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Outcome 8 - Indigenous Health

Closing the gap in life expectancy and child mortality rates for Indigenous Australians, including through primary health care, child and maternal health, and substance use services.

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Outcome Summary

Outcome 8 aims to ensure that Aboriginal and Torres Strait Islander peoples have improved access to effective health care services essential to improving health and life expectancy, and to reducing child mortality. The department worked to achieve this outcome by managing initiatives under the program 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 8 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.

The Office for Aboriginal and Torres Strait Islander Health was responsible for Outcome 8 in 2009-10. The Health Workforce Division, the Mental Health and Chronic Disease Division and the department’s state and territory offices also contributed to the achievement of the outcome. In addition, other areas across the department managed programs to ensure effective and accessible health care for Aboriginal and Torres Strait Islander peoples.

Program Administered Under Outcome 8 and 2009-10 Objective

Program 8.1: Aboriginal and Torres Strait Islander Health

Improve health outcomes for Aboriginal and Torres Strait Islander peoples, working with other governments and the broader health sector.

Major Achievements

Increased capacity of the primary care workforce by funding 294 new positions through the Indigenous Chronic Disease Package (Outcomes 1, 5 and 8).
Increased provision of access to antenatal and postnatal health care for Aboriginal and Torres Strait Islander families by funding 56 organisations through the New Directions: Mothers and Babies Services program.
Supported counselling and family tracking for 9,781 Bringing Them Home and Link Up services clients resulting in 425 reunions for members of the Stolen Generations in 2009.

Challenges

Increasing the capacity of service providers to build sustainable and effective structures to provide quality care to Aboriginal and Torres Strait Islander peoples in remote Australia.

Program 8.1: Aboriginal and Torres Strait Islander Health

Program 8.1 aims to tackle the poorer health outcomes of Aboriginal and Torres Strait Islander peoples by improving: prevention and management of chronic disease; child and maternal health services; the availability of Bringing Them Home counsellors and Link Up services; and the capacity of the Australian health workforce, as well as the Indigenous health sector, to meet the health care needs of Aboriginal and Torres Strait Islander peoples.

Key Strategic Direction for 2009-10

In 2009-10, the department’s strategy to achieve this aim was to:

improve access to effective primary health care, maternal and child health services, substance use services, and social and emotional wellbeing services for Aboriginal and Torres Strait Islander peoples.

Major Activities

Prevention and Management of Chronic Disease

In 2009-10, the department commenced implementation of the Indigenous Chronic Disease Package¹, the Australian Government’s contribution to the National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes, to help meet the Council of Australian Governments’ target of closing the gap in life expectancy within a generation. High rates of chronic disease and associated risk factors are responsible for about two-thirds of the life expectancy gap between Indigenous and non-Indigenous Australians.

Good quality care for people with chronic disease usually involves multiple health care providers across multiple settings. Primary health care is fundamental to the prevention, early detection and ongoing management of chronic diseases and their risk factors, and the primary care provider typically plays a central role in the coordination of care.

The Indigenous Chronic Disease Package intervenes at multiple points in the primary health care system to improve its responsiveness and build the capacity of primary health care providers to better prevent, detect and manage chronic disease for Aboriginal and Torres Strait Islander peoples.

A major achievement in the first year of implementation was the funding of 294 new positions (83 Aboriginal and Torres Strait Islander Outreach Workers; 41 Healthy Lifestyle Workers; 21 Tobacco Action Workers; 20 Tobacco Action Coordinators; 20 Practice Managers; 14 other health professionals; and 95 Indigenous Health Project Officers). Of these, 40 Aboriginal and Torres Strait Islander Outreach Workers, 20 additional practice managers and 14 additional health professionals who worked in Aboriginal community controlled health services were funded through Outcome 8. In addition, 43 Aboriginal and Torres Strait Islander Outreach Workers were funded in Divisions of General Practice under Outcome 5.

¹ More information on the Indigenous Chronic Disease Package can be found at www.health.gov.au/tackling-chronic-disease.

