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Pilot Program to Prevent Rheumatic Fever


  • Acute rheumatic fever and heart disease disproportionately affect Australia’s Aboriginal and Torres Strait Islander populations.
  • The Australian Government partnered with state governments on a preventative pilot program
  • Abt’s evaluation highlighted the effectiveness of the pilot and offered recommendations for an evaluation model.
The Challenge

Acute rheumatic fever (ARF) and Rheumatic heart disease (RHD) are preventable health problems that disproportionately affect Australia’s Aboriginal and Torres Strait Islander populations and cause serious health problems and premature deaths.

In Australia between 2016 and 2020, the number and rate of ARF notifications increased, with Aboriginal and Torres Strait Islander peoples accounting for 92% of cases (RHD Australia). The rates in remote Aboriginal and Torres Strait Islander communities in Northern and Central Australia are among the highest reported in the world. Prevalence rates were highest in females and young people aged 5–14.

Policymakers can help control these diseases by improving living conditions, reducing overcrowding, and increasing access to health care and antibiotics.

The Approach

The Australian Department of Health and Aged Care developed a pilot program for delivery from 2019-2021 that focused on primordial and primary prevention of ARF and RHD.

The department engaged six Aboriginal community-controlled service provider organisations in seven First Nation communities with high prevalence of ARF and RHD. Providers had leeway to design their programs as they saw fit.

Abt and the service providers co-designed an evaluation process that included key performance indicators and defined the evaluation methodology to measure the pilot’s effectiveness. Abt’s mixed methodology used both qualitative and quantitative techniques, including interviews with stakeholders (providers, referrers/partners, and consumers) and a review of program documentation, data, and budgets.

The Results

The evaluation found that the pilot program was largely effective. All service providers delivered as planned, increased community awareness, and improved referrals, however, a further focus on technical rigor was needed. In the seven locations, the evaluation found greater levels of community engagement and participation by both target families and the broader community.

Abt’s key recommendation was for national cultural, service provider representatives and technical bodies to co-design a primordial and primary prevention model (a set of principles, approaches, and components) to guide local implementation of activities and ensure consistent evidence-based approaches.