish individual / group contacts.

Establishing and conducting an online (and hard copy) survey that also provided the baseline

for small group discussions.

Analysing the data to establish a gained understanding of barriers and enablers; service gaps

and models to address the health and wellbeing needs of rural women; the emerging themes

provided evidence for the project recommendations and proposed placed-based service

delivery models or models of care.

Key Findings

The key over-arching theme that applied to all the findings was that of ‘Access’. Women reported a

range of access issues (physical, geographical, structural/system, cultural, social, etc.). This access lens

applied to general / primary health care services, specialist / secondary health care services, or hospital

/ tertiary health care services and community care and wellbeing services.

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205 women participated in the 2-month online (Survey Monkey) and hard copy survey, which had a

49% completion rate for 24 questions: 16 quantitative questions and 8 qualitative open-ended

questions.

The project workers were guests at 10 groups not confined to project eligible participants. There were

91 group participants in total with 77 women; four groups provided survey information only to 41

women; 50 people participated in six discussion groups with 39 eligible women. The open-ended survey

questions were conversational prompts in the group discussions.

Irrespective of the cohort (e.g. age, location or other demographic), three common themes emerged

within both the survey and group discussions.

A. Service availability - 72 survey respondents and all discussion groups identified service

availability as a barrier to use or affecting service access. The issues raised were for one or

multiple elements of the three sub-themes within this category:

i. Service awareness

ii. Issues accessing local services

iii. Issues accessing specialist services

B. Service affordability / Cost - 31 survey responses and all discussion groups reported the

financial costs of health care being a barrier to use or affecting service access. Issues raised

covered elements of the two sub-themes in this category:

i. Costs associated with Public vs. Private services

ii. Impact of high service costs

C. Transport - 18 survey responses and all discussion groups reported transport or travel as a

barrier to use or affecting service access. Issues raised covered elements of the two sub-themes

in this category:

i. Public transport

ii. Rural travel

Recommendations

The project recommendations summarise the issues identified in the project findings and needs analysis,

i.e. recommendations addressing identified service gaps and access issues. Unless stated the

recommendations are for the Murray PHN to follow-up.

1. Develop rural healthcare models that promote the main service features important to rural women,

i.e.:

- Being affordable;

- Being local;

- Being physically accessible (including accessible transport);

- Having multiple services in the one place;

- Having (access to) outreach services;

- Being all-age friendly.

2. Seek ways for local and regional services, and the Murray PHN, to improve healthcare service

awareness and dissemination to rural women, including service availability and costs.

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3. Seek ways to address the perceived gap in the lack of bulk-billing services, e.g. make additional

bulk-billing services available in the LGA, and increase the transparency of bulk-billing items for

better consumer understanding around bulk billing and pricing of services

4. Seek ways to increase options for after-hours medical services in the LGA

5. Seek ways to fund medical staff at the local hospital, Benalla Health

6. Seek options to increase access to women’s health services in the LGA, including

- Service delivery elements, such as mammogram and screening services

- Systems that support women’s health, e.g. female GPs and gender specific services.

7. Explore ways to support the delivery of affordable services and service delivery options for rural

women, especially related to general practice, dental health and mental health.

8. Explore ways to support the delivery of outreach health and wellbeing services in the LGA.

9. Explore ways to increase the delivery of specialist services in the LGA, including specialist psychiatric

services (including Headspace and youth mental health), physicians and surgeons, Alcohol and

other Drugs (AOD) services (including AA and NA), and Family Violence services.

10. Explore ways to address social access issues, such as inclusive family friendly services with childcare

and transport access.

11. Explore ways to provide a range of integrated health and wellbeing services in one location, such

as a Wellbeing Hub or One Stop Shop.

Proposed Service Model

The proposed service model of a Mobile Wellbeing Hub or One-Stop-Shop is based on the project

findings and needs analysis.

The Mobile Wellbeing Hub would be a first to support a broader regional area and would coordinate

a range of generalist and specialist services to visit locations in the Benalla LGA in a manner that is

inclusive and family friendly, e.g. promoting childcare and care support for carers needing to access

services. Service locations could be both in Benalla and outreaching to geographically targeted towns

across the LGA, e.g. Swanpool, Thoona, Baddaginnie. Local drivers, such as local champions and local

infrastructure (viable hall or service centre, road access, internet access, etc.) would help determine

successful locations,

Coordination of the specialist services would facilitate a Mobile Multiservice Hub or Mobile One-Stop-

Shop, e.g. being available on the same day as the generalist primary care services, albeit a set time

and day of the month; also to link in with existing local and regional outreach services, e.g. Community

Health Nurse, Rural Financial Counselling, Rural Outreach – Mental Health.

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3 BACKGROUND

Benalla is the largest town and service centre for the Benalla LGA. It is located approximately 193kms

northeast of Melbourne. The LGA is one of four LGAs within the Central Hume Primary Care

Partnership (PCP) catchment, and one of 12 LGAs within the Hume Region. The following descriptive

except from the Benalla Rural City Council Plan 2017-2021 (p.8) provides an overview of the Benalla

LGA geography and commerce.

Benalla Rural City is located in north-east Victoria, 193km north east of Melbourne, and is centred in

the Broken River valley. The current estimated resident population of Benalla Rural City is 13,597, with

approximately 9,000 living in the Benalla urban area and the remainder living in and around our smaller

towns. The population forecast for 2031 is 14,834.

Benalla Rural City was established as an agricultural and pastoral district in the 1840s, following long

habitation by Aboriginal people. The rural area was characterised by wheat, oats and potato growing,

alongside some vineyards and mining. It was proclaimed a city in 1965 and Lake Benalla was artificially

created in 1973.

The geography of Benalla Rural City is divided by the Hume Freeway with hills, valleys, grazing land

and forests to the south. The communities include those of Acherton, Baddaginnie, Boho South,

Glenrowan West, Lima, Lima South, Lurg, Molyullah, Moorngag, Samaria, Swanpool, Tatong, Upper

Lurg, Upper Ryan’s Creek, Warrenbayne and Winton.

The north side of the freeway is characterised by plains and rolling hills used as cropping and grazing

land. The communities include those of Boweya, Boxwood, Broken Creek, Bungeet, Chesney Vale,

Devenish, Goomalibee, Goorambat, Stewarton, Taminick, Tarnook and Thoona.

The Benalla Rural City economic sectors include the town’s role as a regional centre, agricultural

production, tourism and manufacturing. It is dominated by employment in the manufacturing, retail

trade, health and community services sectors. The proportion of people employed in agriculture is

above the state average.

Some of the main tourism attractions include, but are not limited to, the Winton Motor Raceway, Winton

Wetlands, State Gliding Centre (Benalla Airport), Benalla Street Art Wall to Wall Festival and the Benalla

Art Gallery.

The rural areas of the municipality are recognised for their good soils and many areas have access to

irrigation. The major agricultural industries are prime lamb and beef production, some dairying and

broad acre cropping. Recent agricultural diversification has seen a rise in viticulture, more intensive

forms of horticulture and forestry.

Benalla Rural City offers a lifestyle that has a choice of primary and secondary schools, a TAFE college,

comprehensive health services and a wealth of participation opportunities including theatre, sport,

music, wine and art. Lake Benalla, with the surrounding Botanical Gardens and walking track, is a key

attraction located within the town. Benalla Rural City has well developed disability, aged care and

childcare services. There are many active community and service groups throughout Benalla Rural City.

Source: Benalla Rural City Council Plan 2017-2021, p.8 http://www.benalla.vic.gov.au/Your-Community/Health-

Wellbeing/Community-Wellbeing/Health-Wellbeing

http://www.benalla.vic.gov.au/Your-Community/Health-Wellbeing/Community-Wellbeing/Health-Wellbeing


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Figure 1: Maps of Benalla Local Government Area – BRCC Geographical and Schematic towns and tourist features

1

2

Sources: 1. Department of Health and Human Services (2017) – Benalla RC Profile 2015; 2. Benalla Rural City Council

Plan 2017-2021, p.9

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The following excerpt from the Department of Health and Human Services (DHHS) population health

profile on the Benalla LGA provides a background overview relevant for this project.

Population • Benalla experienced a slightly negative population growth over the past decade and

population growth is projected to remain almost flat for the next decade. • The percentage of the

population aged 25–44 is well below average while people aged 45+ are over-represented. • The

teenage fertility rate is above the state measure.

Diversity • The percentage of people of Aboriginal and Torres Strait Islander origin is higher than

average. • The percentage of people born overseas is much lower than average. • The rate of new

settler arrivals is well below average, with no humanitarian settlers.

Disadvantage and social engagement • The percentage of people with food insecurity is among the

lowest in the state. • The rate of family violence incidents per 1,000 population is well above average.

• A higher than average percentage of people consider Benalla to be an active community.

Housing, transport and education • The percentage of households with rental stress is among the

highest in the state, however the percentage of rental housing that is affordable is above the state

measure. • The percentage of people 19 years old having completed year 12 is among the lowest in

the state. • The percentages of year 9 students attaining national minimum standards in literacy and

numeracy are both higher than average.

