In 2007–08, the Department worked to implement the key findings of a national review that identified barriers in Aboriginal and Torres Strait Islander access to Medicare funded health services and the Pharmaceutical Benefits Scheme.
In particular, the Department established a two-year project to improve the health outcomes of Aboriginal and Torres Strait Islander peoples who attend project-participating Aboriginal Community Controlled Health Services in rural and urban areas. The project provides structured support for Quality Use of Medicines in Aboriginal Community Controlled Health Services, via community pharmacy, through the implementation of service level Quality of Use Medicines work plans. It aims to improve access to Pharmaceutical Benefits Scheme medicines through trialling interventions that address cultural, transport and financial barriers to access. The project will operate until March 2010.
The Department also worked towards improving access to responsive, mainstream health systems through the delivery of Aboriginal and Torres Strait Islander health workforce initiatives. Achievements for this year are discussed in the Outcome 12 – Health Workforce Capacity chapter.
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 their choice of, and access to, culturally appropriate mainstream health services.
During the year, the Department funded the Canning Division of General Practice Limited (in partnership with the Derbarl Yerrigan Health Service Incorporated), to become the second urban brokerage service under the Improving Indigenous Access to Health Care Services initiative. This brokerage service will provide the link between mainstream health care providers and the Aboriginal and Torres Strait Islander people in metropolitan Perth.
The Department will undertake another funding round in 2008–09 to select the three remaining brokerage services under this initiative.
Extensive international and local evidence has established that nurse-led home visiting programs for mothers and babies are an effective way to improve outcomes for vulnerable and disadvantaged children.
In 2007–08, the Department commenced implementation of the Health@Home Plus initiative – a nurse-led home visiting program for Aboriginal and Torres Strait Islander babies and their mothers. The Department negotiated a license to use the internationally-recognised Nurse Family Partnership home visiting model and supporting materials for this program in Australia. The Department also provided funding for the first three home visiting sites in Alice Springs, Cairns and Melbourne. Home visiting services will commence in these sites during 2008–09.
A major achievement was the provision of funding through the New Directions: An Equal Start in Life for Indigenous Children initiative to five new Mothers and Babies Services which will provide Aboriginal and Torres Strait Islander children and their mothers with access to antenatal care, standard information about baby care, and practical advice. Mothers will receive parenting assistance through the initiative, while children will benefit by having their developmental milestones monitored by a primary health care service. They will also have their hearing, sight and speech tested before starting school. Up to 15 new Mothers and Babies Services will be established in areas of high need during 2008–09 with further services considered each year.
During the year, the Department continued to work with services rated as high or extreme risk. Assistance was provided with financial, management and governance issues through the provision of professional support by financial administrators and health management advisors. Further assistance was provided to organisations in the areas of governance training and support, organisational and service delivery reviews and funding for regional state and territory workshops on governance and financial and risk management.
The Department increased the number of Aboriginal and Torres Strait Islander substance use services funded under the substance use program from 70 to 93. Of these, 46 were Aboriginal and Torres Strait Islander specific substance use services (including 30 providing residential care), and 46 received funding as part of Indigenous primary health care services. The remaining service was a state peak body for drug and alcohol services. The Aboriginal and Torres Strait Islander Substance Use Program supports the delivery of culturally appropriate treatment and rehabilitation programs to Indigenous communities across Australia through recurrent funding to service providers. The program aims to improve access to substance use services by Aboriginal and Torres Strait Islander people in urban, regional and remote Australia.
The Department also continued 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, with funding agreements for new and expanded drug and alcohol services being signed in Western Australia, Queensland, the Northern Territory, New South Wales and South Australia.
In the Northern Territory, Aboriginal and Torres Strait Islander people have an incidence rate of treated end stage renal disease 17 times higher than that for non-Indigenous Australians. In response, the Department continued to work collaboratively with the Northern Territory Government and other stakeholders, to improve access to renal and related support services for Aboriginal and Torres Islander people from remote communities. As part of this activity, the Department provided funding for six relocatable dialysis facilities to help renal patients to undertake self-care dialysis in their home communities. In addition, the Department commenced implementation of phase one of the Australian Government’s commitment announced in the 2008–09 Budget to improve access to renal services for remote communities in the Northern Territory. This will increase community based infrastructure for self-care dialysis, create additional renal health promotion resources, and establish an evidence base to inform the development of innovative service delivery options for phase two of the initiative.