Table 8.1.1: Australian Government Contribution to National Partnership by Outcome

Activity	Outcomes Responsible
Reducing smoking rates among Aboriginal and Torres Strait Islander peoples.	Outcome 1
Tackling chronic disease risk factors including poor nutrition and lack of exercise, and delivering community education initiatives to reduce the number of Indigenous Australians with these risk factors.	Outcomes 1 and 10
Improving access to Pharmaceutical Benefits Scheme medicines.	Outcome 2
Improving chronic disease management in primary care by providing incentives and support for accredited general practices and Indigenous health services to detect, treat and manage chronic disease more effectively.	Outcome 5
Increasing the uptake of Medicare Benefits Schedule funded primary care services by Aboriginal and Torres Strait Islander peoples including adult health checks.	Outcome 3
Improving chronic disease follow-up care by increasing access to affordable specialist, allied health care and multi-disciplinary health care for Indigenous Australians with a chronic disease.	Outcomes 5, 6 and 8
Increasing the capacity of the primary care workforce to deliver effective health care to Indigenous Australians by funding 83 new Aboriginal and Torres Strait Islander Outreach Workers, 75 additional health professionals and practice managers in Aboriginal and Torres Strait Islander health services, and a range of workforce training and professional development activities over four years.	Outcomes 5, 8 and 12

The department continued to support the prevention, treatment and management of chronic disease in Indigenous Australians through the Healthy for Life program. The Healthy for Life program provides dedicated funding to 100 primary health care services in all states and territories through 57 sites.

Early detection and measurement of chronic conditions, such as diabetes and cardiovascular disease, is a key component of the Healthy for Life program. Services participating in the Healthy for Life program must report details about the management of chronic disease in Aboriginal and Torres Strait Islander peoples through five of the program’s 11 essential indicators. Management is enhanced by the encouragement of regular health checks, regular screening and monitoring of chronic disease.

Improved Child and Maternal Health

Maternal and child health is important for both Aboriginal and Torres Strait Islander mothers and their children. Good health during pregnancy contributes to reduced perinatal and infant mortality, and reduces the proportion of low birth weight babies as well as reducing the likelihood of maternal mortality. A healthy start to life, beginning in pregnancy, gives children the best opportunity to achieve their full potential in the future. There are encouraging positive trends in reducing the mortality rate of Aboriginal and Torres Strait Islander children with progress in key areas such as the increased proportion of Aboriginal and Torres Strait Islander mothers accessing antenatal care services at least once during pregnancy.

Indigenous Early Childhood Development National Partnership

The department supported state and territory governments to finalise their Implementation Plans under the Indigenous Early Childhood Development National Partnership.² All states and territories commenced implementation of strategies to improve access to antenatal care, pre-pregnancy and reproductive health services for Indigenous people.

Figure 8.1.1 – Proportion of mothers who attended at least one antenatal care session,by Indigenous status NSW, Qld, SA, and NT combined, 1998–2007.

2 For more information on the Implementation Plans refer to the Ministerial Council for Federal Financial Relations website accessible at www.federalfinancialrelations.gov.au.

New Directions: An Equal Start to life for Indigenous Children

During 2009-10, the department continued to implement the New Directions: An Equal Start to life for Indigenous Children initiative which increased access to antenatal and postnatal health services for Aboriginal and Torres Strait Islander mothers and their babies by funding 56 organisations to deliver these services. This included approval of an additional 13 organisations in 2009-10.

Through the initiative, families were provided with important information about baby care and given practical advice and assistance with breastfeeding, nutrition, and parenting. Healthcare providers monitored developmental milestones, including immunisation status and infections, and provided health checks for children prior to commencing school.

