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Annual Report - Outcome 8: Indigenous Health > Part 1 Outcome Performance Report

Major Achievements

  • Replaced regular unleaded petrol with non-sniffable Opal fuel in an additional 45 sites, bringing the total number of sites receiving Opal fuel to 104. There was a complete replacement of regular unleaded fuel with Opal in Alice Springs. Evidence has shown a reduction in petrol sniffing in the Anangu Pitjantjatjara Yankunytjatjara Lands by more than 80 per cent since the introduction of Opal fuel.
  • Conversion of 151 positions subsidised by the Community Development Employment Projects Program in primary health care and substance use organisations funded through the Aboriginal and Torres Strait Islander program to permanent fully-waged positions.
  • Halved the number of Aboriginal and Torres Strait Islander health organisations with efficiency issues rated to be of serious concern to the Department, through improved risk management and support strategies.
  • Provided funding for 22 additional counsellor positions in response to the report Evaluation of the Bringing Them Home and Indigenous Mental Health Programs, which was publicly released on 9 May 2007.
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Challenge

  • While the number of Aboriginal and Torres Strait Islander health organisations with efficiency issues of serious concern to the Department was significantly reduced, as at March 2007, 21 (10 per cent) of Aboriginal and Torres Strait Islander health organisations were rated to be of serious concern requiring significant additional support from the Department. Support was in the form of business and clinical management expertise, to improve governance and management and ensure continued service delivery.
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Key Strategic Directions for 2006–07

Improved Access to and Responsiveness of the Mainstream Health System


The Department continued to work with Medicare Australia to improve Indigenous Australians’ uptake of Medicare and the Pharmaceutical Benefits Scheme. In response to the findings of a national review investigating current barriers in Aboriginal and Torres Strait Islander access to Medicare and major health programs, the Department conducted workshops for Aboriginal and Torres Strait Islander primary health care services who receive payment of Medicare rebates through exemptions under subsection 19(2) of the Health Insurance Act 1973. Nine workshops in eight locations across the country provided information on Medicare and the major health programs of the Department, and were attended by 90 of the 114 services that bulk bill Medicare. The workshops were well received and seven more services have since begun attracting Medicare rebates as a result of the workshops.

Brokerage Services

The Sydney South West Indigenous Community Health Brokerage Service was funded in June 2007 as the first of five urban brokerage services to be funded under the Improving Indigenous Access to Health Care Services Initiative. Urban brokerage services provide Aboriginal and Torres Strait Islander people in urban or regional areas with an identifiable and accessible entry point to the health care system to increase choice and access to culturally appropriate mainstream health services.

Pharmaceutical Benefits Scheme Listings

From 1 August 2006, the Pharmaceutical Benefits Scheme included new medicines specific to Aboriginal and Torres Strait Islander people. The new listings approved to date include iron and folic acid supplements, thiamine, a variety of topical antifungal agents, hookworm treatment and a new treatment for chronic otitis media. The Pharmaceutical Benefits Scheme was also amended to enable all Aboriginal and Torres Strait Islander people in very high risk categories to access lipid-lowering therapy at any cholesterol level. The new items can only be prescribed to people who self-identify as Aboriginal and/or Torres Strait Islander.

Child Health Checks

Following the Council of Australian Governments (COAG) meeting in July 2006, the Government provided funding over two years for an accelerated roll-out of the Medicare Benefits Schedule Aboriginal and Torres Strait Islander Child Health Check in up to ten remote regions across Australia, as one of the supporting health-related measures within COAG’s package of policing, justice, and governance initiatives. Following bilateral discussions with State and Territory governments, implementation will commence from July 2007.

As part of the communications strategy to promote the uptake of the Medicare Benefits Schedule Aboriginal and Torres Strait Islander Child Health Check, the National Aboriginal and Torres Strait Islander Child Health Check Roadshow visited 24 communities and health services across Australia from August to November 2006. Led by Nova Peris, along with other prominent Indigenous persons, the roadshow travelled to community events, festivals, Aboriginal Medical Services and other health services to encourage Indigenous parents and their children to go to their local health service or general practitioner for a health check. From April to October 2007 the roadshow will travel to all states and territories, working with local health services in 47 communities to promote healthy lifestyles and regular health checks for Indigenous children, as well as adults.

Since it was introduced in May 2006, there have been 5,347 Medicare Benefits Schedule Aboriginal and Torres Strait Islander Child Health Checks conducted nationally in the 12 months to the end of April 2007.

Workforce Development

With the graduation of 26 Puggy Hunter Memorial Scholarship Scheme recipients in 2006, the supply of Aboriginal and Torres Strait Islander health professionals increased. A further 70 full-time equivalent scholarship recipients commenced studies in 2007.

To improve access to and responsiveness of the mainstream health system, as of September 2006 the Department consolidated the majority of its workforce programs into the Mental Health and Workforce Division. Consequently the majority of Indigenous health workforce reporting will occur under Outcome 12.

