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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 Strategy

Outcome 8 aims to improve access for Aboriginal and Torres Strait Islander peoples to effective health care services essential to improving health and life expectancy, and reducing child mortality. This supports the Government’s broader commitments to close the gap between Aboriginal and Torres Strait Islander peoples and non‑Indigenous Australians in health, education and employment. 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 major activities and performance indicators published in the Outcome 8 chapter of the 2010-11 Health and Ageing Portfolio Budget Statements (PB Statements) and the 2010-11 Health and Ageing Portfolio Additional Estimates Statements (PAES). It also includes a table summarising the estimated and actual expenditure for this Outcome.

In 2010-11, the Office for Aboriginal and Torres Strait Islander Health was responsible for Outcome 8. The Mental Health and Chronic Disease Division, Health Workforce Division, Primary and Ambulatory Care Division, Population Health Division, Medical Benefits Division, Pharmaceutical Benefits Division, Ageing and Aged Care Division, the Office of Health Protection and the department’s state and territory offices also contributed to the achievement of the Outcome.

Program Name Program Objectives in 2010-11
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.

Program Name	Program Objectives in 2010-11
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.

Table 2.4.8.1: The following Health and Ageing programs also make significant contributions to Aboriginal and Torres Strait Islander health

Outcome Contributions to Aboriginal and Torres Strait Islander health

Outcome 1 Drug Strategy (Program 1.3)

Outcome 2 Pharmaceuticals and Pharmaceutical Services (Program 2.2)

Outcome 3 Medicare Services (Program 3.1)

Outcome 4 Culturally Appropriate Aged Care (Program 4.5)

Outcome 5 Primary Care, Financing, Quality and Access (Program 5.2)
Primary Care Practice Incentives (Program 5.4)

Outcome 6 Rural Health Services (Program 6.1)

Outcome 10 Chronic Disease – Treatment (Program 10.1)
Health Infrastructure (Program 10.7)

Outcome 12 Workforce (Program 12.2)

Outcome	Contributions to Aboriginal and Torres Strait Islander health
Outcome 1	Drug Strategy (Program 1.3)
Outcome 2	Pharmaceuticals and Pharmaceutical Services (Program 2.2)
Outcome 3	Medicare Services (Program 3.1)
Outcome 4	Culturally Appropriate Aged Care (Program 4.5)
Outcome 5	Primary Care, Financing, Quality and Access (Program 5.2) Primary Care Practice Incentives (Program 5.4)
Outcome 6	Rural Health Services (Program 6.1)
Outcome 10	Chronic Disease – Treatment (Program 10.1) Health Infrastructure (Program 10.7)
Outcome 12	Workforce (Program 12.2)

Major Achievements

Provided 48,954 Aboriginal and Torres Strait Islander health assessments for those aged 15 years and over in the 2010-11 financial year; an increase of 64% over the same period in 2009-10.
Increased access for 79,076 eligible Aboriginal and Torres Strait Islander people to more affordable Pharmaceutical Benefits Scheme (PBS) medicines through the Indigenous Chronic Disease Package PBS Co-payment Measure.
Increased capacity of the primary care workforce by funding 363 positions nationally through the Indigenous Chronic Disease Package (Outcomes 1, 5, 8 and 12).
Increased capacity of the Northern Territory Aboriginal primary health care services workforce. Since its implementation, 273 new service delivery positions have been established in remote Health Service Delivery Areas in the Northern Territory.
Developed a set of 24 national Key Performance Indicators (nKPIs) to measure progress in Indigenous-specific primary health care services on closing the gap in Indigenous life expectancy and halving the gap in child mortality rates.

Challenges

Ensuring national coverage of key initiatives within the Indigenous Chronic Disease Package.
Strengthening the governance capability within the sector to enable organisations to remain effective, efficient and viable, thereby ensuring ongoing service provision to their communities.
Addressing complex land tenure issues that impact on the construction of health service facilities and essential staff housing in remote Indigenous communities.

Trends

Figure 2.4.8.1: Chronic disease related mortality rates from 1998 to 2031 required to close the gap⁸¹

Figure 2.4.8.1 shows that over the period 1998 to 2008 there has been a non-significant decrease in Indigenous chronic disease mortality rate and a significant decrease in the non-Indigenous rate and hence no closing of the gap. There was an increase in the Indigenous mortality rate in 2008 which is in part due to administrative effects on death registrations in Western Australia. Early indications from 2009 chronic disease mortality data (not shown here) show a decline from the 2008 levels.

Figure 2.4.8.2: Child mortality rates from 1998 to 2018 required to halve the gap⁸¹

Figure 2.4.8.2 shows that the Indigenous mortality rate for children under five years of age has declined significantly since 1998 and demonstrates a narrowing of the gap.
Text version of this chart

Figure 2.4.8.2 shows that the Indigenous mortality rate for children under five years of age has declined significantly since 1998 and demonstrates a narrowing of the gap. The 2008 rate (221 per 100,000) was within the confidence interval in the 2010-11 PB Statements projection for 2008 (190.7-269.9). Early indications from 2009 child mortality data (not shown here) suggest that the trend continues to decline and is within the range required to meet the 2018 target.

Program 8.1: Aboriginal and Torres Strait Islander Health

Program 8.1 aims to contribute to closing the gap in life expectancy within a generation and halving the gap in the mortality rate for Indigenous children under five years of age within a decade through preventing and managing chronic disease; improving access to maternal and child health services; improving access to effective primary health care and substance use services; improving social and emotional wellbeing services; and improving workforce capacity.