Australian Nurse Family Partnership Program

The department continued to implement the Australian Nurse Family Partnership Program, a home-visiting program that aims to improve pregnancy and childhood outcomes; and empower parents to make good decisions about their life and their child’s life. The department funded the Central Australian Aboriginal Congress, Wuchopperen Health Service, Victorian Aboriginal Health Service and Wellington Aboriginal Corporation Health Service to implement the program and these organisations are currently delivering home visiting services in Alice Springs, Cairns, Melbourne and Wellington/Dubbo.

Rheumatic Fever Strategy

The department is continuing to support efforts to control acute rheumatic fever and manage rheumatic heart disease through the Rheumatic Fever Strategy. The Rheumatic Fever Strategy primarily targets Indigenous Australians as rates of rheumatic fever for Indigenous children in some communities are among the highest in the world. In 2009-10, the department continued to collaborate with its Northern Territory, Western Australia and Queensland counterparts to implement disease register and control programs. These programs will improve health outcomes for Indigenous Australians by improving case detection, clinical care and follow-up treatment. The control programs will also provide training to health care providers as well as education and health promotion for individuals, families and communities.

A key milestone for the Rheumatic Fever Strategy in 2009-10 was the establishment of the national coordination unit, RHDAustralia. RHDAustralia will help to ensure consistency across the participating jurisdictions, Northern Territory, Western Australia and Queensland, around effective clinical responses including preventative care and data provision for national monitoring by the Australian Institute of Health and Welfare.

Healthy for Life

In 2009-10, the department continued to deliver the Healthy for Life program through 100 services across the country. The Healthy for Life program seeks to improve health outcomes in the areas of child and maternal health, chronic disease management and detection and men’s health. In addition, the department hosted the Healthy for Life and New Directions Mothers and Babies Services Conference in Brisbane, providing a professional development opportunity for 358 health workers including general practitioners, midwives, maternal and child health workers and Aboriginal Health Workers.

Improving Eye and Ear Health Services

In 2009-10, the department commenced implementation of the Improving Eye and Ear Health Services for Indigenous Australians for Better Education and Employment Outcomes initiative. Activities include expanded trachoma control activities in the Northern Territory and Western Australia, which enabled people in more than 120 Aboriginal communities with endemic trachoma to be screened and, where appropriate, treated. Additional outreach optometry services to national priority locations including Ali Curung, Ampilatwatj, Anmatjere, Elliot, Jilkminggan, Lake Nash, Mataranka, Milingimbi, Mount Leibig, Papunya, Ramingining and Titjikala commenced in May 2010, under the Visiting Optometrists Scheme. In addition, 101 eye surgical procedures were completed through two intensive surgery weeks held in Alice Springs as part of the Central Australian and Barkly Integrated Eye Health Strategy project.

The department ordered new ear health equipment, including otoscopes and tympanometers, for more than 70 Indigenous primary health care services. In June 2010, the department entered into an agreement with the National Aboriginal Community Controlled Health Organisation to develop orientation and nationally accredited training packages in ear health. Also in June 2010, the department sought proposals from state and territory governments for additional ear surgery and other related activities to commence in 2010-11. These activities will be informed by a scoping study into state and territory activity in ear and hearing health. Research completed in early June 2010 will inform a national communication campaign to raise awareness of ear disease and the importance of providing and following treatment to reduce hearing loss in Indigenous communities. The Recommendations for Clinical Care Guidelines on the Management of Otitis Media in Aboriginal and Torres Strait Islander Populations (March 2001), were reviewed by the Menzies School of Health Research and an update is expected to be finalised in early 2010-11. This will ensure health workers and professionals can access up-to-date information on the management of ear disease.
Doctor examining child

Improved Access to Effective Health Services

Access to primary health care is critical for preventing ill health, effectively managing chronic disease and improving health outcomes to close the gap in life expectancy between Indigenous and non-Indigenous Australians.

Expanding Health Service Delivery Initiative

In 2009-10, the department continued to implement the Expanding Health Service Delivery Initiative. This initiative supports primary health care service expansion in remote communities of the Northern Territory as well as funding services, including for employment of an additional 237 primary health care staff. In addition, health service organisations continued to receive the support of the Remote Area Health Corps which commenced in 2008.