Health status and service utilisation • The rate of people receiving disability services support per 1,000

population is among the highest in the state. • The rate of notifications of influenza per 100,000

population is the highest in the state. • The percentage of people who do not meet physical activity

guidelines is among the highest in the state. • The percentage of females reporting fair or poor health

status is among the lowest in the state. • The percentage of GP attendances bulk billed is among the

lowest in the state while the percentage of diagnostic imaging services bulk billed is among the highest.

Child and family characteristics and service utilisation • The percentage of children developmentally

vulnerable in two or more domains is the highest in the state. • The rates of child protection

investigations completed, child protection substantiations and Child FIRST assessments per 1,000

eligible population are among the highest in the state.

Source: Department of Health and Human Services (2017) – Benalla RC Profile 2015

https://www2.health.vic.gov.au/about/publications/data/hume-region-2015

A Benalla LGA Data Profile was produced by Central Hume PCP in February 2017. The following health

and wellbeing data from the profile is relevant to this project.

HIGHLIGHTS

High levels of social capital/engagement compared to the Victorian measure – e.g. able to get help

from neighbours (68.5% v 54.5%), feel valued by society (57.2% v 52.9%), rated their community

as an active community (93.3% v 81.8%) and volunteerism (28.5% v 19.3%)

Community rated as a pleasant environment (96.7% v 95.1%)


https://www.centralhumepcp.org/wp-content/uploads/2018/02/Data_Profile_for_Benalla_Local_Government_Area_February_2017.pdf

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Estimated homeless persons per 1,000 population is lower than Victorian measure (2.2 v 4.0).

CHALLENGES

Ranked 16th of the Victorian 79 LGAs in the Index of Relative Socio-economic disadvantage (IRSD);

IRSD score 957.

Percentage of highly disadvantaged Statistical Area 1 (SA1) blocks is higher than Victorian measure

(29.7% v 20.0%)

(Note: SA1s are the smallest unit of measurable data e.g. a population block of between 200 and

800 people with an average population size of approximately 400 people.)

Higher percentage of rental stress than Victorian measure

Higher rate of family violence incidences offences per 1,000 population compared to Victorian

measure (21.3 v 12.4)

Very high teenage fertility rate per 1,000 population compared to Victorian measure (22.2 v 10.4)

Higher percentage of children developmentally vulnerable on two or more childhood domains

than Victorian measure (20.8% v 9.5%).

The recent 2017 Victorian Population Health Survey (2019) provides the following highlights for the

Benalla LGA.

Items more favourable than state (Proportion of adult population)

Spent ≥7 hours per day spent sitting on an average: Week day (16.3% v 26.6%); and weekend day

(9.7% v 14.1%)

Health related checks, conducted by a doctor or other health professional, in the last two years:

Blood pressure (88.5% v 79.6%); Blood lipids (61.6% v 56.8%); and Blood glucose (61.0% v 50.7%)

50yrs+ who completed and returned the FOBT kit in the mail (70.2% v 60.1%)

Females 50yrs+ who had a mammogram in the last two years (86.0% v 79.2%)

Items less favourable than state (Proportion of adult population)

Obese BMI category (31.0% v 19.3%)

Overweight (pre-obese or obese) (61.3% v 50.8%)

Consumed sugar-sweetened beverages daily (19.3% v 10.1%)

Did not meet fruit and vegetable consumption guidelines (58.4% v 51.7%)

Met physical activity guidelines (40.3% v 50.9%)

Had high/very high level of psychological distress (19.3% v 15.4%)

Self-reported dental health status as ‘fair’ or ‘poor’ (36.3% v 24.4%)

Doctor diagnosed:

- Anxiety and Depression (37% v 27%)

- Hypertension (35% v 25%)

- Asthma – ever diagnosed (31% v 20%)

- Two, or more, chronic conditions (31% v 25%)

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4 SUMMARY OF ACTIVITY

The Project Work Plan outlines the agreed project activities associated with the three project objectives

below. (See Attachment 9.2, p.38). A narrative description of the activities is summarised under the

associated objective.

It is important to note that for this project, ‘health’ is described in the broadest sense: viewed through

a social health and wellbeing and determinates lens (WHO Ottawa Charter 1986).

1. To leverage local relationships with health and community organisations in the Benalla LGA to

maximise service system knowledge and engagement strategies

a. Source contacts through PCP partners

Members of the Central Hume PCP’s local Benalla Health and Wellbeing Partnership provided

the project workers with potential key stakeholder and participant contact sources. This

occurred at the August Forum meeting and via follow-up with individual members. A

summary update on the project occurred at the October meeting where members were keen

to hear the needs analysis results and project outcomes.

Dissemination of project information also occurred via the Central Hume PCP’s weekly e-

bulletin and Facebook page.

b. Contact key stakeholders

Through the first 4 weeks of the project key stakeholders were contacted via phone, email and

face-to-face. Key stakeholders included 25 staff and community members from a wide range

of sectors and organisations (n=13) including health services, community services, aged care

services, early childhood services, education, and community groups.

Key stakeholders promoted the project in a range of ways, namely: supported or facilitated

contact with potential participants (individuals and groups); electronically disseminated project

flyers and the on-line survey link; and supported the in-house dissemination of the project

flyers and, where relevant, hard copies of the survey (See Attachment 9.3, p.40).

See Attachment 9.4 p.41 for the key stakeholder contacts list and 92 dissemination points.

c. Map current health service system

Consultation with local health stakeholders identified that a ‘Women’s Health Directory’

booklet for consumers has been complied by the Benalla Health community health nurse. To

promote alignment, the directory categories became the baseline to map the health and

wellbeing service usage of survey and group participants.

As a brief summary, the major health care providers located in the Benalla LGA are generalist

primary care services (including general practices, pharmacist, dental and allied health

services), community care services (e.g. community health, home nursing, aged care and

disability), and residential aged care. Visiting health and wellbeing services include some

specialist medical consultants and specialist health and well-being services, such as Aboriginal

Health, Drug and Alcohol, Mental Health, Sexual Health, and Youth services,

In addition to using the range of Benalla-based and visiting health and wellbeing services,

project participants reported using out-of-area health and wellbeing services. Participants

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reported travelling to a range of locations primarily for health and wellbeing and specialist

services including: Wangaratta, Shepparton, Albury/Wodonga, and Melbourne services. (See

section 5.1, p.20 for results of service user mapping).

d. Use partners to review service system mapping

Health care providers review the directory annually as part of the community health role.

Project participants also provided some suggestions to be included in the directory; this was

feedback to the Community Health Nurse for consideration.


identify specific self-reported health needs and the potential service models to meet these needs.

a. Map women-focused community groups.

The main categories of women-focused groups identified in the Benalla LGA, and targeted for

the project were:

(i) Maternal and Child Health (M&CH) and parenting services: The Tomorrow Today

Foundation facilitates the Benalla Parenting Early Education Partnership (PEEP).

(ii) Country Women’s Association (CWA): The three CWA groups in the LGA, Benalla,

Swanpool and Thoona CWA, were engaged via their president and / or secretaries,

(iii) Women’s wellbeing groups: Waminda Neighbourhood House facilitates the West End

Women’s Group,

(iv) The Boob Bus: The Benalla Health Community Health Nurse encouraged bus participants

to complete the survey (either online or hard copy) during the bus trip

(v) Benalla Girl Guides (senior Guides): The project details and survey link were emailed to

the Guides for dissemination.

b. Identify and engage potential participants (snowballing)

Identifying key contacts and key dissemination points

In addition to the above women-focused community groups, key-stakeholders suggested that

female orientated work places would be useful to disseminate the project flyers as a means to

engage female staff or tertiary students. Suggestions included health care services, child-care

and education services, disability and aged care services. The project team also met with

Women’s Health Goulburn North East (WHGNE) to discuss potential strategies for increasing

engagement with the target cohort.

To ensure a range of age cohorts, youth and age-care specific services were targeted, e.g.

youth the BRCC L2P program and NEYSAY; and older adults the BRCC Aged Care

Coordinator, Cooinda Independent Living facility, Senior Citizens and U3A. Other specific

special needs groups or demographic cohorts were also contacted, e.g. Warrenbayne Play

Group mothers; Benalla Coffee Club.

The general practice and pharmacy providers in Benalla were contacted directly with a face-

to-face flyer drop off and a proceeding follow-up email.

Flyers were posted on the notice boards of local cafes, post offices, supermarkets and the

Benalla Library. Emails were sent to a range of rural contacts, including local rural newsletters,

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rural hall committees and suggested rural members. Key stakeholders also disseminated the

flyers. (See 9.4 – Dissemination points, p.41 and 9.5 – Flyers, p.42).

Communicating with participants or group contact persons

Initial communication with the potential contact or group was by phone or email. Follow-up

email correspondence or meetings occurred to identify potential participants and arrange the

best participation method for the contact’s suggested group or individuals.