Table 2.4.8.2: Australian Government contribution to National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes, by Outcome

Activity Outcomes responsible

Reduce smoking rates among Aboriginal and Torres Strait Islander peoples. Outcome 1

Tackle 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 5

Improve Indigenous Australians’ access to Pharmaceutical Benefits Scheme medicines. Outcome 2

Improve 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

Increase the uptake of Medicare Benefits Schedule funded primary care services by Aboriginal and Torres Strait Islander peoples, including adult health checks. Outcomes 3 and 5

Improve 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, 8 and 12

Increase the capacity of the primary care workforce to deliver effective health care to Indigenous Australians by funding more than 160 new Aboriginal and Torres Strait Islander Outreach Workers, 75 additional health professionals and practice managers in Indigenous health services, and a range of workforce training and professional development activities. Outcomes 5, 8 and 12

Live Longer Local Community Campaign Grants. Indigenous person eating healthy food and displays the logo ‘GET ACTIVE EAT GOOD TUCKER LIVE LONGER!’ The campaign invites applications for grants to fund local activities that promote healthy lifestyles

Activity	Outcomes responsible
Reduce smoking rates among Aboriginal and Torres Strait Islander peoples.	Outcome 1
Tackle 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 5
Improve Indigenous Australians’ access to Pharmaceutical Benefits Scheme medicines.	Outcome 2
Improve 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
Increase the uptake of Medicare Benefits Schedule funded primary care services by Aboriginal and Torres Strait Islander peoples, including adult health checks.	Outcomes 3 and 5
Improve 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, 8 and 12
Increase the capacity of the primary care workforce to deliver effective health care to Indigenous Australians by funding more than 160 new Aboriginal and Torres Strait Islander Outreach Workers, 75 additional health professionals and practice managers in Indigenous health services, and a range of workforce training and professional development activities.	Outcomes 5, 8 and 12

Prevent and Manage Chronic Disease

The department commenced implementation of the Indigenous Chronic Disease Package in 2009-10. The package is the Australian Government’s contribution to the $1.6 billion National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes, and plays an important role in the wider response to closing the gap in Indigenous disadvantage.

The package aims to decrease the burden of chronic disease and associated risk factors that account for about two-thirds of the life-expectancy gap between Indigenous and non-Indigenous Australians. This is being achieved by building a primary health care system that effectively meets the needs of Aboriginal and Torres Strait Islander peoples.

A major achievement for the department in 2010-11 was the continued funding for the Indigenous health workforce, which enabled funding of 363 positions under the package (127.5 Full Time Equivalent (FTE) Aboriginal and Torres Strait Islander Outreach Workers; 43 FTE Healthy Lifestyle Workers; 94.45 FTE Indigenous Health Project Officers; 20.1 FTE Practice Managers; 12.8 FTE additional health professionals; 21 FTE Regional Tobacco Coordinators; 22 FTE Tobacco Action Workers; and 22.1 FTE Care Coordinators).

Quantitative Deliverable: Additional workforce for the prevention and management of chronic disease.

2010-11 Target: 154 2010-11 Actual: 160.4

Result: Deliverable met.

The deliverable relates to the Aboriginal and Torres Strait Islander Outreach Workers, Practice Managers and additional health professionals component of the total workforce funded under the Indigenous Chronic Disease Package.

In 2010-11, the department exceeded the target and funded 160.4 (127.5 Aboriginal and Torres Strait Islander Outreach Workers; 20.1 Practice Managers; and 12.8 additional health professionals) for the prevention and management of chronic disease.

The department was able to fund an additional 6.4 positions as funds became available within the package. This resulted in a good outcome as it allowed greater coverage of Outreach Workers across Australia.

The number of Aboriginal and Torres Strait Islander health assessments for those aged 15 years and over, has continued to increase significantly, with 48,954 provided in the 2010-11 financial year. This was an increase of 64% over the previous year. The introduction of the PBS Co-payments Measure has also provided 79,076 eligible Aboriginal and Torres Strait Islanders with more affordable PBS medicines.

Qualitative KPI: Sentinel sites established to show impact of the Indigenous Chronic Disease Package.

2010-11 Reference Point: Sentinel sites report on effectiveness of the implementation of the Indigenous Chronic Disease package.

Result: Indicator met.

In 2010-11, 23 sentinel sites were established, providing place-based feedback on the implementation of the Indigenous Chronic Disease Package.
Early feedback shows that the community and health professionals perceive improved access to medicines through the PBS Co-payment Measure and to Aboriginal and Torres Strait Islander health assessments in the sentinel sites.

The department, in partnership with state and territory health departments and in collaboration with the Australian Institute of Health and Welfare (AIHW), developed a set of 24 national Key Performance Indicators for Indigenous-specific primary health care services.⁸² These were endorsed by the Australian Health Ministers’ Advisory Council (AHMAC) on 30 June 2011 and will be implemented by all health departments over the next three years, along with a coordinated web-based data collection system.

Quantitative KPI: Principal causes of chronic disease related mortality rate per 100,000.⁸³

Target Indigenous: 915-1,036 2008 Actual: 1,004

Target Non-Indigenous: 454-457 2008 Actual: 501

Target rate difference 460-581 2008 Actual: 503

Result: Indicator met for Indigenous rate and the rate difference. Note: the non-Indigenous rate was higher than the target range.

Over the period 1998 to 2008 there has been a non-significant decrease in Indigenous chronic disease mortality rates and a significant decrease for non-Indigenous rates and hence no closing of the gap. There was an increase in the Indigenous mortality rate in 2008 in part due to administrative effects on death registrations in Western Australia.