A major achievement was the implementation of the Improving Child and Family Health initiative which delivered child health checks to 9,454 Indigenous children under 16 years of age in remote Northern Territory communities; and commencing some follow-up services. While a number of children were able to benefit from follow-up services, securing the required infrastructure and workforce to deliver this care was a challenge. Land access issues for additional clinic and staff infrastructure were complex. The Department provided assistance to local health service providers to expedite resolution of these issues. The Australian Government has committed an additional $13.6 million in 2008–09 to continue the delivery of follow-up services to ensure that all Indigenous children receive the follow-up health services identified as required through the child health checks.
The Department also delivered a package of initiatives to assist Indigenous people dealing with the effects of alcohol withdrawal after the introduction of alcohol bans. This included the provision of dedicated alcohol treatment hospital beds and specialist clinical teams at Katherine and Tennant Creek hospitals, additional capacity for substance use treatment services, and expansion of the alcohol and other drug workforce in primary health care and substance use services. In addition, the Department funded the Northern Territory Government to develop and implement a mobile outreach service model that extends their current regionally delivered Sexual Assault Referral Centre services into remote communities. Aboriginal children and families will benefit from culturally safe professional sexual assault counselling, support and education services delivered within their own communities.
The Department continued to fund a range of programs to reconnect families and provide social and emotional wellbeing and mental health services and workplace support to Aboriginal and Torres Strait Islander people. These include the Bringing Them Home Counsellors, Mental Health Services, Social and Emotional Wellbeing Regional Centres and the Link Up Program.
In 2007–08, the Department worked closely with eleven Link Up services to assist with the expansion of these services, and to place ten new caseworkers. In addition, two new mental health worker positions were established in Aboriginal and Torres Strait Islander medical services.
Efforts were made during the year to help strengthen the Indigenous health sector’s capacity. Through a range of activities, the Department provided funding for 89 additional workers – including 42 health workers (six general practitioners, six nurses, three Aboriginal and Torres Strait Islander health workers and 27 allied health professionals) and 47 other service and support positions (including practice managers and administrative officers).
In addition, the Department managed funding for capital works projects to construct, upgrade and maintain health clinics, substance use facilities and staff housing, particularly in rural and remote areas. In 2007–08, 28 new capital works projects were completed. This included ten health staff houses and 18 new or upgraded health facilities in rural and remote areas.
A major achievement was the delivery by the Department of the Budgeri Booroody Excellence in Aboriginal and Torres Strait Islander Health Conference. The conference, which was convened by the Department in consultation with key stakeholders in the Indigenous primary health care sector provided a forum for over 350 participants from the Aboriginal and Torres Strait Islander health sector to share stories on successes in quality health care service delivery. The inaugural National Excellence Awards in Aboriginal and Torres Strait Islander Health encouraged improved quality of service delivery by recognising individuals and organisations that had made outstanding contributions to the quality of health care provided to Aboriginal and Torres Strait Islander people.
The Department focused on ensuring that the quality and effectiveness of all primary health care services provided by Aboriginal and Torres Strait Islander community controlled health organisations are equivalent to that generally available within the Australian health care system. The Department also established the Indigenous Health Service Accreditation Advisory Committee to investigate the readiness of community controlled health services to achieve accreditation against mainstream safety and quality frameworks, and to provide advice to government on practical support to achieve such quality assurance.
During 2007–08, the Department worked with other Australian Government agencies, State Governments, the fuel industry and local communities to continue the implementation of the Petrol Sniffing Prevention Strategy. The Department took the lead in rolling out Opal fuel (providing fuel suppliers with low aromatic fuel), developing communication strategies and increasing access to treatment and rehabilitation services in the designated regions. A major achievement was the introduction of Opal fuel to an additional 13 sites, expanding the total number of sites receiving the low aromatic fuel to 117. The Department also collected data on the prevalence of petrol sniffing in 74 remote Indigenous communities and formulated a set of indicators which it will use as a minimum data set in monitoring petrol sniffing prevalence and effects.
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