Appointments were made for 10 groups to participate in the project: some group interactions

were a means to further disseminate the project (e.g. a hard copy of the survey), whilst other

groups preferred and agreed to the concept of a round-table group discussion. For this

project, individuals did not self-identify for kitchen-table style conversations or in-depth-

discussions; rather individuals undertake the survey.

c. Develop a brief survey

Survey Monkey was the data collection tool used to collate online and hard copy responses

of the survey. This tool aided analysis of quantitative data. (See Appendix 9.6, p. 43 for survey

questions).

A 24-question survey was developed. The survey had three sections:

i. Section 1: Your Personal Details. This quantitative section had 10 demographic

questions, with ‘Town/postcode’ as the only compulsory question. This baseline data

helped ensure a broad range of respondents and enabled targeted promotion and

flyer dissemination if there was an obvious cohort gap.

ii. Section 2: Health and Wellbeing Services You Use. This 6-question section, (1 open-

ended question and 5 quantitative questions) mapped the services women used;

respondents were required to enter at least one response for 2 questions. The data

collection was grouped into 4 categories as a means to promote broad ‘health and

wellbeing’ responses: physical and medical health and wellbeing; emotional, spiritual

and mental health and wellbeing; social wellbeing; and, women and children focused

wellbeing. To assist respondents and data analysis drop-down choices for each of the

4 categories; ‘Service/group type’,’ Town’, and ‘How often’.

iii. Section 3: Health Needs. This 8-question final section was predominately open-ended

questions, with a strategically placed final rating question to capture any unstated

important ‘model’ features. The previous open-ended service system questions

focused on service system features that were enablers or barriers; service gaps; and

potential improvements.

The survey was drafted and tested internally. All Central Hume PCP providing feedback on

the content and format of the survey prior to the survey going live 12 August 2019. The

online survey was open for 8 weeks; final hard copy returns completed 14 October 2019.

d. Develop guiding questions for round table discussions

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To align group discussion and the survey data, the guiding questions for the round-table

discussions were those qualitative (open-ended) questions in the survey. Depending on the

group, these discussions were structured or semi-structured conversations, i.e. the Benalla

GOTAFE session was structured with 2 groups of 6 working through each question and feeding

back to the group; the 3 Parents Early Education Partnership (PEEP) sessions were semi-

structured; and the Cooinda and CWA sessions were facilitated conversations.

Of the 10 scheduled groups, six were discussion groups and four were project promotional

activities e.g. disseminating hard copies of the survey and providing information about the

survey and question explanations if needed.

3. To propose place-based (service model) solutions that will address the identified health needs of

the rural women in the Benalla LGA

The hypothesis was that the data collected through the survey and group discussion activities

would drive place-based solutions and project recommendations for service system improvements

and guide the development of a recommended service model/s to address the identified health

needs of rural women. The findings and proposed model are in the next section. This section

focuses on the activities and demographics of the participating women.

a. Collate and analyse data

Participant demographics

The survey collected specific demographic data related to the participants, whereas the group

sessions did not gather demographic data (except for postcodes where possible).

Survey responses

205 women participated in the survey: 186 women across all age-cohorts participated online

(90.73% of respondents); and 19 women from the age cohorts of 55 years and over completed

a hard-copy survey (9.27% of survey participants) that was manually added to Survey Monkey.

The survey completion rate was 49% due to the survey structure with few compulsory fields.

The average time spent on the survey was 9 minutes.

92.2% of respondents were within the eligible catchment area; out-of-area respondents were

all in the Hume region. Out-of-area responses reduced after the first week of the survey being

open following a revision of the survey title, i.e. specifying Benalla LGA.

The response rate for the demographic section of the survey was excellent, with only one or

two respondents skipping 6 of the 10 questions. The snowballing nature of the survey

dissemination meant there was little control in knowing who was participating in the survey

and whether there was a good cross section of Benalla LGA women. However, the targeting

of group participants tried to overcome some of these shortcomings. Overall, the survey

respondents were from a wide cross-section of women 18-years and over living in the Benalla

LGA with exception of the extreme ends of the age cohorts, and of the Aboriginal and Torres

Strait Islander (ATSI) community.

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Figure 2: Survey respondents (%) by postcode (n=205)

Towns / Postcodes

In-scope/area responses (n=189; 92.2% of respondents):

postcode 3672 (Benalla and surrounds) 67.32% of respondents;

postcode 3673 (East LGA area, e.g. Swanpool, Winton etc.) 18.54% of respondents;

postcode 3725 (NW LGA area, e.g. Thoona) 4.39% of respondents;

postcode 3670 (South LGA area, e.g. Baddaginnie) 1.97% of respondents;

Out of scope/area responses (n=16; 7.8% of respondents), which included:

South Wangaratta postcode area 3675 (2.44%);

Wangaratta / 3677 (1.48%)

(Refer to Figure 2: Survey respondents (%) by postcode (n=205), p. 15)

Age cohorts (n=204)

Survey respondents were from all age cohorts except for women 90 years of age and over.

5-year increments were used to better see the age cohort spread. Women under 20 years

of age were not well represented with only 1 respondent in that cohort. One person

skipped this question.

The highest respondents by age cohort: 55-59 (12.75%); 35-39 (12.25%); 25-29 (10.78%);

60-64 (9.80%); 65-69 (8.33%).

Age range % respondents Total responses

18-19 0.49% 1

20-24 5.88% 12

25-29 10.78% 22

30-34 7.35% 15

35-39 12.25% 25

40-44 6.86% 14

0.49% 0.49% 0.49% 0.49% 1.95%

67.32%

18.54%

2.44% 1.46% 0.98% 0.49%4.39%

0.49%0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

3644 3646 3666 3669 3670 3672 3673 3675 3677 3690 3723 3725 3749

% Survey respondents per postcode (n=205)

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45-49 7.84% 16

50-54 4.90% 10

55-59 12.75% 26

60-64 9.80% 20

65-69 8.33% 17

70-74 6.37% 13

75-79 3.92% 8

80-84 1.47% 3

85-89 0.98% 2

90+ 0.00% 0

Aboriginal and Torres Strait Islander / ATSI (n=204)

2 respondents identified as ATSI (0.98% of respondents). 1 person skipped the question

Cultural and Linguistically Diverse / CALD (n=203)

12 respondents identified as being from a CALD background (5.91%). 2 people skipped

the question.

Lesbian, Gay, Bi-sexual, Transsexual, Queer, Intersex + / LGBTQI+ (n=204)

6 respondents identified as LGBTQI+ (2.94%). 1 person skipped the question

Chronic Condition (n=203):

50 respondents identified as having a chronic condition (23.63%). This significantly

represented nearly ¼ of the survey respondents. 2 people skipped the question.

Rely on public transport / others (n=204):

9 respondents reported relying on either public transport or others for transport (4.41%).

1 person skipped the question.

Live alone (n=205)

29 respondents reported living alone (14.15%).

Carer of someone with a special needs (n=205)

24 respondents reported being a carer (11.71%).

Employment status (n=205)

Over half of the respondents reported being employed (59.51% /122 respondents); 54

respondents (26. 34%) reported ‘Other’ status, which included being retired, working part

time employed, farm work, self-employed, volunteering, and being a carer. The question

did not distinguish between full-time and part-time work, or if people had multiple roles,

Employment Status % respondents Total responses

Student 7.32% 15

Not Employed 10.24% 21

Employed 59.51% 122

Other (please specify) 26.34% 54

Group activities

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10 groups were engaged during the project period, late August to mid October 2019. 7

groups were in Benalla (postcode 3672); 1 in Swanpool (postcode 3673 / east LGA area); 1 in

Thoona (postcode 3762 / NW LGA area); and 1 in Warrenbayne (postcode 3670 / south LGA

area).

Figure 3: Female group participants by postcode

There were 91 group participants across the 10 groups; a group average of 9.10. However,

as the project workers were guests to existing groups, the groups were not confined to project

eligible participants, i.e. from the Benalla LGA, and not exclusively women-only. 77 of group

participants were women (84.62%), and 72 self-identified during the activity as eligible

participants (79.12% of overall participants and 93.51% of female participants). The postcodes

of 6 female participants were not recorded.

Nor were the events always conducive to group discussions. Consequently, 4 group activities

were dissemination of survey information only. The numbers reflect the group activity related

constraints: 50 people were participants of the group discussions (a group average of 8.33),

with 39 eligible women (78.00% female participants and a female group average of 6.5) and

11 men (22%). Despite the group constraints, there was valuable information gleaned from

the group / round-table discussions.

The survey was also promoted and further dissemination to female networks encouraged (hard

copies were available).

Data analysis

Thematic analysis was the methodology used to analyse the qualitative data for both the group

discussions and survey responses. Responses were grouped into categories; sub-themes and

themes then emerged until the data was exhausted. The online survey and group data was

initially analysed separately; and as like-themes emerged, the common themes were

combined.

The quantitative data was used as comparative data and a means to identify data themes.