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Complementary Action through Aboriginal and Torres Strait Islander Specific Health and Substance Use Services


Indigenous-specific Health Service Delivery

The Department worked to improve access to comprehensive primary health care for Aboriginal and Torres Strait Islander people during
2006–07, particularly in rural and remote areas. This included funding for the recruitment of additional health professionals and administrative staff to four remote and less accessible primary health care sites in Cape York (Queensland), Toomelah (New South Wales), Wadeye (Northern Territory) and the Wheatbelt (Western Australia) through the Improved Primary Health Care Initiative. In addition, the Department provided new funding for the expansion of ten multi-disciplinary teams of health professionals and provision of capital infrastructure to support expanded services in rural and remote areas under the Improving Indigenous Access to Health Care Services Initiative.

Through these and other activities in 2006–07, the Department increased access to primary health care services for Aboriginal and Torres Strait Islander people, providing funding for over 66 additional health workers, including 16 general practitioners, 24 nurses, 26 Aboriginal and Torres Strait Islander health workers, and 235 additional other service and support positions (including other health professionals, patient transport drivers and child/youth health workers). In addition, over 32 new capital works projects were completed. This included 14 health staff houses in remote areas and 18 projects to establish new, and enhance existing, health facilities.

Indigenous Australians working in Aboriginal and Torres Strait Islander primary health care and substance use services under the Community Development Employment Projects Program in 2006–07 received increased recognition and employment opportunities under the Improving Indigenous Health Worker Employment Initiative. The Department provided funding to convert 151 Community Development Employment Projects subsidised positions to permanent, fully waged employment, with 102 positions having been filled permanently as at June 2007.

Focus on Improving Efficiency and Effectiveness

The Department focused on ensuring in 2006–07 that the quality and effectiveness of all primary health care services provided by Aboriginal and Torres Strait Islander community controlled health organisations is equivalent to that generally available within the Australian health care system. This year saw the final phase of the roll-out of the Service Development and Reporting Framework to Government-funded Indigenous health organisations to consolidate and streamline reporting requirements for these services. In a joint project with the New South Wales Department of Health, state-funded Indigenous health services also adopted the Service Development and Reporting Framework as their reporting mechanism.

The Continuous Quality Improvement Initiative expands upon the Service Development and Reporting Framework to deliver improved business and strategic planning to enhance service delivery throughout the Aboriginal and Torres Strait Islander community controlled health sector. In 2006–07, 19 Government-funded Indigenous health services engaged in three-year Continuous Quality Improvement Initiative projects which have a whole-of-organisation focus and are supported by the expertise of Quality Facilitators.

The Department also established the National Excellence Awards in Aboriginal and Torres Strait Islander Health to showcase the achievements of individuals and organisations in improving the quality of health care for Aboriginal and Torres Strait Islander people. Nominations for the 2007 Excellence Awards opened in June 2007. The awards highlight innovation and leadership and promote quality in health service delivery.

Improving the efficiency of Aboriginal and Torres Strait Islander health organisations remains a priority focus for the Department. While most organisations are well managed, and the number of services rated to be of serious concern to the Department has halved, a small number require support to improve governance, management and service delivery. A review of the Risk Assessment Procedure, introduced in 2004, will align with Australian and New Zealand Risk Management Standards and further improve early identification of, timely response to, and reporting on, crucial risk factors as well as facilitate self-assessment by organisations.

Targeting Community Health Priorities

Through the Healthy for Life Program, over 80 primary health care services provide additional child and maternal health services to Aboriginal and Torres Strait Islander mothers and babies. Healthy for Life is also improving the delivery of chronic disease prevention, identification and management to Aboriginal and Torres Strait Islander people.

The Department increased the number of aged care places in Alice Springs for Indigenous people with renal disease by 30 during 2006–07, providing improved care and accommodation options for older renal patients relocating for treatment. Funding was also provided for new Nurse Case Manager positions (Renal) in four Aboriginal Community Controlled Health Services across the Northern Territory to case manage all Aboriginal and Torres Strait Islanders with advanced chronic kidney disease in their respective regions. The Department negotiated, and is a significant partner in, a second Shared Responsibility Agreement between Commonwealth agencies and the Western Desert Nganampa Walytja Palyantjaku Tjutaku Aboriginal Corporation, to consolidate the renal support services currently provided in Kintore and Alice Springs.

To provide high quality national data and improved monitoring of the disease, the Department established a national Trachoma Surveillance and Reporting Unit, and Western Australia and Northern Territory health departments were also funded to enhance trachoma training and screening programs within their jurisdictions.

Social Health Programs

The Department continued to fund a range of programs during 2006–07 to reconnect families and provide social and emotional wellbeing, mental health services and workforce support to Indigenous Australians. These included the Bringing Them Home Counsellors, Mental Health Services, Social and Emotional Well Being Regional Centres and the Link Up Program.

To evaluate these programs, the Department engaged Urbis Keys Young, who publicly released their report, Evaluation of the Bringing Them Home and Indigenous Mental Health Programs, on 9 May 2007, accessible at www.health.gov.au/bringingthemhome. This report found the Link Up and Bringing Them Home Programs to have provided services to a large number of Indigenous clients in a culturally appropriate manner, and there was a generally high level of client satisfaction with services. The report outlined future directions and actions regarding the programs. In response to this report, funding for an additional 22 counsellor positions for Link Up services nationally was announced on 24 May 2007.

