Despite recent success in many areas, substantial challenges to delivering comprehensive high-quality vaccination services remain.
WA is a large, diverse and unevenly populated area, and this contributes to the complexity of delivering equitable immunisation services statewide. Providers in the public and private sectors deliver varying sets of service. Robust immunisation services necessitate a coordinated effort and resources from many stakeholders. Ambiguity about the role of these parties may inadvertently lead to gaps in service and sub-optimal vaccination coverage. A better understanding of how responsibility for keeping children fully up to date with their vaccinations should be apportioned among parents, providers and health departments at local, state and national level is required.
The recent, relatively rapid transition from immunisation activities supported by GP Divisions, first to Medicare Locals, and now to the Primary Health Networks has added to the uncertainty about roles and responsibilities for improving immunisation services in WA. GPs provide the majority of vaccinations administered in WA, so robust collaboration with the private primary healthcare sector is essential for improving and sustaining quality immunisation services. The new WA Primary Health Alliance, representing the Primary Health Networks in WA, intends to build a robust and responsive patient-centred primary healthcare system through innovative and meaningful partnerships at the local and statewide level. Specifics on how immunisation initiatives undertaken by WA Primary Health Alliance will interface with those provided by Child and Adolescent Health Service (CAHS), WA Country Health Service (WACHS), and local Public/Population Health Units are currently being finalised.
Accountability for improving immunisation services is arguably the most challenging to articulate for metropolitan Perth. This is most likely because of the organisational structure of the department, resulting in CAHS having responsibility for delivering immunisation services to children (predominantly) and the public health units in the two metropolitan Area Health Services having responsibility for supporting immunisation services and improving uptake.
Last, legislation controlling the prescribing and administration of medicines has, historically, not allowed certain health professional groups autonomy to vaccinate without the direct supervision of a medical practitioner. Under newly passed legislation, however, efforts are underway to permit nurses and other trained and competent health professionals to independently administer vaccinations in the routine WA Immunisation Schedule using special prescribing arrangements. It is anticipated the work required to accomplish this will be completed in 2016.