61.97%

2.82% 5.63%1.41%

7.04%1.41%

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Female group particpants by postcodes (77 female participants: n=71 recorded postcodes)

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The hypothesis was that the data would drive place-based solutions and service system

improvements and guide the development of a recommended service model/s to address the

identified health needs of rural women.

b. Focus Group of interested stakeholder and participants

The initial concept was that a Focus Group would help guide the development of a service

model once the data had been analysed. Participants and Key Stakeholders were invited to join

a Focus Group, but there was no uptake.

At the beginning of October, a brief project update was presented to the Central Hume PCP

Benalla Health and Wellbeing Forum. Members expressed interest in the report outcomes,

especially those that would help guide future planning.

5 FINDINGS

The findings are set out as per the 3 key areas in the Murray PHN reporting guidelines:

I. Rural Women’s Health Needs

II. Service Needs Analysis

III. Proposed Service Model

The key over-arching theme that applied to all the findings was that of ‘Access’. Women reported a

range of access issues (physical, geographical, structural/system, cultural, social, etc.). This access lens

applied to general / primary health care services, specialist / secondary health care services, or hospital

/ tertiary health care services and community care and wellbeing services. Thus the themes and health

needs solutions have been categorised through an access lens.

5.1 Rural Women’s Health Needs

Survey results

205 women participated in the 2-month online and hard copy survey, which had a 49% completion

rate for 24 questions: 16 quantitative questions and 8 qualitative open-ended questions. (Refer to

previous section 4: Summary of activity, item 3.a, p. 14 for demographic details).

Section 2 of the survey, Health and Wellbeing Services You Use, took a snapshot of service use and

mapped the service locations and use frequency of participating women.

When asked what services were most important to health and wellbeing, most of the 137 women who

responded to this open-ended question listed a range of emergency, primary, secondary and tertiary

care health services as well as community and social services. Frequently listed services were General

Practice; Dental; Optometrist; Allied Health including physiotherapy, podiatry, dietetics, speech therapy

and chiropractor; Pharmacies; Ambulance; and Benalla and Wangaratta Acute Health facilities including

the Emergency / Urgent Care Departments, Community Health, and radiology. Other services listed

included Mental Health such as psychology and counselling; Specialist services such as cardiac,

oncology, maternal services, women’s health or gynaecology, and Royal Children’s Hospital;

Community Health; Pathology; and alternative therapies including acupuncture, naturopath, and

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myotherapy. A few women considered broader social determinants of health and included things like

the library, exercise groups, aquatic centre, hydrotherapy, social groups, church, access to bulk billing

services, access to fresh fruit and vegetables, good roads and walking paths,

As described previously, 4 health and wellbeing categories were explored to map health service usage.

In summary the quantitative questions elicited a total of n=898 responses to being engaged with one

or more of the listed service types across all health and wellbeing service categories; n=789 being

current or active service engagements. The majority of responses were associated with the category

Physical and Medical Health and Wellbeing (n=137); then Women and Children’s Health and Wellbeing

(n=112); Emotional, Spiritual and Mental Health and Wellbeing (n=76); and Social Wellbeing (n=32*).

Results for these categories follow this general summary. (Note: *See Social Wellbeing Service Types,

p.22, for a detailed explanation of the revised data in this category related to the recorded Not

Applicable or Currently Not Using a Service response).

Of these service engagements, there were a further n=747 responses to the associated Service Location

and n=740 responses to associated Frequency of Use.

Benalla was the location of service access for 460 of the reported service engagements, meaning

women travelled beyond Benalla for 287 services. Wangaratta (121 services) and Shepparton (66

services) were the next most frequented locations for service engagement access; Albury–Wodonga

collectively recorded 25 service access engagements and Melbourne recorded 23 service access

engagements. Travel to beyond Benalla was generally for specialist services; however, a few women

travelled to Mansfield and Euroa for a GP service. Respondents did not list ‘Other’ locations (18). (Refer

to Figure 4: Total Service Use reported by Location (n=747), p. 20).

Whilst the frequency of service access was greatest for larger intervals of 6-monhtly (131 responses),

yearly (160 responses) and 2-yearly (138 responses), a small number of women reported accessing a

service daily (5 responses), twice weekly (20 responses), weekly (36 responses) and fortnightly (16

responses). Of the total frequency of use responses (n=740), 56 stated that no service was currently

being accessed. (Refer to Figure 5: Frequency of Use - Total responses for all 4 health and wellbeing

service categories (n=740), p.20).

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Figure 4: Total Service Use reported by Location (n=747)

Figure 5: Frequency of Use - Total responses for all 4 health and wellbeing service categories (n=740)

Physical and Medical Health and Wellbeing Service Types

137 women responded to the service use question related to Physical and Medical Health and

Wellbeing Service Types. Multiple services could be selected, with up to 8 service use options: 137

reported using at least one physical and medical health and wellbeing service type; 10 of the 137

recorded using 8 services. N=505 was the total reported physical and medical health and wellbeing

services accessed by the 137 respondents. 494 were reported as current active engagements; all

women reported being actively engaged with at least one service; for the remaining 7 options, 11

reported not being actively engaged in a service (see Figure 6: Reported Service Use Chart - Physical

and Medical Health and Wellbeing Service Types, p.21).

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The majority of the women reported accessing a GP (89.78% of respondents), however 14 women did

not list accessing a GP service (10.22%). Over half the respondents reported using dental (56.93%) and

eye care services (51.09%). Significantly, 59 respondents (43.07%) did not report engaging with a dental

care service and 67 respondents (48.91%) did not access eye care or check-ups.

Figure 6: Reported Service Use Chart - Physical and Medical Health and Wellbeing Service Types

‘Other’ responses predominately related to musculoskeletal therapies, including Myotherapy,

Osteopathy, Chiropractor, Bowen Therapy, and Massage. Also listed were Yoga and Pilates, swimming

and exercise classes. 2 of the ‘Other’ responses related to both the mental health and women’s health

categories. Two respondents listed using the internet as a means to access medical health and

wellbeing information; one specifically stated using an online ME/CFS service. The internet was missing

as a dropdown option, thus not captured.

One respondent, who identified as having a chronic condition/s, reported using 8 local and regional

services and added a 9th medical service in the ‘Other’ comments box: Visiting a Melbourne Diabetes

Specialist (Endocrinologist). This respondent also reported services from the other categories.

Emotional, Spiritual and Mental Wellbeing Service Types

76 women responded to the Emotional, Spiritual and Mental Wellbeing service use question. Multiple

services could be selected, with up to 5 service use options: all 76 respondents reported using at least

one listed service type. The highest reported service type accessed was Mediation / Mindfulness

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Therapies (23), followed by Counselling (17), Phycologist (13), Support Groups (10), and Mental Health

/ Psychiatric Services (8). (Refer to the Figure 7, p.22).

Of note, the seconded highest recorded service type was ‘Other’ (20) responses included: Church /

Bible classes / religious worship (10); Yoga (5); Online tools (4) including the report of a Yoga and

Medication App; Gym (1), African Drumming (1); Tomorrow Today Foundation Play Groups (1). One

respondent reported that “Tried to get a psych but none available”.

Figure 7: Reported Service Use Chart - Emotional, Spiritual and Mental Wellbeing Service Type

Whilst some services such as meditation, counselling and support groups were available and therefore

accessed in Benalla, specialist mental health services are not available in Benalla and were accessed

predominantly in Wangaratta and Shepparton; although 2 respondents accessed a Beechworth and

Mansfield Psychology service.

Social Wellbeing Service Types

91 women responded to this question, however the data required a revision as 59 respondents

recorded ‘Not applicable – not using a service’ to their first and only entry. The revised data reduced

the response rate to N=32 respondents, with 42 total services of which 38 were active service access

engagements. The highest response field was ‘Other’ (18); listed responses included connecting with

friends and community social groups (4), Church (2), CWA (2), YMCA(1), Probus (1), Art group (1). As

detailed in Figure 8 (p.23), few people reported using the various listed social supported services: the

highest social support services accessed were support groups (7), carer support service (4), disability

support (3) and relationship support (3).

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Figure 8: Reported Service Use Chart - Social Wellbeing Service Type

Women & Children Wellbeing Service Type

112 women responded to this Women and Children Health and Wellbeing Services question.

Multiple services could be selected, with up to 5 service use options: all 112 respondents reported

actively using at least one listed service type. N=182 was the total reported services accessed by the

112 respondents; 152 being current active engagements, and 30 reported not currently using a

service.

Figure 9: Reported Service Use Chart - Women & Children Wellbeing Service Type

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As detailed in Figure 9 (p.23), the highest response fields were Breast Screening (55), Cervical screening

(32), Gynaecologist (18), Maternal and Child Health (13), Sexual and Reproductive Health (7), Womens

Health Service (6), Paediatric specialist (6) and Parenting services (5). ‘Other’ listed responses include

PEEP (2), Breast Thermal Imaging / Ultrasound (1) and Talk-therapies (1).

