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Outcome 1 – Population Health

A reduction in the incidence of preventable mortality and morbidity in Australia, including through regulation and national initiatives that support healthy lifestyles and disease prevention.

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Outcome Summary

Outcome 1 aims to minimise the incidence of preventable mortality, illness and injury in Australians. A fundamental objective of the Government’s reform process is to move the focus of the health system from one with a predominant emphasis on treating people when they become sick, to one focused on keeping people healthy and out of hospital. The department worked to achieve this outcome by managing initiatives under the programs outlined below.

This chapter reports on the major activities undertaken by the department during the year, reporting against each of the key strategic directions and performance indicators published in the Outcome 1 chapters of the 2009-10 Health and Ageing Portfolio Budget Statements and 2009-10 Health and Ageing Portfolio Additional Estimates Statements. It also includes a table summarising the estimated and actual expenditure for this outcome.

Outcome 1 was managed in 2009-10 by Population Health Division, Mental Health and Chronic Disease Division, the Office of Health Protection, the Therapeutic Goods Administration, the National Industrial Chemicals Notification Assessment Scheme, the Office of the Gene Technology Regulator and Regulatory Policy and Governance Division. The department’s state and territory offices also contributed to the achievement of the outcome.

In addition to the measures reported under this outcome, the department funds a number of preventative health and cancer activities through Outcome 10.

Programs Administered under Outcome 1 and 2009-10 Objectives

Program 1.1: Chronic Disease – Early Detection and Prevention

Work with state and territory governments to prevent chronic disease by promoting the adoption of healthy lifestyles, chronic disease education, supporting early cancer detection and prevention, and social marketing campaigns.

Program 1.2: Communicable Disease Control

Reduce the transmission of blood borne viruses and sexually transmissible infections.

Program 1.3: Drug Strategy

Reduce the significant health and social problems caused by excessive alcohol consumption, tobacco use and illicit drug use.

Program 1.4: Regulatory Policy

Provide direction and national leadership in food regulatory policy issues.
Administer the therapeutic goods regulatory framework for quality, safety, and efficacy and performance of therapeutic goods for human use.
Protect human health and the environment by regulating the safe and sustainable use of industrial chemicals.
Protect the health and safety of people and the environment by regulating dealings with genetically modified organisms.

Program 1.5: Immunisation

Improve immunisation coverage rates and reduce the incidence of vaccine preventable disease.

Program 1.6: Public Health

Reduce pressure on the health system by developing and maintaining health infrastructure and workforce capacity.
Provide training in population health, including health promotion, provide advice on lifestyle risks of chronic diseases, and develop and implement national policies to support improvements in child, youth, women’s and men’s health.

Major Achievements

Finalisation and release of preventative health strategy. Taking Preventative Action, the Government’s response to the Preventative Health Taskforce’s final report, was released in May 2010 and sets out future direction for preventative health through health reform.
Passage of the ‘alcopops’ legislation in August 2009, which has resulted in a decrease in consumption of these products.
Developed five new national strategies to combat rising blood borne viruses and sexually transmissible infections for the period 2010-2013. This work included the introduction of Australia’s first national strategy for hepatitis B.
The National Partnership Agreement on Essential Vaccines was endorsed by the Prime Minister and all state premiers and territory chief ministers.
A draft Intergovernmental Agreement was negotiated between the Australian Government and state and territory governments which, once signed by the Council of Australian Governments, will help to improve consistency of the food regulation system across Australia.
Negotiated with New Zealand amendments to the Agreement between the Government of Australia and the Government of New Zealand concerning a Joint Food Standards System. These amendments will promote alignment and consistency of food standards developed between Australia and New Zealand, thereby maintaining a trans-Tasman market for food and reducing unnecessary barriers to trade while protecting public health and safety.
Improved transparency of Therapeutic Goods Administration (TGA) regulatory decisions by publishing Australian Public Assessment Reports on the TGA website. This provides consumers, industry and health professionals’ information that the TGA considered prior to allowing new prescription medicines onto the market or major changes to products already on the market.
Finalisation of the review of the human health impacts of the chemical diethylhexyl phthalate (DEHP), with recommendations to limit exposure of children to DEHP from toys and childcare articles, and exposure of adults to DEHP from cosmetics.
The Australian National Breastfeeding Strategy 2010-2015 and its implementation plan were endorsed by the Australian Health Ministers’ Conference. The strategy provides a framework for priorities and action for Australian governments at all levels to protect, promote, support and monitor breastfeeding throughout Australia.
Australia’s first National Male Health Policy was released in May 2010. The policy benefits all Australian males by providing a framework for improving their health and practical suggestions for action aimed at health professionals and consumers.
On 22 March 2010, the first reformulation targets were announced under the Food and Health Dialogue. Agreement was obtained from the breakfast cereal and bread sectors to reduce salt levels across a range of bread and ready-to-eat breakfast cereals over the next four years.

Challenges

Lower than anticipated number of participants in lifestyle modification programs for people at high risk of type 2 diabetes.

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Program 1.1: Chronic Disease – Early Detection and Prevention

Program 1.1 aims to work with state and territory governments to prevent chronic disease, through promoting the adoption of healthy lifestyles, chronic disease education, supporting early cancer detection and prevention, and social marketing campaigns.

Key Strategic Direction for 2009-10

The department’s strategy to achieve this aim was to:

reduce chronic disease through healthy lifestyle choices, and support targeted disease prevention and early detection through cancer screening initiatives.

Major Activities

Prevention of Chronic Disease

Promoting the Adoption of Healthy Lifestyles

In 2009-10, the department introduced initiatives under the National Partnership Agreement on Preventive Health aimed at promoting healthy lifestyles and curbing the growth of chronic disease in the community. In April 2010, the department facilitated agreement between the Australian Government and state and territory governments to adopt the National Implementation Plan and policy initiatives and communication frameworks under the agreement. These arrangements will combat the rising prevalence of lifestyle related chronic disease by laying the foundations for healthy behaviours in the daily lives of Australians, through setting-based initiatives in communities, childhood and workplace environments, supported by national social marketing campaigns and infrastructure to monitor and evaluate interventions.

The department undertook a number of major activities under the National Partnership Agreement on Preventive Health in 2009-10, including selection of 12 pilot local government sites to participate in the first phase of the Healthy Communities initiative. The Healthy Communities initiative aims to increase participation in accredited, community-based physical activity and healthy eating programs or activities, with priority given to socio-economically disadvantaged areas.

The department also conducted formative research for the next phase of Measure Up, an advertising campaign that concentrated on generating greater recognition of the significant risks associated with specific lifestyle factors (poor nutrition, physical inactivity and unhealthy weight) and motivating Australians to take action in reducing these risks now. The department also undertook research to develop a new anti-tobacco campaign which will run in 2010-11.

In March 2010, the department signed a Memorandum of Understanding with the Australian Bureau of Statistics to deliver the Australian Health Survey and supported the passage of legislation through the House of Representatives in October 2009 to establish the Australian National Preventive Health Agency.

Throughout the year, the department continued to implement the Stephanie Alexander Kitchen Garden Program, with the second funding round bringing the total number of participating primary schools to 88. This program teaches children in years three to six to grow, cook and share fresh food in the belief that this approach will provide a better chance to positively influence children’s current and future food choices. In May 2010, school eligibility for the third round of funding was expanded to include non-government schools recognised through the Smarter Schools National Partnership – Low Socio-Economic Status School Communities initiative and special schools with a primary enrolment. A fourth funding round is scheduled for 2010-11.

The Healthy Active Australia Community and Schools Grants Program was substantially finalised in 2009-10, with approximately 500 grants awarded to encourage sustainable physical activity and healthy eating habits in communities and schools. The department will continue to work with grant recipients to finalise the remaining grants in the first quarter of 2010-11.

The department continued to work during the year with the food industry through the Food and Health Dialogue to create action plans and set targets for reducing the consumption of risk-associated nutrients (e.g. saturated fat, trans-fatty acids, sugar and salt), and improving consumer awareness and education to improve health outcomes from dietary choices. A Reformulation Working Group was created to investigate 10 priority food categories identified as presenting an opportunity for public health benefit through reformulation. Reformulation involves a change of ingredients or the percentages of ingredients that compose a given product. Through reformulation, the department, together with the food industry, is able to reduce the percentage of ingredients in foods that are detrimental to health and increase those that are beneficial. On 22 March 2010, the first salt reformulation targets for bread and breakfast cereals were announced.

Image of doctor, mother and child

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Supporting Early Cancer Detection and Prevention

During the year, the department continued to work with the states and territories to provide free mammographic screening through the BreastScreen Australia program, targeted at well women 50 to 69 years of age. The findings of the BreastScreen Australia evaluation were released and the roll-out of digital mammography technology commenced across BreastScreen Australia services. In 2009-10, nine BreastScreen Australia locations received an upgrade to digital mammography technology. Eight new mammography machines were provided for fixed, relocatable and mobile BreastScreen Australia services. This included the commissioning of a first of its kind four wheel drive mobile unit operating in rural and remote Queensland. Queensland also received the technology to support the transfer of electronic mammography images. Since the introduction of the BreastScreen Australia program in 1991, breast cancer mortality in Australia has dropped by more than 31 per cent.¹

The department also continued work in the areas of early detection and prevention of cervical cancer through the National Cervical Screening Program. This included continuing to work closely with state and territory governments to deliver the program. The department supported the development of a colposcopy quality improvement program and worked with the Australian Institute of Health and Welfare to refine the monitoring process for the program. Since the introduction of the National Cervical Screening Program in 1991, there has been a 54 per cent reduction in the mortality from cervical cancer.²

The National Bowel Cancer Screening Program aims to reduce the incidence of and mortality from bowel cancer through early detection of abnormalities and where bowel cancer has developed. Bowel cancer comprises 13.1 per cent of all invasive cancers diagnosed in 2006, and is the second most commonly diagnosed cancer in Australia.³ Randomised controlled trials have demonstrated that screening using a faecal occult blood test can reduce overall mortality from bowel cancer by 15 per cent to 33 per cent and reduce incidence by
20 per cent.⁴

The National Bowel Cancer Screening Program involves screening of asymptomatic people with a faecal occult blood test, which detects small amounts of blood in the bowel motion. Eligible people are sent an invitation package, including a test kit to be completed in their own home and mailed to a pathology laboratory for analysis. Participants with a positive test result are advised to discuss the result with their doctor, who will generally refer them for further investigations, usually a colonoscopy.

On 11 May 2009, the department suspended issuing invitations under the National Bowel Cancer Screening Program due to a problem with the faecal occult blood test kit introduced in December 2008. The National Bowel Cancer Screening Program recommenced on 2 November 2009, following the listing of a replacement test kit on the Australian Therapeutic Goods Register. The department issued replacement kits to all people affected by the problem in 2009-10, and has resumed issuing invitations to the eligible people under phase two of the program. The remaining eligible people under phase two of the program will be invited to participate by April 2011.

1 Australian Institute of Health and Welfare (AIHW) 2010. BreastScreen Australia monitoring report 2006-2007 and 2007-2008. Cancer series no. 55. Cat. No. CAN 51. Canberra: AIHW.
2 Australian Institute of Health and Welfare (AIHW) 2010. Cervical Screening in Australia 2006-2007: data report. Cancer series no. 54. Cat. No. CAN 50. Canberra: AIHW.
3 Australian Institute of Health and Welfare (AIHW) and Australian Government Department of Health and Ageing (2008). National Bowel Cancer Screening Program Monitoring Report 2008. Cancer series no. 44. Cat. No.40 AIHW.
4 Australian Cancer Network Colorectal Cancer Guidelines Revision Committee (2005). Guidelines for the Prevention, Early Detection and Management of Colorectal Cancer. Sydney: The Cancer Council of Australia and Australian Cancer Network Sydney.

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Performance Information for Outcome 1

Program 1.1: Deliverables

Qualitative Deliverables

Prevention of Chronic Disease
Qualitative Deliverable:	Timely production of evidence-based policy research: De-identified data from the COAG Reducing the Risk of Type 2 Diabetes initiative will measure the take-up, and will be used to refine the current initiative and improve successive lifestyle modification programs.
Result: Deliverable substantially met.
De-identified data from the COAG Reducing the Risk of Type 2 Diabetes initiative has been used to measure take-up of lifestyle modification programs. As uptake of the initiative increases, it is expected the data will be an important tool to influence preventive health policy.
Qualitative Deliverable:	Timely production of evidence-based policy research: In 2009-10, through the National Partnership Agreement on Preventative Health, a national audit of the preventative health workforce will be conducted to identify gaps and issues, and to develop a strategy to resolve them.
Result: Deliverable substantially met.
Under the National Partnership Agreement on Preventive Health, a workforce audit commenced in 2009-10 to assess the needs of the prevention workforce and to identify gaps and issues to assist implementation of partnership initiatives. The workforce audit required extensive consultations and collaboration with key stakeholders. The audit included a literature review, a program survey and data collection in 2009-10. A prevention workforce strategy will be developed using the findings of the audit in 2010-11.
Qualitative Deliverable:	Regular stakeholder participation in program development through a range of avenues, such as surveys, submissions on departmental discussion papers, conferences and committees. In addition: the department will consult regularly with the Australian General Practice Network and the Divisions of General Practice network in the management of, and any changes to, the COAG Type 2 Diabetes initiative.
Result: Deliverable met.
In 2009-10, the department established cross jurisdictional committees to support the implementation of the National Partnership Agreement on Preventive Health. Consultation occurred between government, non-government and private stakeholders to assist in the development and implementation of initiatives under the National Partnership Agreement. In addition, the department consulted regularly with the Australian General Practice Network and the Divisions of General Practice network on the management of the Australian Government’s contribution to the COAG Type 2 Diabetes initiative, including through regular meetings and a series of state based workshops.

Quantitative Deliverables

Prevention of Chronic Disease
Quantitative Deliverable:	Percentage of variance between actual and budgeted expenses.
2009-10 Target:	≤0.5%	2009-10 Actual:	-8.2%
Result: Deliverable not met.
The department did not achieve the performance target with actual administered expenses varying by -8.2 per cent to budget expenses. This is attributable to a lower than anticipated number of participants in lifestyle modification programs for people at high risk of type 2 diabetes.
Quantitative Deliverable:	Number of government primary schools to implement the Stephanie Alexander Kitchen Garden Program.
2009-10 Target:	≤50	2009-10 Actual:	47
Result: Deliverable met.
In 2009-10, 47 additional government primary schools were successful in receiving a grant to deliver the Stephanie Alexander Kitchen Garden National Program. Eighty-eight schools across Australia are now actively participating in the program.
Quantitative Deliverable:	Number of grants administered through the Healthy Active Australia Community and School Grants Program.
2009-10 Target:	≤500	2009-10 Actual:	500
Result: Deliverable met.
Delays in finalising some grants by 30 June 2010 occurred due to delays in receiving final reports from grant recipients. The department will continue to work with grant recipients to finalise the remaining grants in the first quarter of 2010-11.
Quantitative Deliverable:	Number of participants in lifestyle modification programs.
2009-10 Target:	approx. 45,500	2009-10 Actual:	approx. 680
Result: Deliverable not met.
Uptake of lifestyle modification programs is below the level anticipated and original targets have proven to be unrealistic. The department, in close consultation with the Australian General Practice Network, has put in place targeted activities to promote and support participation in lifestyle modification programs, including seed and pilot grants to the Divisions of General Practice network. This additional activity commenced in June 2010 and is anticipated to increase the uptake of lifestyle modification programs in 2010-11.
Quantitative Deliverable:	Proportion of up to 2 million invitations sent to eligible Australians in the second phase of the National Bowel Cancer Screening Program.
2009-10 Target:	approx. 44%	2009-10 Actual:	22%
Result: Deliverable not met.
The target was not met because of the impact of the remediation process which involved replacement kits being issued to people who were affected by the faulty test kits. However, all people eligible for kits in the three year program period will be invited to participate by April 2011.