Expanding Drug and Alcohol Treatment and Rehabilitation Services

During 2006–07, the Department increased the number of Aboriginal and Torres Strait Islander substance use services funded under the Substance Use Program from 64 to 70. Of these services, 42 are Aboriginal and Torres Strait Islander specific substance use services (including 29 services providing residential care) and 28 receive funding as part of Indigenous primary health care services.

The Department commenced implementation of the Addressing Violence and Child Abuse in Indigenous Communities: Drug and Alcohol Treatment and Rehabilitation Services for Indigenous Australians in Remote and Regional Areas Initiative and reached agreement with South Australia, Western Australia and the Northern Territory on new and expanded services.

Addressing Petrol Sniffing

The Department contributed to the whole-of-government Petrol Sniffing Strategy Eight Point Plan during 2006–07. Under the plan, the Department took the lead in rolling out non-sniffable Opal fuel, implementing communication activities and increasing access to treatment and rehabilitation services in the designated regions. In February 2007, the East Kimberley was announced as a designated region for the petrol sniffing strategy and the Central Desert Region in the Northern Territory was expanded.

The availability of non-sniffable Opal fuel was extended to an additional 45 sites and the total number of sites receiving Opal fuel expanded to 104, including 72 remote Aboriginal communities, three pastoral properties and 29 service stations and roadhouses. All 11 service stations in Alice Springs replaced regular unleaded fuel with non-sniffable Opal unleaded fuel in March 2007. A local multimedia campaign implemented in February and March 2007 provided crucial contributions to the success of the Opal fuel roll-out in Alice Springs.

Early evidence shows that the roll-out of Opal fuel is having a positive impact, with an 80 per cent reduction in the prevalence of petrol sniffing in the Anangu Pitjantjatjara Yankunytjatjara Lands since the introduction of Opal fuel. Anecdotal evidence suggests a 95 per cent decrease in petrol sniffing in the western desert communities in the Northern Territory.

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Improved Service Delivery and Outcomes


Council of Australian Governments Whole-of-Government Trials

The Department continues to take a lead role in seeing through Government commitments in the Anangu Pitjantjatjarra Yankunytjatjara (APY) Lands.

Two particular projects included the Mai Wiru Regional Stores Policy and the PY Ku Network. The Mai Wiru Regional Stores Policy focused in 2006–07 on improving the availability and affordability of healthy food supplies, while the PY Ku Network of transaction centres located in each community, aimed to improve access to a wide range of social and community services on the APY Lands. This also involved linking financial services and consumer literacy with banking services through the PY Ku Network.

Both the Mai Wiru Regional Stores Project Policy and the PY Ku Network also improved training and employment opportunities for communities on the APY Lands, with approximately 18 local people employed.

Eight Shared Responsibility Agreements were signed on the APY Lands. These focus on improving housing infrastructure, early childhood, employment and health outcomes.

In addition, the Tjungungku Kuranyukutu Palyantjaku Regional Forum, consisting of representatives from local Anangu service providers, the Commonwealth and the South Australian Government, continued to provide guidance for whole-of-government activity on the APY Lands.

The Government’s Indigenous Affairs Arrangements

Immediately following the Prime Minister’s announcement on 21 June 2006 of the Government’s response to the Ampe Akelyernemane Meke Mekarle Little Children are Sacred report on the sexual abuse of Indigenous children in the Northern Territory, the Department established a Northern Territory Emergency Coordination Centre to coordinate the key health activities in support of the whole-of-government response. The Department also continued to be involved in policy and program development work relating to the Government’s Indigenous affairs arrangements during 2006–07, which included engagement with Indigenous Coordination Centres.

As at 30 June 2007, the Department financially supported more than 20 signed Shared Responsibility Agreements and administered non-financial contributions to others. The Department also contributed to two Regional Partnership Agreements.

Improving the Capacity of Workers in Indigenous Communities

The Department collaborated across governments and the health sector during 2006–07 to implement the COAG Indigenous mental health initiative Improving the Capacity of Workers in Indigenous Communities. Under this initiative, the Department provided funding to engage professional services to develop a five-day in-service mental health training program for Aboriginal Health Workers and to deliver culturally appropriate Mental Health First Aid training programs. During 2007, two mental health first aid instructor workshops were delivered in Orange, New South Wales and Cairns, Queensland.

In 2007, the Department engaged a consultant to develop a multi-media mental health resource package to support Aboriginal Health Workers, counsellors and other clinical staff in Aboriginal and Torres Strait Islander health services to recognise and treat common mental health conditions and contributing lifestyle factors. It
also supported an additional ten mental health worker positions nationally during the year.


Produced by the Portfolio Strategies Division, Australian Government Department of Health and Ageing.
URL: http://www.health.gov.au/internet/annrpt/publishing.nsf/Content/outcome-08-part-1-outcome-performance-report-3
If you would like to know more or give us your comments contact: annrep@health.gov.au