A note in ‘Other’ stated that the new 5-year interval for Cervical Screening was not a drop-down data

option for ‘frequency’. Given this oversight it is hard to interpret the significantly low cervical screening

response rate (32 respondents; 28.57%); even if combined with ‘currently not using a service’ (30;

26.79%) the rate is still low.

Whilst generalist primary health care services are available in Benalla for women (e.g. cervical screening,

maternal and child health services), with the exception of a fortnightly visiting Sexual Health Nurse there

are no specialist women’s health services in Benalla. Women travelled to Shepparton, Wangaratta and

Melbourne for their Mammogram checks and predominantly to Wangaratta and Wodonga for

gynaecological appointments.

Most valued service category

Throughout this service usage section, women had indicated in both the open-ended and mapping,

the highest service usage and value was Physical and medical health and wellbeing services. However,

this category has, and consequently listed, the largest range of service types.

The ranking question further confirmed a preference for valuing or a predominance in usage and

availability of medical health services across the health and well-being categories. Of the 137

respondents to this question, 109 (79.56%) ranked Physical and medical health and wellbeing as the

most valued service category (i.e. ranked first), and highest in the overall ranking score. The overall

ranking score converted to 3.68 as per the Figure 10 below.

Significantly, given the reduced specialist access, mental health was the second highest ranking with 21

of the 137 respondents (15.33%) rating Emotional, spiritual and mental health and wellbeing services

as the most valued service category (i.e. ranked first), compared to the first ranked responses for

Women and children focused services (3.65%) and Social wellbeing service (1.46%).

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Figure 10: The type of service most valued - Total ranking scores for the 4 health and wellbeing service categories

In comments, a few respondents noted that ranking was difficult when all categories were equally

valued and important. At least one respondent viewed the categorising of services negatively.

“I take issue with splitting mental health off from "medical health". It's this kind of dichotomy that

has seen the two tier system that we have today, where significant health issues stemming from

mental health disrupt and even take lives, daily.”

The project workers were conscious that the categories could be both ambiguous and challenging but

opted to use them to avoid long overwhelming dropdown lists. Service types covering multiple

categories were potentially problematic as was a generalist primary care service (e.g. GP) in which a

broad range of medical services are provided, including mental health and women’s health,

Features of a health and wellbeing service

The final section of the survey sought to identify the barriers and enablers to service access and to find

the features that were important to rural women when using a health and wellbeing service.

The four open-ended questions relating to barriers and enablers drew similar themes to the group

sessions that collectively helped identify recommendations and a proposed service model for rural

women (see next section – item 5.3 Proposed Service Model, p.33),

To help quantify the data, a Likert style scale was used for identify the importance of 13 features relevant

to the planning and delivery of a health and wellbeing service. Between 114-118 women responded

to one or more of the listed features as being: Very important; Important; Somewhat important; Not

important; or Not applicable. (Refer to Figure 11: Table and chart - Important features in a health and

wellbeing service, p.27).

Service affordability was the feature that rated the highest weighted average score of 3.78; 96 women

(81.36% of the 118 respondents) identified ‘being affordable’ as a ‘very important’ service feature. The

3.68

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qualitative survey and group session data also replicated this result; affordability was a major theme

with women not using services due to service costs and the lack of bulk billing.

The top five weighted features identified were:

Being affordable (3.78) – 96 women identified this as Very Important (81.36%)

Being local (3.63) – 82 women identified this as Very Important (70.09%)

Being physically accessible (3.28) – 71 women identified this as Very Important (60.68%)

Having multiple services in one place (3.26) – 63 women identified this as Very Important

(55.26%)

Having outreach services (3.03) – 55 women identified this as Very Important (47.41%)

Being age-friendly (3.03) – 54 women identified this as Very Important (46.55%).

(See Figure 11, p.27).

These top 5 features, plus having access to child-care, match the themed discussions and form the

features of the proposed model (refer to item 5.3 Proposed Service Model, p.33). ‘Being local’ included

services being available to rural communities outside the Benalla service centre yet within the Benalla

LGA, as well as having access to more specialist services locally. Physical accessibility, whilst being

inclusive of disability friendly features, also addresses travel and transport issues and after hours service

access.

Having the feature of ‘being gender specific’ rated the highest as ‘Not Important’ (35 responses; 30.43%

of the 115 respondents), thus resulting in the lowest weighted average score of 2.03. The highest ‘Not

applicable’ response (18.08%) was for ‘being LGBTQI sensitive and inclusive’ (22 of the 117

respondents), making this feature was the second lowest weighted average score (2.15).

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Figure 11: Table and chart - Important features in a health and wellbeing service

3.63 3.78

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Features Very Important Important Somewhat Important Not Important Not Applicable Total

Being local 70.09% 82 23.93% 28 5.13% 6 0.85% 1 0.00% 0 117

Being affordable 81.36% 96 15.25% 18 3.39% 4 0.00% 0 0.00% 0 118

Being culturally sensitive and inclusive 43.97% 51 19.83% 23 22.41% 26 8.62% 10 5.17% 6 116

Being physically accessible 60.68% 71 17.95% 21 13.68% 16 4.27% 5 3.42% 4 117

Being disability friendly 45.76% 54 22.03% 26 14.41% 17 9.32% 11 8.47% 10 118

Being gender specific 13.04% 15 21.74% 25 27.83% 32 30.43% 35 6.96% 8 115

Being child friendly 35.04% 41 24.79% 29 17.09% 20 11.97% 14 11.11% 13 117

Being youth friendly 32.48% 38 23.93% 28 16.24% 19 14.53% 17 12.82% 15 117

Being age friendly 46.55% 54 27.59% 32 12.93% 15 8.62% 10 4.31% 5 116

Being LGBTQI sensitive and inclusive 23.08% 27 21.37% 25 22.22% 26 14.53% 17 18.80% 22 117

Having a female worker 35.04% 41 27.35% 32 23.93% 28 11.11% 13 2.56% 3 117

Having multiple services in one place 55.26% 63 23.68% 27 14.04% 16 6.14% 7 0.88% 1 114

Having outreach services 47.41% 55 26.72% 31 12.07% 14 8.62% 10 5.17% 6 116

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Survey and Discussion Group questions – Common Themes

The responses to the following 6 open-ended survey questions were group and themed. The themes

and sub-themes are interrelated. The survey response rates are as detailed below.

i. What things are good about the services that you use or need/plan to use? (n=95)

ii. What things are not so good about the services that you use or need/plan to use? (n=98)

iii. What hinders or stops you from using services that you may need? i.e. barriers to service

usage (n=88)

iv. What helps you access health and wellbeing services? i.e. enablers to service usage (n=80)

v. What health and wellbeing services would you like to see in your area that currently do not

exist? (n=75)

vi. If you could create your perfect Health and Wellbeing service, what would it look like? (n=66)

vii. Other comments (n=24)

Describing a ‘Perfect Health and Wellbeing Service’ was the hardest question eliciting only 66 responses,

however, as detailed in the previous section, 118 women responded to the following quantitative scale

question about Important Features (see Figure 11, p.27).

The survey questions were also conversational prompts in the group discussions. 50 people

participated in six discussion groups, of which 39 women were eligible participants; this was due to the

mixed nature of some community group and out-of-area participants.

Irrespective of the cohort (e.g. age, location or other demographic), 3 common themes emerged within

both the survey and group discussions.

A. Service availability (72 survey responses reported availability being a barrier)

B. Service affordability / Cost (31 survey responses reported financial costs being a barrier)

C. Transport (18 survey responses reported transport being a barrier.)

A. SERVICE AVAILABILITY

72 survey respondents and all discussion groups identified service availability as a barrier to use or

affecting service access. The issues raised were for one or multiple elements of the three sub-themes

within this category:

i. Service awareness

ii. Issues accessing local services

iii. Issues accessing specialist services

Service awareness:

Women within the survey and discussion groups reported a range of aspects of service awareness that

influenced service access outcomes:

a) Lack of awareness about the service availability and referral pathways

Women and/or other community members were not aware of the range of health and

wellbeing services provided in Benalla (and also beyond);

Women or community members did not know how to access local and specialist services;

Staff, especially frontline staff, in community and health services were not aware of, or up-to-

date with, the range of health and wellbeing services, and/or how to access them; including

those within their own organisation, e.g. projects and health promotion services.

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b) Service directories

Participants noted that there was not one place (including internet directories) in which the

services were comprehensively recorded and kept up to date;

Knowledge of the local paper-based Women Health Directory was patchy;

The internet was not equally available or reliable for all women in the LGA, thus reducing a

mode of service awareness and health and wellbeing knowledge access.

c) Funding and service constraints

There was confusion about the capacity or funding constraints of some health services that

resulted in frustration and perceived service gaps; e.g. local hospital Urgent Care services and

After-hours services were issues of incurred costs not associated with an Emergency

Department; ambiguity regards ‘bulk-billing’ items in general practice.