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Program 1.1: Key Performance Indicators

Qualitative Key Performance Indicators

Prevention of Chronic Disease
Qualitative Indicator:	Under the National Partnership Agreement on Preventive Health, the Australian Government and states and territories have agreed to meet the following performance benchmarks related to physical activity for children and adults: increase the proportion of children participating in at least 60 minutes of moderate physical activity every day by five per cent from baseline for each state by 2013; by 15 per cent by 2015; and increase the proportion of adults participating in at least 30 minutes of moderate physical activity on five or more days of the week by five per cent from baseline for each state by 2013; by 15 per cent by 2015.
Result: Cannot be reported.
Under the National Partnership Agreement on Preventive Health, work commenced on development of a framework for monitoring performance benchmarks and reward methodology related to the Healthy Children and Healthy Workers initiatives. First performance reports will be delivered by jurisdictions in August 2013. In March 2010, a Memorandum of Understanding was signed with the Australian Bureau of Statistics to deliver the Australian Health Survey. The survey will randomly select about 50,000 people, including adults and children, to gather information on what Australians are eating and how physically active they are, alongside other health information such as whether people have been diagnosed with a chronic disease.⁵ Results from the Healthy Children and Healthy Workers initiative, and from the Australian Health Survey, will be used to evaluate progress against this indicator.
Qualitative Indicator:	Data reported in 2008 demonstrated that: in 2004-05, 56.2 per cent of women in the target groups participated in the BreastScreen Australia Program;⁶ in 2005-06, 60.6 per cent of women in the target groups participated in the National Cervical Screening Program;⁷ and in 2007-08, 42.9 per cent of people in the target groups participated in the National Bowel Cancer Screening Program.⁸ The structure and shape of a future National Bowel Cancer Screening Program will be determined by the outcomes of an evaluation to be undertaken by 2010-11. Participation rates post 2010-11 will depend on the outcomes of the evaluation.
Result: Indicator partially met.
The latest data for the National Cervical Screening Program shows increased participation in women 20 to 69 years of age. In 2007-08, 61.2 per cent of women in this age group participated in the program. In 2007-08, 54.9 per cent of women aged 50 to 69 years had breast cancer screening through BreastScreen Australia, which is below the rate of 56.2 reported in 2008-09. The Australian Government will continue to work with states and territories to encourage women in the target age group to participate in the program. BreastScreen Australia and the National Cervical Screening Program continue to be successful in protecting Australian women from breast and cervical cancer and related mortality. The BreastScreen Australia Evaluation, released in 2009-10, found that the program has been responsible for a fall in breast cancer mortality of approximately 25 per cent in Australian women in the target age range. The most recent available data on the National Cervical Screening Program shows there has been a decline of 54 per cent in mortality due to cervical screening since the program began in 1991. The suspension of the National Bowel Cancer Screening Program from 11 May to 2 November 2009 continues to influence the participation rate for 2009-10. Final data will be available following completion of phase two of the program in June 2011.

5 For more information on the Australian Health Survey, please see Program 1.6.

6 AIHW, 2008, BreastScreen Australia monitoring report 2004-05. Cancer series no. 42. Cat. No. CAN 37. Canberra: AIHW.

7 AIHW, 2008, National Cervical Screening Program monitoring report 2005-06. Cancer series no. 41. Cat no. CAN 36. Canberra: AIHW.

8 AIHW, 2008, National Bowel Cancer Screening Program monitoring report 2008.

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Quantitative Key Performance Indicators

Prevention of Chronic Disease
Quantitative Indicator:	Proportion of adults engaging in sufficient physical activity.
2009-10 Target:	52%	2009-10 Actual:	Data not available
Result: Cannot be reported.
National data is not available for 2009-10 on the percentage of adults engaging in sufficient physical activity (i.e. meeting national guidelines). The most recent national data that assessed physical activity levels against the guidelines was reported in Australia’s Health 2006 and found that in 2004, 52 per cent of Australian adults were engaged in sufficient physical activity for health benefits. Data from the Australian Bureau of Statistics National Health Surveys over the past 12 years, whilst not able to show the proportion of people engaging in sufficient physical activity for health benefits, shows that physical activity levels have not changed markedly over this period. To promote increased physical activity levels, the department continued to fund the Heart Foundation Walking Program which provides access to free, coordinated walking groups across Australia. At the end of 2009-10, there were more than 9,700 regular walkers participating in the program in more than 850 communities. The department also continued the Measure Up social marketing campaign, which aims to raise awareness of the link between chronic disease and lifestyle risk factors, and to encourage Australians to adopt healthier eating and increase their physical activity. Evaluation results show that knowledge, attitudes, intentions and behaviour regarding waist measurement increased amongst the target audience (adults 25-50 years of age with children).
Quantitative Indicator:	Proportion of children engaged in sufficient physical activity.
2009-10 Target:	69%	2009-10 Actual:	Data not available
Result: Cannot be reported.
National data is not available for 2009-10 on the percentage of children engaging in sufficient physical activity. The most recent data from 2007 Australian National Children's Nutrition and Physical Activity Survey found that approximately 69 per cent of children 9-16 years of age undertook sufficient physical activity for health benefits. The Healthy Active Australia Community and Schools Grants Program provided grants to schools and the broader community to promote positive behavioural changes in children in relation to physical activity and healthy eating. The department also continued to provide funding support for the Walk Safely to School Day initiative, an annual awareness-raising event to encourage walking rather than car use for short trips.
Quantitative Indicator:	Percentage of women in target groups participating in the BreastScreen Australia Program.
2009-10 Target:	2005-06 56.2%	2009-10 Actual:	2005-06 56.9%
Result: Indicator met.
In 2005-06, the participation rate of 56.9 per cent met the target rate for the 2009-10 reporting period.
Quantitative Indicator:	Percentage of women in target group participating in the National Cervical Screening Program.
2009-10 Target:	2006-07 60.6%	2009-10 Actual:	2006-07 61.5%
Result: Indicator met.
The participation rate in 2006-07 and 2007-08, of 61.5 and 61.2 per cent respectively, exceeded the target rate for the 2009-10 reporting period.
Quantitative Indicator:	Percentage of people participating in the National Bowel Cancer Screening Program.
2009-10 Target:	2008-09 42.9%	2009-10 Actual:	Cannot be reported
Result: Indicator not met
The suspension of the National Bowel Cancer Screening Program from 11 May to 2 November 2009 continues to influence the participation rate for 2009-10. Final data will be available following completion of phase two of the program in late 2011.

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Program 1.2: Communicable Disease Control

Program 1.2 aims to reduce the transmission of blood borne viruses and sexually transmissible infections. This will be achieved through the development and implementation of national strategies, targeted multimedia education, pilot screening of targeted populations and quality assurance programs to maintain a safe blood supply in Australia.

Key Strategic Direction for 2009-10

The department’s strategy to achieve these aims was to:

decrease the incidence of sexually transmissible infections and blood borne viruses, including chlamydia, syphilis, gonorrhoea and viral hepatitis in the Australian population.

Major Activities

Reducing the Prevalence of Communicable Disease in the Australian Population

In 2009-10, the department sought to ensure that policies and programs to reduce the prevalence of blood borne viruses and sexually transmissible infections were evidence-based and informed by the experiences of people living with blood borne viruses and sexually transmissible infections. This was achieved through extensive consultation processes and close stakeholder participation to identify priorities, develop policy and program responses, and monitor and evaluate arrangements.

Education and Awareness Campaign on Sexually Transmissible Infections

As part of the National Sexually Transmissible Infections Prevention Program, during 2009-10, the department continued to oversee the sexual health campaign to raise awareness of sexually transmissible infections and encourage safe sexual practices, including condom use, with the aim of reducing the prevalence of sexually transmissible infections among those 15-29 years of age.

The campaign was run in magazines, including gay and medical press, washroom posters, online advertising and Indigenous and print-handicapped radio.⁹ As part of the campaign, the department initiated a range of youth marketing activities to complement and extend the advertising and campaign messages. This includes the distribution of condom dispenser tins and condoms, and a condom tin design competition. The department will undertake an evaluation of the campaign in 2010-11, which will be informed by tracking research undertaken in 2009-10.

Revitalising Australia’s Response to Blood Borne Viruses and Sexually Transmissible Infections

During the year, five new national strategies for blood borne viruses and sexually transmissible infections were developed in partnership with community based organisations, state and territory governments, research centres and the Ministerial Advisory Committee on Blood Borne Viruses and Sexually Transmissible Infections. The new strategies, which cover the period 2010-2013, were endorsed by the Australian Health Ministers’ Conference in April 2010 and will provide a framework for reducing the prevalence of blood borne viruses and sexually transmissible infections in Australia. Priority actions outlined in each strategy will be rolled out in cooperation with stakeholders and directed towards priority populations identified in each strategy, with the aim of reducing the personal and social impacts these diseases cause.

This partnership model, successful in developing the strategies, will be used to implement the new strategies over the next three years.

Pilot Chlamydia Testing of Targeted Populations

Chlamydia continues to be the most frequently reported notifiable condition in Australia. In 2009-10, the department worked closely with the University of Melbourne to design and begin implementation of a chlamydia testing pilot program. The program, known as the Australian Chlamydia Control Effectiveness Pilot, aims to assess the feasibility, acceptability, efficacy and cost-effectiveness of testing for chlamydia in general practice settings. The program will increase the diagnosis and treatment of chlamydia and therefore reduce chlamydia transmission. The design of the pilot was completed in 2009-10; due to complexities with the pilot, testing will commence from 2010-11. An evaluation of the pilot is expected to be completed by December 2011.

Ensuring the Safety and Quality of Test Kits used to Detect HIV and Hepatitis C

In 2009-10, the department continued to fund the National Serology Reference Laboratory to ensure the quality of HIV and hepatitis C testing kits, and to provide a comprehensive quality control and quality assurance program for laboratories using these test kits. This work supports Australia’s commitment to ensuring a safe, high quality national blood supply.

The department worked closely with the Australian Red Cross Blood Service in 2009-10, in collaboration with the National Serology Reference Laboratory, so that hepatitis B nucleic acid testing of the blood supply could commence from 5 July 2010. The department has also worked with the National Serology Reference Laboratory and Therapeutic Goods Administration to plan for the transition to the new in-vitro diagnostic device regulatory framework and identify its implications. The new framework will enable the regulation of a wider range of in-vitro diagnostic devices, in addition to hepatitis C and HIV, using a risk based approach to safety and performance characteristics and aligns Australia with the recommendations of the Global Harmonization Task Force for Medical Device Regulation. The Therapeutic Goods Administration will begin implementing the new framework in 2010-11.

9 Print-handicapped radio is a service offered to people who, for any reason, are unable to access printed material.

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Performance Information for Outcome 1

Program 1.2: Deliverables

Qualitative Deliverables

Reducing the Prevalence of Communicable Diseases in the Australian Population

Qualitative Deliverable: Regular stakeholder participation in program development through a range of avenues, such as surveys, submissions on departmental discussion papers, conferences and meetings. In addition:

The department will develop national strategies on Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (HIV/AIDS), viral hepatitis, Aboriginal and Torres Strait Islander sexual health and sexually transmissible infections for consideration by the Australian Health Ministers’ Advisory Council in 2009.

Meetings include the Ministerial Advisory Committee on Blood Borne Viruses and Sexually Transmissible Infections, and the Blood Borne Virus and Sexually Transmissible Infections Subcommittee of the Australian Health Ministers’ Advisory Council.

Result: Deliverable met.

In 2009-10, five new national strategies for blood borne viruses and sexually transmissible infections were developed in partnership with community based organisations, state and territory governments and health professionals. The strategies were endorsed by the Australian Health Ministers’ Conference in April 2010 and published soon after. Two thousand copies of each strategy have been printed for distribution.

Both the Ministerial Advisory Committee on Blood Borne Viruses and Sexually Transmissible Infections and the Blood Borne Virus and Sexually Transmissible Infections Subcommittee met four times, face-to-face, in 2009-10 and oversaw the development of the new national strategies.

Qualitative Deliverable: The department will implement the National Sexually Transmissible Infections Prevention program education and awareness campaign in 2009-10.

Result: Deliverable met.

In 2009-10, the sexually transmissible infections campaign continued with activities including magazine and medical press, washroom posters, online advertising and Indigenous and print-handicapped radio messages, a condom tin design competition, youth marketing and peer education projects.

Results of research conducted from this round of campaign tracking continue to show a strong awareness of the campaign across the target group.

In December 2009, the department supported a number of peak national bodies to disseminate information relating to HIV and viral hepatitis for World AIDS Day and World Hepatitis Awareness Week.

Reducing the Prevalence of Communicable Diseases in the Australian Population
Qualitative Deliverable:	Regular stakeholder participation in program development through a range of avenues, such as surveys, submissions on departmental discussion papers, conferences and meetings. In addition: The department will develop national strategies on Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (HIV/AIDS), viral hepatitis, Aboriginal and Torres Strait Islander sexual health and sexually transmissible infections for consideration by the Australian Health Ministers’ Advisory Council in 2009. Meetings include the Ministerial Advisory Committee on Blood Borne Viruses and Sexually Transmissible Infections, and the Blood Borne Virus and Sexually Transmissible Infections Subcommittee of the Australian Health Ministers’ Advisory Council.
Result: Deliverable met.
In 2009-10, five new national strategies for blood borne viruses and sexually transmissible infections were developed in partnership with community based organisations, state and territory governments and health professionals. The strategies were endorsed by the Australian Health Ministers’ Conference in April 2010 and published soon after. Two thousand copies of each strategy have been printed for distribution. Both the Ministerial Advisory Committee on Blood Borne Viruses and Sexually Transmissible Infections and the Blood Borne Virus and Sexually Transmissible Infections Subcommittee met four times, face-to-face, in 2009-10 and oversaw the development of the new national strategies.
Qualitative Deliverable:	The department will implement the National Sexually Transmissible Infections Prevention program education and awareness campaign in 2009-10.
Result: Deliverable met.
In 2009-10, the sexually transmissible infections campaign continued with activities including magazine and medical press, washroom posters, online advertising and Indigenous and print-handicapped radio messages, a condom tin design competition, youth marketing and peer education projects. Results of research conducted from this round of campaign tracking continue to show a strong awareness of the campaign across the target group. In December 2009, the department supported a number of peak national bodies to disseminate information relating to HIV and viral hepatitis for World AIDS Day and World Hepatitis Awareness Week.

Quantitative Deliverables

Reducing the Prevalence of Communicable Diseases in the Australian Population
Quantitative Deliverable:	Percentage of variance between actual and budgeted expenses.
2009-10 Target:	≤0.5%	2009-10 Actual:	-0.2%
Result: Deliverable met.
The department’s underspend was a result of small underspends across activities within the program.
Quantitative Deliverable:	Number of peak national bodies supported to disseminate information and education.
2009-10 Target:	≤10	2009-10 Actual:	7
Result: Deliverable met.
The department provided funding to seven community based organisations in 2009-10 to undertake prevention and education activities in the HIV/AIDS, sexually transmitted infections and viral hepatitis sectors.
Quantitative Deliverable:	Number of geographic locations to administer Chlamydia Testing in General Practice program.
2009-10 Target:	4	2009-10 Actual:	0
Result: Deliverable not met.
The Chlamydia Testing in General Practice pilot design was finalised in 2009-10. Due to the complexities of implementing the pilot, testing in general practice has been delayed, however, testing will commence from 2010-11.
Quantitative Deliverable:	Assessment rate for all new HIV and hepatitis C virus test kits entering the Australian market.
2009-10 Target:	100%	2009-10 Actual:	100%
Result: Deliverable met.
The department ensured pre-market assessment and post market monitoring of the safety and performance of in-vitro diagnostic devices for the testing of human blood samples for HIV and hepatitis C through the National Serology Reference Laboratory. The nucleic acid amplification testing quality assurance program tests the blood supply for the presence of HIV and hepatitis C.