The 2008 Indigenous rate (1,004 per 100,000) and the rate difference (503 per 100,000) were within the confidence intervals in the 2010-11 PB Statements projection for 2008. The high rates of chronic disease mortality up until 2008 underpin the Commonwealth’s Indigenous Chronic Disease Package which was developed specifically to prevent and better manage chronic disease. The 2008 mortality data is prior to the commencement of this work in July 2009.⁸⁴

Quantitative KPI: Circulatory disease mortality rate per 100,000.⁸⁵

Target Indigenous: 337-410 2008 Actual: 370

Target Non-Indigenous: 191-196 2008 Actual: 210

Target rate difference: 145-215 2008 Actual: 161

Result: Indicator met for Indigenous rate and the rate difference. Note: the non-Indigenous rate was higher than the target range.

The Indigenous circulatory disease mortality rate has declined significantly between 1998 and 2008, although there has been a slowing in recent years. The Indigenous rate in 2008 (370 per 100,000) and the rate difference (161 per 100,000) between Indigenous and non-Indigenous were within the confidence intervals in the 2010-11 PB Statements projections for 2008.⁸⁶

Qualitative Deliverable: Report on the implementation of the Indigenous Chronic Disease Package.

2010-11 Reference Point: Annual Report provided to states and territories and Aboriginal and Torres Strait Islander organisations against the benchmarks and timelines as detailed in the Commonwealth’s Implementation Plan.

Result: Deliverable met.

The 2009-10 Indigenous Chronic Disease Package Annual Report was launched on 9 December 2010. Hard copies were distributed to key stakeholders, including states and territories and Aboriginal and
Torres Strait Islander organisations, in early January 2011.

Indigenous Anti-Smoking Campaign logo – ‘QUIT SMOKING AND BREAK THE CHAIN’ featuring an Aboriginal and Torres Strait Islander woman with two children. A quote ‘If I can do it, we all can’ which featured in the television advertising is prominent.

Quantitative Deliverable:	Additional workforce for the prevention and management of chronic disease.
2010-11 Target:	154	2010-11 Actual:	160.4
Result: Deliverable met.
The deliverable relates to the Aboriginal and Torres Strait Islander Outreach Workers, Practice Managers and additional health professionals component of the total workforce funded under the Indigenous Chronic Disease Package. In 2010-11, the department exceeded the target and funded 160.4 (127.5 Aboriginal and Torres Strait Islander Outreach Workers; 20.1 Practice Managers; and 12.8 additional health professionals) for the prevention and management of chronic disease. The department was able to fund an additional 6.4 positions as funds became available within the package. This resulted in a good outcome as it allowed greater coverage of Outreach Workers across Australia.

Qualitative KPI:	Sentinel sites established to show impact of the Indigenous Chronic Disease Package.
2010-11 Reference Point:	Sentinel sites report on effectiveness of the implementation of the Indigenous Chronic Disease package.
Result: Indicator met.
In 2010-11, 23 sentinel sites were established, providing place-based feedback on the implementation of the Indigenous Chronic Disease Package. Early feedback shows that the community and health professionals perceive improved access to medicines through the PBS Co-payment Measure and to Aboriginal and Torres Strait Islander health assessments in the sentinel sites.

Quantitative KPI:	Principal causes of chronic disease related mortality rate per 100,000.⁸³
Target Indigenous:	915-1,036	2008 Actual:	1,004
Target Non-Indigenous:	454-457	2008 Actual:	501
Target rate difference	460-581	2008 Actual:	503
Result: Indicator met for Indigenous rate and the rate difference. Note: the non-Indigenous rate was higher than the target range.
Over the period 1998 to 2008 there has been a non-significant decrease in Indigenous chronic disease mortality rates and a significant decrease for non-Indigenous rates and hence no closing of the gap. There was an increase in the Indigenous mortality rate in 2008 in part due to administrative effects on death registrations in Western Australia. The 2008 Indigenous rate (1,004 per 100,000) and the rate difference (503 per 100,000) were within the confidence intervals in the 2010-11 PB Statements projection for 2008. The high rates of chronic disease mortality up until 2008 underpin the Commonwealth’s Indigenous Chronic Disease Package which was developed specifically to prevent and better manage chronic disease. The 2008 mortality data is prior to the commencement of this work in July 2009.⁸⁴
Quantitative KPI:	Circulatory disease mortality rate per 100,000.⁸⁵
Target Indigenous:	337-410	2008 Actual:	370
Target Non-Indigenous:	191-196	2008 Actual:	210
Target rate difference:	145-215	2008 Actual:	161
Result: Indicator met for Indigenous rate and the rate difference. Note: the non-Indigenous rate was higher than the target range.
The Indigenous circulatory disease mortality rate has declined significantly between 1998 and 2008, although there has been a slowing in recent years. The Indigenous rate in 2008 (370 per 100,000) and the rate difference (161 per 100,000) between Indigenous and non-Indigenous were within the confidence intervals in the 2010-11 PB Statements projections for 2008.⁸⁶
Qualitative Deliverable:	Report on the implementation of the Indigenous Chronic Disease Package.
2010-11 Reference Point:	Annual Report provided to states and territories and Aboriginal and Torres Strait Islander organisations against the benchmarks and timelines as detailed in the Commonwealth’s Implementation Plan.
Result: Deliverable met.
The 2009-10 Indigenous Chronic Disease Package Annual Report was launched on 9 December 2010. Hard copies were distributed to key stakeholders, including states and territories and Aboriginal and Torres Strait Islander organisations, in early January 2011.

Improve Child and Maternal Health

Improving child and maternal health is a key step in improving long-term health outcomes for Aboriginal and Torres Strait Islander peoples. A healthy start to life, beginning in pregnancy, gives children the best opportunity to achieve their full potential, and may also provide protection from the development of chronic diseases later in life.