Issues accessing local services

Women within the survey and discussion groups reported a range of issues in the accessing of local

health and wellbeing services:

a) Absence of a ‘No-Wrong-Door’ approach

In addition to staff lack of service awareness, women reported that some services did not have

or implement a ‘no-wrong door’ or ‘warm referral’ approach resulting in delayed or no service

access.

b) Long waiting times

Women reported excessively long waiting times, especially for GP appointments, in which

multiple group participants stated waiting for periods of 3 to 4 weeks;

Group participants also commented on long waitlist times for other primary care services such

as dental and allied health for both initial and ongoing appointments. The survey respondents

(15) who identified waiting times as a barrier to service use generally did not elaborate on the

health sector or purpose of the wait (initial appointment or follow-ups);

Participants commented on longer waitlist times of up to 6 months and more for initial

appointments with specialist services, for example mental health practitioners such as

Psychologists and Psychiatrists.

c) Unable to access a preferred practitioner or service

Survey and group participants stated they had experiences of being unable to see a preferred

doctor; or not being able to see their preferred doctor in a timely manner;

Women noted a lack of access to and/or availability of female GPs in Benalla;

Access to dental care, including affordable care, was identified as a service gap;

There was frequent reference from survey participants to the lack of after-hours services;

A few participants viewed the absence of funded medical doctor positions in the local hospital

as a service issue, e.g. to conduct surgery, but many identified the lack of a staffed and funded

Emergency Department as an issue.

d) Prohibitive service costs

Participants frequently stated that service costs were a prohibitive factor in accessing local

generalist and specialist services, and the after-hours service provided at the local hospital

Urgent Care unit (staff by an on-call GP/VMO), which required a fee for service.

e) Privacy and confidentiality

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Women within the survey and group discussions reported privacy and confidentiality, or

reduced anonymity, as a rural specific issue that has the potential to affect their accessing local

health and wellbeing services. Specifically knowing staff or accessing an identifiable service

could affect one’s personal privacy and heighten the fear of a confidentiality breach.

f) Lack of (occasional) childcare support

Some women espoused the availability of childcare as a means to enable a more focused and

effective health care engagement.

Issues accessing specialist services

Women within the survey and group discussions reported a range of issues in the accessing of

specialist health and wellbeing services:

a) Minimal visiting specialist services or programs

Throughout the survey and within groups, women reported having to travel distances to seek

specialist services (public and private).

The few publically funded visiting services reported by participants were the Albury Wodonga

Aboriginal Health Service (AWAS); the Sexual Health Nurse; the Aged Care Assessment Service

(ACAS); and the Albury Wodonga Health (AWH) – Adult Mental Health Service (AMHS).

b) Lack of gender specific / women health services locally

Throughout the survey and within groups, women reported having to travel distances to seek

specialist women’s health services such as mammogram service (including references to a

planned group bus trip to appointments, known locally as the boob-bus), gynaecology and

obstetrics services, and menopause services;

Some women suggested the need for a local Women’s Health Service(s) and or gendered

services to address gender service access issues;

A few women identified the need for Family Violence (FV) services to be more readily accessible.

c) Centralised Intake Issues

A delay in the provision of service assessment (and subsequent service delivery) to the rural

LGA was specifically reported for services with a Central Intake system. These included age care

assessments, disability (NDIS), and mental health.

d) Out-of-area service provision

Women from all cohorts reported travelling to locations 40 to 150 minutes from Benalla to

access a range of biopsychosocial specialist services;

Women did not report specialist services offering a telehealth appointment, directly to the

individual or via Benalla Health service or their primary care provider (e.g. GP).

B. SERVICE AFFORDABILITY / COST

31 survey responses and all discussion groups reported the financial costs of health care being a barrier

to use or affecting service access. Issues raised covered elements of the two sub-themes in this

category:

i. Costs associated with Public vs. Private services

ii. Impact of high service costs

Costs associated with Public vs. Private services

Women within the survey and group discussions reported a range of financial issues related to the

funding of public and private health and wellbeing services:

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a) Cost of private services

Participants frequently stated private health and wellbeing services were unaffordable. This

included the primary care services of General Practice and Dental Care;

Local after-hours medical services were private fee-for-service practices;

Specialist services were generally private services with medical fees significantly more than $100.

The exceptions were (i) the specialist service was associated with a public hospital admission or

an outpatient appointment, including mental health; or (ii) the service was part of a funded

Medicare item appointment e.g. Psychologist or Allied Health care;

The publically funded Community Health service provides a range of community nursing and

allied health services, but does not provide medical care (generalist or specialist). The rare

exception is the availability of an endorsed Nurse Practitioner who can prescribe and practice

in a specific specialist field, e.g. the visiting Sexual Health Nurse.

b) Bulk billing

Women frequently raised the lack of bulk billing General Practices in Benalla as a service access

issue, indicating women could not afford or needed to prioritise GP appointments;

Women stated they were unsure of which GP appointment type, i.e. Medicare item number,

invoked a ‘bulk billing service’ (i.e. a fully funded Medicare service or free service), and could

not prioritise appointments (personal or family appointments) based on their financial capacity;

There were anecdotal reports of high patronage of the publically funded Albury Wodonga

Aboriginal Health Service (AWAHS) Mobile Bus and the associated bulk billing medical services.

c) Wangaratta Emergency Department vs the local Urgent Care

Several participants voiced frustration at having to travel to, and wait at, a publically funded

Emergency Department for free after-hours care, whereas Urgent Care provided access to an

on-call GP (private provider) who charged a fee-for-service;

The Emergency Department could also provide a higher level of acute care and additional

services if required, such as X-ray.

Impact of high service costs

Participants reported four key negative impacts associated with high health care costs, but these are by

no means the only negative impacts:

a) A lack of service choice.

b) A fear of health service costs, including on-the-day payments.

c) Avoidance of service usage for non-urgent care, e.g. dental care,

d) Delayed access to services, impacting on prevention and early intervention treatments

C. TRANSPORT OR RURAL TRAVEL

18 survey responses and all discussion groups reported transport or travel as a barrier to use or

affecting service access. Issues raised covered elements of the two sub-themes in this category:

iii. Public transport

iv. Rural travel

Public transport (PT)

a) Lack of public transport services in Benalla

Participants who lived in Benalla reported having access to limited public transport, e.g. West

End PT;

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Those unable to travel independently relied on the limited in-town services or support from

family and friends to access health and wellbeing services;

Train travel could be used to access health services on the Benalla line, though the service was

limited;

Service appointments did not line up with PT timetables and there could be long waits;

Out-of-town participants relied on car transport to access health and wellbeing services.

b) Transport fees

a) Taxi fees were additional costs incurred by participants in order to access health services if there

were mobility issues, or PT or other supports were not available or suitable.

Rural Travel

Participants reported two main issues associated with rural travel and health service access

a) Distances to travelled to access health services are greater for rural women than city women;

b) The cost of travel is an additional cost incurred by women in order to access health services.

5.2 Service Needs Analysis

The local health and wellbeing services for women in the Benalla LGA are located in the rural service

town of Benalla. As detailed in section 5.1, the major health care providers located in the Benalla LGA

are generalist primary care services (including general practices, pharmacist, dental and allied health

services), community care services (e.g. community health, home nursing, aged care and disability), and

residential aged care. Visiting health and wellbeing services include some specialist medical consultants

and specialist health and well-being services, such as Aboriginal Health, Drug and Alcohol, Mental

Health, Sexual Health, and Youth services,

In addition to using the range of Benalla-based and visiting health and wellbeing services, project

participants reported using out-of-area health and wellbeing services. Participants reported travelling

to a range of locations primarily for health and wellbeing and specialist services including: Wangaratta,

Shepparton, Albury/Wodonga, and Melbourne services. (See section 5.1, p.20 for results of service

user mapping).

Women participating the project identified a range of service gaps and access issues to be addressed:

a) Addressing service gaps:

Service Information

Additional bulk billing services

After hours medical services

Funded medical staff at the local hospital

Women’s health services, including mammogram and screening services

Gendered services

Female GPs

b) Addressing access issues:

Affordable services and service delivery

The provision of more local health and wellbeing services, within Benalla and outreaching

to outlying towns in the LGA

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More specialist services, including specialist psychiatric services (including Headspace and

youth mental health), physicians and surgeons, Alcohol and other Drugs (AOD) services

(including AA and NA), and FV services

Addressing social access issues, such as inclusive family friendly services with child care and

transport access

The provision of a range of integrated health and wellbeing services in one location, such

as a Wellbeing Hub or One Stop Shop

The above service needs can be further re-enforced by the top five features participants identified as

important features of a health and wellbeing service:

1. Being affordable

2. Being local

3. Being physically accessible

4. Having multiple services in one place

5. (a) Having outreach services, and 5 (b) Being (all) age-friendly (See Figure 10, p.25).

This service needs analysis has shaped the development of the proposed place-based service model

and the project recommendations

5.3 Proposed Service Model

Various service models could help to address the service needs of women in the Benalla LGA (e.g.

increasing Nurse Practitioners, promoting telehealth services), however the proposed service model

could be inclusive of the above initiatives.