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Program 1.2: Key Performance Indicators

Qualitative Key Performance Indicators

Reducing the Prevalence of Communicable Diseases in the Australian Population
Qualitative Indicator:	Progress on implementation of priority actions to reduce the transmission of sexually transmissible and blood borne viral infections measured through periodic reports against the new national strategies.
Result: Indicator met.
New national strategies were endorsed by the Australian Health Ministers’ Conference in April 2010. Considerable preliminary work was undertaken in 2010 by both the Ministerial Advisory Committee on Blood Borne Viruses and Sexually Transmissible Infections and the Blood Borne Viruses and Sexually Transmissible Infections Subcommittee to determine the key strategic priorities under each of the five new national strategies and ensure monitoring and evaluation are built on a sound evidence base. Both committees progressed implementation plans for the five new national strategies.
Qualitative Indicator:	Effective communicable disease prevention and detection in accordance with a sound evidence base and with responsiveness to new and emerging trends, measured through a positive impact on notification rates of HIV/AIDS, hepatitis C and sexually transmissible infections.
Result: Indicator met.
Throughout 2009-10, the department worked closely with stakeholders to revise and develop national strategies which will provide a framework for preventing and reducing the transmission of blood borne viruses and sexually transmissible infections in Australia and ensuring optimal treatment, care and support for those affected. The department funded qualitative research into knowledge, attitudes, beliefs and behaviours, to provide data that supports evidence-based approaches to education and prevention. Whilst notification rates for hepatitis C continue to decline, rates of gonorrhoea, infectious syphilis, hepatitis B and HIV have remained constant in recent years. Chlamydia continues to be the most frequently reported infection, with notification rates for chlamydia continuing to increase in 2009-10 consistent with previous year trends.
Qualitative Indicator:	Improved knowledge, attitude and behaviours in relation to sexually transmissible infections and associated health risks through targeted health promotion and disease prevention campaigns, including social marketing, measured through an evaluation of the sexually transmissible infections campaign.
Result: Indicator met.
Preliminary results of tracking research for the second phase of the campaign show a continued strong awareness of the campaign across the target group of young people 15 to 29 years of age. Results show that the target group sees the campaign as believable and informative, and that the campaign has influenced them around condom use, testing and engaging with sexual partners around sexually transmissible infections. An evaluation of the campaign will commence in September 2010.
Qualitative Indicator:	The impact of the Communicable Disease Control program will be measured by an increase in the detection and treatment of chlamydia in the community.
Result: Indicator substantially met.
The reported incidence of chlamydia has increased due to an increase in testing. In 2008-09, 680,384 tests were ordered through the Medicare Benefits Schedule. In 2009-10 this rose to 753,956 tests. This is an increase of about 11 per cent. The number of notifications of chlamydia increased by about 10 per cent in 2009-10, compared with 2008-09 from 61,232 to 67,344 notifications.

Quantitative Key Performance Indicators

Reducing the Prevalence of Communicable Diseases in the Australian Population
Quantitative Indicator:	Number of newly diagnosed cases of chlamydial infection.
2009-10 Target:	65,000-70,000	2009-10 Actual:	67,344
Result: Indicator met.
To reduce the burden of sexually transmissible infections during 2009-10, the department continued awareness programs aimed at improving knowledge, attitudes and behaviours among target populations, including the promotion of sexually transmissible infection testing. The continuing increase in the detection of chlamydial infections, particularly among young people and other at-risk populations, is seen as a positive achievement. Due to the often asymptomatic nature of the infection, the increase in diagnoses enables early treatment, which can reduce longer term health complications. Increased detection also shows greater access by the community to sexual health services.

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Program 1.3: Drug Strategy

Program 1.3 aims to reduce the significant health and social problems caused by excessive alcohol consumption, tobacco use, and illicit drug use by targeted education and awareness campaigns, research and education, treatment services, service capacity building, and regulatory action.

Key Strategic Direction for 2009-10

The department’s strategy to achieve this aim was to:

reduce binge drinking, risky alcohol consumption, the harmful effects of tobacco use, and the demand, supply and harm caused by illicit drug use.

Major Activities

Reducing Risky Consumption of Alcohol, Tobacco and Illicit Drugs

Curbing Excessive Alcohol Consumption

In 2009-10, the department continued to implement the National Binge Drinking Strategy. Phase two of the Don’t Turn a Night Out into a Nightmare campaign was launched in November 2009 with hard hitting television, radio, print and internet advertisements, confronting teenagers, young adults and parents with the negative consequences of binge drinking. An independent evaluation of the campaign showed it achieved strong awareness among these target groups. A second round of 19 community-led projects were funded under the Community Level Initiative, to tackle the culture of binge drinking in local areas. The Good Sports program, which seeks to promote responsible drinking practices among sporting clubs, was extended to a total of 3,675 participating organisations.

The department finalised agreements for the Early Intervention Pilot Program with seven states and territories. The program brings together state and territory police and health departments to divert young people at risk from binge drinking to counselling and other assistance to encourage a change in attitudes and behaviours.

During the year, the department developed and distributed communication materials to raise community awareness of the Australian Guidelines to Reduce Health Risks from Drinking Alcohol. Updated clinical Guidelines for the Treatment of Alcohol Problems were released in February 2010, with more than 14,500 copies distributed to health professionals who treat people with alcohol problems. The department also initiated a number of targeted projects to help address foetal alcohol spectrum disorders, including the development of pregnancy diagnostic resources, improvements to data collection and targeted information and communication materials.

In September 2009, the department undertook a broad stakeholder consultation on the World Health Organization’s Global strategy to reduce the harmful use of alcohol, which contains 10 recommended policy areas for countries to consider when developing policies to reduce alcohol-related harms. Consensus on the strategy from all 193 WHO Member States in May 2010 signals that countries are prepared to work together to take a strong stand against the harmful use of alcohol.

The department also developed a response to the Preventative Health Taskforce Report recommendations on alcohol, which signals future directions in alcohol policy and programs. This includes continuing to place a strong emphasis on changing the drinking culture in Australia, particularly the culture around binge drinking. Through the Council of Australian Governments and the Ministerial Council on Drug Strategy, the department will also continue to work with the states and territories on liquor control laws and their effective enforcement, as they are a legislative mechanism for ensuring the safety of the people who drink and those around them. The Ministerial Council on Drug Strategy submitted a report to the Council of Australian Governments in November 2009 on options to reduce binge drinking.

Reducing the Prevalence of Smoking

The department supported the development of a package of reforms in 2009-10 to help achieve the Council of Australian Governments’ National Healthcare Agreement target of reducing the prevalence of smoking among Australians to 10 per cent, and halving Indigenous smoking rates by 2018. The package, announced by the Government in April 2010, included: a 25 per cent increase in the excise on tobacco products, increasing the price of a packet of 30 cigarettes by $2.16; a commitment to legislation to mandate plain packaging of tobacco products from 2012; an additional $27.8 million for anti-smoking social marketing campaigns targeting high need and highly disadvantaged groups including pregnant women and their partners, people living in disadvantaged areas, people from culturally and linguistically diverse backgrounds, people with mental illness and people in prison; and legislation to restrict Australian internet advertising of tobacco products, bringing the internet into line with restrictions already in place in other media.

During 2009-10, the department re-launched the When you smoke you inhale over 4,000 chemicals social marketing campaign, which warns Australians of the health risks from smoking, and commenced the development of the $61 million anti-smoking social marketing campaign under the Council of Australian Governments’ National Partnership Agreement on Preventive Health with guidance from an expert advisory committee.

The department led the Australian delegation to the fourth Intergovernmental Negotiating Body on a Protocol to Eliminate the Illicit Trade in Tobacco Products under the Framework Convention on Tobacco Control, which saw the further development of the protocol text, and participated in a number of international technical meetings to develop guidelines under various articles of the framework.

The department also provided funding for targeted research projects to assist in reducing smoking prevalence among highly disadvantaged groups, including people with mental illness and prisoners.

The department supported the largest ever efforts to reduce smoking prevalence among Aboriginal and Torres Strait Islander people. The department conducted an open funding round under the $14.5 million Indigenous Tobacco Control Initiative, which saw funding provided to some 14 projects around Australia to trial and implement innovative approaches to smoking prevention and cessation in Indigenous communities. The department also commenced the roll-out of the $100.6 million Council of Australian Governments’ Closing the Gap in Indigenous Health Outcomes Tackling Smoking measure, engaging Dr Tom Calma as the National Coordinator – Tackling Indigenous Smoking, and finalising funding agreements for the employment and training of Regional Tobacco Coordinators and Tobacco Action Workers in 20 regions around Australia. This work was guided by a technical reference group of experts and stakeholders in the field.

Commencing in 2009-10, the department initiated an evaluation of the National Tobacco Strategy and supported the development of the Government’s response to the Preventative Health Taskforce report recommendations on tobacco, which signals future directions in tobacco policy and programs.

Targeting Illicit Drug Use

In February 2010, the department launched stage two of the fourth phase of the National Drugs Campaign. This phase of the campaign aims to help reduce the uptake of ecstasy, marijuana, methamphetamine (ice) and other illicit drugs among young Australians.

The department continued to provide funding for non-government drug and alcohol treatment services and for the Improved Services Initiative to help drug and alcohol treatment services provide better support for people with co-occurring drug and alcohol and mental health issues. The department also continued major investments in data and research on drug and alcohol issues, including supporting the 2010 National Drug Strategy Household Survey, expected to report in 2011.

The department led the Australian delegation to the 53rd session of the Commission on Narcotic Drugs in March 2010. The commission considered enhancements to international data collection on narcotic drug issues initiated by Australia in 2009. Australia also helped support a resolution of the commission to promote the adequate availability of internationally controlled licit drugs for medical and scientific purposes while preventing their diversion and abuse.

Working with states and territories, the department led work on the 2010-2015 National Drug Strategy, convening a working group of the Intergovernmental Committee on Drugs and supporting the release of a consultation paper by the Ministerial Council on Drug Strategy in December 2009. The department supported a process of public submissions, which closed in February 2010, and targeted stakeholder roundtables in April 2010, in response to the consultation paper. A consultation draft of the National Drug Strategy is expected to be considered by the Ministerial Council on Drug Strategy in the second half of 2010.
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Performance Information for Outcome 1

Program 1.3: Deliverables

Qualitative Deliverables

Reducing Risky Consumption of Alcohol, Tobacco and Illicit Drugs
Qualitative Deliverable:	Timely production of evidence-based policy research through: The work of the National Drug Research Centres of Excellence and the Australian Institute of Health and Welfare on tobacco, alcohol and workforce development will provide an evidence-base to monitor the National Binge Drinking Strategy and the Government’s closing the gap commitment.
Result: Deliverable met.
The department funded the three National Drug Research Centres (the National Drug and Alcohol Research Centre, the National Drug Research Institute and the National Centre for Education and Training on Addiction) to provide high quality research products that contribute to evidence-informed policy and practice by health, law enforcement and education services. The department engaged the National Centre for Education and Training on Addiction to develop a National Alcohol Data Knowledgebase, including the development of a public reference document for alcohol-related information and nationally agreed standards and procedures for deriving and reporting alcohol related information. The department engaged the Australian Institute of Health and Welfare to conduct the 2010 National Drug Strategy Household Survey.
Qualitative Deliverable:	Continue working with the Ministerial Council on Drug Strategy to develop national policies and programs to reduce drug related harm in the Australian community. The Strategy is the peak policy and decision-making body in relation to licit and illicit drugs in Australia, and comprises Australian Government and State and Territory Ministers responsible for health and law enforcement and the Australian Government Minister responsible for education.
Result: Deliverable met.
The department provided secretariat support to the Ministerial Council on Drug Strategy and supported the active engagement of the Australian Government in the council and its subsidiary Intergovernmental Committee on Drugs. The department supported two meetings of the Ministerial Council on Drug Strategy and four meetings of the Intergovernmental Committee on Drugs in 2009-10. Under the auspices of the Ministerial Council on Drug Strategy and the Intergovernmental Committee on Drugs, the department led work on the development of the 2010-2015 National Drug Strategy and a paper on options to address binge drinking which was submitted to the Council of Australian Governments in December 2009.
Qualitative Deliverable:	Regular stakeholder participation in program development through a range of avenues, such as surveys, submissions on departmental discussion papers, conferences and committees. In addition: The Australian National Council on Drugs is the principal advisory body to Government on drug policy and plays a critical role in ensuring the voice of the community is heard in relation to drug related policies and strategies. The National Council reports annually to the Ministerial Council on Drug Strategy and bi-annually to the Intergovernmental Council on Drugs. The National Council holds quarterly meetings each year.
Result: Deliverable met.
The department continued to provide funding for the Australian National Council on Drugs and to participate in its meetings as an observer. The department also provided funding for, and had strong and continuing engagement with, peak bodies including the Alcohol and other Drugs Council of Australia and the Australian Therapeutic Communities Association. The department led a major stakeholder consultation on the 2010-2015 National Drug Strategy and sought submissions to an evaluation of the Non-Government Organisation Treatment Grants program.
Qualitative Deliverable:	In 2009-10, the department will continue to implement elements of the National Binge Drinking Strategy, including the Early Intervention Pilot Program and the Good Sports initiative, to curb excessive alcohol consumption. Specific evaluation tools will be developed for each of these measures as they target specific populations in specific locations.
Result: Deliverable met.
The second phase of the Don’t Turn a Night Out into a Nightmare social marketing campaign was launched in November 2009 and an independent evaluation conducted. A second round of Community Level Initiative grants was conducted and an evaluation of administrative processes supporting the program was initiated. Funding agreements have been finalised with seven jurisdictions for the implementation of the Early Intervention Pilot Program. Over 1,000 additional sporting clubs have joined the Good Sports program, bringing the total number of clubs involved in the program to 3,675.
Qualitative Deliverable:	In 2009-10, the department will revise and update the National Alcohol Strategy 2006-2009.
Result: Deliverable not met.
This deliverable was not met as on 24 April 2009, the Ministerial Council on Drug Strategy approved an extension of the term of the current National Alcohol Strategy 2006-2009 until 2011, as its goals and priorities remain current. The strategy is a plan for coordinated action aimed at reducing alcohol-related harm in Australia and was developed through collaboration between Australian governments and other stakeholders. It is a sub-strategy of the National Drug Strategy 2004-2009, which is currently under revision and this process will determine any changes.
Qualitative Deliverable:	In 2009-10, the department will continue to work with other agencies to support the ready-to-drink alcohol beverages tax initiative.
Result: Deliverable met.
Following consultations between the department, the Australian Taxation Office and the Treasury, in August 2009, the Excise and Customs Tariff Amendment Acts received Royal Assent, thereby closing the previous tax loophole that existed with regard to ready-to-drink alcohol products.
Qualitative Deliverable:	In 2009-10, the department will continue to work with industry and other stakeholders to ensure that alcohol advertising in Australia is consistent with community standards and alcohol advertising codes.
Result: Deliverable met.
The department continues to participate as a member of the Alcohol Beverages Advertising Code Management Committee. During 2009-10 officers of the department attended four meetings of the management committee. On 1 November 2009, the Code’s coverage was expanded to include the naming and packaging of new alcohol beverage products.
Qualitative Deliverable:	In 2009-10, the National Tobacco Strategy will be reviewed and a new strategy will be developed and implemented in 2010-11.
Result: Deliverable met.
An independent evaluation of the National Tobacco Strategy was commissioned in 2009-10 to inform the development of a new strategy in 2010-11. The department received a draft evaluation report in June 2010.
Qualitative Deliverable:	In 2009-10, the department will develop a social marketing campaign to raise awareness about the risks of tobacco smoking for development of chronic disease. The campaign will commence in 2010-11 and will be evaluated in 2013-14.
Result: Deliverable met.
The department re-launched the When you smoke you inhale over 4,000 chemicals social marketing campaign in February 2010, and commenced the development of the $61 million anti-smoking social marketing campaign under the Council of Australian Governments’ National Partnership Agreement on Preventive Health with guidance from an Expert Advisory Committee. Complementary activities focusing on high-risk and hard to reach groups will be undertaken through the National Tobacco Campaign – More Targeted Approaches activity as announced in the 2010-11 Budget.
Qualitative Deliverable:	The department will develop a national network of Indigenous campaign coordinators to support communities to develop local communication strategies.
Result: Deliverable met.
The department entered funding agreements with health services in 20 regions around Australia to employ regional tobacco coordinators and tobacco action workers to support Indigenous communities to develop local anti-smoking campaigns under the Council of Australian Governments’ Closing the Gap in Indigenous Health Outcomes National Partnership Agreement. By 2012-13, this network will cover 57 regions around Australia.
Qualitative Deliverable:	The department will provide funding for local Indigenous community campaigns promoting quit smoking and healthy lifestyles.
Result: Deliverable met.
The department commissioned formative research to help inform local Indigenous community campaigns promoting quit smoking and healthy lifestyles. About $100,000 per region per annum is being made available to Regional Tobacco Coordinators to fund the campaigns.
Qualitative Deliverable:	The department will develop a national Indigenous tobacco control-training program for health workers and community educators.
Result: Deliverable met.
The department commissioned the Centre for Excellence in Indigenous Tobacco Control to develop national induction training for the Regional Tobacco Coordinators and Tobacco Action Workers and has commissioned HealthInfoNet to develop resource materials for the workers. Funding is provided to employing health services to support appropriate vocational education and training qualifications for the workers.
Qualitative Deliverable:	In 2010, the next phase of Australia’s National Drug Strategy will be implemented following an extensive consultation process and building on the findings from the evaluation of the 2004-09 National Drug Strategy.
Result: Deliverable substantially met.
The department worked with states and territories on the 2010-2015 National Drug Strategy, convening a working group of the Intergovernmental Committee on Drugs and supporting the release of a consultation paper by the Ministerial Council on Drug Strategy in December 2009. The department supported a process of public submissions, which closed in February 2010, and targeted stakeholder roundtables in April 2010, in response to the consultation paper. A consultation draft of the National Drug Strategy is expected to be considered by the Ministerial Council on Drug Strategy in the second half of 2010.
Qualitative Deliverable:	As part of the Targeting Youth Methamphetamine Users campaign which provides young Australians with up-to-date information about methamphetamines, ecstasy and cannabis, targeted messages will be delivered through advertising, industry publications, public relation activities, and communication with stakeholders.
Result: Deliverable met.
The department launched stage two of phase four of the National Drugs Campaign in February 2010. The campaign provided targeted up-to-date messages about the risks and harms associated with ecstasy, methamphetamine and cannabis use. The campaign includes radio, print, outdoor, online and in-venue advertising; a National Drugs Campaign website¹⁰ and the 1800 250 015 information line.
Qualitative Deliverable:	Support and contract management to treatment services will continue under the Non-Government Organisation Treatment Grants program.
Result: Deliverable met.
The department continued to provide support and contract management arrangements across all states and territories to non-government organisations through the Non-Government Organisations Treatment Grants program to operate a range of alcohol and drug treatment services. The department commenced an independent evaluation of the program that will help inform future funding arrangements and program management and performance.

