Enhanced Maternal and Child Health Program Performance

Intended reach and hours

The department's funding for EMCH is based on the program supporting 15 per cent of children aged 3 or under who were enrolled in the Universal MCH program the previous year. 

The department allocates funding annually to councils based on an assumed number of service delivery hours for each age cohort. These are shown in Figure 2.

Figure 2: Service hours allocation for each age cohort 

Source: VAGO, using information from the department.

Although this is the funding model’s basis, the department tells councils that they should use funding flexibly to meet families’ needs. In its EMCH funding factsheet and other written communications, the department advises councils to use professional judgement when offering EMCH support so that no families who need and want it miss out. Even if a family does not meet EMCH’s eligibility criteria, if the council has capacity to support the family and can see a role for EMCH, the family may be offered EMCH support. 

Program reach

From 2022–23 to 2024–25, the department did not monitor EMCH reach. The department advised that this is because the system does not capture or cannot report all relevant data. 

EMCH is intended to support 15 per cent of families with children aged 3 or under. The department allocates EMCH funding to councils based on the number of children aged 3 or under in a council. It does not know if EMCH supported 15 per cent of families or children.

This means the department might be funding services that are not being delivered to as many families or children as intended across the state.

We were unable to assess this because the department does not have data on the number of families enrolled in the Universal MCH program (it only knows the number of children), or on the number of children supported by EMCH (it only knows the number of families), in any given year.

Service hours 

The department does not monitor if EMCH service delivery aligns to the hours of service assumed in the funding model. This includes if:

• families are receiving an average of 20 hours of EMCH
• children aged zero to one year old receive an average of 10 hours (11.33 hours in rural areas) 
• children aged one-to-2 and 2-to-3 years old receive an average of 5 hours (5.67 hours in rural areas).

While the funding model includes this information about average hours of service delivery, the department does not have a target number of hours that should be delivered to each family receiving EMCH support.

But as Figure 3 shows, in 2024–25 most councils reported providing fewer than 20 hours to families. On average, families received around 10 hours.

The amount of support councils reported that families received varied significantly between councils, from one hour per family in one council to 27 hours per family in another council.

This variation means the department may be funding EMCH that is not being delivered in quantities that maximise positive outcomes for families. 
 

Figure 3: Councils' average EMCH hours delivery per family in 2024–25

Note: < means less than.
Source: VAGO, based on council-reported data provided by the department.

Program eligibility

Referrals into EMCH commonly come from nurses delivering the Universal MCH program and other professionals including child protection practitioners, hospital staff or social workers. 

The 2019 guidelines require councils to check that families meet 3 eligibility criteria before enrolling them into EMCH: 

1. the child is aged 3 years or under
2. families have an appropriate level of need, presenting with 2 or more risk factors
3. EMCH can respond effectively.

Data on eligibility

The department does not oversee whether councils apply the eligibility criteria. Councils do not formally monitor or report on whether their families met the eligibility criteria.

The system does not allow a consistent way to record if each family meets the eligibility criteria. This is because: 

• no data is captured for referrals that do not proceed to program entry 
• for criteria 1 and 3, referral forms that contain relevant information are completed outside the system
• for criterion 2, risk factors are captured as ‘referral reasons’ in the system, but these referral reasons include multiple risk factors. This means a family could have only one referral reason recorded in the system, but still fulfil criterion 2 by having more than one risk factor. The 2019 guidelines and EMCH referral form template list the many risk factors that may fall under a single referral reason. 

All 6 audited councils told us that they use their professional judgement when enrolling a family into EMCH to make sure no families that need and want EMCH miss out. 

Some councils use flexible approaches such as running group sessions or ‘holding’ a family in the Universal MCH program for extra time until they can transition them into EMCH. This can occur even if a family does not meet one or more of the eligibility criteria. For example, if a council has capacity to accept a family into EMCH and the family needs support but has only one risk factor, the family may still be accepted. This may not happen if the council’s EMCH staff are at capacity.

