Outcome 8 - Indigenous Health

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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

Major Achievements

• 65,501 Medicare health assessments were provided to Aboriginal and Torres Strait Islander peoples aged 15 and over.
• Over 150,000 Aboriginal and Torres Strait Islander patients with, or at risk of, chronic disease accessed more affordable PBS medicines, with 96% of community pharmacies participating in the program.
• Seventy seven per cent of eligible Aboriginal and Torres Strait Islander Community Controlled Health Services achieved clinical accreditation under the Royal Australian College of General Practitioners Standard for general practices through assistance provided under the Establishing Quality Health Services-Continuation measure.
• The first collection of national KPI data for Indigenous specific primary health care services, through the new online reporting tool OCHREStreams, occurred in March 2012.
• Under the Remote Area Health Corps Program, 598 health professionals were placed in remote Aboriginal communities in the Northern Territory: they provided almost 2,000 weeks of health service delivery to help meet workforce shortages in remote areas.

Challenges

• Strengthening the capacity of the board of directors and senior management in the Aboriginal and Torres Strait Islander community controlled health sector to ensure robust governance practices are in place to deliver quality health outcomes.

Trends

Figure 8.1: Chronic disease related mortality rates from 1998 to 2031 required to close the gap ⁹⁶

Text version of Figure 8.1

Figure 8.1 shows that over the period 1998 to 2009 there has been a significant decrease in the Indigenous chronic disease mortality rate and a significant decrease in the non-Indigenous rate. There has been no significant change in the gap between the two populations.

Figure 8.2: Child mortality rates from 1998 to 2018 required to halve the gap ⁹⁷

Text version of Figure 8.2

Figure 8.2 shows that over the period 1998 to 2009 there has been a significant decrease in the Indigenous mortality rate for children under five years of age and a significant decrease in the non-Indigenous rate. Furthermore, the gap has significantly narrowed and is within the range required to meet the 2018 target.

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 in this chapter and through contributions from other Health and Ageing programs detailed below.

Table 8.1: Health and Ageing programs that make significant contributions to Aboriginal and Torres Strait Islander Health

Program 8.1: Aboriginal and Torres Strait Islander Health

Program 8.1 aims to improve: the prevention and management of chronic disease through the Aboriginal and Torres Strait Islander Chronic Disease Fund; access to maternal and child health services; access to effective primary health care services; and social and emotional wellbeing services.

Table 8.2 Australian Government Contribution to National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes

Aboriginal and Torres Strait Islander Chronic Disease Fund

The Aboriginal and Torres Strait Islander Chronic Disease Fund (the Fund)⁹⁸ was established on 1 July 2011, consolidating the majority of programs from the Indigenous Chronic Disease Package as well as funding for the National Coordination Unit funded through the Rheumatic Fever Strategy and funding for training of Aboriginal Health Workers in ear health.⁹⁹

The objectives of the Fund are to improve the prevention, detection and management of chronic disease in Aboriginal and Torres Strait Islander peoples to increase life expectancy.

In 2011-12, the Department consulted with stakeholders on implementation arrangements and developed operational guidelines. The Government has allocated some $834 million over the next four years to the Fund.

The Annual Progress Report 2010-11 against the Commonwealth’s Implementation Plan¹⁰⁰ was finalised in October 2011 and was distributed to states and territories and Aboriginal and Torres Strait Islander organisations in February 2012. The report notes that significant progress has been made in developing and rolling out initiatives under the Indigenous Chronic Disease Package, with new and increased services on the ground in many areas.

In September 2011, the Department distributed a discussion paper to key stakeholders, inviting submissions and comments on implementation arrangements for the Fund and the development of Fund guidelines. The discussion paper was also published on the Department’s website. The Department received 20 submissions during the consultation phase. These submissions were fully considered and helped inform the development of the Fund’s implementation arrangements and the Fund guidelines.

The Department released operational guidelines for the Fund in July 2012. The guidelines are available on the Department’s website.