10 Accessible at www.australia.gov.au/drugs.

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Quantitative Deliverables

Reducing Risky Consumption of Alcohol, Tobacco and Illicit Drugs
Quantitative Deliverable:	Percentage of variance between actual and budgeted expenses.
2009-10 Target:	≤0.5%	2009-10 Actual:	-1.1%
Result: Deliverable not met.
The actual administered expenses for Outcome 1.3 were 1.1 per cent below budget expenses. This was primarily due to longer than expected negotiations and subsequent delays in a number of funding agreements.
Quantitative Deliverable:	The number of clubs participating in the Good Sports program (funding ends in 2011-12).
2009-10 Target:	2,862	2009-10 Actual:	3,675
Result: Deliverable met.
More than 1,000 additional sporting clubs have joined the program, bringing the total number of clubs participating in the program to 3,675.
Quantitative Deliverable:	The number of young people referred to counselling under innovative early intervention programs (referrals commence in 2009-10).
2009-10 Target:	250	2009-10 Actual:	Nil
Result: Deliverable not met.
States and territories have taken longer than anticipated to roll-out programs, and this has delayed the collection of data which is now underway. All states and territories, except New South Wales, are participating in the program and negotiations with New South Wales are continuing. Until data is available from states and territories, the program’s success should be measured by state and territory participation in the program as an early intervention option for underage drinkers.
Quantitative Deliverable:	Number of services funded under the capacity building grants component of the Improved Services initiative (funding ends in 2010-11).
2009-10 Target:	122	2009-10 Actual:	122
Result: Deliverable met.
The department provided support and direction to 122 non-government drug and alcohol treatment services to build their organisational capacity and for developing and building partnerships with other service providers.
Quantitative Deliverable:	Number of services funded to deliver the Non-Government Organisation Treatment Grants program (funding ends in 2010-11).
2009-10 Target:	197	2009-10 Actual:	197
Result: Deliverable met.
Through the Non-Government Organisation Treatment Grants program the department in 2009-10 continued to provide support to 197 non-government organisations to provide a wide range of treatment service options for substance abuse and misuse of alcohol and other drugs.

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Program 1.3: Key Performance Indicators

Qualitative Key Performance Indicators

Reducing Risky Consumption of Alcohol, Tobacco and Illicit Drugs
Qualitative Indicator:	The National Drug Strategy Household Survey will be undertaken in 2010 with data indicating alcohol consumption, smoking rates and risk levels, and illicit drug use. The results of this survey are expected to be available in 2011.
Result: Indicator met.
The department engaged the Australian Institute of Health and Welfare to manage the 2010 National Drug Strategy Household Survey. Cognitive testing and pilot testing of the questionnaire and information was completed in January 2010. Fieldwork for the 2010 survey commenced at the end of April 2010 and is expected to be completed in July 2010. The survey results are expected to be available in August 2011.
Qualitative Indicator:	In 2009-10, the department will complete an evaluation of the National Binge Drinking Social Marketing Campaign. There will be a number of waves of data collection, with an evaluation report submitted to the Minister for Health and Ageing by June 2010.
Result: Indicator not met.
The department has completed the fieldwork for the evaluation and received the draft report from the consultant (Ipsos-Eureka Social Research Institute). The draft is currently being reviewed by the department and is expected to be finalised in 2010 for consideration by the Minister for Health and Ageing.

Quantitative Key Performance Indicators

Reducing Risky Consumption of Alcohol, Tobacco and Illicit Drugs
Quantitative Indicator:	Percentage of the target audience (15-25 year olds) exposed to National Binge Drinking Campaign (funding ends in 2009-10).
2009-10 Target:	90%	2009-10 Actual:	Not available
Result: Cannot be reported.
The department has completed the fieldwork for the evaluation and received the draft report from the consultant. The draft is currently being reviewed by the department and is expected to be finalised late in 2010 for consideration by the Minister for Health and Ageing.
Quantitative Indicator:	Number of sites covered by regional national network of Indigenous campaign coordinators.
2009-10 Target:	20	2009-10 Actual:	20
Result: Indicator met.
The department entered into funding agreements with host services to employ Regional Tobacco Coordinators and Tobacco Action Workers in the first 20 of 57 regions.
Quantitative Indicator:	Percentage of the target audience (15-25 year olds) exposed to the Targeting Young Methamphetamine Users campaign (Stages 1 and 2 of the campaign conclude in 2009-10. Future stages are yet to be determined).
2009-10 Target:	92%	2009-10 Actual:	Not available
Result: Not available.
The department has completed the fieldwork for the evaluation and received the draft report from the consultant. The draft is currently being reviewed by the department and is expected to be finalised late August 2010 for consideration by the Minister for Health and Ageing.

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Sub-program 1.4.1: Food Regulation Policy

Sub-program 1.4.1 aims to provide responsible national leadership in food regulation policy and governance issues by promoting a nationally consistent approach to food regulation, and developing advice and policy for the Government at both a national and international level.

Key Strategic Direction for 2009-10

The department’s strategy to achieve this aim was to:

support the Australian Government and the Australia and New Zealand Food Regulation Ministerial Council in the development of joint food standards, and food regulation policy and advice.

Major Activities

Food Regulation Policy

The department undertakes a number of activities to develop food standards and food regulation policy and advice. This involves working closely with a range of stakeholders, such as industry representatives, Food Standards Australia New Zealand (FSANZ), government departments and the New Zealand Government.

Throughout 2009-10, the department collaborated with FSANZ and other agencies, including the Department of Agriculture Fisheries and Forestry, the Department of Foreign Affairs and Trade, state and territory governments and the New Zealand Government, to provide advice on national and international food regulatory policy issues, including the development of national and international standards which facilitates export trade and ensures safe imported food products for Australian consumers.

As part of the Council of Australian Governments’ microeconomic reform to deliver a seamless national economy, the department led a working group to develop options for greater consistency across states and territories in the monitoring and enforcement of food standards. This will be delivered through a new interpretive advisory service which will provide advice as requested to interested stakeholders, including state and territory food regulatory enforcement agencies and businesses, which will enable better understanding, and consistent application, monitoring and enforcement of food standards. This will provide improved clarity of regulatory requirements for business, particularly those operating in more than one jurisdiction.

The department successfully completed the arrangements necessary to amend the Agreement between the Government of Australia and the Government of New Zealand concerning a Joint Food Standards System. The amendments will provide greater clarity in the operation of the agreement, promoting the Trans-Tasman trade in food through the development of more consistent and common food standards, and by the reduction of unnecessary barriers to trade.

The department provided advice, support and secretariat services to the Australia and New Zealand Food Regulation Ministerial Council and its subcommittees, which work cooperatively within the food regulatory system to protect consumer health and safety in relation to food.

The department also provided advice, support and secretariat services to the review of food labelling law and policy, which is being undertaken by an independent expert panel led by Dr Neal Blewett. The panel has been asked to provide advice on what principles should guide decisions about regulatory intervention and to make recommendations on how to improve food labelling law and policy. The final report of the review is due to be presented to the Australia and New Zealand Food Regulation Ministerial Council in December 2010 and to the Council of Australian Governments in early 2011.

Performance Information for Outcome 1

Sub-program 1.4.1: Deliverables

Qualitative Deliverables

Food Regulation Policy
Qualitative Deliverable:	Food standards are developed in accordance with the legislative requirements of the Food Standards Australia New Zealand (FSANZ) Act (1991). The department fulfils these legislative requirements both through providing policy advice for Australian Government ministerial consideration of draft standards developed by FSANZ, and through its secretariat functions; the department coordinates the Ministerial Council consideration and provision of advice back to FSANZ, ensuring input to all notifications.
Result: Deliverable met.
In 2009-10, the department fulfilled the legislative requirement for the development of food standards by providing high quality policy advice for ministerial consideration of draft food standards. The department managed the associated secretariat functions; coordinated Australia New Zealand Food Regulation Ministerial Council consideration and provided food policy advice to FSANZ; and ensured input was provided to all notifications.

Quantitative Deliverables

Food Regulation Policy
Quantitative Deliverable:	Percentage of variance between actual and budgeted expenses.
2009-10 Target:	≤0.5%	2009-10 Actual:	-19.3%
Result: Deliverable not met.
The underspend resulted primarily from the cancellation of a meeting of the Food Regulation Standing Committee.
Quantitative Deliverable:	Percentage of input into food standards Final Assessment Report Notification, and first and second reviews report.
2009-10 Target:	100%	2009-10 Actual:	100%
Result: Deliverable met.
This deliverable was met by managing notifications through a clearly articulated process, including strict deadlines, and maintaining high quality relationships between departmental officers and ministerial staffers.

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Sub-program 1.4.1: Key Performance Indicators

Qualitative Key Performance Indicator

Food Regulation Policy
Qualitative Indicator:	Timely, accurate and relevant advice on food regulation policy, measured by the Parliamentary Secretary’s satisfaction.
Result: Indicator met.
The department regularly provides timely, accurate and relevant advice on food regulation policy matters. In 2009-10, the department responded to more than 1,100 letters to ministers and prepared more than 50 Minutes to the Minister on food regulation policy. More than 95 per cent of letters to ministers were responded to within the set timeframe.

Quantitative Key Performance Indicator

Food Regulation Policy
Quantitative Indicator:	Percentage of papers sent out on time to the Ministerial Council and its subcommittees.
2009-10 Target:	80-90%	2009-10 Actual:	85%
Result: Indicator met.
One-hundred per cent of papers received by the department on the due date were distributed on time. Those received late were distributed within 48 hours of receipt.

Sub-program 1.4.2: Therapeutic Goods

Sub-program 1.4.2 aims to ensure that all Australians have access to medicines and medical devices that are safe and effective to use for their intended purpose, and are manufactured in accordance with the principles of Good Manufacturing Practice. The Therapeutic Goods Administration (TGA) applies a risk management approach to the administration of the national framework for regulating the quality, safety and efficacy or performance of therapeutic goods for human use.

Key Strategic Direction for 2009-10

The department’s strategy to achieve this aim was to:

ensure that therapeutic goods manufactured or supplied in or exported from Australia are of high quality, and are safe and effective to use for their intended purpose, and to implement further reforms to Australia’s regulatory framework.

Major Activities

Therapeutic Goods

Therapeutic Goods Regulatory Reforms

Ensuring the Australian community has timely access to therapeutic goods that are of high quality and are safe and effective for their intended purpose is an ongoing priority for the Australian Government.

In 2009-10, the TGA continued its program of reforms to update and streamline the Australian therapeutic goods regulatory scheme. This important reform program ensures that the therapeutic goods regulatory framework in Australia remains contemporary, responsive and consistent with community standards and international best practice.

Three bills to implement a series of reforms were passed by Parliament in 2009-10. The key legislative changes provide for the implementation in 2010-11 of: revised arrangements for the scheduling of medicines and chemicals; a new framework for the regulation of human cellular and tissue based therapy products, known as biologicals; as well as other improvements to the TGA regulatory scheme.

Transparency and Availability of Consumer Information

Throughout 2009-10, the TGA worked with stakeholders to progress prescription medicines business process reforms, to significantly improve the timelines for the registration of prescription medicines, increase the transparency of the regulatory process and provide enhanced access to prescription medicine information.

Information about the evaluation of a prescription medicine and the considerations that led the TGA to approve or not approve a prescription medicine submission is included in an Australian Public Assessment Report. Thirty-six assessment reports were published on the TGA website in 2009-10. The TGA also provided enhanced access to prescription medicine information by facilitating access to up-to-date Consumer Medicine Information and Product Information (for health professionals and consumers) on the TGA website. In 2009-10, more than 2,000 Product Information documents and more than 1,400 Consumer Medicine Information sheets were made available on the TGA website.¹¹

Advertising Arrangements

Regulating the way therapeutic goods are advertised is important for public health. A review examining options to improve existing arrangements for the regulation of therapeutic goods advertisements commenced in June 2010 with the publication of a consultation paper on the TGA website and a call for submissions from all interested parties.

The aim of the review is to make sure the advertising regulatory framework is efficient, effective, transparent and consistent. Reforms being considered include changes to the pre-approval process, complaints handling and the level and type of sanctions for non-compliance. The review is expected to be finalised during 2010-11.

Post-market Monitoring and Product Safety for Consumers

During 2009-10, the TGA continued to implement new systems and processes to improve the balance between pre and post market regulatory activity consistent with other comparable international regulators. A new TGA structure has been designed to ensure that, in the increasingly complex world of therapeutic goods, the TGA continues to fulfil its public health mandate through the appropriate, consistent, effective and efficient regulation of medicines, medical devices and biological products throughout their lifecycle.

Detailed planning and consultation occurred in 2009-10 for the new TGA structural arrangements which realigns TGA’s workforce into three streams – the Market Authorisation Group that will authorise products coming onto the market; the Monitoring and Compliance Group that will monitor products once they are in the marketplace; and the Regulatory Support Group that will provide administrative and infrastructure support. This will improve consistency of regulatory approach across different product areas and achieve efficiency through reduction in duplicated services. The new structural arrangements will be in place from 1 July 2010.