In 2009-10, the department continued to work with the Aboriginal Medical Services Alliance of the Northern Territory and the Northern Territory Department of Health and Families to progress regional reform of primary health care services in the Northern Territory. Regional reform of health services aims to increase the level of community control in health service delivery and decision making, and integrate existing services under a single service provider. This reform also aims to benefit Aboriginal people in the Northern Territory by improving the quality and range of services available. Priority regions are Barkly, West Arnhem, East Arnhem and Central Australia. In each of these regions, progress has been achieved towards the development of regional governance models and joint planning to improve coordination of existing services.

During the year, the department, in partnership with the Aboriginal Medical Services Alliance of the Northern Territory and the Northern Territory Department of Health and Families (NT Aboriginal Health Forum partners), undertook reforms to improve the range, quality and consistency of primary health care in the Northern Territory. This included a new Northern Territory hearing health and audiology service, to follow-up outcomes from the Northern Territory Emergency Response child health checks and further reforms to improve hearing health case management. A framework for continuous quality improvement in primary health care was agreed with the NT Aboriginal Health Forum partners and implementation commenced through departmental funding for 13 regional continuous quality improvement facilitators. Agreement was reached between NT Aboriginal Health Forum partners to introduce primary health care service planning in 2010-11 using an agreed suite of core or essential services. Eleven workshops were held in five regional centres to assist service providers to commence core service planning. Further development of the core primary health care services framework and tools will be undertaken in 2010-11.

Ear, Nose and Throat and Dental Follow-Up Services

In 2009-10, the department engaged the Northern Territory Department of Health and Families to provide ear, nose and throat follow-up services to Indigenous children in prescribed communities in the Northern Territory. Between 1 July 2009 and 30 June 2010, the Northern Territory Department of Health and Families provided 1,721 ear, nose and throat consultations and 271 ear, nose and throat surgical procedures.

The department also engaged the Northern Territory Department of Health and Families and a number of Aboriginal Medical Services to provide dental follow-up services to Indigenous children in prescribed communities in the Northern Territory. Between 1 July 2009 and 30 June 2010 a total of 4,237 occasions of dental services were provided.

Renal Access Program

In 2009-10, the department funded the Northern Territory Government to expand the capacity of a Community Self-Care Haemodialysis Program in rural and remote communities by providing six relocatable dialysis facilities in the Northern Territory. The units are in Ti Tree, Ali Curung, Millingimbi, Amoonguna and Ngukurr, and a nurse-assisted renal relocatable dialysis facility is in Ntaria (Hermannsburg).

The department funded the Northern Territory Government to produce and disseminate resources for use in the communities to educate and reinforce renal concepts, including prevention and delaying progression to end stage renal disease; treatment options and consequences; information regarding transition to the urban area e.g. housing options, financial support, Advanced Care Plans, and actual treatment mechanisms and techniques.

Mobile Outreach Service Plus

In 2009-10, the department increased sexual assault counselling services in remote Northern Territory areas and significantly expanded the scope and size of the Mobile Outreach Service, which is now known as MOS Plus. MOS Plus is progressively being implemented by the department in partnership with the Northern Territory Department of Health and Families and builds on the model developed under the Northern Territory Emergency Response. MOS Plus provides culturally safe counselling and support services to Aboriginal children, young people and their families and communities affected by any form of child abuse or related trauma. Services are delivered by mobile teams based in Alice Springs, Darwin and Tennant Creek.

During the year, 201 visits were made in 77 communities to provide casework, community education and external professional development in 12 remote Health Service Delivery Areas.

The Centre for Remote Health and the Northern Territory Department of Health and Families’ Safe Kids Strong Futures program continued to deliver training and information sessions to primary health care and community service providers from remote Northern Territory communities to assist them to respond to child abuse and related trauma, including raising awareness of their mandatory reporting obligations in this sensitive area.