The proposed model is that of a Mobile Wellbeing Hub or Mobile One-Stop-Shop. The concept of a

Mobile Wellbeing Hub is based on the successful Albury Wodonga Aboriginal Heath Service (AWAHS)

Mobile Health Service (GP Bus). This GP bus has set a local precedent as improving service access and

health outcomes for Indigenous women and children in the Benalla LGA. The service provides

affordable local primary care services including medical general practice, dental, eye care and hearing

services to the Aboriginal community at a location that supports the needs of its community; the

Waminda Neighbourhood House.

Mobile Wellbeing Hub

The proposed Mobile Wellbeing Hub would coordinate a range of generalist and specialist services to

the broader community by visiting locations in the Benalla LGA in a manner that is inclusive and family

friendly, e.g. promoting childcare and care support for carers needing to access services. Service

locations could be both in Benalla and outreaching to geographically targeted towns across the LGA,

e.g. Swanpool, Thoona, Baddaginnie. Local drivers, such as local champions and local infrastructure

(viable hall or service centre, road access, internet access, etc.) would help determine successful

locations,

Coordination of the specialist services would facilitate a Mobile Multiservice Hub or Mobile One-Stop-

Shop, e.g. being available on the same day as the generalist primary care services, albeit a set time and

day of the month; also to link in with existing local and regional outreach services, e.g. Community

Health Nurse, Rural Financial Counselling, Rural Outreach – Mental Health.

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The model would require the following resources:

a) Staff, including:

• Wellbeing Hub Coordinator

• Facility (intake and assessment) nurse or Community Health Nurse

• Medical staff – GP, (endorsed) Nurse Practitioner

• Allied Health – Physiotherapist, Podiatrist, etc

• Dental Health – Dentist, Dental Nurse, Dental Technician

• Mental Health – Psychiatric Nurse (endorsed), etc

• Visiting specialists

b) Location facilities:

• Hall or service room(s) for hire (e.g. Neighbourhood House)

• Essential utilities e.g. electricity, water, internet access,

• Mobile phones

• Computers with Internet – telehealth facilities

• Telehealth facility (monitor, speaker and audio)

• Childcare or play group activities

c) Car or bus (purchase or hire)

• (explore existing mobile bus services for co-use)

d) Specialist and multi-use equipment, including

• Chairs and stools for clinicians (e.g. podiatry)

• Examination benches, lamps and screens (portable)

• Stethoscopes, thermometers, BP machine, ECG, etc

• Disposable examination packs, needles, syringes, etc

• Refrigeration for medication (e.g. immunisation) and pathology, etc.

See Appendix 9.7: Proposed Service Model Indicative , p.51.

6 RECOMMENDATIONS

The project recommendations summarise the issues identified in the project findings and needs analysis,

i.e. recommendations addressing identified service gaps and access issues. Unless stated the

recommendations are for the Murray PHN to follow-up.

1. Develop rural healthcare models that promote the main service features important to rural women,

i.e.:

- Being affordable;

- Being local;

- Being physically accessible (including accessible transport);

- Having multiple services in the one place;

- Having (access to) outreach services;

- Being all-age friendly.

2. Seek ways for local and regional services, and the Murray PHN, to improve healthcare service

awareness and dissemination to rural women, including service availability and costs.

3. Seek ways to address the perceived gap in the lack of bulk-billing services, e.g. make additional

bulk-billing services available in the LGA, and increase the transparency of bulk-billing items for

better consumer understanding around bulk billing and pricing of services

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4. Seek ways to increase options for after-hours medical services in the LGA

5. Seek ways to fund medical staff at the local hospital, Benalla Health

6. Seek options to increase access to women’s health services in the LGA, including

- Service delivery elements, such as mammogram and screening services

- Systems that support women’s health, e.g. female GPs and gender specific services.

7. Explore ways to support the delivery of affordable services and service delivery options for rural

women, especially related to general practice, dental health and mental health.

8. Explore ways to support the delivery of outreach health and wellbeing services in the LGA.

9. Explore ways to increase the delivery of specialist services in the LGA, including specialist psychiatric

services (including Headspace and youth mental health), physicians and surgeons, Alcohol and

other Drugs (AOD) services (including AA and NA), and FV services.

10. Explore ways to address social access issues, such as inclusive family friendly services with childcare

and transport access.

11. Explore ways to provide a range of integrated health and wellbeing services in one location, such

as a Wellbeing Hub or One Stop Shop.

7 ACHIEVEMENTS, CHALLENGES AND KEY LEARNINGS

Key project successes

The major success story of the project was the survey response rate, 205 survey participants, and the

relative diversity of participants e.g. age, location and chronic conditions.

Relationships built within and beyond the PCP’s member agencies in the short timeframe was also

viewed a key advantage to having two project workers.

The support given by staff within the key contact organisations for this project was invaluable.

Completing the project on time, within budget, albeit with additional in-kind staffing hours, and meeting

the planned evaluation indicators was gratifying for the project team.

Barriers and project challenges

The major challenges were:

i. Time constraints of the project i.e. 2 days per week over 13 weeks (26 days) to enable

development of resources, establishing contacts and groups within a limited window of time,

and data analysis and reporting.

ii. Capacity to develop project specific groups for in-depth consultations / round table interviews,

thus consultations with pre-existing local groups were tailored to fit the group make up, time

constraints, and focus of the group.

iii. Implementing the principles underpinning a ‘place-based’ approach’ within a tight timeframe

and a pre-set agenda, hence there was limited capacity to establish a focus group for guiding

and reviewing the project outcomes, and having little local ownership over the next steps

(recommendations).

iv. One local group had recently participated extensively in a range of local surveys, including the

WHGNE project, and survey burden potentially negatively influenced their participation rate in

this project.

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8 REFERENCES

Australian Early Development Census Data 2015 (published 2016)

https://www.aedc.gov.au/data/downloads

Benalla Rural City Council Plan 2017-2021, http://www.benalla.vic.gov.au/Your-Community/Health-

Wellbeing/Community-Wellbeing/Health-Wellbeing

Central Hume Primary Care Partnership (2017), Data Profile for Benalla Local Government area,

https://www.centralhumepcp.org/wp-

content/uploads/2018/02/Data_Profile_for_Benalla_Local_Government_Area_February_2017.pdf

Department of Health and Human Services, Victoria (2107) Benalla RC Profile 2015

https://www2.health.vic.gov.au/about/reporting-planning-data/gis-and-planning-products/geographical-

profiles - https://www2.health.vic.gov.au/about/publications/data/hume-region-2015

Victorian Department of Health & Human Services, LGA Profiles, 2015 (published January 2017)

https://www2.health.vic.gov.au/about/reporting-planning-data/gis-and-planning-products/geographical-

profiles

Victorian Health Information Surveillance System - Ambulatory Care Sensitive Conditions data for 2013-14

https://hns.dhs.vic.gov.au/3netapps/vhisspublicsite/ReportParameter.aspx?ReportID=23&TopicID=1&Subt

opicID=15

Victorian Population Health Survey 2014 (published July 2016)

www.health.vic.gov.au/healthstatus/survey/vphs.htm

Victorian Population Health Survey 2017 (published 2019) https://www2.health.vic.gov.au/public-

health/population-health-systems/health-status-of-victorians/survey-data-and-reports/victorian-

population-health-survey/victorian-population-health-survey-2017

World Health Organisation, Ottawa Charter for Health Promotion (21 November 1986)

https://www.who.int/healthpromotion/conferences/previous/ottawa/en/

https://www.aedc.gov.au/data/downloads





https://www2.health.vic.gov.au/about/reporting-planning-data/gis-and-planning-products/geographical-profiles





https://hns.dhs.vic.gov.au/3netapps/vhisspublicsite/ReportParameter.aspx?ReportID=23&TopicID=1&SubtopicID=15

https://hns.dhs.vic.gov.au/3netapps/vhisspublicsite/ReportParameter.aspx?ReportID=23&TopicID=1&SubtopicID=15

http://www.health.vic.gov.au/healthstatus/survey/vphs.htm

https://www2.health.vic.gov.au/public-health/population-health-systems/health-status-of-victorians/survey-data-and-reports/victorian-population-health-survey/victorian-population-health-survey-2017



https://www.who.int/healthpromotion/conferences/previous/ottawa/en/

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9 APPENDICES

9.1 Acronyms

Acronym Description

AA and NA Alcoholics Anonymous and Narcotics Anonymous

ACAS Aged Care Assessment Service

AOD Alcohol and other Drugs including

AMHS Adult Mental Health Service

ATSI Aboriginal and Torres Strait Islander

AWAHS Albury Wodonga Aboriginal Health Service

AWH Albury Wodonga Health

BH Benalla Health

BRCC Benalla Rural City Council

CALD Cultural and Linguistically Diverse

CWA Country Women’s Association

DEDJTR (Victorian) Department of Economic Development, Jobs, Transport and Resources

DHHS (Victorian) Department of Health & Human Services

FV Family Violence

GOTAFE Goulburn Ovens TAFE

GP General Practitioner

IRSD Index of Relative Socio-economic disadvantage

L2P Learners to Probationary (driving)

LGA Local Government Area

LGBTIQ+ Lesbian, Gay, Bi-sexual, Transsexual, Queer, Intersex +

M&CH Maternal and Child Health

NDIS National Disability Insurance Scheme

NE North East

NEMA North East Multicultural Association

NESAY North East Support & Action for Youth

PCP Primary Care Partnership

PEEP Parents Early Education Partnership

PHN Primary Health Network

PT Public Transport

SA1 Statistical Area 1

U3A University of the Third Age

VHISS Victorian Health Information Surveillance System

VMO Visiting Medical Officer

WHGNE Women’s Health Goulburn North East

WHO World Health Organisation

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9.2 Murray PHN Rural Women’s Health Needs Project (RWHNP) - Action Plan

Target population: Rural women living in Benalla LGA

Timeline: July – October 2019 – Final report due 31st October 2019

Aim: The aim of this project is to determine the health and service needs of women living in the

Benalla Municipality, and propose a new service model to address the prioritised need

Objective

1. To leverage local relationships with health and community organisations in the Benalla LGA

to maximise service system knowledge and engagement strategies


identify specific self-reported health needs and the potential service models to meet these

needs.