Preventing Chronic Disease

The Department continued to raise awareness of the prevention of chronic disease in Aboriginal and Torres Strait Islander peoples. During 2011-12, 36 Regional Tackling Smoking and Healthy Lifestyle Teams were rolled out across Australia, 48 ‘Live Longer’ Healthy Community Day events were held and the Community Health Action Pack, a health promotion resource kit, was distributed nationally.

In 2011-12, Healthy Lifestyle Workers (who form part of the Regional Tackling Smoking and Healthy Lifestyle Teams) reported increased awareness and engagement with chronic disease prevention activity in Indigenous communities. These teams organised a wide range of smoke-free healthy lifestyle events and activities and promoted health checks.

The Department managed the ongoing implementation of 38 social marketing projects funded in the targeted round of the Local Community Campaigns to Promote Better Health Aboriginal and Torres Strait Islander Health Program. These projects are in a range of urban, regional and remote locations across Australia.

The funded projects promoted the adoption of healthy lifestyle behaviours for the prevention of chronic disease and increased use of health services for preventive purposes. The projects covered a wide range of activities, including communications and media initiatives, lifestyle modification and exercises, cultural camps and events promoting engagement with health services. Supporting communications complemented the projects, including the delivery of ‘Healthy Community Day’ events in communities across the country between April and December 2011, the provision of the Community Health Action Packs (a guide to health promotion and social marketing), and the promotion of healthy lifestyle messages on the Live Longer! Website.¹⁰¹

The National Coordinator Tackling Indigenous Smoking, Regional Tackling Smoking and Healthy Lifestyle Teams, members of the Tobacco Technical Reference Group and Quitlines all report a growing awareness and understanding in Indigenous communities of the impact of smoking on health outcomes and engagement in activities to reduce smoking in communities. This trend is also identified in Sentinel Sites Evaluation Reports.

Each of the 38 projects funded through the Local Community Campaigns to Promote Better Health measure encourages smoking cessation, with one specific anti-smoking project (in NSW Hunter region), as well as ten further projects which have distinct smoking cessation elements. The Community Health Action Pack and Live Longer! website also promote local anti-smoking activities.

The first national Indigenous specific anti-smoking campaign ’Break the Chain’ continues to be well received. Localised social marketing campaigns are also being developed across Australia as part of the COAG Tackling Smoking measure. With leadership from Dr Tom Calma, National Coordinator Tackling Indigenous Smoking, Regional Tackling Smoking and Healthy Lifestyle Teams have been implementing a range of local anti-smoking social marketing campaigns in their communities to raise awareness of the dangers of smoking, complementing the National Tobacco Campaign. Quitlines have also been enhanced to make their services more accessible and appealing to Aboriginal and Torres Strait Islander peoples.

Sentinel Sites evaluation has indicated improved levels of awareness of dangers of smoking among the target audience.

Improving the Detection and Ongoing Management of Chronic Disease

The uptake of Medicare Benefits Schedule (MBS) items for Aboriginal and Torres Strait Islander peoples continued to increase in 2011-12. MBS health assessments are important for preventing and detecting chronic disease. From July 2011 to June 2012, 65,501 health assessments were provided to Aboriginal and Torres Strait Islander peoples aged 15 years and over, an increase of 33.8 per cent compared to the 2010-11 financial year.

Ninety-six per cent of community pharmacies nationwide dispensed prescriptions to eligible Aboriginal and Torres Strait Islander patients under the Fund’s PBS Co-payment measure, with over 150,000 Aboriginal and Torres Strait Islander patients, with or at risk of chronic disease, accessing more affordable PBS medicines by 30 June 2012.

Eighty-seven full time equivelant (FTE) care coordinators employed within the Fund’s Care Coordination and Supplementary Services Program provided assistance to patients to access services identified in their chronic disease management plan. Access to specialists increased through the Urban Specialist Outreach Assistance Program available in all states and the Australian Capital Territory; and to specialists and allied health professionals through the Medical Specialist Outreach Assistance Program – Indigenous Chronic Disease for all states and territories, except the Australian Capital Territory.