During 2010-11, the department improved and expanded child and maternal health services for Aboriginal and Torres Strait Islander peoples. Twenty additional primary health care services received funding under the New Directions: Mothers and Babies Services initiative, bringing the total number of new and additional services to 76.

Quantitative Deliverable:	Number of New Directions: Mothers and Babies Services.
2010-11 Target:	65	2010-11 Actual:	76
Result: Deliverable met.
The target was exceeded due to the high standard of applications received and organisations requesting smaller funding amounts than anticipated. This resulted in a good outcome - a larger number of New Directions: Mothers and Babies Services being established.

The implementation of the Australian Nurse-Family Partnership Program (ANFPP) continues in four locations across Australia (Alice Springs, Cairns, Melbourne and Wellington-Dubbo). The ANFPP continues to provide home visits to women pregnant with an Aboriginal and/or Torres Strait Islander child until their child is two years of age. An evaluation of the program has commenced and the results are expected in late 2011.

Qualitative Deliverable: Australian Nurse Family Partnership Program evaluation.

2010-11 Reference Point: Evaluation commences in 2010-11.

Result: Deliverable met.

Ernst and Young was engaged in August 2010 to develop an evaluation framework and to conduct the first stage of the ANFPP evaluation. Site visits commenced in June 2011. The final first stage evaluation report will be provided by 31 October 2011.

Qualitative Deliverable:	Australian Nurse Family Partnership Program evaluation.
2010-11 Reference Point:	Evaluation commences in 2010-11.
Result: Deliverable met.
Ernst and Young was engaged in August 2010 to develop an evaluation framework and to conduct the first stage of the ANFPP evaluation. Site visits commenced in June 2011. The final first stage evaluation report will be provided by 31 October 2011.

Throughout 2010-11, the department worked in collaboration with the Department of Education, Employment and Workplace Relations (DEEWR), the lead agency, to implement the Indigenous Early Childhood Development National Partnership (IECD NP) with state and territory governments. The department continued to monitor progress of the activities undertaken by state and territory governments, and provide them with funding to establish and deliver services, programs and activities designed to increase access to, and use of, antenatal care, pre-pregnancy and teenage sexual and reproductive health services by Indigenous families.

Through the New Directions: Mothers and Babies Services program, the department provided increased access for Indigenous families to maternal and child health services. The department also contributed to planning for a comprehensive evaluation of the IECD NP, which is being managed by DEEWR.

Quantitative KPI: Child 0-4 mortality rate per 100,000.⁸⁷

Target Indigenous: 190.7-269.9 2008 Actual: 221

Target Non-Indigenous: 97.6-110.7 2008 Actual: 100

Target rate difference 86.0-166.3 2008 Actual: 121

Result: Indicator met.

The Indigenous child mortality rate has declined significantly and the gap between Indigenous and non-Indigenous Australians in this indicator is closing. The 2008 rate (221 per 100,000) was within the confidence interval in the 2010-11 PB Statements projection for 2008 (190.7-269.9).⁸⁸

Quantitative KPI: Infant mortality rate per 1,000 live births.⁸⁹

Target Indigenous: 7.4-10.6 2008 Actual: 7.8

Target Non-Indigenous: 4.1-4.6 2008 Actual: 4.0

Target rate difference: 3.3-6.1 2008 Actual: 3.8

Result: Indicator met.

The Indigenous infant mortality rate has declined significantly and the gap between Indigenous and non-Indigenous Australians in this indicator is closing. The 2008 rate (7.8 per 1,000) was within the confidence interval in the 2010-11 PB Statements projection for 2008 (7.4-10.6).⁹⁰

Quantitative KPI: Low birth weight rate per 100 live births.⁹¹

Target Indigenous: 12.0-13.3 2008 Actual: 12.2

Target Non-Indigenous: 6.2-6.4 2008 Actual: 5.9

Target rate difference: 5.7-7.1 2008 Actual: 6.3

Result: Indicator met.

The 2008 Indigenous rate (12.2 per 100 live births) was within the confidence interval in the 2010-11 PB Statements projection for 2008 (12.0-13.3). Longer term trend analysis from 1991 to 2008 shows that the Indigenous rate has increased significantly and the gap has widened. However, from 2005 onwards there appears to be a downward trend in the Indigenous rate and the gap.

Quantitative KPI: Percentage of mothers who attended at least one antenatal care visit.⁹²

Target Indigenous: 94.8-99.6 2008 Actual: 96.8

Target Non-Indigenous: 98.8-99.8 2008 Actual: 98.7

Target rate difference: -4.6-0.4 2008 Actual: -1.9

Result: Indicator met.

Rates are increasing significantly for both Indigenous and non-Indigenous mothers. The 2008 Indigenous rate (96.8 per 100 mothers) was within the confidence interval in the 2010-11 PB Statements projection for 2008 (94.8 – 99.6 per 100 mothers).⁹³