3. To propose place-based (service model) solutions that will address the identified health

needs of the rural women in the Benalla LGA

Scope

- Women over 18 years

- Women living in the Benalla LGA

Resources

- Project Staff

- PCP Board members and Benalla LGA partners, i.e. Benalla Health and Wellbeing Partnership

- Networks e.g. Upper Hume Primary Care Partnership, Benalla Rural Outreach Worker

Reference Group

- Existing services providers e.g. Benalla Rural City Council, Community Health Centre

- Community Groups (CWA, Red Cross, Mothers Groups)

Evaluation Indicators

A gained understanding of the enablers and barriers for women living in the Benalla LGA to accessing

health and wellbeing services, the service gaps, and the models that would address their health and

wellbeing needs.

Risk Management

Potential Risk Mitigation Strategy

Time Management Developed Action Plan

Timeline identified with outlined milestones

Missing women who are not engaged Conducting engagement across a broad range of geographical and demographic areas

Confidentiality in groups Group and Individuals data collected separately

Sensitive issues raised Support resources made available

Staff capacity Partnership relationships

Division of roles for engagement process

Shared roles in development of report

Project staff have limited direct engagement with consumers

Utilise PCP partners and their relationships with consumers

Survey Fatigue/ No incentive to engage Identify local incentives/individual buy in

Follow up communication

Focus Group

Background to project unknown by community Good communication processes

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Work Plan

Objective Strategy/Action By When Process Evaluation Indicators Status

1. To leverage local relationships with health and community organisations in the Benalla LGA to maximise service system knowledge and engagement strategies

Source contacts through PCP partners 09/08/2019 Key stakeholder List

Contact key stakeholders 09/08/2019 Contact made

Map current health service system 09/08/2019 List of Health and wellbeing services

Use partners to review service system mapping 16/08/2019 Feedback from partnership members

2. To engage with a broad range of women in the Benalla LGA using a place-based approach to identify specific self-reported health needs and the potential service models to meet these needs.

Map women-focused community groups 16/08/2019 List of women-focused community groups

List potential participants (snowballing) 20/08/2019 Number of potential participants

Develop guiding questions for round table discussions

09/08/2019 Qualitative data method identified

Develop a brief survey 09/08/2019 Survey developed

Make contact with groups key contact person and make times to attend group meetings

16/08/2019 Number of key contact persons Number of meetings made

Make contact with individuals 20/09/2019 Number of individuals contacted Number of meetings made

Engagement with groups completed 27/09/2019 Number of groups engaged Number of participants Feedback collected

Engagement with individuals completed 27/09/2019 Number of individuals engaged Feedback collected

3. To propose place-based (service model) solutions that will address the identified health needs of the rural women in the Benalla LGA

Organise a Focus Group of interested stakeholder and participants for format of data collection and of final report

27/09/2019 Awareness raised with key stakeholders and individuals Focus group created

Collate and analyse data 04/10/2019 Data analysed

Draft Report – 1st draft 04/10/2019 1st Draft Report completed

Feedback to focus group 11/10/2019 Focus group meeting held Feedback on the report

2nd Draft Report with feedback modifications 18/10/2019 2nd Draft completed Report approved by EO

Final Report and propose service model/s 31/10/2019 Report completed

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9.3 Letter to Stakeholders

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9.4 List of contacts and flyer dissemination points

Key Organisations (n=14): Key Contacts (n=25); Dissemination only (n=5)

Benalla Health Benalla P-12

Benalla Rural City Council Central Hume PCP

Cooinda Independent Living CWA Benalla

CWA Swanpool CWA Thoona

Murray PHN TAFE

Tomorrow Today Waminda Neighbourhood House

Warrenbayne Play Group Womens Health Goulburn North East / WHGNE

Poster Dissemination Points only (n=54): Contacts (n=62)

*Individuals x2 Benalla Bakeries x 3

Benalla Cafés x3 Benalla Childcare Centre x1

Benalla Girl Guides Benalla Library

Benalla Primal Health Club Benalla Relay for Life

Benalla Scouts Benalla U3A

Central Hume PCP e-Newsletter Central Hume PCP Facebook posts

Chemist - Benalla Amcal Chemist - Benalla Priceline

Chemist - Jenny Milner - Marisha Watson Pharmacy DEDJTR – Transport

Dementia Victoria DHHS

FCJ College Benalla Goorambat Hotel

Goorambat Post Office Goorambat Silo Art Committee

GP - Benalla Healthcare Centre GP - Carrier Street Clinic

GP - Church Street Surgery GP - Coster Street Medical Practice

GV Health Shepparton – Sexual Health Nurse Hairdresser - Benalla

Hall Committee - Warrenbayne Hall Committee - Lurg

Latrobe Community Health – NDIS NE Coordinator NE Artisans

North East Multicultural Association / NEMA NESAY

Newsletter - Baddaginnie Newsletter - Greta

Newsletter - Swanpool Newsletter - Tatong

Newsletter - Lurg North East Health

Noticeboards x 4 Specsavers

St Vincent’s De Paul Benalla Swanpool Anglican Ladies Guild

Swanpool Community Development Association YMCA Benalla

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9.5 Flyer

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9.6 Murray PHN Rural Women’s Health Needs Project (RWHNP) – Survey Questions

Hard copy version of the online survey - Page 1

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Murray PHN Rural Women’s Health Needs Project (RWHNP) – Survey Questions p2

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9.7 Proposed Service Model Indicative Costs

Mobile Wellbeing Hub Indicative Costs

A Mobile Medical Service in the Benalla LGA would be the first to service a broader regional area. Costings

for a mobile wellbeing hub delivering medical services varies depending on a variety of factors. Listed below

are a range of resources that would be need to be considered in costing out this service. Vehicle costs are

likely to be in the range of $150,000, but costs will depend on the type of vehicle and fit out. If immunisations

are required a specialised fridge might need to be fitted ($5,000). Staffing costs would also vary, ranging from

$43/hour (plus salary on costs and organisational costs) through to $85/hour (including oncosts and

organisational costs) for allied health staff. GP, Nursing and other medical staff would depend on

qualifications and experience.

Set up costs and running costs for the first year could be in the vicinity of $200,000. One of the Central Hume

PCP member agencies, Benalla Health, are undertaking a full costing exercise on a mobile medical service

which is likely to be completed early in 2020.

Examples of other Mobile Medical Services can be found through Cohealth’s Street Doctor Program and

Freo Street Doctor.

Resource

Staffing(salaries and indirect costs)

- Mobile Wellbeing Hub Coordinator

- General Nurse (RN)

- Medical staff

- Allied Health – Physiotherapist, Podiatrist, etc.

- Dental Health – Dentist, Dental Nurse, Dental Technician

- Mental Health – Psychiatric Nurse (endorsed), etc.

- Visiting specialists

Location and Administration costs

- Venue Hire: Hall or service room(s) for hire (e.g. Neighbourhood House)

- Utilities e.g. electricity, water, internet access

- Mobile phones

- Computers with Internet – telehealth facilities

- Telehealth facility (monitor, speaker and audio)

- Childcare or play group activities

- Stationary

Car or bus

- Purchase or hire or co-use

- Travel

Specialist and multi-use equipment, including

- Chairs and stools for clinicians (e.g. podiatry)

- Examination benches, lamps and screens (portable)

- Stethoscopes, thermometers, BP machine, ECG, etc.

- Disposable examination packs, needles, syringes, etc.

- Refrigeration for medication (e.g. immunisation) and pathology, etc.

https://www.abc.net.au/news/2019-08-25/doctors-street-surgery-for-homeless-patients/11405412

https://www.blackswanhealth.com.au/services/primary-health-services/freo-street-doctor/

RURAL WOMEN’S HEALTH NEEDS PROJECT BENALLA LOCAL … · 2020. 2. 14. · Some of the main tourism...

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