Since implementation on 1 July 2010, the measure has proven to be highly successful with the number of Aboriginal and Torres Strait Islander patients accessing more affordable PBS medicines well above expectations. In addition, over 5,127 community pharmacies (approximately 96%) have dispensed prescriptions to eligible patients.

Since implementation on 1 July 2010, the measure has proven to be highly successful with the number of Aboriginal and Torres Strait Islander patients accessing more affordable PBS medicines well above expectations. In 2011-12, over 150,000 patients participated in the measure, which is well above the forecast number of 40,000.

63 of 75 eligible Aboriginal Community Controlled Health Services (ACCHS) are participating in the Subsidising PBS Medicine Co-payments Measure.

Ongoing evaluation processes have highlighted an emerging perception amongst stakeholders that the measure is providing a tangible improvement in access to, and affordability of, PBS medicines for Aboriginal and Torres Strait Islander patients, which in turn encourages more regular attendance for health care and better adherence to prescribed medicines.

The Section 100 (s100) Support Allowance (administered under the Fifth Community Pharmacy Agreement) aims to improve health outcomes for clients of remote area AHSs. AHSs that participate in special PBS supply arrangements under s100 of the National Health Act 1953 are paid an allowance. The allowance assists pharmacists and AHS staff in determining what services they need in delivering quality use of medicine support in accordance with the needs of their local community. Of the 174 approved remote area AHSs that participated in the s100 supply arrangements, 122 of these received QUM support and medication management services provided to them by 22 pharmacists.

The Department funded all states and the Australian Capital Territory to deliver urban specialist outreach services. The Northern Territory was not eligible for funding as there are no regions in the Northern Territory classified as Australian Standard Geographical Classification (ASGC) – Remoteness Areas (RA) 1 or 2 (major cities and inner regional). However, the Department funded outreach medical services in the Northern Territory through the Medical Specialist Outreach Assistance Program – Indigenous Chronic Disease measure.

During 2011-12 the Department funded organisations to provide culturally sensitive medical specialist outreach services for Aboriginal and Torres Strait Islander peoples in major cities and inner regional areas of all states and the Australian Capital Territory.

In 2011-12, 1,330 multidisciplinary team services were delivered through the MSOAP-Indigenous Chronic Disease measure. These services included specialist, allied health and general practitioner services.

440 existing health professionals received Chronic Disease Self-Management training from Flinders University of South Australia by 30 June 2012, a year ahead of schedule. To date, feedback from health professionals gathered by Flinders University suggests commitment and participation of Indigenous patients in self-management is increasing.

Building the Capacity of the Workforce

In 2011-12, the Fund supported activities to build the capacity of the Indigenous health workforce. Careers in Aboriginal and Torres Strait Islander health were promoted to Aboriginal and Torres Strait Islander secondary students, students in health-related disciplines and existing health professionals, through the national ‘Health Heroes’ advertising campaign’s ‘Do Something Real’ website.¹⁰²

Chronic Disease Self-Management training was provided to 440 health workers, well ahead of the target of 250. This training enables health workers to help Aboriginal and Torres Strait Islander peoples to better manage their chronic conditions and live healthier lifestyles.

In 2011-12, the Department funded 204.3 additional workforce positions for the prevention and management of chronic disease (149 Aboriginal and Torres Strait Islander Outreach Workers, 31 Practice Managers and 22.3 additional health professionals).

In addition, the Department funded 87 FTE care coordinators to assist Aboriginal and Torres Strait Islander patients with chronic disease to access specialist and allied health services.

As at 31 May 2012, 96 of the 121 Aboriginal and Torres Strait Islander Outreach Workers recruited had received orientation training. Forty-five Outreach Workers received training support. Some Outreach Workers were recruited later in the financial year and therefore not all were able to receive orientation training by 31 May 2012.

The Department is undertaking further consultation with stakeholders to ensure that Outreach Workers are aware of orientation and training options available to support them in their important role.

As at 30 June 2012, 37 regions have recruited Indigenous tobacco workers. The Department will roll out workforce positions in the remaining regions in 2012-13.

As at 30 June 2012, 75 healthy lifestyle workers have been employed over the life of the program.