Council compliance with family need 

We assessed if families receiving EMCH support from the 6 audited councils met eligibility criterion 2 (families have an appropriate level of need, presenting with 2 or more risk factors). This is the only criterion that councils have reportable data on. It is captured in the system as referral reasons.

As Figure 4 shows, no council showed that all families were meeting criterion 2. This is mainly because the system limits MCH professionals' ability to effectively record data and monitor eligibility.

In Bayside, 29 per cent of families had no referral reason recorded. In Bayside and Mildura, less than 63 per cent of their families had 2 or more referral reasons. 

Figure 4: Eligible EMCH referrals per criterion 2, 1 July 2022 to 30 June 2025

Source: VAGO, based on data provided by the 6 audited councils. 

Actual statewide program delivery

The department’s EMCH program output measure has an annual service delivery target of 248,000 hours. In 2024–25, the department funded 261,195 hours. 

Despite this, councils reported to the department that they delivered only 181,308 hours that year, which is: 

• 27 per cent less than the annual service delivery target
• 31 per cent less than the total hours funded. 

For 2024–25, the gap in reported hours equates to about $11 million of the total funding the department gave councils for EMCH service delivery.

Councils reported delivering significantly fewer hours than their annual targets in all years, delivering between 63 and 73 per cent. Councils also reported delivering significantly fewer hours than they were funded for in all years, delivering between 58 and 69 per cent, as shown in Figure 5.

Figure 5: Program delivery from 2022–23 to 2024–25 compared to funding (actual hours compared to funded hours) as a percentage

Source: VAGO, based on data provided by the department.

Service delivery oversight

Despite councils consistently delivering less hours overall than they are funded to deliver, the department has continued to fully fund all councils. The department does not reduce councils’ future year funding based on the prior years’ service delivery hours. It also does not actively engage with councils to understand the reasons contributing to under-delivery or to support them to lift their performance. 

The department’s oversight of EMCH service delivery lacks key elements of contract management such as performance monitoring and engagement with councils to make sure funded services meet expected standards. This means the department cannot show that it is achieving value for money from EMCH. 

We discuss EMCH funding in chapter 4 and EMCH performance monitoring in chapter 5.

Service delivery against funded hours 

Most councils reported to the department that they delivered either substantially more or fewer hours than they are funded for. 

Most councils (17 of 20 councils) that reported delivering more than their funded hours also reported delivering fewer than 20 hours of support to a family. This shows that they supported more families than they were funded for.

Fifteen of the state’s 79 councils reported delivering 110 per cent or more of their funded hours. The majority of these (12 councils) were metropolitan councils. By contrast, 52 councils reported delivering 90 per cent or less of their funded hours. The majority of these (40 councils) were rural councils, as Figure 6 shows.

Figure 6: Councils' reported actual EMCH hours as a percentage of funded hours, 2024–25

Source: VAGO, based on data provided by the department.

Of the councils we audited, from 2022–23 to 2024–25, Bayside and Darebin (both metropolitan councils) delivered more than their funded hours. Both councils subsidise the department's EMCH funding. 

Three of the 4 audited councils that delivered fewer than their funded hours experienced staff shortages over the audit period and said this affected their ability to achieve full service delivery. Two of these councils had plans approved by the department that outlined  short term strategies to supplement their workforces and support families during periods of staff shortages. 

Councils told us that reported service hours may be less than actual hours delivered because of issues such as data entry inaccuracy and inconsistency. 

Data accuracy 

We found that the data councils reported to the department was not accurate. The reasons for this include that: 

• nurses record time spent on program delivery inconsistently
• the system cannot capture time spent in support of a family before they have agreed to receive EMCH support or after their case file has been closed
• errors entered into the system are difficult to correct once saved.

The department is aware that EMCH data is not accurate. We saw evidence of the department reinforcing to councils the need for data accuracy. 

Case study 1: Data accuracy issues in a sampled audited council

Source: VAGO, using case file information provided by a sampled audited council.

New system

The department is replacing the system used for the MCH Service, including EMCH. It is due to complete the new system in late 2026 and roll it out in 2026–27. 

