Immunisation win for Wheatbelt
A three-pronged approach to improving immunisation rates in Western Australia's Wheatbelt region has proved a winner for the area, with immunisation rates for each of the main reporting ages — 12 months, 24 months, and 60 months — having risen over the past 3 years (Figures 1, 2 and 3).
The Wheatbelt area of Western Australia covers more than 154,000 square kilometres and has a population of approximately 71,000 residents. The Wheatbelt Population Health Service extends from Jurien Bay in the north, to Southern Cross in the east, and Darkan and Lake Grace in the south. It is divided into 4 districts, each centred around a major town in the area3.
A key role of the Wheatbelt Public Health Unit (WPHU) is to prevent and control communicable and non-communicable diseases through various methods and programs, including immunisation of children4. The Australian Childhood Immunisation Register is able to produce quarterly reports on immunisation rates within different regions. These rates are distributed by the Communicable Disease Control Directorate in Perth. The benchmark for immunisation rates outlined by the Coalition of Australian Governments Reform Council (2011)5 is 92.5%.
In 2008, immunisation rates in the Wheatbelt were below 90% in the 12 month and 60 month age groups. The WPHU have turned these figures around using the following measures.
Distributing monthly overdue reports
Monthly ACIR overdue reports are obtained and sent to the senior community nurses in each Wheatbelt district. The senior nurses distribute these overdue reports to the community nurses (school/child health) and each nurse follows up with the children on their list for that month. Follow-up involves contacting the parents of children who are overdue for immunisation by phone, SMS, letter and/or a home visit to arrange and provide immunisation. The reports are then updated and returned to the WPHU.
An updated master list of the children’s names is kept at the WPHU. This indicates whether each child is up to date with their immunisation, has been booked for immunisation, has moved house, is living overseas, has had natural immunity and/or conscientious objector forms signed on their behalf, has had medical contraindications to immunisation, is a non responder or still requires catch-up. Once the WPHU Administration Officer obtains the monthly reports from ACIR, a check is made against the master list and updated reports sent out.
Making immunisation a priority
Immunisation updates in the districts have highlighted the need to increase immunisation rates, and provide further education, training and support for staff. Particular emphasis has been placed on reducing the substantial gap between immunisation rates in Aboriginal and non-Aboriginal children.
Taking a team approach
The Wheatbelt has multi-skilled child and school health nurses who immunise children and adults. Immunisation occurs in a variety of venues including child health clinics (as part of routine appointments), at specific immunisation clinics in some towns, at the Wheatbelt Aboriginal Health Service, in schools during immunisation team visits, at hospital outpatient departments, GP surgeries or via home visits. Flexibility around immunisation provision has been a big factor in reducing the number of overdue children. For example, school nurses have successfully targeted kindergartens to perform catch-up immunisations.
The senior community nurses of each district are an important link in distributing the reports, supporting their staff and liaising with the public health nurses to provide feedback and strategies to improve the system.
Administrative staff members at the WPHU have played a vital role in the process of extracting reports from ACIR each month and separating them into districts and towns for distribution. They provide feedback to the senior staff and community nurses by providing percentages on the number of reports received each month. They have also helped streamline the system for reporting overdue immunisations by developing a template that makes completing the reports less time-consuming for nurses.
The Communicable Disease Control Directorate in Perth issues quarterly reports on immunisation rates for each public health unit, provide immunisation updates and develop statewide policy relating to immunisation, education and training in Western Australia.
Wheatbelt public health nurses have held overall control of the overdue reporting system. They provide staff with immunisation updates, encourage new staff to complete the immunisation training course and continue to seek ways of improving the system.
For the second quarter of 2012, the combined age-group rates were the highest in the State. Wheatbelt rates compare favourably with those in other states of Australia.
Figure 1: Yearly immunisation rates for 12-month age group in WA Country Health Services (WACHS) public health units 2007 to 2012.
Figure 2: Immunisation rates for 24-month age group in WACHS Public Health Units, 2007 to 2012.
Figure 3: Immunisation rates for 60-month age group in WACHS Public Health Units, December 2007 to 2012.
- WA Country Health Service — Wheatbelt Regional Profile.
- Wheatbelt Population Health Core Functions, accessed from wachs.hdwa.health.wa.gov.au/index.php?id=4591
- COAG Reform Council, 2011, National Partnership Agreement on Essential Vaccines: Performance Report for April 2010-March 2011.