11 Accessible at www.tga.gov.au.

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Performance Information for Outcome 1

Sub-program 1.4.2: Deliverables

Qualitative Deliverables

Therapeutic Goods
Qualitative Deliverable:	The majority of stakeholders satisfied with the TGA’s regulatory performance, communication and consultation processes. A baseline assessment will be undertaken in 2009-10.
Result: Deliverable substantially met.
Building on the June 2009 online survey of stakeholder satisfaction with TGA’s communication and consultation, TGA commenced a major redevelopment of its website in late 2009. Involvement of TGA stakeholders through the TGA Internet Site Redevelopment External Reference Group provided regular positive feedback on TGA’s communications, consultation and processes.
Qualitative Deliverable:	The TGA will provide access to Product Information, Consumer Medicine Information and Australian Public Assessment Reports via the TGA website.
Result: Deliverable met.
Thirty-six Australian Public Assessment Reports were published on the TGA website in 2009-10. TGA also provided enhanced access to prescription medicine information by facilitating access to up-to-date Consumer Medicine Information and Product Information (for health professionals and consumers) on the TGA website. In 2009-10, over 2,000 Product Information documents and over 1,400 Consumer Medicine Information sheets were made available on the TGA website.
Qualitative Deliverable:	The TGA will prepare legislative changes for consideration by the Australian Parliament in 2009-10 to improve the advertising arrangements for therapeutic goods in Australia.
Result: Deliverable not met.
Improvements to the existing advertising arrangements for the regulation of therapeutic goods advertisements commenced in June 2010 with the publication of a consultation paper on the TGA website and a call for submissions from industry and other interested parties. The review is expected to be finalised during 2010-11.
Qualitative Deliverable:	The majority of key stakeholders are satisfied with the TGA’s implementation of post-market monitoring and product safety for consumers.
Result: Deliverable substantially met.
The TGA conducted an information campaign aimed at its key stakeholders to outline the proposed changes to the post market monitoring and product safety regulatory framework. The TGA sent letters to all therapeutic products sponsors on the proposed changes. The reforms were met with positive responses from key stakeholders, including the Consumers Health Forum and relevant industry associations.
Qualitative Deliverable:	International relationships with key regulatory agencies facilitate cooperation in the implementation of regulatory controls for therapeutic products. This will be achieved by contributing to regular meetings and consultations.
Result: Deliverable met.
The TGA actively participated in international forums to harmonise regulatory requirements and standards for therapeutic goods, and to enhance cooperation between international therapeutic goods regulators. These forums included: Global Harmonization Task Force; Pharmaceutical Inspection Convention and Pharmaceutical Inspection Co-operation Scheme; Asian Harmonization Working Party; International Organisation for Standardisation; International Laboratory Forum on Counterfeit Medicines; and various World Health Organization (WHO) meetings such as: WHO Global Action Plan Advisory Committee; WHO International Regulatory Cooperation for Herbal Medicines; WHO Blood Regulators Network; WHO Paediatric Regulators Network; WHO Strategic Advisory Group of Experts Pandemic Influenza meeting; WHO Expert Committee on Biological Standardisation; and WHO International Conference of Drug Regulatory Authorities. The TGA also continued to support existing bilateral cooperative arrangements with international regulators and implemented a range of new arrangements to facilitate information sharing and other collaborative activities.

Quantitative Deliverables

Therapeutic Goods
Quantitative Deliverable:	Percentage of evaluations and appeals of decisions in relation to the entry of therapeutic goods onto the Australian Register of Therapeutic Goods¹² made within legislated timeframes where applicable.
2009-10 Target:	100%	2009-10 Actual:	100%
Result: Deliverable met.
The Therapeutic Goods Administration completed: 404 (100 per cent) Category 1 and 1316 (99.9 per cent) Category 3 evaluations for prescription medicines within legislated timeframes (255 and 45 working days, respectively); 0 Category 2 evaluations; and 55 (100 per cent) Design Examination Conformity Assessments for medical devices within the 255 day legislative timeframe. The TGA completed 100 per cent of S60 internal reviews within the legislated timeframes.
Quantitative Deliverable:	Percentage of licensing and surveillance audits performed within target timeframes (Australian manufacturers).
2009-10 Target:	100%	2009-10 Actual:	86%
Result: Deliverable substantially met.
The Therapeutic Goods Administration performed 333 audits of Australian manufacturers during 2009-10, with 285 (86 per cent) performed within the target timeframe. This compares with 312 audits in 2008-09, of which 254 (84 per cent) were performed within target timeframes. There were six overdue audits at the end of 2009–10.
Quantitative Deliverable:	Percentage of licensing and surveillance audits performed within target timeframes (overseas manufacturers).
2009-10 Target:	90%	2009-10 Actual:	94%
Result: Deliverable met.
The Therapeutic Goods Administration performed 136 audits of overseas manufacturers during 2009–10, with 127 (94 per cent) performed within the target timeframe. This compares with 125 audits in 2008–09, of which 116 (94 per cent) were performed within target timeframes. There were two overdue audits at the end of 2009–10.
Quantitative Deliverable:	Percentage of consumer information (Australian Public Assessment Reports, Consumer Medicines Information and Product Information) published on the TGA website within the target timeframe.
2009-10 Target:	100%	2009-10 Actual:	N/A
Result: Cannot be reported.
Australian Public Assessment Reports for new medicines (new chemical or biological entities, extension of indications, and major variations) considered by the advisory committee on prescription medicines after October 2009 were placed on the TGA website within 4-6 weeks after registration on the Australian Register of Therapeutic Goods. From November 2009, the TGA, with the support of sponsors, began a program of publishing Product Information and Consumer Medicine Information documents for already registered products. To date, more than 2,000 Product Information documents, covering more than 50 per cent of prescription medicines on the register, and more than 1,400 Consumer Medicine Information documents, have been made available on the TGA website. From February 2010, new Product Information documents must be lodged with the TGA within two weeks of the date of registration, or variation to the registration, of products. New Consumer Medicine Information documents must also be lodged with the TGA within two weeks of approval or variation. These documents are published on the TGA website prior to supply of the products. Transition to immediate publication of Product Information documents post registration or variation is presently being progressed.

¹² Accessible at www.tga.gov.au/docs/html/artg.htm.

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Sub-program 1.4.2: Key Performance Indicators

Qualitative Key Performance Indicators

Therapeutic Goods
Qualitative Indicator:	The majority of stakeholders satisfied with the TGA’s regulatory performance, communication and consultation processes. A baseline assessment will be undertaken in 2009-10.
Result: Indicator substantially met.
In June 2009, the TGA conducted an online survey of stakeholder satisfaction with its communication and consultation processes. The information gathered during this survey is informing the redevelopment of the TGA internet site and a series of strategies aimed at targeting and tailoring communication and consultation activities conducted by the TGA. An external group, the TGA Internet site redevelopment External Reference Group, has been convened to provide advice to the TGA on the TGA internet site redevelopment. The TGA is also developing a new visual presentation for all its internal and external communications.
Qualitative Indicator:	A high degree of cooperation with key international regulatory agencies measured by cooperative regulatory arrangements and active participation in key international forums.
Result: Indicator met.
In 2009-10, the TGA entered into five bilateral cooperative arrangements to facilitate information sharing and collaborative activities with key international regulatory partners. In addition, the TGA continued to contribute to key international forums through representation via teleconferences, email and letter communication and face-to-face meetings.

Quantitative Key Performance Indicators

Therapeutic Goods
Quantitative Indicator:	Efficient and effective laboratory testing program measured by the minimum number of therapeutic goods tested.
2009-10 Target:	800	2009-10 Actual:	771
Result: Indicator substantially met.
In 2009-10, the TGA, through its Office of Laboratories and Scientific Services, tested 771 products consisting of 1,991 samples. In addition, the TGA completed protocol release evaluations for 582 batches of biological medicines. This compared with 1,024 products and 2,300 samples in 2008-09, and 818 products and 2,038 samples in 2007-08.
Quantitative Indicator:	High level of compliance with the Therapeutic Goods Act 1989, measured by number of working days taken to assess reports of alleged breaches and initiate an appropriate response.
2009-10 Target:	10	2009-10 Actual:	10
Result: Indicator met.
In 2009–10, the TGA received 1,009 alleged offence reports of breaches of the Therapeutic Goods Act 1989 from stakeholders, including members of the public, industry, local and international law enforcement agencies, and regulatory agencies. This compares with 1,068 reports in 2008–09 and 1,107 in 2007–08. The TGA acknowledged receipt, in writing, of all 1,009 identifiable complaints within 10 working days. The TGA investigated 649 of the alleged offence reports to completion, with 348 formal warnings issued to persons or companies. Eight persons or companies were charged and convicted of 161 criminal offences and civil penalty contraventions.

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Sub-program 1.4.3: Industrial Chemicals

Sub-program 1.4.3 aims to achieve a responsive and effective industrial chemicals regulatory scheme so workers, the public and the environment are protected from the risks of industrial chemicals. To achieve this, the National Industrial Chemicals Notification Assessment Scheme (NICNAS) focuses on scientific excellence, regulatory efficiency, and working actively with national and international partners.

Key Strategic Direction for 2009-10

The department’s strategy to achieve this aim was to:

protect human health and the environment through regulating to promote the safe and sustainable use of industrial chemicals, including information provision, and implementation of further reforms to the industrial chemicals regulatory scheme.

Major Activities

Protecting Human Health and the Environment

Safe and Sustainable Use of Industrial Chemicals

Ensuring a responsive and effective industrial chemicals regulatory scheme that protects the community and the environment from the risks of industrial chemicals continues to be a priority. In 2009-10, the department, through NICNAS, assessed 311 chemicals not previously used in Australia, as well as a number of chemicals already in use. NICNAS also continued development of a more comprehensive, scientifically robust and responsive approach for identifying chemicals in use that warrant further investigation of their human health and environmental impacts. During 2009-10, NICNAS has been developing a framework for prioritising chemicals on the national inventory that should be evaluated further.

During 2009-10, NICNAS finalised two major reviews of chemicals already in use. The review of the human health impacts of the chemical diethylhexyl phthalate (DEHP), recommended limiting exposure of children to DEHP from toys and childcare articles, and exposure of adults to DEHP from cosmetics. The review resulted in the Australian Competition and Consumer Commission placing a temporary 18 month ban on plastic products intended for use by children up to three years old, where they contain more than one per cent DEHP. In 2010-11, NICNAS will conduct public health risk assessments on other phthalates identified as being of concern. The final NICNAS report on sodium cyanide, released in February 2010, made recommendations for better management of risks to the environment from the chemical, notably for transport and the risks to wildlife.

Industrial Chemicals Reform

Ongoing reforms to the industrial chemicals regulatory framework continued to reduce the regulatory burden on industry and enhance the provision of chemical safety information to the community. During 2009-10, NICNAS consulted on a regulatory proposal for industrial nanomaterials aimed at providing appropriate regulatory oversight, industry cooperation and community confidence in this emerging class of chemicals. NICNAS also worked to better align the level of regulatory burden with the risk posed by the chemicals in two product classes; certain hard surface disinfectants and certain cosmetic types. This included consulting on a proposal to transfer certain hard surface disinfectants to the industrial chemicals framework as well as identifying the chemicals in certain cosmetics to be recognised as industrial chemicals and developing the legal mechanism to achieve this recognition. These initiatives will inform work on these important reforms in 2010-11.

Performance Information for Outcome 1

Sub-program 1.4.3: Deliverables

Qualitative Deliverables

Protecting Human Health and the Environment
Qualitative Deliverable:	Assessments of hazards and risks of industrial chemicals to public health, occupational health and safety and the environment based on the best available scientific knowledge and evidence, completed within legislated timeframes.
Result: Deliverable met.
NICNAS completed 311 assessments of chemicals new to Australia and three existing chemical assessments, all within legislated timeframes. The existing chemicals assessments are the public health risk assessment of DEHP focusing on use of DEHP in cosmetics and children’s toys and childcare articles; environmental risk assessment of sodium cyanide, and the occupational, public health and environmental risk assessment of Complex Soap TH17. The assessments are science based, using information on the use of the chemical and its hazard provided by industry, and comprehensive literature reviews, to develop a conservative estimate of the risk.
Qualitative Deliverable:	Promotion of a culture of industry compliance with NICNAS legislative requirements, measured by attendance at NICNAS training with 95 per cent customer satisfaction and an expanded client base.
Result: Deliverable met.
NICNAS ran 11 training courses for 113 customers with over 95 per cent satisfaction. The training was held in five capital cities and different sessions were targeted to the chemical industry generally or to specific sectors. Training sessions covered introduction to obligations and responsibilities under the Industrial Chemicals (Notification and Assessment) Act 1989, regulation of cosmetics in Australia, obligations for introducers of new chemicals and recent reforms to the new chemicals notification and assessment framework.
Qualitative Deliverable:	Publications including Chemical Assessment Reports and associated information products, Handbook for Notifiers, NICNAS’s electronic newsletter and the Chemical Gazette – with an annual customer survey to measure satisfaction.
Result: Deliverable substantially met.
In 2009-10, NICNAS published all final chemical assessment reports on its website, four issues of NICNAS Matters and 12 issues of the Chemical Gazette. The Handbook for Notifiers, which has been reviewed to make it simpler to use, more consistent in style and content and more comprehensive in its coverage, neared completion, with the updated document due to be published later in 2010. The annual customer survey was substantially redeveloped for running in July 2010.
Qualitative Deliverable:	Enhanced cooperative arrangements with state and territory agencies, as measured by implementing revised arrangements for linkages with state and territory agencies.
Result: Deliverable substantially met.
NICNAS used existing national mechanisms, including the Environmental Health Committee and the National Framework for Chemicals Environmental Management, to enhance linkages with state and territory environmental and health agencies. NICNAS strengthened information exchange and consultation on major chemical reviews and regulatory reform proposals and sought representatives for advisory committees.
Qualitative Deliverable:	Influential role in international assessments, regulatory approaches, and methodologies for incorporation, as appropriate, into Australian industrial chemicals assessment and management systems. Measured by active participation in international harmonisation activities and progression of bilateral relationships, notably by leading the development of a revised and focused work plan for the Organisation for Economic Co-operation and Development (OECD) New Chemicals Clearing House and progressing the agreed work program on existing chemicals with the United States of America and Canada.
Result: Deliverable met.
NICNAS played an influential role in international harmonisation activities and implemented additional bilateral work sharing arrangements. Within the OECD, NICNAS: chaired the OECD Clearing House on New Chemicals, facilitating mutual recognition of assessments of new chemicals; contributed to international assessment programs on existing chemicals (including having the NICNAS assessment on triclosan¹³ adopted as an OECD agreed international hazard assessment); acted as lead in an OECD survey of production, use and release of perfluorinated¹⁴ chemicals; and chaired one of the project groups of the Working Party on Manufactured Nanomaterials, which is developing advice on the assessment and management of industrial nanomaterials.
Qualitative Deliverable:	Existing Chemicals Program Review – screening and prioritisation recommendations. Measured by development of a framework for prioritising the inventory for health and environmental risks.
Result: Deliverable met.
NICNAS developed a framework for prioritising chemicals of concern on the inventory for health and environmental risks. In particular, NICNAS developed the criteria to identify chemicals hazardous to human health or the environment, mechanisms to obtain information about the extent of exposure to industrial chemicals in Australia and the expertise to use modelling tools to address gaps in the available experimental information. Further testing and consultation as part of an implementation plan for the framework will be a major focus for 2010-11.
Qualitative Deliverable:	Legislative package for regulation of hard surface disinfectants, measured by reaching an agreed position on disinfectant regulation by December 2009.
Result: Deliverable not met.
A proposed approach for the regulation of hard surface disinfectants was developed in 2009-10 and subjected to public consultations. The consultation documents included a joint NICNAS-TGA regulatory impact statement and a business impact survey for the proposed transfer of household and commercial disinfectants (without specific claims) and sanitisers, sanitary fluids and antibacterial surface wipes. The stakeholder comments have been analysed and refinements to the proposal are being developed to address stakeholder concerns. The proposed reforms will be further progressed in 2010-11.
Qualitative Deliverable:	Review, and amend as necessary, the requirements for industrial nanomaterials. Measured by refinement, if required, to assessment and notification processes for new and existing chemicals.
Result: Deliverable substantially met.
The regulatory strategy for industrial nanomaterials that considered both nanomaterials as new chemicals and the nano form of existing chemicals was finalised. Public consultations on the regulatory proposal were completed in 2009-10. In 2010-11, the proposed reforms to the NICNAS New Chemicals Program will be implemented and the proposals for reforms to the NICNAS Existing Chemicals Program further developed.
Qualitative Deliverable:	In consultation with a stakeholder group, progress outstanding elements of cosmetic reforms. Measured by resolution of outstanding reforms using a consultative mechanism.
Result: Deliverable substantially met.
NICNAS reviewed its internal data and used a call for information to industry to identify those chemicals potentially eligible for transfer to the industrial chemicals regulatory regime. The new arrangements cover products previously regulated as therapeutics which are now regulated as cosmetics. NICNAS also developed legal options to give effect to this transfer.