Indigenous Drug and Alcohol Services

Alcohol use accounts for five per cent of the Indigenous burden of disease and four per cent of the health gap between Indigenous and non-Indigenous Australians. Illicit drug use accounts for three per cent of the Indigenous burden of disease and four per cent of the health gap. Drug and alcohol treatment, rehabilitation and prevention programs support Aboriginal and Torres Strait Islander peoples and communities to address substance use issues. In 2009-10, the department funded more than 130 organisations across Australia to provide, or support, Aboriginal and Torres Strait Islander-specific substance use services.

Available support included residential rehabilitation, non-residential treatment programs, primary health care services, sobering up shelters, multidisciplinary teams specialising in substance use and related issues, outreach services and transitional aftercare services. The department also funded peak bodies and state and territory governments to support and build the capacity of these service providers.

The Council of Australian Governments’ Closing the Gap – Indigenous Drug and Alcohol Services measure is expanding the number and quality of Indigenous substance use services in regional and remote areas. To implement the measure, in 2009-10, the department funded: the establishment and enhancement of four new Wellbeing Centres in Queensland as part of the Cape York Welfare Reforms; commenced developing new residential rehabilitation facilities for Western Australia, South Australia, the Australian Capital Territory and Queensland; and enhanced capacity of Community Drug Service Teams in Western Australia. The department also funded the development of the remote drug and alcohol workforce and a new youth volatile substance use treatment service in the Northern Territory; upgraded a sobering up shelter in Katherine, Northern Territory; and provided funding for the enhancement of substance use services in New South Wales and Tasmania.

Quality Health Standards

The department continued to support eligible Indigenous health organisations to meet best practice and quality standards through clinical and organisational accreditation processes to improve the quality and effectiveness of health service delivery for Aboriginal and Torres Strait Islander peoples. In this capacity, the department has worked with the Indigenous health sector and relevant accreditation agencies to provide training and develop resources to assist Indigenous health organisations meet relevant mainstream accreditation standards.

At 30 June 2010, 75 per cent of Indigenous health organisations were engaged in departmentally funded accreditation related activities, up from 50 per cent last year. This includes 30 organisations that achieved accreditation in 2009-10.

Improved Social and Emotional Wellbeing

In 2009-10, the department helped Aboriginal and Torres Strait Islander peoples affected by the past practice of forcibly removing children from their families, to reunite with their families, culture and community, and to restore their social and emotional wellbeing. Through the Bringing Them Home Counsellor program, which provides counselling and other related services to individuals and families, the department worked closely with more than 80 Aboriginal Community Controlled Health Organisations to provide counselling and support.

The department funded 16 additional staff, including caseworkers and administrative support in the Link Up services, to address a critical backlog of clients awaiting reunions under the Expanding Link Up measure. The 11 Link Up Services across Australia provided family tracing services for 9,781 clients and 425 reunions for members of Stolen Generations in 2009.

The department also provided additional project funding for 19 community-based projects across Australia to improve access to counselling and family tracing services, improve links between services, and to promote referral to mainstream services including mental health services. The department worked closely with Link Up Services to identify and implement enhancements to the data collection systems to enable the services to be reported and recognised.

Improved Workforce Capacity

In 2009-10, the department supported Aboriginal and Torres Strait Islander peoples to enter the health workforce and ensure non-Indigenous Australians have the skills to provide effective support to Aboriginal and Torres Strait Islander peoples. This was achieved through the department’s support of Aboriginal and Torres Strait Islander health professional groups. For example, the department continued to support the training of Aboriginal and Torres Strait Islander health workers through the Puggy Hunter Memorial Scholarship Scheme. Through this scheme the department assisted more than 345 Aboriginal and Torres Strait Islander students to study in a range of health disciplines including medicine, dentistry, nursing, allied health, and Aboriginal and Torres Strait Islander health workers.

A key challenge for the department during the year was to identify strategies to increase the Aboriginal and Torres Strait Islander health workforce in regional and remote Australia. The department responded to this challenge through implementation of the Indigenous Chronic Disease Package’s workforce expansion initiatives and the ongoing management of the National Indigenous Health Workforce Training Package.