Quantitative KPI:	Child 0-4 mortality rate per 100,000.⁸⁷
Target Indigenous:	190.7-269.9	2008 Actual:	221
Target Non-Indigenous:	97.6-110.7	2008 Actual:	100
Target rate difference	86.0-166.3	2008 Actual:	121
Result: Indicator met.
The Indigenous child mortality rate has declined significantly and the gap between Indigenous and non-Indigenous Australians in this indicator is closing. The 2008 rate (221 per 100,000) was within the confidence interval in the 2010-11 PB Statements projection for 2008 (190.7-269.9).⁸⁸
Quantitative KPI:	Infant mortality rate per 1,000 live births.⁸⁹
Target Indigenous:	7.4-10.6	2008 Actual:	7.8
Target Non-Indigenous:	4.1-4.6	2008 Actual:	4.0
Target rate difference:	3.3-6.1	2008 Actual:	3.8
Result: Indicator met.
The Indigenous infant mortality rate has declined significantly and the gap between Indigenous and non-Indigenous Australians in this indicator is closing. The 2008 rate (7.8 per 1,000) was within the confidence interval in the 2010-11 PB Statements projection for 2008 (7.4-10.6).⁹⁰
Quantitative KPI:	Low birth weight rate per 100 live births.⁹¹
Target Indigenous:	12.0-13.3	2008 Actual:	12.2
Target Non-Indigenous:	6.2-6.4	2008 Actual:	5.9
Target rate difference:	5.7-7.1	2008 Actual:	6.3
Result: Indicator met.
The 2008 Indigenous rate (12.2 per 100 live births) was within the confidence interval in the 2010-11 PB Statements projection for 2008 (12.0-13.3). Longer term trend analysis from 1991 to 2008 shows that the Indigenous rate has increased significantly and the gap has widened. However, from 2005 onwards there appears to be a downward trend in the Indigenous rate and the gap.
Quantitative KPI:	Percentage of mothers who attended at least one antenatal care visit.⁹²
Target Indigenous:	94.8-99.6	2008 Actual:	96.8
Target Non-Indigenous:	98.8-99.8	2008 Actual:	98.7
Target rate difference:	-4.6-0.4	2008 Actual:	-1.9
Result: Indicator met.
Rates are increasing significantly for both Indigenous and non-Indigenous mothers. The 2008 Indigenous rate (96.8 per 100 mothers) was within the confidence interval in the 2010-11 PB Statements projection for 2008 (94.8 – 99.6 per 100 mothers).⁹³

Improve 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. In 2010-11, the department provided grant funding to 286 organisations to deliver comprehensive primary health care and other health services that meet the needs of their communities. These include clinical services for the treatment of illnesses, emergency care, management of chronic conditions and referrals, as well as a range of population health programs that respond to community needs. Of these 286 organisations 180 (equivalent to over 60%) are Aboriginal and Torres Strait Islander Community Controlled Health Services.

Qualitative Deliverable:	Stakeholders participate in program development through a range of avenues.
2010-11 Reference Point:	Stakeholders participated in program development through avenues such as regular consultative committees, conferences, stakeholder engagement forums, surveys, submissions on departmental discussion papers and meetings.
Result: Deliverable met.
The department continued to consult and engage with key stakeholders throughout the implementation of health reform initiatives and other program development activities. Stakeholders were engaged through a range of avenues including: the National Indigenous Health Equality Council (NIHEC) and its Portfolio Working Groups; the National Aboriginal Community Controlled Health Organisation and other peak representative bodies in Indigenous health; Indigenous Health Partnership Forums in states and territories; and the Governance Enhancement Working Group.
Qualitative Deliverable:	Produce relevant and timely evidence-based policy research.
2010-11 Reference Point:	Relevant evidence-based policy research produced in a timely manner.
Result: Deliverable met.
In 2010-11, the department provided relevant evidence-based policy research in a timely manner through providing high quality data, analysis and reporting to support policy and program development. These activities included: preparation for the Aboriginal and Torres Strait Islander Health Performance Framework report. This work informs policy analysis, planning and program implementation by providing a ready reference to verified data and research; provision of advice to inform Council of Australian Governments performance indicator development, closing the gap targets, and support for national data activities; and funding the Australian Indigenous HealthInfoNet94 an internet resource for policy and research material on Aboriginal and Torres Strait Islander health.

Qualitative Deliverable:	Increase access and range of primary health care services to remote Indigenous communities in the Northern Territory.
2010-11 Reference Point:	Timely allocation of increased primary health care funding in 2010-11.
Result: Deliverable met.
In 2010-11, 98.3% of increased primary health care funding in the Northern Territory was allocated to service delivery organisations within the first quarter, with 1.7% of funds committed in the final quarter.

Quantitative Deliverable:		Increased episodes of primary health care for Indigenous Australians.
2010-11 Target:		1.8m	2010-11 Actual:	Data will be available in 2012.
Result: Cannot be reported
In 2009-10, Australian Government funded Aboriginal and Torres Strait Islander primary health care services provided 2.4 million episodes of care. Of these, two million were provided to Aboriginal and Torres Strait Islander peoples. This proportion is similar to the previous year (86% and 82% respectively). It is expected that this indicator will be met; however, data for 2010-11 will not be available until August 2012, and will be published by the Australian Institute of Health and Welfare.

Capacity Building

The department continued to provide practical support, funding and resources to more than 200 eligible Indigenous health organisations to meet quality standards through accreditation under Australian health care standards. As at 30 June 2011, 106 organisations have clinical accreditation under the Royal Australian College of General Practitioners’ Standards and/or organisational accreditation under the Quality Improvement Council, the International Organization for Standardization or the Australian Council of Healthcare Standards. The department is continuing to partner with the Aboriginal and Torres Strait Islander health sector, Accreditation Standards owners and other stakeholders to achieve these outcomes.

The department has continued to work in cooperation with Aboriginal and Torres Strait Islander community controlled health organisations to improve their corporate and clinical governance. In December 2010, the department established the Office for Aboriginal and Torres Strait Islander Health Governance Enhancement Working Group, which includes highly experienced representatives from the Aboriginal and Torres Strait Islander community controlled health sector, government and academia to consider how to enhance governance within the sector. The working group has actively engaged with the National Aboriginal Community Controlled Health Organisation in the ongoing development of strategies to assist the sector.

Qualitative KPI: Support eligible health organisations to meet quality standards through accreditation under Australian health care standards.

