The Well Child Frameworkpage 1
Published in March 2002 by the
Ministry of Health
PO Box 5013, Wellington, New Zealand
ISBN 0-478-27047-X [Internet]
Introduction
Ensuring access to appropriate Well Child and immunisation services has been a priority for successive government. ‘Ensuring access to appropriate child health care services including Well Child and family health care and immunisation’ is one of the thirteen population health strategies outlined in the New Zealand Health Strategy (2000).
In order to achieve this goal the Ministry of Health has developed a new framework for delivering ‘Well Child care’. This document describes the process for the development of the framework and the key elements of the framework. Implementation will be undertaken by District Health Boards, and will occur over a two to three-year period.
Development of the framework has drawn on findings of a review of Well Child Providers (WCPs), the Child Health Strategy (which was supported by an extensive literature review) and the advice of specialists within the Ministry of Health (including the Chief Advisor Child Health) and Well Child Technical Advisory Group (WCTAG). (Attached in Appendix One is membership of WCTAG.)
The framework applies to WCPs and has key linkages with Lead Maternity Carers (LMCs), General Practice Teams (GPTs) and the National Vision Hearing Screening Programme. Once implemented the new Well Child service specification will supersede and replace existing service specifications: Well Child/Tamariki Ora; Well Child 0–5; Facilitation; Whanau Care and Support; Whanau Awhina; and First Year of Life Support. This document should be read in conjunction with the new Well Child service specification (Appendix Three).
A Well Child project team was established in 1999 by the former Health Funding Authority to develop a plan for the effective delivery of Well Child/Tamariki Ora services, particularly to those priority children identified in the Child Health Strategy. The project also incorporated the objectives for the future direction of child health services also specified in the Child Health Strategy.
The 1998 Child Health Strategy runs until 2010 and specifically reinforces the value of effective delivery of Well Child services and immunisation for children aged 0–5 years. It also highlights that children from Maori, Pacific Island and lower socioeconomic backgrounds are less likely to access Well Child care and immunisation than their counterparts in more affluent socioeconomic conditions.
The role of the project team to develop a Well Child Purchase Plan for the streamlined funding of Well Child/Tamariki Ora services included:
- facilitating buy-in from key stakeholders in the process of recommending whether immunisation and Well Child care service specifications should be combined as a single service
- determining the most effective use of home visiting services
- formalising links between General Practice and Well Child/Tamariki Ora in contractual requirements (eg, every child has a ‘General Practice Home’ and access to other services).
Document availability
This publication is not available in hard copy. It is only available on this website in PDF or Word format below or you can read it online:
Well Child Framework
(PDF, 168 kB) 
(Word, 92 kB)
Well Child Service Specification
(PDF, 55 kB) 
(Word, 276 kB)
This publication is not available in hard copy. It is only available from this website in PDF or Word format above.
National Schedule
(PDF, 108 kB) 
(Word, 63 kB)
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Contents
Introduction
Background
Phase One
Phase Two
Phase Three
The Framework
Service Delivery Framework
Pricing Framework
Appendix One
Membership of Well Child Technical Advisory Group
Appendix Two
Degrees of Deprivation
Appendix Three
Well Child Service Specification
Background
The project has been carried out in three phases:
Phase One – establishment of a Well Child Technical Advisory Group and assessment of the implications of linking immunisation to Well Child care within a single service specification.
Phase Two – review of WCPs and literature, analysis of data and development of a new framework for service funding and delivery.
Phase Three – still in progress, and involves the Ministry of Health working with District Health Boards to plan implementation of the framework.
Phase One
Establishment of Well Child Technical Advisory Group – November 1999
A Well Child Technical Advisory Group (WCTAG) was established to provide advice on improving access and coverage of Well Child care and immunisation. The WCTAG identified a number of strategic issues to be addressed before a simplified funding model could be considered. Strategic issues that need to be addressed are included in the Tamariki Ora/Well Child Technical Advisory Group Phase One Report (May 2000) and in summary include:
- a clear definition for Well Child service – including eligibility for core and additional services
- immunisation – identification of drivers for improving coverage
- universality versus targeting
- coverage/choice of provider/continuity of care – duplication/gaps
- price – national price; same service for the same price
- workforce development and provider development – competencies and training
- quality – framework to ensure consistent systems and processes across providers, and competency to deliver the service
- key indicators/outcome measures
- child health information systems
- Health and Development Record Book – usefulness/review
- Maori health – implementing Treaty of Waitangi, addressing inequities
- Pacific health – addressing inequities
- Information/communication – informing parents/providers.
Phase Two
Review of Providers – May 2000
A review of 70% of WCPs (WCPs) was undertaken to provide information for the development of a simplified funding model. Eight geographic areas were chosen, which ensured an urban and rural mix, and which covered a full range of provider groups (HHS, IPA, Plunket, Maori, Pacific) and contract types (Well Child, Facilitation, Whanau Care and Support, Dental Education).
The review had three areas of focus:
- service questionnaire – to assist understanding of what is happening now, what works, what could be improved
- audit against (draft) Health and Disability Sector Standards – to gain understanding of where providers are in terms of quality systems and processes
- pricing questionnaire – to gain information on which to base a more robust pricing framework.
WCTAG were involved in planning the review. Many providers within that group also participated in the review.
Analysis of Provider Review – September 2000
The WCPs who took part in the review were provided with their own Findings Report and a copy of Well Child Framework 2000 Project, Review of Well Child/Tamariki Ora Services (November 2000).
Key messages from the review included:
- a desire to provide the total package of Well Child care as outlined in the Well Child/Tamariki Ora National Schedule
- unanimous agreement that eight core contacts are the minimum required
- additional contacts above the minimum eight are required for high-support and high-need families
- high support = first-time parent or in cases of infant feeding, behaviour concerns, or postnatal depression
- high need = families at risk of poor health outcomes
- home visiting for ALL high need families
- no more fragmentation of service – WCPs (Maori and Pacific) want to deliver total package of care to defined populations, including immunisation for high-need families
- no more competing with other Well Child Providers to engage the same families – enrolment with one provider
- formal standardised referral and/or handover protocols between providers
- national standards for care and competency, training needs met
- recognition that Registered Nurse and Community Health Workers’ roles are complementary
- all providers paid the same price for delivering the same level of care
- all providers bought up to the same quality standards
- interagency co-operation is effective – wanting open communication from ‘funder’ about who has contracts
- national service specification
- output reporting should lead to outcome reporting.
Development of new Well Child framework – November 2000
Development of the framework has drawn on review findings, the Child Health Strategy (which was supported by an extensive literature review) and the advice of specialists within the Ministry of Health (including the Chief Advisor Child and Youth Health) and WCTAG.
Key Health Funding Authority/Ministry of Health personnel (including contract managers and those developing Immunisation, Child Health Information and Primary Health Care Strategies) were informed of progress and consulted regarding the proposed framework as it was developed.
Phase Three
This phase is in progress and involves the Ministry of Health working with District Health Boards to plan implementation of the new Well Child Framework throughout New Zealand.
Related information
Child Health in New Zealand - information from the Ministry of Health