**Background**
Aboriginal and Torres Strait Islander people comprise 3.3% of the Australian population, with one fifth living in remote or very remote settings. Indigenous children in remote Australia experience a greater burden of disease than metropolitan children, with Indigenous babies twice as likely (12% vs 6%) to have low birth weight and an infant mortality rate 1.8 times higher (5.1 vs 2.9 per 1000 live births). Indigenous Australians are hospitalised at 2.6 times the rate of non-Indigenous Australians, often for potentially preventable conditions. One in five Indigenous children live with disability (22%). Despite the 2009 'Closing the Gap' strategy, the 2021 report showed mixed results: a 17% reduction in avoidable deaths between 2006 and 2018, but Indigenous Australians still die from avoidable causes at three times the rate of non-Indigenous Australians, and child mortality rates have not changed since 2005.
**Methods**
This scoping review searched seven electronic databases (MEDLINE, CINAHL, PsycINFO, Web of Knowledge, EMBASE, ERIC, Scopus) and extensive grey literature sources including government websites, Indigenous health research institutes, and parliamentary hearings. Publications from January 1990 to May 2021 describing health services, service use, or needs relating to Indigenous Australian children (0–18 years) in remote settings were included. Two authors reviewed all publications, with a third resolving disagreements. From 1775 identified publications, 406 duplicates were removed, 1369 abstracts reviewed, and 1152 excluded. Following full-text review of 217 papers, 70 were included, plus 45 reports from grey literature, totalling 116 papers.
**Key Results**
Indigenous children are less likely than non-Indigenous children to have used a health service in the previous 12 months (mean 2.5 vs 3.1 visits, p<0.001), use maternal and child health services (OR=0.35, 95% CI: 0.24–0.49), general practitioners (OR=0.45, 95% CI: 0.35–0.64), or paediatricians (OR=0.52, 95% CI: 0.35–0.77), but are more likely to be hospitalised (17% vs 9.9%, p=0.01). Barriers to effective service delivery include poor access (distance, dirt roads, lack of transport), poor infrastructure (limited internet/telephone, sewerage, water), lack of skilled health professionals, limited Aboriginal health workforce, environmental factors, economic factors, cultural safety issues, and failure to engage consumers. In one very remote community, 6.5% of people were evacuated by air between 2003–2005 (one evacuation every 2.2 days), with children (37.7%) over-represented. Respiratory disease (21%), gastroenteritis (14%), and injury/poisoning (11%) accounted for 46% of aeromedical evacuations. In rural NSW and Victoria, over 30% of residents live beyond 50km from an allied health professional, and 98.6% of allied health treatments are not delivered at the ideal weekly frequency. In 2020, fewer than 1,500 of over 104,000 registered medical doctors worked in remote and very remote areas. The average annual expenditure per Indigenous Australian was approximately $8,494 (130% of the $6,657 for non-Indigenous Australians), with almost half ($4,436) going to hospital services. Preventable hospitalisations in Western Australia were 3.8 times higher in Indigenous Australians (91 vs 24 per 1,000). National immunisation rates in 5-year-olds were higher for Indigenous (97%) than non-Indigenous (95%) children in 2018. The Queensland Government spends $1.2 billion annually ($29,000 per person) on services for remote Indigenous groups, yet the Queensland Productivity Commission found the system 'is broken'.
**Clinical Implications**
Aboriginal Community Controlled Health Services have contributed to significant gains in maternal and child health, with over 97% of Indigenous children aged 5 fully immunised in 2021. Best practice models require community leadership, collaboration, and holistic approaches addressing physical, mental, cultural, and spiritual health. Key recommendations include: increasing the Aboriginal health workforce and cultural competency training; improving coordination between primary, secondary, and tertiary services; implementing continuous quality improvement; addressing social determinants (housing, nutrition, transport, education); expanding outreach and telehealth services; ensuring adequate infrastructure and accommodation for health workers; and developing culturally appropriate assessment tools and KPIs. The review emphasises that Indigenous community leadership through Aboriginal Community-Controlled Organisations is essential for identifying service needs and delivery methods.