2010-11 Reference Point: Progress in supporting accreditation in eligible health organisations.

Result: Indicator met.

The department continued working with the Indigenous health sector and accreditation agencies to provide support and resources to assist eligible Indigenous health organisations in achieving, or working towards, mainstream clinical and/or organisational accreditation.
At 30 June 2011, 92% of eligible Indigenous health organisations were engaged in departmentally funded accreditation related activities, up from 75% last year; while another 27 organisations achieved re-accreditation in 2010-11.

Qualitative KPI:	Support eligible health organisations to meet quality standards through accreditation under Australian health care standards.
2010-11 Reference Point:	Progress in supporting accreditation in eligible health organisations.
Result: Indicator met.
The department continued working with the Indigenous health sector and accreditation agencies to provide support and resources to assist eligible Indigenous health organisations in achieving, or working towards, mainstream clinical and/or organisational accreditation. At 30 June 2011, 92% of eligible Indigenous health organisations were engaged in departmentally funded accreditation related activities, up from 75% last year; while another 27 organisations achieved re-accreditation in 2010-11.

Improving Eye and Ear Health Services

In 2010-11, the department continued implementation of the Improving Eye and Ear Health Services for Indigenous Australians for Better Education and Employment Outcomes initiative. Under the initiative, the Northern Territory, Western Australia and South Australia governments were provided with more than $4 million to conduct trachoma control activities in more than 130 communities in 15 regions where trachoma is endemic. An additional 41 eye health surgical procedures were performed for Aboriginal and Torres Strait Islander people under the Central Australia and Barkly Integrated Eye Health Strategy.

An additional 17 optometrists were engaged under the Visiting Optometrists Scheme Expansion for Indigenous Australians in 2010-11, with agreements in place for service delivery in 123 locations and approximately 5,600 patient contacts. One hundred and six eligible health services have received 478 pieces of ear and hearing health equipment, including pneumatic and video otoscopes and tympanometers.

In parallel to distribution of equipment, over 140 Aboriginal Health Workers have received training in how to use this ear health equipment. An accredited training course for ear and hearing health is under development and has been trialled in four pilot sites, with national roll-out of the training to commence in late 2011. Research and concept testing has led to the development of mothers, carers and teachers ear and hearing health promotion kits. The campaign commenced on 1 July 2011.

Rheumatic Fever Strategy

In 2010-11, the department continued to support efforts to control acute rheumatic fever (ARF) and manage rheumatic heart disease (RHD) through the Rheumatic Fever Strategy. The department worked closely with the Northern Territory, Western Australia and Queensland governments on the implementation of disease register and control programs to improve case detection, clinical care and follow-up treatment of rheumatic fever. In addition to its ongoing role in the provision of expert advice and support to the participating jurisdictions, RHDAustralia⁹⁵ has made significant progress in the development of an ARF and RHD data set and model for national data collection. RHDAustralia also hosted a national workshop on 22-23 August 2010 bringing together clinicians, researchers, policy makers and community organisations to further the understanding and management of ARF and RHD.

Expanding Health Service Delivery Initiative

The department continued to support the expansion of primary health care services in remote communities in the Northern Territory. Since the Expanding Health Service Delivery Initiative was implemented, an additional 273 primary health care staff have been employed. This initiative also funded the Remote Area Health Corps (RAHC) to place urban health professionals in short-term positions in remote primary care services and supported hearing health service delivery through regional hubs.

Quantitative Deliverable:		Number of health professionals placed in remote primary health care services in the Northern Territory.
2010-11 Target:		300		2010-11 Actual:		465
Result: Deliverable met.
Under the Expanding Health Service Delivery Initiative, the RAHC recruits urban based health professionals, including general practitioners, registered nurses, allied health professionals and dental personnel, for short-term placements. The target for the number of health professionals deployed in remote Aboriginal communities was exceeded due to an increase in the number of health professionals available for repeat deployments, along with greater awareness of the RAHC program and demand for staff from remote health services.
Quantitative Deliverable:	Number of Indigenous children who receive a hearing service in the Northern Territory.
2010-11 Target:	2,636		2010-11 Actual:		1,193
Result: Deliverable not met.
Since 31 December 2010, there has been a reduction in the number of audiology services due to the extended and severe wet season, and a slowdown in service delivery during a reorganisation of hearing health services and funding arrangements.

The department continued to focus on regional reform in heath service delivery. In partnership with the Aboriginal and Medical Services Alliance of the Northern Territory and the Northern Territory Department of Health, the department is working to increase community control in health service delivery and decision making.

The Red Lily Health Board has been established as a regional community controlled health board in the West Arnhem health service delivery area. In the Barkly health service delivery area, the Anyinginyi Health Aboriginal Corporation is preparing for the role of regional health service provider. Other priority regions are East Arnhem and Central Australia, where progress has been achieved towards the development of regional governance models and joint planning to improve coordination of existing health care services. The Remote Area Health Corps continued to support health service organisations in the Northern Territory. Over 940 health professionals have undertaken short-term placements in Northern Territory health services.

Ear, Nose and Throat and Dental Follow-Up Services

In 2010-11, the department engaged the Northern Territory Department of Health to provide ear, nose and throat follow-up services to Indigenous children in prescribed communities in the Northern Territory. Between 1 July 2010 and 31 December 2010, the Northern Territory Department of Health provided 777 ear, nose and throat consultations and 42 ear, nose and throat surgical procedures.

Quantitative Deliverable:	Number of children who receive an ear, nose and throat service in the Northern Territory.
2010-11 Target:	585	2010-11 Actual:	765
Result: Deliverable met.
The target for children who received an ear, nose and throat service was exceeded due to greater than expected efficiency in the service delivery model.