13 Triclosan is an antimicrobial agent, commonly found in soap, toothpaste, cosmetics, cleaning agents etc.

14 Perfluorinated chemicals are found in fire-fighting foam.

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Quantitative Deliverables

Protecting Human Health and the Environment
Quantitative Deliverable:	Percentage of NICNAS Priority Existing Chemicals recommendations developed in consultation with relevant stakeholders.
2009-10 Target:	100%	2009-10 Actual:	100%
Result: Deliverable met.
NICNAS developed all Priority Existing Chemicals recommendations in consultation with relevant stakeholders. Recommendations on use of DEHP were framed for the Australian Competition and Consumer Commission (ACCC) and poisons scheduling process. These were developed in consultation with the ACCC and relevant companies. For Complex Soap TH17, recommendations were to industry and were developed in consultation with the company using the chemical. Recommendations for sodium cyanide were developed in consultation with relevant stakeholders such as state and territory environmental agencies, manufacturers and importers of the chemical and mines using the chemical.
Quantitative Deliverable:	Percentage of reports on assessed chemicals posted to the NICNAS website (new chemicals).
2009-10 Target:	100%	2009-10 Actual:	100%
Result: Deliverable met.
NICNAS published all new chemicals assessment reports on its website available at <www.nicnas.gov.au>. These assessments were for chemicals used in various industry sectors, primarily those used in cosmetics and surface coatings.
Quantitative Deliverable:	Percentage of reports on assessed chemicals posted to the NICNAS website (existing chemicals).
2009-10 Target:	100%	2009-10 Actual:	100%
Result: Deliverable substantially met.
NICNAS published all finalised existing chemicals assessment reports on its website. Note that the report for DEHP will be finalised and published in early 2010-11.
Quantitative Deliverable:	Customer satisfaction with NICNAS training.
2009-10 Target:	95%	2009-10 Actual:	95%
Result: Deliverable met.
NICNAS achieved at least 95 per cent customer satisfaction with its training. A significant decrease in training participants from previous years was noted.
Quantitative Deliverable:	Increase in visitor sessions to NICNAS website.
2009-10 Target:	5%	2009-10 Actual:	9%
Result: Deliverable met.
In 2009-10, NICNAS achieved over a five per cent increase in visitor sessions to its website with the Australian Inventory of Chemical Substances page, the NICNAS Handbook for Notifiers, publications and registration information the most popular. The release of the Chemical Gazette on the first Tuesday of each month coincides with increased usage.
Quantitative Deliverable:	Percentage of customer satisfaction with chemical safety information.
2009-10 Target:	95%	2009-10 Actual:	Data not available
Result: Deliverable substantially met.
The 2009-10 NICNAS stakeholder survey was substantially different to previous years’ surveys resulting in little scope for comparison. However, in relation to customer satisfaction with chemical safety information feedback in the 2009-10 survey to NICNAS publications was positive, notably for accuracy and ease of understanding. The target will be re-evaluated for 2010-11.
Quantitative Deliverable:	Percentage of new chemicals assessed which are safer and less hazardous.
2009-10 Target:	80%	2009-10 Actual:	81%
Result: Deliverable met.
The regulatory requirements for chemicals being introduced into Australia for the first time have been revised to facilitate the introduction of less hazardous and lower risk chemicals. These arrangements came into full effect in 2008-09. The percentage of new chemicals assessed that are safer and less hazardous improved from 76 per cent in 2008-09 to 81 per cent in 2009-10.

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Sub-program 1.4.3: Key Performance Indicators

Qualitative Key Performance Indicators

Protecting Human Health and the Environment
Qualitative Indicator:	Provision of efficient and effective regulatory and scientific advice to key stakeholders. Measured by the high level of stakeholder satisfaction and uptake of NICNAS recommendations.
Result: Indicator met.
The recommendations from the assessments of existing chemicals have been progressed by the relevant authorities; for example, the Minister for Competition and Consumer Affairs has acted on the recommendation for regulatory measures to limit exposure to DEHP in young children by putting in place a temporary ban on DEHP in certain articles for a period of 18 months, effective from 2 March 2010. Restrictions on the use of two chemicals will be considered via the scheduling process, namely DEHP and triclosan. In addition, NICNAS’s assessment of triclosan has formed the basis of an international assessment via the OECD review process. Recommendations relating to environmental controls on sodium cyanide are being progressed through the National Framework for Chemicals Environmental Management.

Quantitative Key Performance Indicators

Protecting Human Health and the Environment
Quantitative Indicator:	Percentage of compliant companies with respect to NICNAS registration obligations, payment of fees and annual reporting.
2009-10 Target:	50%	2009-10 Actual:	83%
Result: Indicator met.
NICNAS’s activities ensured a high rate of compliant companies for NICNAS registration obligations, payment of fees and annual reporting. The 83 per cent of compliant companies is based on audit results. At 30 June 2010, the total number (4,733) of industrial chemical introducers was stable compared with 30 June 2009 (0.25 per cent decrease). The number of Tier 1 registrants decreased by two per cent whereas Tier 2 and Tier 3 registrants increased by 6.7 per cent and 3.6 per cent respectively.
Quantitative Indicator:	Percentage of new chemicals assessments considered within legislated timeframes.
2009-10 Target:	96%	2009-10 Actual:	97%
Result: Indicator met.
In 2009-10, a total of 311 new chemicals assessment certificates and permits were issued consisting of 176 assessment certificates and 135 permits. For these assessments, 97 per cent were completed within legislated timeframes with 99 per cent of assessment certificates issued on time and 94 per cent permits issued on time.
Quantitative Indicator:	Adherence to legislated timeframes for existing chemicals.
2009-10 Target:	100%	2009-10 Actual:	100%
Result: Indicator met.
NICNAS fully adhered to legislated timeframes for existing chemicals. There is a statutory two stage consultation process, including timeframes. In the first stage, the assessment report is forwarded to the importers/manufacturers of the chemical that applied for assessment and in the second stage the report is released for public comment. Both these stages have strict 28 day timeframes each for stakeholder input and for NICNAS to address these comments. There are defined processes for gazettal of these activities.

Sub-program 1.4.4: Gene Technology Regulation

Sub-program 1.4.4 aims to protect health and safety of people and the environment by regulating dealings with genetically modified organisms.

Key Strategic Direction for 2009-10

The department’s strategy to achieve this aim was to:

work to ensure that the regulatory system for gene technology continues to be a responsive, efficient and effective science-based system for the regulation of activities involving genetically modified organisms.

Major Activities

Gene Technology Regulation

The Gene Technology Regulator, supported by the department’s Office of the Gene Technology Regulator, administers the Commonwealth Gene Technology Act 2000 and corresponding state and territory legislation to protect the health and safety of Australians and the environment by regulating dealings with genetically modified organisms. The functions of the Regulator are prescribed in the legislation and the Regulator can delegate roles and responsibilities to employees of the office, where appropriate.

The department, through the office, focused on protecting the health and safety of people and the environment by assisting the Regulator in the control of activities with genetically modified organisms. In 2009-10, technical and scientific experts, state and territory governments, Australian Government agencies and the wider community were consulted on the assessment of all intentional release licence applications¹⁵ to ensure that the assessments were credible and based on current science.

During 2009-10, the Regulator continued the review of the Gene Technology Regulations 2001, initiated in 2008-09, and developed draft amendments to ensure that the regulatory requirements are up-to-date with scientific advances and are commensurate with risk. The Regulator consulted with experts, the regulated community, other stakeholders and the public on proposed changes. Amendments will be finalised taking into account issues raised in the consultation. It is anticipated that amendments to the regulations will be made in mid 2010-11 and changes will be implemented by end of 2010-11.

The Regulator participated in the ‘Regulator’s Forum’ to exchange information between relevant regulatory agencies (Food Standards Australia New Zealand, National Industrial Chemicals Notification Assessment Scheme, Therapeutic Goods Administration, Australian Pesticides and Veterinary Medicines Authority and the Biosecurity Services Group within the Department of Agriculture, Fisheries and Forestry). The office engaged actively in international harmonisation activities in the risk assessment and regulation of genetically modified organisms. This included contribution to the development of guidance documents by relevant groups under the Organisation for Economic Cooperation and Development and Cartagena Protocol on Biosafety forums. The office was also invited to contribute in capacity building workshops on risk assessment and regulation of genetically modified organisms in the region covered by the Association of South East Asian Nations.

These activities contributed to ensuring a responsive, efficient and effective regulatory scheme that protects people and the environment, with regulatory burden proportional to risks.

15 Intentional release licence applications are submitted by organisations that propose to conduct dealings ranging from limited and controlled releases (e.g. field trials) through to more extensive general or commercial releases of genetically modified organisms. The purpose of licensing is to protect human health and/or the environment by identifying and managing risks posed by genetically modified organisms. OGTR prepares the risk assessment and risk management plans for all licence applications which form the basis of Regulator’s decisions on whether or not to issue licences and on conditions of each licence.

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Performance Information for Outcome 1

Sub-program 1.4.4: Deliverables

Qualitative Deliverables

Gene Technology Regulation
Qualitative Deliverable:	Timely and thorough consultation with key stakeholders on regulatory change in relation to GMOs. Measured through stakeholder feedback on proposed amendments to the Gene Technology Regulations 2001.
Result: Deliverable met.
During 2009-10, in conjunction with the Office of Legislative Drafting and Publishing, the Office of the Gene Technology Regulator prepared and consulted with key stakeholders on the Draft Gene Technology Amendment Regulations 2010. The proposed changes are intended to: ensure that dealings with genetically modified organisms continue to be classified appropriately according to current understanding of risks which they may pose; improve the efficiency and effectiveness of the system; and assist users to better understand and comply with their legislative obligations. It is expected that the net effect of the proposed changes will reduce the regulatory burden on organisations undertaking dealings with genetically modified organisms. The Regulator consulted with a wide range of stakeholders in May and June 2010 on the Draft Gene Technology Amendment Regulations 2010. Submissions were received from a range of stakeholders including the public. The majority of submissions indicated broad support for the proposed changes. It is anticipated that amendments will be made by mid-2010-11 and take effect by the end of 2010-11.

Quantitative Deliverables

Gene Technology Regulation
Quantitative Deliverable:	Number of risk assessment and risk management plans produced.
2009-10 Target:	26*	2009-10 Actual:	26*
Result: Deliverable met.
The office prepared risk assessment and risk management plans for all licence applications, which formed the basis of Regulator’s decisions on whether or not to issue licences and on conditions of each licence. In 2009-10, the office produced 26 risk assessment and risk management plans in response to licence applications received by the Regulator. A risk assessment and risk management plan was produced for every application where decision was required to be made in 2009-10.
Quantitative Deliverable:	Number of licences issued for intentional release.
2009-10 Target:	10*	2009-10 Actual:	8*
Result: Deliverable substantially met.
The Regulator issued eight licences for activities involving intentional release of genetically modified organisms. All decisions on licence applications were made within applicable statutory timeframes. In 2009-10, the Regulator received 10 licence applications for dealings involving intentional release of genetically modified organisms into the environment. Two applications, received in June 2010, are still under consideration as the decision making process has a statutory timeframe of up to 255 days.
Quantitative Deliverable:	Number of licences issued for contained dealings.
2009-10 Target:	16*	2009-10 Actual:	18*
Result: Deliverable met.
The Regulator issued 18 licences for conducting contained dealings with genetically modified organisms. This exceeded the target for the number of licences issued for contained dealings in 2009-10.
Quantitative Deliverable:	Number of assessments of alleged breaches assessed within 10 working days and appropriate response initiated.
2009-10 Target:	100%	2009-10 Actual:	100%
Result: Deliverable met.
Three cases of non-compliances (alleged breaches) with the gene technology legislation required formal investigation. Each case of non-compliance was assessed based on Australian Government investigation standards within 10 working days and resolved through corrective actions. All three presented negligible risk to human health and safety or to the environment.
Quantitative Deliverable:	Number of organisations accredited.
2009-10 Target:	7*	2009-10 Actual:	8*
Result: Deliverable met.
The office received eight applications for accreditation of organisations. The Regulator accredited all eight organisations during the reporting period.
Quantitative Deliverable:	Number of facilities certified.
2009-10 Target:	215*	2009-10 Actual:	182*
Result: Deliverable substantially met.
The Regulator certified 182 physical containment facilities for organisations that continue to work or intend to work with genetically modified organisms.
Quantitative Deliverable:	Percentage of field trial sites and higher level containment facilities inspected.
2009-10 Target:	20%	2009-10 Actual:	53% and 22%
Result: Deliverable met.
Field trial sites are inspected to monitor for compliance with licence conditions so that risks to human health and safety and the environment are managed. In 2009-10, the office inspected 53 per cent of current and post-harvest genetically modified crop field trial sites. The field trial sites inspected were spread across South Australia, New South Wales, Victoria, Queensland and the Australian Capital Territory. Genetically modified crop trials inspected included canola, wheat, barley, banana, sugarcane, cotton, Indian mustard and grapevines. Of the 54 higher level containment facilities that had certification instruments in force at the beginning of 2009-10, 12 were inspected, representing 22 per cent of higher level containment facilities, exceeding the target of 20 per cent inspection.
Quantitative Deliverable:	Number of variations to licences and other instruments processed.
2009-10 Target:	329*	2009-10 Actual:	357*
Result: Deliverable met.
The office processed a total of 357 variations to licences and other instruments.

Data caveats: * Numbers of licence or other applications received (and assessed/licence issued) are highly variable and particularly difficult to predict for forward years as these are dependent on external factors such as research direction, funding or the financial viability and commercial decisions of the applicant organisations.

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Sub-program 1.4.4: Key Performance Indicators

Qualitative Key Performance Indicators

Gene Technology Regulation
Qualitative Indicator:	Protection of people and the environment through identification and management of risks from GMOs. Measured by high level of compliance with the gene technology legislation and no adverse human health or environmental outcomes from GMOs.
Result: Indicator met.
In 2009-10, the Regulator prepared comprehensive risk assessments and risk management plans for proposed activities with genetically modified organisms. Stringent licence conditions were imposed to ensure containment of genetically modified organisms and manage identified risks. There was a high level of compliance with the gene technology legislation and no adverse effects on human health or the environment as a result of activities with the genetically modified organisms were reported.
Qualitative Indicator:	Majority of stakeholders satisfied with OGTR’s efficient and effective regulatory system for GMOs, communication and consultation processes. Measured by high level of stakeholder satisfaction.
Result: Indicator met.
The Regulator was invited to participate in a number of public forums in 2009-10 and continued on a national program of visits to key stakeholders throughout Australia. The office received positive feedback from the regulated community and state and territory officials. There were no appeals of decisions made by the Regulator. The office has also received positive feedback from stakeholders from the public consultation on the proposed changes to the Gene Technology Regulations 2001, especially in relation to the rationale for the reclassification of dealings with viral vectors. The office was invited to contribute to a number of international workshops to build capacity in the region for risk assessment of genetically modified organisms. One of the host countries has subsequently arranged to have the Office of the Gene Technology Regulator ‘Risk Analysis Framework’ translated into its language. The office received very positive feedback from these meetings, indicating that the Australian regulatory system is well regarded and is considered as a good international model for gene technology regulation.