Flinders University of South Australia is delivering specialist Chronic Disease Self-Management training which is suitable for delivery by health professionals to Indigenous Australians in a range of settings and circumstances.

The Attracting More People to Work in Indigenous Health measure has two key components; the ‘Health Heroes’ campaign, which targets Aboriginal and Torres Strait Islander secondary students – encouraging them to consider working in health and the ‘Do Something Real’ campaign, which targets existing health professionals and tertiary students in health courses – encouraging them to consider working in Aboriginal and Torres Strait Islander health.

The campaign’s focus is to drive traffic to the websites, increase exposure of real Health Heroes stories via videos online, market the campaign’s messages to target audiences, and engage with influencers such as career advisors and secondary schools. Activities undertaken to achieve this include:

• ‘Health Heroes’ mass media advertising campaign ran from July to November 2011;
• ‘Health Heroes’ website informing students about the range of health jobs, training options, career pathways and support available launched in July 2011; and
• ‘Do Something Real’ website launched August 2011.

  Non-Indigenous: 532-540  Non-Indigenous: 474

  Rate difference: 458-582  Rate difference: 418

In June 2012, the ABS published revised Indigenous and non-Indigenous mortality data for 2007, 2008 and 2009 due to an error in Western Australian data. Consequently, the targets published in the 2011-12 Portfolio Budget Statements need to be adjusted to reflect this revision. The 2009 Indigenous rate (892 per 100,000) was within the revised target for 2009 (849-942 per 100,000). The difference between Indigenous and non-Indigenous rates for 2009 (418 per 100,000) was also within the revised target for 2009 (356-449 per 100,000).

Over the period 1998 to 2009 there has been a significant decrease in Indigenous chronic disease mortality rates and a significant decrease in non-Indigenous rates and no significant change in the gap.

‘Closing the Gap’ is a long term commitment. It is anticipated that there will be a time lag between improved health system performance and improvements in mortality.

The Commonwealth’s Indigenous Chronic Disease Package, which commenced in 2009, was developed specifically to prevent and better manage chronic disease. The Package forms the Commonwealth contribution to the National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes.

  Non-Indigenous: 199-204  Non-Indigenous: 193

  Rate difference: 121-191  Rate difference: 148

In June 2012, the ABS published revised Indigenous and non-Indigenous mortality data for 2007, 2008 and 2009 due to an error in Western Australian data. Consequently, the targets published in the 2011-12 Portfolio Budget Statements need to be adjusted to reflect this revision. The 2009 Indigenous rate (340 per 100,000) was within the revised target for 2009 (298-351 per 100,000). The difference between Indigenous and non-Indigenous rates for 2009 (148 per 100,000) was also within the revised target for 2009 (95-148 per 100,000).

Over the period 1998 to 2009 there has been a significant decrease in Indigenous mortality rates for circulatory disease and a significant decrease in non-Indigenous rates. There has been a significant decrease in the gap.

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 2011-12, the Department continued to implement the Australian Nurse-Family Partnership Program, an evidence-based program that aims to improve pregnancy outcomes by helping women, who are pregnant with an Aboriginal and Torres Strait Islander child, engage in good preventive health practices, support parents to improve their child’s health and development, and help parents develop a vision for their own future, including continuing education and finding work.

As at 30 June 2012 there were 473 patients enrolled into the Australian Nurse-Family Partnership Program.

The first stage evaluation report, completed in June 2012, concluded that although well received by communities, the Program was not achieving economies of scale. Organisational capacity was also a limiting factor in expanding the Program to other sites. Feedback was given to key stakeholders and program providers in May 2012, prior to finalising the report.

The Department will use the findings of the evaluation report to continue to refine the program in the three implementation sites.

The Department also worked closely with Aboriginal Community Controlled Health Organisations to continue to improve and expand child and maternal health services for Aboriginal and Torres Strait Islander peoples, funding additional New Directions: Mothers and Babies Services, bringing the total number of services to 85.