Expanding Health Service Delivery Initiative

In 2009-10, the Remote Area Health Corps supported urban-based health professionals in 375 short-term placements across more than 70 sites, clinics and primary health programs in the Northern Territory. The department also continued funding 14 positions in six Aboriginal Medical Services to improve access to drug and alcohol treatment through primary health care settings.
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Performance Information for Outcome 8

Program 8.1: Deliverables

Qualitative Deliverables

Qualitative Deliverable:	Regular stakeholder participation in program development through consultative bodies and processes including meetings, conferences and all jurisdictional Health Forums.
Result: Deliverable met.
The National Indigenous Health Equality Council brings together Indigenous and non-Indigenous health experts from across the country to provide advice to Government on the implementation of, and progress towards, closing the gap in health inequality. In 2009-10, the department provided secretariat support for the council’s quarterly meetings; and to the council’s Portfolio Groups, which convened regularly during the year. The department also supported Indigenous Health Partnership Forums in each jurisdiction. These forums and working groups provided advice on the implementation of measures and priorities under the Australian Government’s Indigenous Chronic Disease Package. The National Aboriginal and Torres Strait Islander Health Officials Network brings together senior jurisdictional Aboriginal and Torres Strait Islander health officials with knowledge and expertise in local and jurisdiction level issues concerning the funding and implementation of Aboriginal and Torres Strait Islander health programs and policies, and local and national stakeholder relationships. As a Standing Committee of the Australian Health Ministers’ Advisory Council’s Health Policy Priorities Principal Committee, the network continues to provide strategic advice on Aboriginal and Torres Strait Islander health to the Australian Health Ministers’ Advisory Council and its principal committees via the committee.

Quantitative Deliverables

Prevention and Management of Chronic Disease
Quantitative Deliverable:	Percentage of variance between actual and budgeted expenses.
2009-10 Target:	≤0.5%	2009-10 Actual:	-1.5%
Result: Deliverable not met.
The total actual expense was $585.8 million against a notional budget of $594.5 million, resulting in a -1.5 per cent variance. A more effective business planning process and early action on program work has been initiated to minimise the variance in 2010-11.
Quantitative Deliverable:	Additional workforce for the prevention and management of chronic disease (funding commences 1 July 2009).
2009-10 Target:	71	2009-10 Actual:	117
Result: Deliverable met.
In 2009-10, the department exceeded the target and funded 83 new Aboriginal and Torres Strait Islander Outreach Workers, 20 practice managers and 14 additional health professionals under the Indigenous Chronic Disease Package.
Improved Child and Maternal Health
Quantitative Deliverable:	Percentage of mothers who attended at least one antenatal care visit:
2009-10 Target Indigenous; and Non-Indigenous.	2006³ 94.1-99.1% 98.3-99.3%	2009-10 Actual Indigenous; and Non-Indigenous.	2006⁴ 96.2% 98.5%
Result: Deliverable met.
In 2006, the proportion of Indigenous women who attended at least one antenatal care visit was 96.2%. This was within the target range of 94.1-99.1 per cent.
Improved Access to Effective Health Services
Quantitative Deliverable:	Increased episodes of primary health care for Indigenous Australians.
2009-10 Target:	1.7 million	2009-10 Actual:	Data will be available in 2010-11.
Result: Cannot be reported.
In 2008-09, Australian Government-funded Aboriginal and Torres Strait Islander primary health care services provided 2.1 million episodes of care. Of these, 1.7 million were provided to Aboriginal and Torres Strait Islander peoples. It is expected that this indicator will be met; however, data for 2009-10 will not be available until June 2011 and will be published by the Australian Institute of Health and Welfare.⁵
Improved Social and Emotional Wellbeing
Quantitative Deliverable:	Demonstrated access to culturally appropriate social and emotional wellbeing and mental health services. Measured by the number of client contacts.
2009-10 Target:	110,000	2009-10 Actual:	Data will be available in 2010-11.
Result: Cannot be reported.
In 2008-09, there were approximately 109,000 client contacts with social and emotional wellbeing staff or psychiatrists within Australian Government-funded Aboriginal and Torres Strait Islander primary health care services. These client contacts do not include contacts with other staff, such as doctors or Aboriginal and Torres Strait Islander health workers that are not designated as social and emotional wellbeing staff. It is therefore considered an underestimate of access to culturally appropriate social and emotional wellbeing client services. It is expected that this indicator will be met; however, data for 2009-10 will not be available until June 2011 and will be published by the Australian Institute of Health and Welfare.⁵
Improved Workforce Capacity
Quantitative Deliverable:	Number of Puggy Hunter Memorial Scholarships allocated in an academic year to support Indigenous Australians to study health-related disciplines.
2009-10 Target:	2009 245	2009-10 Actual:	2010 295
Result: Deliverable met.
The Puggy Hunter Memorial Scholarship Scheme provides University and Vocational Education and Training sector scholarships for students studying in Medicine, Nursing, Allied Health and Dentistry, Mental Health, Aboriginal and Torres Strait Islander Health Workers, and health management. There are currently 345 Aboriginal and Torres Strait Islander students receiving a scholarship.