The new system’s specifications show that it will not capture general EMCH effort that is not related to an individual client, such as scheduling group sessions or discussing families that are referred to EMCH but do not proceed to become EMCH clients. 

But the specifications show that the department: 

• will address other data accuracy issues we identified
• would be doing further system design work in consultation with MCH professionals. 

We saw evidence of plans for features in the new system that should contribute to a professional and smooth user experience. These improvements may help to address MCH professionals not always documenting their time accurately in the system. 

Planned features include:

• intuitive, logical and flexible methods for a user to complete a task or workflow 
• consistent design of features and formatting 
• responsive design for all devices 
• capability for a user to personalise the system 
• help desk support available during business hours 
• an always-available, in-built system support manual on how to use and navigate the system.

The department told us that alongside the system replacement project, it is also delivering a collaboration platform as a common site to share practice, guidelines and service updates with the MCH workforce.  

Understanding demand

The department knows how many children are born in Victoria each year. Councils also annually report the number of families accessing EMCH. 

But this does not provide enough useful information for the department to have a strong understanding of EMCH demand. There is more information available in the system councils use that would improve the department’s understanding. 

Aligning funding to demand

The department does not use EMCH data as an input to determine future funding allocations. This may mean that councils are over or underfunded to deliver EMCH.

The department uses a funding model to distribute funding to each council based on its:

• number of children aged 3 or under in the previous year 
• number of recipients of the Australian Government’s Family Tax Benefit Part A (relative population size and socioeconomic disadvantage)
• rurality.

The department provides additional funding to interface councils to reflect their growing populations and a small additional funding component to all councils to assist with MCH nurses’ professional practice. 

The former Department of Education and Training developed the EMCH funding model. The department has not confirmed if the funding model’s inputs allow it to target funding allocations to demand.  

The department told us that one reason it does not use EMCH data as part of its funding model is that it is not accurate enough to use as a basis for funding calculations. But the department uses this data for its annual performance reporting to Parliament.

The department also told us that it does not know how efficiently councils use EMCH funding. 

Socioeconomic disadvantage

The challenges experienced by families that are eligible for EMCH are broad and not only faced by those who are socioeconomically disadvantaged. 

But the department does not know the most common challenges families receiving EMCH support face because they do not request this data from councils.

This means that the department’s funding allocations may not align with the challenges families receiving EMCH support face. 

To understand the most common challenges faced by families receiving EMCH support in the audited councils, we looked at the reasons documented in the system for each family’s referral. This is shown in Figure 7. 

Figure 7: Most common EMCH referral reasons, 2022–23 to 2024–25, in the 6 audited councils

Note: The referrals in the figure relate to families who agreed to receive EMCH support. The system does not allow councils to consistently capture information about referrals where the family did not go on to become an EMCH participant. 
Source: VAGO, based on data provided by the 6 audited councils. 

Rural councils' travel time

Rural councils receive additional funding to reflect that the distances they need to travel to visit families in their homes may be greater than the distances travelled by metropolitan councils. 

But only a small number of rural councils reported travelling more than metropolitan councils. 

In 2024–25, only 12 of the 47 rural councils, and no metropolitan councils, reported spending more than 20 per cent of EMCH service delivery time on travel. The remaining 35 rural councils reported spending less than 20 per cent of their total EMCH delivery time on travel, the same as all metropolitan councils. This is shown in Figure 8. 

This suggests that not all rural councils may need the additional funding specifically to assist with more travel. We heard from Central Goldfields, a rural council, that some families in their local area prefer to receive EMCH support in an MCH centre in town rather than in their homes. 

But some rural nurses who work across multiple MCH programs may not accurately capture their travel time across the various programs they deliver to a family in a single consultation. This means there may be more travel time spent on EMCH than is reflected in the data reported by councils. 

The department expects that its new system will help MCH professionals more accurately report their time, including travel time.

Figure 8: Councils' travel hours as percentage of total hours reported for 2024–25

Note: < means less than.
Source: VAGO, based on data provided by the department. 