In 2011-12, the Department exceeded the target and funded a total of 85 New Directions: Mothers and Babies Services. Organisations undertook activities in a variety of service delivery models, including home visiting, outreach models, provision of antenatal classes, and education and awareness about early childhood development. The New Directions: Mothers and Babies Services program constitutes the Australian Government’s contribution to the Indigenous Early Childhood Development National Partnership.

The Australian National Audit Office (ANAO) conducted an audit of the New Directions: Mothers and Babies Services program between July 2011 and March 2012 and the final report was tabled in Parliament on 29 May 2012. The ANAO made one recommendation pertaining to performance monitoring of the program and the Department has commenced a range of activities to address the report’s recommendation.

The Department continued to support the Healthy for Life Program. This Program enhances the capacity of over 100 primary health care services caring for Aboriginal and Torres Strait Islander peoples. It improves the quality of child and maternal health services, chronic disease care and the capacity of the Indigenous health workforce.

The IECD NP specifies that jurisdictions are to report progress against the 10 performance indicators in annual reports to the Department of Education, Employment and Workplace Relations for Element 1 and the Department of Health and Ageing for Elements 2 and 3. However, as there is no agreed approach to measure performance indicators 1 and 4, other ways of collecting these data are currently being explored by the IECD NP Steering Committee. Reporting on health related indicators 5 to 10 was delayed while issues pertaining to indicators 1 to 4 were being resolved. Given that data are available from existing national data collections, the Steering Committee agreed that reporting for indicators 5 to10 will commence from August 2012.

  Non-Indigenous: 93-105  Non-Indigenous: 99

  Rate difference: 77-153  Rate difference: 115

In June 2012, the ABS published revised Indigenous and non-Indigenous mortality data for 2007, 2008 and 2009 due to an error in Western Australian data. Consequently, the targets published in the 2011-12 Portfolio Budget Statements need to be adjusted to reflect this revision. The 2009 Indigenous rate (214 per 100,000) was within the revised target for 2009 (170-241 per 100,000). The difference between Indigenous and non-Indigenous rates for 2009 (115 per 100,000) was also within the revised target for 2009 (70-142 per 100,000).

Over the period 1998 to 2009 there has been a significant decrease in Indigenous child mortality rates and a significant decrease in non-Indigenous child mortality rates. There has been a significant decrease in the gap.

  Non-Indigenous: 3.9-4.5  Non-Indigenous: 4.1

  Rate difference: 1.7-3.5  Rate difference: 2.7

In June 2012, the ABS published revised Indigenous and non-Indigenous mortality data for 2007, 2008 and 2009 due to an error in Western Australian data. Consequently, the targets published in the 2011-12 Portfolio Budget Statements need to be adjusted to reflect this revision. The 2009 Indigenous rate (6.8 per 1,000) was within the revised target for 2009 (5.8-8.7 per 1,000). The difference between Indigenous and non-Indigenous rates for 2009 (2.7 per 1,000) was also within the revised target for 2009 (2.2-4.4 per 1,000).

Over the period 1998 to 2009 there has been a significant decrease in Indigenous infant mortality rates and a significant decrease in non-Indigenous infant mortality rates. There has been a significant decrease in the gap.

  Non-Indigenous: 5.8-6.0  Non-Indigenous: 5.9

  Rate difference: 5.4-6.7  Rate difference: 6.0

The 2009 Indigenous rate (11.9 per 100 live births) and the rate difference (6.0 per 100 live births) were within the confidence intervals in the 2011-12 Portfolio Budget Statements projection for 2009. Longer term analysis from 1991 to 2009 shows that the Indigenous rate has increased significantly and the gap has widened.

  Non-Indigenous: 98.4-99.4  Non-Indigenous: 98.7

  Rate difference: 4.2-0.5  Rate difference: -1.4

Over the period 1998 to 2009 rates of attendance at antenatal visits increased significantly for Indigenous mothers. The gap between Indigenous and non-Indigenous mothers has also narrowed significantly. The 2009 Indigenous rate (97.3 per 100 mothers) and the rate difference (-1.4 per 100 mothers) were within the confidence intervals in the 2011-12 Portfolio Budget Statements projection for 2009.