Quantitative Key Performance Indicators

Gene Technology Regulation
Quantitative Indicator:	High level of compliance with the Gene Technology Act 2000.
2009-10 Target:	100%	2009-10 Actual:	100%
Result: Indicator substantially met.
The regulated community demonstrated a high level of compliance with the gene technology legislation, consistent with the trend observed over the last three reporting periods. The office identified a small number of minor non-compliances or alleged breaches during routine monitoring of containment facilities and licensed dealings involving genetically modified organisms. In all instances, the Regulator determined that findings of non-compliances presented negligible risk to human health and safety or to the environment, were minor in nature, involved negligible or zero culpability, and were resolved by reminders, education and/or cooperative compliance.
Quantitative Indicator:	Percentage of licence decisions made within statutory timeframes.
2009-10 Target:	100%	2009-10 Actual:	100%
Result: Indicator met.
The Regulator made decisions on all licences within the applicable statutory timeframes as has been the trend for the last three reporting periods. There were no appeals of decisions made by the Regulator.
Quantitative Indicator:	Percentage of field trial sites and higher level containment facilities inspected.
2009-10 Target:	20%	2009-10 Actual:	53% and 22%
Result: Indicator met.
The office inspected 53 per cent of current and post-harvest genetically modified crop field trial sites. This compares with 59 per cent of field trials inspected in 2008-09, and 51 per cent in 2007-08, and 37 per cent in 2006-07. Of the 54 higher level containment facilities that had certification instruments in force at the beginning of 2009-10, 12 were inspected, representing 22 per cent of higher level containment facilities. This compares with 27 per cent in 2008-09 and 28 per cent in 2007-08.

Program 1.5: Immunisation

Program 1.5 aims to improve immunisation coverage rates through immunisation initiatives to protect Australians against major vaccine preventable diseases.

Key Strategic Direction for 2009-10

The department’s strategy to achieve this aim was to:

improve immunisation coverage rates and reduce the incidence of vaccine preventable disease by ensuring the ongoing appropriateness, efficiency and effectiveness of the National Immunisation Program and developing a National Immunisation Strategy.

Major Activities

Improving Immunisation

Immunisation Coverage Rates

Immunisation is an important part of the Government’s strategy to reduce preventable mortality and morbidity. In 2009-10, the department, through the National Immunisation Program, continued to support the provision of immunisations to the Australian community and maintain a high level of immunisation coverage. High immunisation coverage rates across the Australian community provide better protection against major vaccine preventable diseases and reduces the incidence of these diseases in the Australian community. The program targets measles, mumps, rubella, polio, pneumococcal disease, pertussis (whooping cough), rotavirus, varicella (chickenpox), diphtheria, tetanus, hepatitis B, meningococcal C and Haemophilus influenzae type b for children less than seven years of age. For adolescents, the program targets Human Papillomavirus (HPV) for females only, hepatitis B (catch-up), varicella (catch-up), diphtheria, tetanus and pertussis (booster) and, for older Australians, influenza and pneumococcal disease. Additional diseases targeted for Indigenous Australians include hepatitis A (children at-risk) and pneumococcal disease (adults at-risk).

From 1 January 2010, eligibility was expanded for the seasonal influenza vaccine under the National Immunisation Program to include people with conditions that increase their risk of complications arising from influenza infection. As a result, this vaccine was removed from the Pharmaceutical Benefits Scheme. An additional 2.2 million Australians every year are now eligible for free seasonal influenza vaccine under the program, including pregnant women, Aboriginal and Torres Strait Islander people 15 to 50 years of age, and people six months to 64 years of age with specific medical conditions such as cardiac disease, respiratory disease, diabetes and chronic renal failure. General practitioners can now provide the influenza vaccine directly to patients with these conditions. These new arrangements will improve access to vaccinations as a prescription is no longer required for a pharmacist to dispense the vaccine and only one visit to a general practitioner is needed. As at the end of 2009-10, an additional 1.458 million doses of seasonal influenza had been purchased for this group.

In 2009-10, the transition to new Commonwealth Own Purpose Expense arrangements for procurement of vaccines was progressed in collaboration with states and territories. Under these new arrangements, the department will undertake procurement processes for all essential vaccines supplied under the National Immunisation Program.

During the year, transition to national purchasing of vaccines was initiated as part of the Intergovernmental Agreement on Federal Financial Relations. Under these transition arrangements, former Australian Immunisation Agreements were replaced with two funding streams: Commonwealth direct national purchasing of vaccines for delivery by states and territories (a Commonwealth Own Purpose Expense); and incentive payments to states and territories under the National Partnership Agreement on Essential Vaccines.

The transition to national purchasing is taking place progressively with three major tenders per annum to 2014. The National Partnership Agreement on Essential Vaccines provides transitional capacity to fund states and territories directly for vaccines they will purchase until each tender is completed. The new arrangements will improve the efficiency and cost-effectiveness of vaccine purchasing arrangements. The tender for supply of seasonal influenza vaccine for the new at risk cohort was completed and a tender for seasonal and pandemic influenza vaccines was released on 26 March 2010. Tender evaluation is in progress and is expected to be finalised early in 2010-11.

National Immunisation Strategy

In 2009-10, the department commenced work on the development of the National Immunisation Strategy. The National Immunisation Committee, which comprises the department, all state and territory health departments, representatives from key stakeholder groups and a consumer, is providing oversight of the strategy’s development. The strategy will provide a planning framework for future directions and initiatives in immunisation and vaccine preventable diseases at the national level, and is expected to be completed in 2010-11.

National Partnership Agreement for Essential Vaccines

The new National Partnership Agreement on Essential Vaccines was endorsed by all first ministers during 2009-10.¹⁶ The agreement outlines the roles and responsibilities of the department and the states and territories in relation to delivery of the National Immunisation Program and the transition arrangements for the department to undertake procurement of vaccines.

The agreement provides states and territories with incentive payments, made up of reward and facilitation payments, to improve the cost-effectiveness of service delivery. The department, in cooperation with states and territories, established new targets and performance measures to assess the effectiveness of the National Immunisation Program as a basis for the reward payments made under the agreement. Reward payments will be made where a jurisdiction achieves two of four performance benchmarks related to: maintaining or increasing vaccine coverage for children four years of age and Indigenous Australians; maintaining or improving coverage in areas where vaccine coverage is low; and for maintaining or decreasing wastage and leakage of vaccines. These targets will inform the priorities of the National Immunisation Strategy. The first assessment of state and territory performance against the targets will occur in 2010-11.

¹⁶ The Prime Minister, state premiers, and territory chief ministers.

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Performance Information for Outcome 1

Program 1.5: Deliverables

Qualitative Deliverables

Improving Immunisation
Qualitative Deliverable:	Timely production of evidence-based policy research: The department will support production of evidence-based policy research through the National Centre for Immunisation Research and Surveillance, data registers such as the Australian Childhood Immunisation Register and the National HPV Register and surveys commissioned by the department. This research will support policy development, surveillance of vaccine-preventable diseases, program evaluation, and the information needs of immunisation providers.
Result: Deliverable met.
The Australian Technical Advisory Group on Immunisation, supported by the National Centre for Immunisation Research and Surveillance and the department, provided high quality and timely evidence-based policy advice to inform guidelines and facts sheets on the use of pandemic (H1N1) 2009 influenza vaccine for immunisation providers and the community to assist in the safe administration of the vaccine, promote public confidence in the program and improve uptake of the vaccine. The Australian Technical Advisory Group on Immunisation, supported by the National Centre for Immunisation Research and Surveillance and the department, conducted a comprehensive investigation into an apparent increase in adverse events following seasonal influenza vaccine in children less than five years of age. This investigation resulted in the Commonwealth Chief Medical Officer, as a precaution, suspending the use of all brands of the 2010 seasonal influenza vaccine in healthy children less than five years of age, pending further data on whether one or more vaccines are associated with increased fever and fever related convulsions.¹⁷ The department contracted the Australian Institute of Health and Welfare to conduct the 2009 Adult Vaccination Survey, which formed part of the evaluation of two vaccine programs for older Australians: the National Influenza Vaccination Program for Older Australians; and the National Pneumococcal Vaccination Program for Older Australians. The survey of 10,231 Australians 18 years of age or older was conducted during November and December 2009, with the final report expected to be completed late in 2010.
Qualitative Deliverable:	Regular stakeholder participation in program development: The National Immunisation Program is a joint Australian Government, state and territory initiative. Stakeholders will participate in policy and program development through a range of avenues, such as surveys, conferences and meetings.
Result: Deliverable met.
The department worked closely with states and territories to implement the new National Partnership Agreement for Essential Vaccines which sets out key objectives, performance indicators and roles and responsibilities for delivering the National Immunisation Program. The department convened six meetings of the National Immunisation Committee and eight meetings of the Jurisdictional Immunisation Coordinators to provide policy and program advice to the department on the program. State and territory representatives participated in the tender evaluation committee to procure seasonal influenza vaccination for the new groups of people eligible for seasonal influenza vaccination. The National Immunisation Committee was consulted in the development of communication activities associated with the implementation of the new arrangements for seasonal influenza in 2010.
Qualitative Deliverable:	The department will maintain rates of vaccination in two year old children under the national childhood vaccination schedule. Data from the Australian Childhood Immunisation Register demonstrate that, as at 31 December 2008, 92.7 per cent of children aged 24-27 months are fully immunised in accordance with the National Immunisation Program schedule.
Result: Deliverable met.
Immunisation rates in 2009-10 continued to be high with the national immunisation coverage rate for children aged 24-27 months being 92.4 per cent as at 31 March 2010, compared with 92.5 per cent as at 31 March 2009.
Qualitative Deliverable:	The department will develop a new National Immunisation Strategy for consideration by the Australian Health Ministers’ Conference in 2009.
Result: Deliverable not met.
The department undertook preparation and planning for the development of the National Immunisation Strategy, working with the National Immunisation Committee and other key stakeholders. Development of the National Immunisation Strategy has been delayed due to a focus of work on the response to pandemic (H1N1) influenza 2009 and roll-out of the associated vaccination program. The National Immunisation Strategy is expected to be completed in the first half of 2011.

17 On 30 July 2010 the Chief Medical Officer advised that immunisation of children less than five years of age could recommence using two of the three seasonal influenza vaccines available in Australia, as these vaccines were not associated with adverse events.

Quantitative Deliverables

Improving Immunisation
Quantitative Deliverable:	Percentage of variance between actual and budgeted expenses.
2009-10 Target:	≤0.5%	2009-10 Actual:	-22.4%
Result: Deliverable not met.
The cost of procurement for the new at risk cohort for seasonal influenza was less than anticipated.
Quantitative Deliverable:	Maintain rates of vaccination in two year old children for childhood vaccination programs.
2009-10 Target:	92.7%	2009-10 Actual:	92.4%
Result: Deliverable substantially met.
Immunisation rates in 2009-10 continued to be high, with the national immunisation coverage rate for children aged 24-27 months being 92.4 per cent as at June 2010, compared with 92.9 per cent in June 2009.

Program 1.5: Key Performance Indicators

Qualitative Key Performance Indicators

Improving Immunisation
Qualitative Indicator:	The department will evaluate the effectiveness of immunisation programs by monitoring notification rates of vaccine preventable diseases and the impact will be measured through immunisation coverage rates for vaccine target groups in the population. Data will be sourced from the Australian Childhood Immunisation Register, the National HPV Register, Communicable Diseases Surveillance and Computer Assisted Telephone Interview surveys.
Result: Indicator met.
The department continued to review the overall effectiveness of the National Immunisation Program through monitoring notification rates for vaccine preventable diseases reported to the National Notifiable Diseases Surveillance System, particularly in relation to pertussis (whooping cough) infections and immunisation vaccine coverage rates for children under the age of seven, through the Australian Childhood Immunisation Register. The incidence of vaccine preventable diseases such as diphtheria, polio, measles, Haemophilus influenzae type b (Hib), pneumococcal and meningococcal diseases among children less than 15 years of age has reduced significantly since the introduction of the National Immunisation Program. Although there have been a number of successes there continue to be cyclical increases in pertussis, with a notification rate in 2009 of 271.8 cases per 100,000 for children less than 15 years of age, an epidemic period that began in mid 2008 and peaked in March 2009. Please note: The graph below shows rates for calendar years, not financial years. The department contracted the Australian Institute of Health and Welfare to conduct the Australian Vaccination Survey in 2009. The results, which are expected to be available in 2010-11, will provide important information to assess the impact of the program, in particular for the pneumococcal and influenza immunisation programs for adults. In 2009-10, the immunisation of a large number of women and girls 12-26 years of age against Human Papillomavirus (HPV) was reported by jurisdictions and general practitioners to the HPV Register. The register, managed by the Victorian Cytology Service on behalf of the department, is an important source of baseline data to evaluate the effectiveness of the HPV program in preventing cervical cancer in women.
Qualitative Indicator:	The National Immunisation program will seek to deliver an increase in immunisation coverage rates among children at 60-63 months of age so that they are comparable with rates for children 24-27 months of age. Currently children at 24-27 months of age have the highest level of immunisation coverage in Australia with 92.7 per cent of children fully immunised in accordance with the National Immunisation Program.¹⁸
Result: Indicator met.
Immunisation rates in 2009-10 continued to be high with the national immunisation coverage rate for children aged 60-63 months being 89.6 per cent as at 31 March 2010, compared with 80.7 per cent as at 31 March 2009. The immunisation rate in 2009-10 for children aged 24-27 months was 92.4 per cent as at 31 March 2010. While the immunisation coverage rate for five year old children continues to be lower than the rate for children aged two years, it has increased in the past 12 months, indicating that a range of initiatives to improve the coverage rate for this age group, including the splitting of the Maternity Immunisation Allowance into two payments, one when the child reaches 18 months of age and the other at four years of age, and implementation of the Healthy Kids Check at four years of age, which includes immunisations, are proving to be effective.

Quantitative Key Performance Indicators

Improving Immunisation
Quantitative Indicator:	Increase in immunisation coverage rates among children 60-63 months of age.
2009-10 Target:	89.0%¹⁹	2009-10 Actual:	89.6%
Result: Indicator met.
Immunisation rates in 2009-10 continued to be high with the national immunisation coverage rate for children aged 60-63 months being 89.6 per cent as at 31 March 2010, compared with 80.7 per cent as at 31 March 2009. While the immunisation coverage rate for five year old children continues to be lower than the rate for children aged two years, it has increased in the past 12 months indicating that a range of initiatives to improve the coverage rate for this age group, including the splitting of the Maternity Immunisation Allowance into two payments, one when the child reaches 18 months of age and the other at four years of age, and implementation of the Healthy Kids Check at four years of age, which includes immunisations, are proving to be effective.

¹⁸ Australian Childhood Immunisation Register as at 31 December 2008.

¹⁹ Data caveat: Participation in the Healthy Kids Check at 4 years of age, which includes Commonwealth funded immunisations, is anticipated to increase immunisation coverage closer to this level. Changes to the Maternity Immunisation Allowance on 1 January 2009 aim to encourage parents to have their four year old children appropriately immunised and this is also anticipated to increase immunisation coverage for this age group.

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Program 1.6: Public Health

Program 1.6 aims to reduce pressure on the health system by developing and maintaining health infrastructure and workforce capacity. It will also provide training in population health, including health promotion, provide advice on lifestyle risks of chronic diseases, and develop and implement national policies to support improvements in child, youth, women’s and men’s health.