EMCH
responsibilities
 

The 2019 guidelines set out EMCH responsibilities for the department and councils. 

Department’s monitoring and reporting

The 2019 guidelines were in place until June 2025 and contained:

• 5 performance measures to track activity quantity, such as hours of service delivered
• 9 outcome measures to track activities directly tied to impact, such as improvements to immunisation rates or family connectedness within the local community. 

The only EMCH performance measure the department regularly reports on is the number of hours councils deliver annually. This is included in the department's annual performance statement and annual report. The department has no publicly reported outcome measures relating to EMCH. 

The department does not report to government on EMCH performance except for this one performance measure. It does not report to government on EMCH outcomes. 

Councils' service agreements

Under the 2019 guidelines, 2 of the 5 performance measures should be set out in each EMCH service agreement between the department and a council. They are:

• the number of families to receive EMCH support 
• the number of hours of service to be provided. 

The service agreements between the department and the 6 audited councils for 2020–24 did not include these performance measures. 

The 2025 guidelines require that service agreements only need to include the number of service hours to be provided. The service agreements the department now has with the audited councils for 2024–28 include this information.

Data timeliness

The department does not have access to the system used by MCH professionals to capture EMCH data. Each council owns its MCH Service data.  

The department can collect data to support activities and functions under the Health Services Act 1988, including to monitor performance. It collects a limited amount of system data from councils annually. 

This raises the risk that the department is not aware of service delivery trends or risks until after the reporting period concludes. 

It also causes a delay in public reporting. The department takes 11 months from the end of the reporting period to publicly publish final data against its one performance measure.

The department may have real-time access to the new system through future design or in future system enhancements. We saw that the department will own the new system and intends to have access to the de-identified data it needs to monitor and report on the MCH Service, including EMCH. 

Data fitness for purpose

We found that EMCH data is not fit for purpose for the department to monitor and report on if it is meeting EMCH performance and outcome measures. 

The system cannot capture complete, structured data on the performance and outcome measures. Data that is captured is not always structured to allow for reports to be run. 

We found that the new system is likely to have functionality to capture data for monitoring and reporting on the full suite of performance and outcome measures. Some aspects of the new system design were still being developed at the time of our audit. 

Performance measure reporting 
2022–23 to 2024–25

The department reports to Parliament against one EMCH performance measure each year. This is the annual number of EMCH program hours delivered for the previous 12 months. 

The department reported inaccurate figures against this measure in both its annual reports and the state Budget papers' performance statements. 

As shown in Figure 9, council-reported data shows that from July 2022 to June 2024 councils delivered between 63 and 71 per cent of the target service hours. But the department reported that between 71 and 100 per cent of its hours were delivered. 

In addition to these discrepancies, the department did not note the known, broader data accuracy issues in its reporting.

Figure 9: Public and internal data relating to the EMCH performance measure

Note: *This figure has been calculated as the difference between early estimate hours and actual hours as the final reported hours were not yet available.
Source: VAGO, using the department’s 2022–23, 2023–24 and 2024–25 annual reports and the 2024–25, 2025–26, 2026–27 state Budget papers, as well as publicly available information and data provided by the department.

The department told us that in 2022–23 and 2023–24 it reported early estimate hours as final hours due to limited data being available at the time. 

In 2023–24 and 2024–25, the department over-reported hours delivered by 0.6 per cent. In its 2024–25 annual report, the department noted that the 2024–25 expected outcome was lower than the target because it estimated the target based on limited available data at the time. It said it would review the performance target in future years.

New measures

We assessed whether the 11 EMCH priority outcome measures in the 2025 guidelines are specific, measurable, achievable, relevant and time-bound. 

We found that the measures are specific, achievable and relevant. But only: 

• 8 of the 11 measures are measurable with targets
• 3 of the 11 are time-bound with a target period for completion. 

None of the priority outcome measures can be reported on through the system. If councils want to measure their progress toward achieving these measures they would have to manually collate individual client data from the system. 

This makes it difficult for the department and councils to assess whether the priority outcomes are being achieved.