Improve Access to Effective Health Services

Access to comprehensive primary health care is critical for the prevention of ill health and to effectively manage chronic disease and improve health outcomes to close the gap between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians.

In 2011-12, the Department provided grant funding to approximately 300 organisations to deliver comprehensive primary health care and other health services to meet community needs. These included clinical services for the treatment of illnesses, emergency care, management of chronic conditions and referral, as well as a range of population health programs that respond to community needs. Of the approximately 300 organisations, 178 (approximately 60 per cent) were Aboriginal and Torres Strait Islander Community Controlled Health Services.

In 2011- 12, the Department, in conjunction with the Australian Institute of Health and Welfare, introduced the reporting of national Key Performance Indicators (nKPIs) for the Aboriginal Community Controlled Health Sector. These nKPIs monitor the performance of Indigenous-specific primary health care services in meeting COAG’s two health related targets of closing the gap in Indigenous life expectancy within a decade, and halving the gap in mortality rates for Indigenous children under five within a decade. In March 2012, 88 services which had previously received Healthy for Life funding, participated in a trial reporting the first 11 nKPIs, through a new web-based reporting tool, OCHREStreams. It is expected that within the next two years Indigenous-specific primary health care services, funded by the Department and states and territories, will report on 24 nKPIs.

In 2010-11, Australian Government funded Aboriginal and Torres Strait Islander primary health care services provided 2.5 million episodes of care, compared with a target of 1.8 million. Of these, 2.1 million episodes of care were provided to Aboriginal and Torres Strait Islander peoples. This proportion is similar to the previous year (84% and 86% respectively).

It is expected that this indicator for 2011-12 will also be met; however, data will not be available for 2011-12 until it is published by the Australian Institute of Health and Welfare in 2013.

Capacity Building

The Department established a Governance Enhancement Working Group to provide advice on governance models for community controlled Aboriginal health services. The priority focus for the Working Group has been to progress the development of ‘National Guiding Principles’ for the Aboriginal and Torres Strait Islander Community Controlled Health Sector as a tool to support and strengthen good governance.

The Department will continue to work with the sector to address other major issues for reform, such as CEO recruitment and performance appraisal, models for board membership and constitutions.

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.

In 2011-12, a further 22 eligible Indigenous health organisations achieved accreditation against Australian health care accreditation standards, with 125 of a total number of 198 eligible Indigenous health organisations now either clinically or organisationally accredited. Of those eligible Indigenous health organisations able to achieve clinical accreditation, 77% are now accredited and able to access financial incentives related to primary health care delivery.

To underpin continued strong Indigenous health sector interest in achieving accreditation, in 2012-13, a number of private providers have been engaged to work closely with the sector to further promote uptake.

National Aboriginal and Torres Strait Islander Health Plan

Development of a National Aboriginal and Torres Strait Islander Health Plan (NATSIHP) aims to improve access to essential health services for Aboriginal and Torres Strait Islander Australians and give effect to the Government’s undertaking to close the gap in life expectancy and infant mortality between Aboriginal and Torres Strait Islander Australians and the broader population. This year, the Department established a Stakeholder Advisory Group (co-Chaired by David Learmonth, Deputy Secretary and Jody Broun co-Chair of the National Congress of Australia’s First Peoples). During 2011-12, two meetings were held which facilitated Aboriginal and Torres Strait Islander people’s contribution to the development of the NATSIHP. In addition, the National Aboriginal and Torres Strait Islander Health Equality Council hosted two roundtables which also provided significant input and advice to support development of the NATSIHP.

Expanding Health Service Delivery Initiative

The Department continued to fund additional health professional positions in the Northern Territory through the Expanding Health Service Delivery Initiative (EHSDI) to improve both the quality and access to primary care services in remote areas. In 2011-12, $17.8 million was provided to the Northern Territory Government and $15.8 million was provided to Aboriginal Community Controlled Health Organisations (ACCHOs) in the Northern Territory to fund 222 additional primary health care positions. These positions included doctors, nurses, Aboriginal Health Workers, and allied health and program delivery workers. The Department also continued to support reform of the primary health care system in the Northern Territory through planning for and development of regional service and governance models.