³ Source: AIHW Perinatal Data Collection 2005. Data caveat: 2005 data is the latest perinatal data available and it is being used as the baseline.

⁴ AIHW Perinatal Data Collection 2006.

⁵ Accessible at www.aihw.gov.au.

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Program 8.1: Key Performance Indicators

Improvements in health outcomes are influenced by factors both within and beyond the health system, such as housing and sanitation and, more broadly, levels of education and employment. Therefore, achieving the targets requires action by all Australian governments in partnership with Indigenous Australians and organisations.

In 2008, the Council of Australian Governments agreed to major new investments in Indigenous affairs, including health, early childhood development and housing. Although implementation commenced in 2009-10, the most recent data available to measure progress against the indicators is for 2007. Therefore, the impact of the new investments is not yet reflected in the data. Programs require time to implement. Improving health outcomes, such as chronic disease mortality, in the context of long standing Indigenous disadvantage requires long-term sustainable improvements across all aspects of peoples’ lives. Health outcomes at a population level generally do not significantly improve within short or medium timeframes. Trend data will also be influenced by variations in the quality of Indigenous identification in mortality and population estimates.

Qualitative Key Performance Indicators

Prevention and Management of Chronic Disease
Qualitative Indicator:	A reduction in the principal causes of chronic disease related mortality rates for Indigenous people.
Result: Indicator not met.
In 2007, the Indigenous principal causes of chronic disease related mortality rate was 1,109 per 100,000. This was outside the target range of 912-1035. The non-Indigenous rates are also outside the target parameters.
Qualitative Indicator:	A reduction in mortality rates from circulatory disease among Indigenous people.
Result: Indicator not met.
In 2007, the Indigenous circulatory disease mortality rate was 470 per 100,000. This was outside the target range of 358-438. The non-Indigenous rates are also outside the target parameters.
Improved Child and Maternal Health
Qualitative Indicator:	A reduction in the child mortality rate difference between Indigenous and non-Indigenous children.
Result: Indicator met.
In 2007, the Indigenous child mortality rate was 243 per 100,000 live births. This was within the target range of 194-275.
Qualitative Indicator:	A reduction in the proportion of babies born with low birth weight to Indigenous mothers.
Result: Indicator met.
In 2007, the Indigenous low birth weight rate was 12.6 per 100 live births. This was within the target range of 11.8-13.2.