The department also engaged the Northern Territory Department of Health 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 2010 and 30 June 2011 a total of 3,184 occasions of dental service were provided.

Quantitative Deliverable: Number of children who receive a dental service in the Northern Territory.

2010-11 Target: 2,792 2010-11 Actual: 2,599

Result: Deliverable substantially met.

The target for children provided with a dental service was not met by a total of 193 children. This is partly due to incomplete data capture from several new service providers and partly due to difficulties in achieving expected levels of service delivery due to the extended and severe wet season.

Quantitative Deliverable:	Number of children who receive a dental service in the Northern Territory.
2010-11 Target:	2,792	2010-11 Actual:	2,599
Result: Deliverable substantially met.
The target for children provided with a dental service was not met by a total of 193 children. This is partly due to incomplete data capture from several new service providers and partly due to difficulties in achieving expected levels of service delivery due to the extended and severe wet season.

Mobile Outreach Service Plus

In 2010-11, the department continued child sexual assault and abuse related counselling services in remote Northern Territory areas through the Mobile Outreach Service (MOS) Plus. MOS Plus is being implemented by the department in partnership with the Northern Territory Department of Children and Families. MOS Plus provides culturally safe counselling and support services to Aboriginal and Torres Strait Islander children, young people and their families and communities who are affected by any form of child abuse related trauma. Services are delivered by mobile teams based in Darwin and Alice Springs.

During the year, 395 visits were made to 83 communities to provide casework, community education and external professional development in 12 remote Health Service Delivery Areas.

Improve Social and Emotional Wellbeing

In 2010-11, the department assisted Aboriginal and Torres Strait Islander peoples separated from their families as a result of past removal policies, institutionalisation and adoption or foster care, to reunite with their families, culture and community.

To achieve these aims, the department funded more than 80 Aboriginal Community Controlled Health Organisations to provide counselling and support through the Bringing Them Home Program, while 10 Link Up services across Australia provided family tracing services for 7,227 clients and 225 reunions for members of Stolen Generations.

During 2010-11, a review of Link Up services in Western Australia, Tasmania and the Australian Capital Territory was undertaken to identify improvements in service delivery and accessibility in these regions. The review recommended no Link Up service be established in Tasmania or the Australian Capital Territory and the development of a new two provider model for Western Australia. Transition arrangements will be put into place in the 2011-12 financial year.

Quantitative Deliverable: Number of Link Up clients.

2010-11 Target: 4,450 2010-11 Actual: 7,227

Result: Deliverable met.

The target for client numbers was exceeded, reflecting the impact of additional funding for 19 community based projects to foster innovation, which aims to improve access to counselling services, awareness of Link Up Services, enhanced links between services and the promotion of referrals to mainstream mental health services. The additional program funding responded to program limitations identified in the 2007 review.

Quantitative Deliverable: Number of reunions under Link Up.

2010-11 Target: 170 2010-11 Actual: 225

Result: Deliverable met.

The target for reunions was exceeded, reflecting the impact of funding for 16 additional Link Up staff, including caseworkers and administrative support, funded under the Expanding Link Up Measure.

Quantitative Deliverable: Demonstrated access to culturally appropriate social and emotional wellbeing and mental health services, measured by the number of client contacts.

2010-11 Target: 120,000 2010-11 Actual: Data will be available in 2012.

Result: Cannot be reported.

Data for 2010-11 is not yet available and will be published by the Australian Institute of Health and Welfare⁹⁶ in August 2012. The department anticipates the target of 120,000 client contacts will be met.

In 2009-10, there were approximately 176,000 client contacts with social and emotional wellbeing staff within Australian Government funded Aboriginal and Torres Strait Islander primary health care services, which exceeded the 2009-10 target of 110,000 client contacts.

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 social and emotional wellbeing staff. It is therefore considered an underestimate of culturally appropriate social and emotional wellbeing and mental health services.

Quantitative Deliverable:	Number of Link Up clients.
2010-11 Target:	4,450	2010-11 Actual:	7,227
Result: Deliverable met.
The target for client numbers was exceeded, reflecting the impact of additional funding for 19 community based projects to foster innovation, which aims to improve access to counselling services, awareness of Link Up Services, enhanced links between services and the promotion of referrals to mainstream mental health services. The additional program funding responded to program limitations identified in the 2007 review.
Quantitative Deliverable:	Number of reunions under Link Up.
2010-11 Target:	170	2010-11 Actual:	225
Result: Deliverable met.
The target for reunions was exceeded, reflecting the impact of funding for 16 additional Link Up staff, including caseworkers and administrative support, funded under the Expanding Link Up Measure.

Quantitative Deliverable:	Demonstrated access to culturally appropriate social and emotional wellbeing and mental health services, measured by the number of client contacts.
2010-11 Target:	120,000	2010-11 Actual:	Data will be available in 2012.
Result: Cannot be reported.
Data for 2010-11 is not yet available and will be published by the Australian Institute of Health and Welfare⁹⁶ in August 2012. The department anticipates the target of 120,000 client contacts will be met. In 2009-10, there were approximately 176,000 client contacts with social and emotional wellbeing staff within Australian Government funded Aboriginal and Torres Strait Islander primary health care services, which exceeded the 2009-10 target of 110,000 client contacts. 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 social and emotional wellbeing staff. It is therefore considered an underestimate of culturally appropriate social and emotional wellbeing and mental health services.