Improvements to safety, quality and access to services continued through the implementation of two key reforms: establishment of a set of core primary health care services for primary health care providers to use for health planning; and a framework for applying quality improvement in all primary health care services across the Northern Territory.

Over 60% of all primary health care service providers used the core services framework and tool to plan services in 2011-12.

In the Northern Territory, over 300 primary health care staff participated in Continuous Quality Improvement training at three regional centres through 11 workshops for primary health staff, visiting specialists and managers. All primary health care providers developed service plans linked to the Northern Territory Aboriginal Health Key Performance Indicators, enabling monitoring and management of service performance in the critical areas of child and maternal health and the management of chronic disease.

All primary care providers in the Northern Territory are required to report against the Northern Territory Aboriginal Health Key Performance Indicators. Out of a total of 84 clinics and health centres, 84 reported in August 2011 and 84 reported in February 2012. Data quality is meeting expectations for this stage of the program.

Rural Area Health Corps recruits urban based health professionals for short term placements in remote primary health care services in the Northern Territory. Placement numbers were exceeded due to an increase in demand, greater availability of staff for repeat placements and an increased awareness of the program.

The Northern Territory Department of Health and several Aboriginal Community Controlled Health Organisations were funded to provide dental follow-up services in 2011-2012 and the target for this year was met.

Mobile Outreach Service Plus

In 2011-12, 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 appropriate 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 or related trauma. Services are delivered by mobile teams based in Darwin and Alice Springs.

During the year, 448 visits were made to 87 communities to provide casework, community education and external professional development in 12 remote Health Service Delivery Areas.

Improve Social and Emotional Wellbeing

In 2011-12, the Department provided funding for social and emotional wellbeing services including counselling, family tracing and reunion services to members of the Stolen Generations through a cohesive Social and Emotional Wellbeing Program. Funding was provided to the existing network of Link Up services and to existing mental health staff in over 90 ACCHOs across Australia and to Workforce Support Units and Indigenous Registered Training Organisations providing associated workforce support and development. National coordination and support was provided, aimed at building capacity and developing good practice including the first Social and Emotional Wellbeing Program National Conference held in Adelaide on 4-7 June with around 230 participants.

Data for 2011-12 is not yet available and will be published by the Australian Institute of Health and Welfare¹¹³ in August 2013. The Department anticipates the target of 130,000 client contacts will be met. In 2010-11, there were approximately 187,000 client contacts with social and emotional wellbeing staff within Australian Government funded Aboriginal and Torres Strait Islander primary health care services, which exceeded the 2010-11 target of 120,000 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.

A consultant has been engaged to work with a stakeholder Working Group to develop the renewed Social and Emotional Wellbeing Framework. A final draft of the renewed framework is expected to be available in March 2013.

The above number represents active clients as at 30 June 2012.

While the number of reunions did not achieve the target figure, some Link Up clients may not have requested a reunion.

As well as the above services providing direct client support, the program funds training, development and support for the social and emotional wellbeing workforce.

In providing a holistic service to clients, social and emotional wellbeing services are required to collaborate with other service providers to provide a network of support.

Whole of Program Performance Information

In 2011-12, the Department provided relevant evidence-based policy research in a timely manner through high quality data, analysis and reporting to support policy and program development. These activities included:

• preparation for the development of the National Aboriginal and Torres Strait Islander Health Plan;
• 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 COAG performance indicator development, closing the gap targets and support for national data activities; and
• funding the Australian Indigenous HealthInfoNet¹¹⁴ an internet resource for policy and research material on Aboriginal and Torres Strait Islander health.

The Department continued to consult and engage with key stakeholders throughout the implementation of National Health Reform activities and other program development activities. Stakeholders were engaged through a range of avenues including:

• the National Aboriginal and Torres Strait Islander Health Equality Council and its Portfolio Working Groups;
• the National Aboriginal Community Controlled Health Organisation and other peak representative bodies in Indigenous health;
• The National Congress of Australia’s First Peoples;
• Indigenous Health Partnership Forums in states and territories;
• ongoing feedback from Indigenous health service providers; and
• the Governance Enhancement Working Group.