Quantitative Key Performance Indicators (2007 Budget Target)

Prevention and Management of Chronic Disease
Quantitative Indicator:	Principle causes of chronic disease related mortality rate per 100,000 ⁶:
Target Indigenous:	912-1,035	Actual Indigenous:	1109
Target Non-Indigenous:	416-419	Actual Non-Indigenous:	487
Target Rate difference:	495-619	Actual Rate difference:	626
Result: Indicator not met.
In 2007, the Indigenous principle causes of chronic disease related mortality rate was 1,109 per 100,000. This was outside the target range of 912-1,035. The non-Indigenous rates are also outside the target parameters. Trend data cannot be provided as this indicator was new in 2009-10.
Quantitative Indicator:	Circulatory disease mortality rate per 100,000 ⁷:
Target Indigenous:	358-438	Actual Indigenous:	470
Target Non-Indigenous:	196-200	Actual Non-Indigenous:	205
Target Rate difference:	160-242	Actual Rate difference:	265
Result: Indicator not met.
In 2007, the Indigenous circulatory disease mortality rate was 470 per 100,000. This was outside the target range of 358-438. The non-Indigenous rates are also outside the target parameters.
Child and Maternal Health
Quantitative Indicator:	Child 0-4 mortality rate per 100,000⁷:
Target Indigenous:	194-275	Actual Indigenous:	243
Target Non-Indigenous:	98.7-112	Actual Non-Indigenous:	101
Target Rate difference:	88.4-170	Actual Rate difference:	142
Result: Indicator met.
In 2007, the Indigenous child mortality rate was 243 per 100,000. This was within the target range of 194-275. Trend data cannot be provided as this indicator was new in 2009-10.
Quantitative Indicator:	Infant mortality rate per 1,000 live births⁷:
Target Indigenous:	7.8-11.2	Actual Indigenous:	8.2
Target Non-Indigenous:	4.1-4.7	Actual Non-Indigenous:	3.6
Target Rate difference:	3.6-6.6	Actual Rate difference:	4.5
Result: Indicator met.
In 2007, the Indigenous infant mortality rate was 8.2 per 100,000. This was within the target range of 7.8-11.2. Trend data cannot be provided as this indicator was new in 2009-10.
Quantitative Indicator:	Low birth weight rate per 100 live births⁸:
Target Indigenous:	11.8-13.2	Actual Indigenous:	12.6
Target Non-Indigenous:	6.1-6.3	Actual Non-Indigenous:	5.9
Target Rate difference:	5.6-7.0	Actual Rate difference:	6.7
Result: Indicator met.
In 2007, the Indigenous low birth weight rate was 12.6 per 100 live births. This was within the target range of 11.8-13.2. Trend data cannot be provided as this indicator was new in 2009-10.

Data caveats: There are limitations with the quality and availability of data on Aboriginal and Torres Strait Islander health, including uncertainty about the size and composition of the Indigenous population. Poor identification of Indigenous Australians is the main issue in most administrative data collections, including the National Perinatal Data Collections and the National Mortality Database. Due to the small size of the Indigenous population, which leads to a wide variability year to year, the forward projections include data confidence intervals.

⁶ Source: AIHW mortality database 1998-2007.

⁷Source: AIHW mortality database 1998-2007.

⁸ Source: AIHW National Perinatal Data Collection.

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Outcome 8 – 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 8.1: Aboriginal and Torres Strait Islander Health
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	594,526	585,785	( 8,741)	661,464
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	59,748	61,491	1,743	58,980
Revenues from other sources	1,037	726	( 311)	1,087
Unfunded depreciation expense¹	-	-	-	1,244
Operating loss / (surplus)	-	33	33	-
Total for Program 8.1	655,311	648,035	( 7,276)	722,775
Outcome 8 Totals by appropriation type
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	594,526	585,785	( 8,741)	661,464
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	59,748	61,491	1,743	58,980
Revenues from other sources	1,037	726	( 311)	1,087
Unfunded depreciation expense¹	-	-	-	1,244
Operating loss / (surplus)	-	33	33	-
Total Expenses for Outcome 8	655,311	648,035	( 7,276)	722,775
Average Staffing Level (Number)	459	459	-	434

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

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