Key Strategic Direction for 2009-10

The department’s strategy to achieve this aim was to:

strengthen the evidence base for prevention of disease, build public health workforce capacity, and improve child, youth, women’s and men’s health.

Major Activities

Building Capacity through Targeting Sub-populations

Population Health Infrastructure and Workforce Capacity

The Population Health Education and Research Program was established in 1987 to address population health workforce shortages in practice and research, including the aim to build a critical mass with ‘surge’ capacity in the specialist trained workforce in Australia and the Pacific region for monitoring, surveillance and intervention in disease outbreaks. More than 1,500 students were supported nationally each year under the program. In the 2009-10 Budget the program was announced for termination by 2010-11, as it had substantially addressed the needs for which it was established, and there is now a critical mass of public health practitioners in Australia.

One of the main objectives of the program was to increase graduate student numbers and improve the consistency and benchmarking of public health training and education against global standards for public health graduates in Australia. In 2009-10, the department, under the program, continued to fund tertiary education institutions and consortia to develop a world-recognised base of specialist professional expertise in design and administration of public health policy and surveillance programs.

In 2009, under the program, the Academic Network of Australian Public Health Institutions finalised the Foundation Competencies for Master of Public Health Graduates in Australia. The national foundation competencies are now used as the benchmark for curricula development for public health tertiary training in Australia.

In recognition that the Indigenous public health workforce was not as fully developed, in February 2010, a four-year tripartite funding agreement with Deakin University and the University of Melbourne was developed to support delivery of Indigenous-specific post-graduate education and evaluation of community based higher education programs for Indigenous students studying in the Masters of Public Health Program. One of the primary aims of the agreement is to increase the number of Indigenous students undertaking post-graduate education in public health. This agreement also supports the National Indigenous Public Health Curriculum Network, a national network of Indigenous academics, working closely with the Academic Network of Australian Public Health Institutions to incorporate the National Quality Framework Competency Standards and the National Indigenous Public Health Curriculum Framework into all Master of Public Health programs nationally.

Strengthening the Evidence Base

In March 2010, the department signed a Memorandum of Understanding with the Australian Bureau of Statistics to undertake the first Australian Health Survey in 2011-12, comprising the existing National Health Survey and National Aboriginal and Torres Strait Islander Health Survey, and two new surveys - the National Nutrition and Physical Activity Survey and the National Health Measures Survey. The latter two surveys were formerly known as the National Health Risk Survey. These surveys will cover a representative sample of children and adults, including Aboriginal and Torres Strait Islander people, and will for the first time collect objective measures of nutritional status and chronic disease risk factors as well as self-reported data. The department collaborated with the Australian Bureau of Statistics with input from technical experts to design the survey. Pre-testing and the pilot test for the general population was completed by the bureau in June 2010, prior to a full test in January 2011 and commencement of the survey in March 2011. A similar process will be undertaken for the Indigenous component of the survey, which will commence in November 2011.

The Australian Health Survey will provide a wealth of information on the population’s food and nutrient intakes, chronic disease risk factors, prevalence of disease and use of medical services, with the potential to crosslink data such as a person’s food intake, physical activity, obesity and diabetes risk factors as well as providing comparable data to that from previous national health surveys for effective monitoring. Participants will gain valuable insight into their own and their children’s health status, and researchers and governments will benefit from insights on factors contributing to chronic disease, which will allow more informed policy decisions and program development.

In addition to the Australian Health Survey, the department undertook a workforce audit in 2009-10 to provide information to support development of an effective preventive health workforce. Under the National Partnership Agreement on Preventive Health, the audit assessed the needs of the prevention workforce and identified gaps and issues to assist implementation of partnership initiatives. The workforce audit required extensive consultations and collaboration with key stakeholders including state and territory governments, local government and community organisations. The audit included a literature review, a program survey and data collection in 2009-10. A prevention workforce strategy will be developed using the findings of the audit in 2010-11.

Supporting Child, Youth, Women’s and Men’s Health

The department submitted the Australian National Breastfeeding Strategy 2010-2015 to the Australian Health Ministers’ Conference for endorsement in November 2009, and the strategy began implementation in April 2010. The strategy provides a framework for priorities and action for Australian governments at all levels to protect, promote, support and monitor breastfeeding throughout Australia and is available from the department’s website at www.health.gov.au/breastfeeding. The implementation plan identifies action areas to be progressed by governments both independently and nationally under the Australian Health Ministers’ Advisory Council, with ongoing leadership from the Australian Government. In 2010-11, the department will continue to support the Australian Breastfeeding Association to operate the national Breastfeeding Helpline²⁰ to provide breastfeeding mothers and their families with access to expert breastfeeding advice and support.

The department also completed the development of the Healthy Eating and Physical Activity Guidelines for Early Childhood Settings. These resources, titled Get Up & Grow: Healthy eating and physical activity for early childhood, were launched in October 2009. The Get Up & Grow resources provide practical information and advice to support and promote healthy eating and appropriate physical activity in children under five years of age and have been translated into nine non-English languages (Arabic, Turkish, Spanish, Chinese, Vietnamese, Malaysian, Filipino, Indonesian, and Korean). The Get Up & Grow resources can be ordered or downloaded directly from the department’s website²¹ or by contacting National Mail and Marketing on 1800 020 103 (free call).

Men and women have different health needs throughout their lives and it is important that health services and initiatives are designed to reflect the different biological, psychological, economic, social, political and cultural factors which impact upon the health of each gender.

The department in 2009-10 developed the first National Male Health Policy to address men’s health issues and access to services. Twenty-six national consultations with 1,300 participants were conducted, including specific consultations with Aboriginal and Torres Strait Islander males, males from culturally diverse backgrounds, males living with long-term mental illness, young males and males from rural, regional and remote locations.

The National Male Health Policy was launched in May 2010 along with several male health initiatives to support improvements to male health and wellbeing. In 2010-11, the department will develop and commence the first national longitudinal study into male health which will provide vital information on specific areas of male health to inform health professionals, policy developers and consumers.

The department also worked on the second National Women’s Health Policy, managing 15 public consultations involving 700 participants and 170 written submissions. The National Women’s Health Policy is being finalised with an anticipated release in late 2010.

The department collaborated with states, territories and Australian Government agencies to progress national strategies that focus on the health and wellbeing of children, young people and families such as the National Early Childhood Development Strategy and the National Framework for Protecting Australia’s Children.

²⁰ Telephone: 1800 MUM 2 MUM (1800 686 2 686).

²¹ Accessible at www.health.gov.au/internet/main/publishing.nsf/Content/phd-gug-staffcarers.

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Performance Information for Outcome 1

Program 1.6: Deliverables

Qualitative Deliverables

Qualitative Deliverable:	The department will produce timely, evidence-based policy research through: The establishment of the National Preventive Health Agency in 2009-10. The department will develop national men’s and women’s health policies in 2009-10. The policies will address the different needs of men and women in looking after their own health. Both policies will be built around five principles: gender equity; a focus on prevention; a strong and emerging evidence base; an action plan to address needs across the life course; and the needs of specific groups of men and women most at risk.
Result: Deliverable substantially met.
The department developed legislation to establish the Australian National Preventive Health Agency however the Agency was not established in 2009-10 due to delays in consideration of the legislation in the Senate. The National Male Health Policy was launched in May 2010 along with several male health initiatives to support improvements to male health and wellbeing. The National Women’s Health Policy is currently in its final stages of development.
Qualitative Deliverable:	Regular stakeholder participation in program development: In 2009, the department will develop the national men’s and women’s health policies from information gathered from an extensive consultation process, including a National Women’s Health Policy Roundtable, a National Men’s Health Roundtable and a series of facilitated consultative forums in each state and territory in regional and metropolitan locations. The department will undertake public consultation on the national evidence-based antenatal care guidelines in mid 2010 and the guidelines will be endorsed by the National Health and Medical Research Council in 2010.
Result: Deliverable substantially met.
In 2009, the department offered a wide range of stakeholders the opportunity to participate in the development of the National Male Health Policy and the National Women’s Health Policy. This included working with eight Male Health Ambassadors, 38 national level men’s health experts, peak bodies and other relevant stakeholders at a National Men’s Health Summit, and the community through 26 forums in the development of the National Male Health Policy. The department also consulted through a National Women’s Health Policy Roundtable, where 166 key national women’s health organisations were invited to participate; and funded 15 peak organisations to provide written submissions and 15 public consultations through community forums to inform the development of the second National Women’s Health Policy. The development of the First Trimester Antenatal Care Guidelines was delayed. Public consultation on the First Trimester Guidelines is expected to take place in 2011.

Quantitative Deliverables

Building Capacity through Targeting Sub-populations
Quantitative Deliverable:	Percentage of variance between actual and budgeted expenses.
2009-10 Target:	≤0.5%	2009-10 Actual:	-3.3%
Result: Deliverable not met.
The actual Administered expenses for Program Group 1.6 varied from budget expenses by 3.3 per cent. This underspend was largely due to consideration of the Australian National Preventive Health Agency Bill 2009, delays in contracted program deliverables and increases in inventories held for distribution due to less than anticipated take-up. For example, issue of Get Up & Grow material was less than anticipated during the year and will be held for future distribution.
Quantitative Deliverable:	Number of core funded institutions providing tertiary public health education, including in areas of workforce deficits (certificates and Masters of Public Health, doctorates etc).
2009-10 Target:	19	2009-10 Actual:	19
Result: Deliverable met.
The department funded 19 core institutions in 2009-10.
Quantitative Deliverable:	Number of Healthy Eating and Physical Activity guideline kits disseminated.
2009-10 Target:	9,000	2009-10 Actual:	13,500
Result: Deliverable met.
In 2009-10, the department disseminated 13,500 customised sets of the Healthy Eating and Physical Activity Guidelines.

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Program 1.6: Key Performance Indicators

Qualitative Key Performance Indicators

Qualitative Indicator:	Extent to which specialist public health practitioners are trained in identified health priorities e.g. epidemiology, bio-statistics, Indigenous health.
Result: Indicator met.
The Masters of Applied Epidemiology, funded under the Public Health Education and Research Program, continued in 2009-10 to provide specialised training in epidemiology. In 2009, there were 10 domestic students enrolled in the program and a reduced intake of five students in 2010. An Indigenous Capacity Building Project was funded in 2010. There are 25 active enrolments in 2009 and 18 new students in 2010.
Qualitative Indicator:	The department will establish a National Preventive Health Agency in 2009-10.
Result: Indicator not met.
The department developed legislation to establish the Australian National Preventive Health Agency. The Agency was not established in 2009-10 due to delays in consideration of legislation in the Senate.

Quantitative Key Performance Indicators

Building Capacity through Targeting Sub-populations
Quantitative Indicator:	Number of collaborations (i.e. consortia) by Public Health Education and Research Program institutions across Australia and in the region.
2009-10 Target:	6	2009-10 Actual:	6
Result: Indicator met.
The department funded six consortia each year from 2006-07 to 2009-10 through the Public Health Education and Research Program.
Quantitative Indicator:	Participation of Public Health Education and Research program-funded institutions in development and implementation of the Quality Framework.
2009-10 Target:	100%	2009-10 Actual:	90%
Result: Indicator substantially met.
The majority of institutions funded under the Public Health Education and Research Program participated in the development of Foundation Competencies for Masters of Public Health graduates (2009) produced by the Academic Network of Public Health Institutions. Institutions that did not participate but were consulted were engaged in predominantly research related activities.

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Outcome 1 — Financial Resources Summary

	(A) Budget Estimate 2009-10 $’000	(B) Actual 2009-10 $’000	Variation (Column B minus Column A) $’000	Budget Estimate 2010-11 $’000
Program 1.1: Chronic Disease – Early Detection and Prevention
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	35,662	32,754	( 2,908)	51,889
Departmental Expense
Ordinary Annual Services (Annual Appropriation Bill 1)	5,435	4,864	( 571)	4,980
Revenues from other sources	139	110	( 29)	144
Unfunded depreciation expense¹	-	-	-	112
Operating loss / (surplus)	-	3	3	-
Total for Program 1.1	41,236	37,731	( 3,505)	57,125
Program 1.2: Communicable Disease Control
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	24,242	24,184	( 58)	24,092
Departmental Expense
Ordinary Annual Services (Annual Appropriation Bill 1)	2,771	2,817	46	2,539
Revenues from other sources	71	64	( 7)	73
Unfunded depreciation expense¹	-	-	-	57
Operating loss / (surplus)	-	1	1	-
Total for Program 1.2	27,084	27,066	( 18)	26,761
Program 1.3: Drug Strategy
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	128,656	127,247	( 1,409)	162,348
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	17,456	18,425	969	15,994
Revenues from other sources	447	418	( 29)	462
Unfunded depreciation expense¹	-	-	-	358
Operating loss / (surplus)	-	10	10	-
Total for Program 1.3	146,559	146,100	( 459)	179,162
Program 1.4: Regulatory Policy
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	307	296	( 11)	589
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	12,925	12,900	( 25)	12,205
to Special Accounts	( 10,252)	( 10,340)	( 88)	( 9,757)
Revenues from other sources	71	58	( 13)	73
Unfunded depreciation expense¹	-	-	-	55
Operating loss / (surplus)	-	1	1	-
Special Accounts
OGTR Special Account	8,412	7,421	( 991)	8,398
NICNAS Special Account	9,322	8,943	( 379)	9,821
TGA Special Account	103,284	97,123	( 6,161)	106,163
Expense adjustment²	( 3,749)	4,394	8,143	( 3,888)
Unfunded depreciation expense¹	-	-	-	12
Total for Program 1.4	120,320	120,796	476	123,671
Program 1.5: Immunisation
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1) to Australian Childhood Immunisation Register	22,405	19,981	( 2,424)	16,600
Special Account	( 5,688)	( 6,688)	( 1,000)	( 5,779)
Special appropriations
National Health Act 1953 – essential vaccines	17,450	11,420	( 6,030)	19,314
Special Accounts
Australian Childhood Immunisation Register Special Account	9,200	8,941	( 259)	9,433
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	4,379	4,480	101	4,013
Revenues from other sources	112	102	( 10)	116
Unfunded depreciation expense¹	-	-	-	90
Operating loss / (surplus)	-	2	2	-
Total for Program 1.5	47,858	38,238	( 9,620)	43,787
Program 1.6: Public Health
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	70,227	67,891	( 2,336)	52,338
Other Services (Annual Appropriation Bill 2)	1,620	1,620	-	7,841
Departmental Expense
Ordinary Annual Services (Annual Appropriation Bill 1)	18,850	17,467	( 1,383)	17,272
Revenues from other sources	483	395	( 88)	499
Unfunded depreciation expense	-	-	-	386
Operating loss / (surplus)	-	9	9	-
Total for Program 1.6	91,180	87,382	( 3,798)	78,336
Outcome 1 Totals by appropriation type
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	281,499	272,353	( 9,146)	307,856
to Special Accounts	( 5,688)	( 6,688)	( 1,000)	( 5,779)
Other Services (Annual Appropriation Bill 2)	1,620	1,620	-	7,841
Special appropriations	17,450	11,420	( 6,030)	19,314
Special Accounts	9,200	8,941	( 259)	9,433
Departmental Expense
Ordinary Annual Services (Annual Appropriation Bill 1)	61,816	60,953	( 863)	57,003
to Special Accounts	( 10,252)	( 10,340)	( 88)	( 9,757)
Revenues from other sources	1,323	1,147	( 176)	1,367
Unfunded depreciation expense¹	-	-	-	1,058
Operating loss / (surplus)	-	26	26	-
Special Accounts	117,269	117,881	612	120,506
Total Expenses for Outcome 1	474,237	457,313	( 16,924)	508,842
Average Staffing Level (Number)	1,023	1,021	( 2)	1,003

1 Reflects the change to net cash appropriation framework implemented from 2010-11.

2 Special accounts are reported on a cash basis. This adjustment reflects the differences between cash and expense.

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