The variance reflects the higher than anticipated take-up of the Practice Incentive Program – Indigenous Health Incentive (PIP-IHI) stream in 2011-12. The PIP IHI aims to support general practices and Indigenous health services to provide better health care for Aboriginal and Torres Strait Islander Australians, including best practice management of chronic disease.

Outcome 8 – Financial Resources Summary

1. Departmental appropriation combines ‘Ordinary annual services (Appropriation Bill 1)’ and ‘Revenue from independent sources (s31)’.
2. ’Expenses not requiring appropriation in the current year’ is made up of depreciation expense, amortisation, make good expense and audit fees. This estimate also includes approved operating losses – please refer to the departmental financial statements for further information.

96. ABS and AIHW analysis of ABS mortality data (unpublished). Rates are from New South Wales, Queensland, Western Australia, South Australia and Northern Territory combined.
97. ABS and AIHW analysis of ABS mortality data (unpublished). Rates are from New South Wales, Queensland, Western Australia, South Australia and Northern Territory combined.
98. In the 2011-12 Budget the Australian Government announced the consolidation of 159 whole or part Health and Ageing programs within 18 flexible Funds. The Aboriginal and Torres Strait Islander Chronic Disease Fund is one of the 18 Funds that came into operation from 1 July 2011. The establishment of flexible Funds will, over time, reduce red-tape for funding recipients in line with the National Compact, provide increased flexibility to government to respond to emerging health and ageing issues, and deliver better value for money and evidence-based funding.
99. A full list of activities consolidated into each flexible Fund is provided at Part 3.6: Activities Consolidated to Establish Flexible Funds.
100. Available at: www.health.gov.au/internet/ctg/publishing.nsf/Content/ctg-2010-11-annual-progress-report
101. Available at: www.livelonger.health.gov.au
102. Available at: www.dosomethingreal.govspace.gov.au/
103. Totals are cumulative over the life of the measure.
104. Figures are cumulative in line with reporting requirements.
105. Figures are cumulative in line with reporting requirements.
106. Figures are cumulative in line with reporting requirements.
107. ABS and AIHW analysis of ABS mortality data 1998-2009 (unpublished). Rates are from New South Wales, Queensland, Western Australia, South Australia and Northern Territory combined. Due to data quality issues with Western Australian deaths data, Indigenous mortality rates were overstated for 2007, 2008 and to a lesser extent 2009. The ABS has since revised Western Australian mortality data and the 2009 actual rates in this Annual Report reflect this revision.
108. ABS and AIHW analysis of ABS mortality data 1998-2009 (unpublished). Rates are from New South Wales, Queensland, Western Australia, South Australia and Northern Territory combined. Due to data quality issues with Western Australian deaths data, Indigenous mortality rates were overstated for 2007, 2008 and to a lesser extent 2009. The ABS has since revised Western Australian mortality data and the 2009 actual rates in this Annual Report reflect this revision.
109. ABS and AIHW analysis of ABS mortality data 1998-2009 (unpublished). Rates are from New South Wales, Queensland, Western Australia, South Australia and Northern Territory combined. Due to data quality issues with Western Australian deaths data, Indigenous mortality rates were overstated for 2007, 2008 and to a lesser extent 2009. The ABS has since revised Western Australian mortality data and the 2009 actual rates in this Annual Report reflect this revision.
110. ABS and AIHW analysis of ABS mortality data 1998-2009 (unpublished). Rates are from New South Wales, Queensland, Western Australia, South Australia and Northern Territory combined. Due to data quality issues with Western Australian deaths data, Indigenous mortality rates were overstated for 2007, 2008 and to a lesser extent 2009. The ABS has since revised Western Australian mortality data and the 2009 actual rates in this Annual Report reflect this revision.
111. AIHW National Perinatal Data Collection.
112. AIHW National Perinatal Data Collection.
113. Available at: www.aihw.gov.au
114. Available at: www.healthinfonet.ecu.edu.au

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