The review of the Waterloo Healthy Living Program at SLHD was undertaken to assess how effectively the program has achieved the expectations of the community and the SLHD, and to provide recommendation for the future

Project Coordinator

Margo Barr

Other Investigators

Margaret Williamson, Hyun Song, Louise Dougherty, Lisa Parcsi (SLHD)

Previous investigators included Jane Lloyd and Kim Webber (HERDU)

Project Rational

There are several high need social housing areas in Australia, all of which have vulnerable populations i.e. those who are economically disadvantaged, from Aboriginal or Torres Strait Islander backgrounds, from culturally and linguistically diverse communities, or elderly. These populations often have health conditions that are exacerbated by barriers to accessing health care and their health problems often overlap with social issues related to housing, poverty, and educational disadvantage. Following several consultations with the Waterloo community, Sydney Local Health District (SLHD) established the Waterloo Healthy Living Program. The Program aimed to provide a point of connection, liaison, and navigation between Waterloo residents (focussing on the residents of the Waterloo Public Housing Estate) and SLHD to address health and well-being issues in the community.

Project Aims

To review the Waterloo Healthy Living Program to assess how effectively the program has achieved the expectations of the community and the SLHD, and to propose options or recommendations to enhance the Program and to develop similar programs across SLHD.

Project Design and Method

The review includes three main components:

  • Position establishment review: undertaken to understand the reasons for establishing the program and its associated role and to describe the current work being undertaken.
  • Key informant interviews: undertaken with the aim of assessing the impact of the program on the Waterloo community, other non-government and government organisations and key SLHD services.
  • Literature reviews: conducted to identify and examine the impact and enablers for the success of other similar community brokerage/navigation roles described in the literature.


The establishment interviews identified that the theory behind the role was capacity building using examples from other parts of Australia, Scotland and the USA. The informants stated the main purpose of the role was to: be a point of connection, facilitate liaison and navigation between the health and hospital service and social housing residents; address health and wellbeing issues through better access to services; and improve the system’s responsiveness to high need residents.

The key informant interviews have been conducted and the data are currently being analysed.

The first literature review identified 21 ‘review’ articles using the terms ‘community health worker’, ‘patient navigator’, ‘social prescribing link workers’, and limiting it to review articles in English from OECD countries published from 2012 to 2019. It provided evidence that similar roles had significant health and wellbeing gains for chronic disease management, mental health, physical activity, appropriate health service use, health literacy, quality of life, and health screening.

The key factors associated with successful implementation of similar programs identified by a second review included: the provision of effective recruitment and training of workers; the centring of work around community needs; the community feeling a sense of ownership of the program; role clarity with and across organisations; and good governance and clear operational processes.



Margo Barr Phone: 02 9065 6041 Email:

Key Partners

Sydney Local Health District


Sydney Local Health District,

Project lead centre
Project stream
Health System Integration and Primary Health Care Development