Through participation in the Stolen Generations Working Partnership Working Group, with the Department of Families, Housing, Community Services and Indigenous Affairs and two Stolen Generations peak bodies, the department has been addressing the priority issues of access to services, healing, justice systems and education identified within the Stolen Generations Working Partnership. Available at: www.aihw.gov.au

Petrol Sniffing Prevention

The department continued working to reduce the incidence and impact of petrol sniffing through the replacement of regular unleaded petrol with low aromatic Opal fuel in Kakadu National Park in the Northern Territory and the Goldfields region in Western Australia.

Communication activities that informed residents and tourists about the effectiveness and reliability of Opal fuel and its role in reducing petrol sniffing supported the introduction of Opal fuel in these regions. The department worked with the National Health and Medical Research Council and clinical experts to develop the Volatile Substance Use Clinical Practice Guideline that provides systematically developed recommendations for the management of volatile substance users in metropolitan, regional and remote communities.

Improve Workforce Capacity

The department continued to support Aboriginal and Torres Strait Islander peoples to enter the health workforce and ensure non-Aboriginal and Torres Strait Islander peoples receive the appropriate training to provide culturally appropriate health services.

This was achieved through the department’s support of Aboriginal and Torres Strait Islander health professional groups, including the Australian Indigenous Doctors Association, Indigenous Allied Health Australia, the National Aboriginal and Torres Strait Islander Health Worker Association, and the Aboriginal and Torres Strait Islander Health Registered Training Organisations National Network. The department also supported the training of Aboriginal and Torres Strait Islander health professionals through the Puggy Hunter Memorial Scholarship Scheme. In 2011, 327 students received a scholarship to pursue studies in a range of health disciplines including medicine, dentistry, nursing, allied health and Aboriginal and Torres Strait Islander health work.

Quantitative Deliverable:	Number of Puggy Hunter Memorial Scholarships allocated to support Aboriginal and Torres Strait Islander Australians to study health-related disciplines.
Academic Year 2011 Target:	265		2011 Academic Year Actual:		327 (287 full time and 40 part time)
Result: Deliverable met.
There are 327 (287 full time and 40 part time) scholarship recipients studying in the 2011 academic year. The Puggy Hunter Memorial Scholarships Scheme provide university and vocational education and training sector scholarships for students studying medicine, nursing, dentistry, allied health and for those wanting to be an Aboriginal and Torres Strait Islander Health Worker.
Quantitative Deliverable:	Percentage of variance between actual and budgeted expenses.
2010-11 Target:	≤0.5%	2010-11 Actual:		-2.7%
Result: Deliverable not met.
The total actual expenditure of $623.8 million against a budget of $640.5 million, resulting in a 2.7% variation. The underspend was caused largely by delays in the construction of health service facilities in rural and remote locations resulting from complex land tenure issues on Aboriginal land.

Outcome 8 – Financial Resources Summary

	(A) Budget Estimate¹ 2010-11 $’000	(B) Actual 2010-11 $’000	Variation (Column B minus Column A) $’000
Program 8.1: Aboriginal and Torres Strait Islander Health
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	640,481	623,799	(16,682)
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	61,060	60,629	(431)
Revenues from other sources (s31)	1,202	1,066	(136)
Unfunded depreciation expense	1,455	1,941	486
Operating loss / (surplus)	-	4	4
Total for Program 8.1	704,198	687,439	(16,759)
Outcome 8 Totals by appropriation type
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	640,481	623,799	(16,682)
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	61,060	60,629	(431)
Revenues from other sources (s31)	1,202	1,066	(136)
Unfunded depreciation expense	1,455	1,941	486
Operating loss / (surplus)	-	4	4
Total expenses for Outcome 8	704,198	687,439	(16,759)
Average Staffing Level (Number)	449	457	8
¹ Budgeted appropriations taken from the 2011-12 Health and Ageing Portfolio Budget Statements and re-aligned to the 2010-11 outcome structure.

⁸¹ABS and AIHW analysis of ABS mortality data (unpublished). Rates are from New South Wales, Queensland, Western Australia, South Australia, and Northern Territory combined.
⁸²Available at: www.aihw.gov.au
⁸³Source: ABSand AIHW analysis of ABSmortality data (unpublished) 1998-2008. Rates are from New South Wales, Queensland, Western Australia, South Australia, and Northern Territory combined.
⁸⁴Data 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. The small size of the Indigenous population leads to a wide variability year to year and therefore the forward projections include data confidence intervals.
⁸⁵Source: ABSand AIHW analysis of ABSmortality data (unpublished) 1998-2008. Rates are from New South Wales, Queensland, Western Australia, South Australia, and Northern Territory combined.
⁸⁶Data 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. The small size of the Indigenous population leads to a wide variability year to year and therefore the forward projections include data confidence intervals.
⁸⁷Source: ABSand AIHW analysis of ABSmortality data (unpublished) 1998-2008. Rates are from New South Wales, Queensland, Western Australia, South Australia, and Northern Territory combined.
⁸⁸Data 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. The small size of the Indigenous population leads to a wide variability year to year and therefore the forward projections include data confidence intervals.
⁸⁹Source: ABSand AIHW analysis of ABSmortality data (unpublished) 1998-2008. Rates are from New South Wales, Queensland, Western Australia, South Australia, and Northern Territory combined.
⁹⁰Source: ABSand AIHW analysis of ABSmortality data (unpublished) 1998-2008. Rates are from New South Wales, Queensland, Western Australia, South Australia, and Northern Territory combined.
⁹¹Source: AIHW National Perinatal Data Collection.
⁹²Source: AIHW National Perinatal Data Collection.
⁹³Data 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. The small size of the Indigenous population leads to a wide variability year to year and therefore the forward projections include data confidence intervals.
⁹⁴Available at: www.healthinfonet.ecu.edu.au
⁹⁵Available at: www.rhdaustralia.org.au/
⁹⁶Available at: www.aihw.gov.au

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