KEY STRATEGIC DIRECTIONS FOR 2004-05
Improving Access to the Mainstream Health System
The Department continued to improve the Medicare Benefits Scheme (MBS) arrangements so that they are more accessible to Aboriginal and Torres Strait Islander peoples. OATSIH maintains the exemptions issued under subsection 19(2) of the Health Insurance Act 1973
that allow payment of Medicare rebates for services provided in 114 Aboriginal and Torres Strait Islander primary health care services and in agreed State and Territory run remote Health Services in Queensland and the Northern Territory. Access to Medicare also allows access to other mainstream funding programs such as the Practice Incentives Program and the General Practice Immunisation Incentives Program, that use Medicare activity in the calculation of payments.
To support future policy development in relation to Indigenous peoples’ access to mainstream health services, the Health Insurance Commission (HIC) and OATSIH jointly commissioned in May 2005 a study of Aboriginal and Torres Strait Islander peoples’ attitudes, perceptions and experiences of the effectiveness of the Australian Government’s major health benefits programs (MBS and PBS and related initiatives) in supporting their access to and use of primary health care services. This research is a follow-up from market research completed in 1997 into Aboriginal and Torres Strait Islander peoples’ access to Medicare and the PBS. The current study is expected to report to the Department and HIC in June 2006.
Improved access to mainstream health services is being further supported by improved data on the use of health services by Indigenous Australians. The Medicare database introduced a voluntary Indigenous identifier in November 2002. The number of Aboriginal and Torres Strait Islander peoples voluntarily identifying as Indigenous stood at 80,658 in June 2005. The Department has continued to facilitate the implementation of special arrangements under Section 100 of the National Health Act 1953
to enable supply of pharmaceuticals covered by the PBS to clients of remote area Aboriginal and Torres Strait Islander primary health care services. Information on these arrangements is reported under Outcome 2.
Access to Primary Health Care
The Department has increased access to primary health care services with further expansion of services through the Primary Health Care Access Program. The Department has implemented a more streamlined approach to the allocation of new funding which ensures that additional health services are established quickly, and are specific to the health care needs of local communities and the capacity of organisations to deliver services effectively.
In 2004-05, OATSIH entered into contracts worth $64.85 million to fund new primary health care services in priority areas as well as a range of initiatives including:
- the expansion of primary health care services;
- capacity building activities such as training and support, information provision and the development of community organisations;
- the upgrade and expansion of health clinics; and
- the construction of health staff housing in remote areas to enable health care staff recruitment in these areas.
In general, the Department administers funding for Aboriginal Community Controlled Health Organisations directly, although variations include administering funds to State Governments to manage Indigenous specific health clinics where there are no alternative providers.
The Department continued to make significant progress in delivering infrastructure priorities identified in the National Indigenous Health Infrastructure Plan, with 27 new projects and variations to 16 existing projects for health/ substance use facilities and staff housing valued at $25 million approved in 2004-05. As at 30 June 2005, 125 projects with a value of $128.5 million were in progress. This funding provides clinics, expands or modifies buildings as health service needs change, and provides accommodation for health staff in remote areas where health services would not otherwise be provided.
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Council of Australian Governments (COAG) Whole-of-Government Trials
The Department continued in its lead role for the Indigenous Council of Australian Governments (COAG) trial site on the Anangu Pitjantjatjara Yankunytjatjara (APY) Lands.
Two specific projects, previously endorsed by the APY Lands COAG Steering Committee and reflecting the priorities identified in the draft APY Lands Shared Responsibility Agreement (SRA), continued to develop in 2004-05, with funding from several Departments. The Mai Wiru Regional Stores Policy focuses on improving the availability and affordability of healthy food supplies and the PY Ku Network focuses on improving access to a wide range of social and community services on the APY Lands. Both projects are also improving training and employment opportunities.
The SRA for the APY Lands neared completion in 2004-05, following delays over the last two years. There have been significant changes in the governance arrangements on the APY Lands during 2004-05, resulting in the lack of a representative community body with whom to sign the Agreement. In February 2005 Anangu partners formed the Wiru Palyantjaku (Better Outcomes) Taskforce representative of their local and regional interests. This taskforce is now part of the reformed COAG Steering Committee, known as Tjungungka Kuranyukutu Palyantjaku (TKP) (Working Together for the Future) along with the Australian Government and South Australian State Government. The TKP will now review and sign the SRA. The five broad regional reform priorities outlined in the SRA under development in the region may now, under the Government’s new Indigenous affairs arrangements, take the form of a Regional Partnership Agreement.
Aboriginal and Torres Strait Islander Health Workforce
The Department works with a range of key stakeholders to support and expand a skilled Aboriginal and Torres Strait Islander health workforce across a range of health care settings.
In September 2004, the Committee of Deans of Australian Medical Schools launched the new Indigenous Health Curriculum Framework. This work has been done in partnership with OATSIH. The framework provides medical schools across the country with guidelines for success in developing and delivering Aboriginal and Torres Strait Islander health content in core medical education. The inclusion of Indigenous health as a core part of the medical curriculum will mean that all medical graduates are equipped to address specific Aboriginal and Torres Strait Islander health, culture and societal issues.
The Department made significant progress, in collaboration with stakeholders, on the development of key competencies for Aboriginal and Torres Strait Islander Health Workers. in August 2004, all stakeholders agreed to establish two functional streams for Aboriginal and Torres Strait Islander Health Workers. This will allow the development of both a primary care and a specialist team. Consultancies have continued on the details of the competencies. Historically there have been divergent views on the role and functions of Aboriginal and Torres Strait Islander Health Workers, which has increased the complexity for professional recognition of these workers. The project has identified two core strands: the Aboriginal and Torres Strait Islander Primary Practice role; and the Aboriginal and Torres Strait Islander Community Care role.
The broad agreement and acknowledgement of new competencies that will underpin future training and work practices was a major achievement in Aboriginal and Torres Strait Islander health. Implementation of the new competency and qualifications framework will commence in 2005-06.
The Puggy Hunter Memorial Scholarship Scheme provides undergraduate scholarships for Aboriginal and Torres Strait Islander students in medicine, nursing, health management and Aboriginal Health Worker courses in recognition of the need for a substantial increase in the number of Aboriginal and Torres Strait Islander health professionals. The Scholarships are worth $15,000 per annum.
For the 2005 academic year 30 scholarships were awarded, of which seven are in medicine, nine nursing, five allied health, eight Aboriginal Health Worker and one health management.
Since the commencement of the Scheme in 2002, 87 scholarships have been awarded and 23 scholarship recipients have graduated in the following areas: five medicine, four nursing, two allied health and 12 Aboriginal Health Workers. Sixty one students are continuing with their studies in the 2005 academic year (three students have withdrawn).
Patient Information and Recall Systems Funding Program
In 2004-05, the Department delivered funding of $1.35 million to 26 organisations to implement or expand patient information and recall systems (PIRS), resulting in 76 per cent of Aboriginal and Torres Strait Islander primary health care services now using or implementing electronic health information systems. Services in remote locations with a number of satellite clinics had particular problems establishing workable PIRS. To address this problem, the Department commissioned a series of technology trials to assess the performance of PIRS applications using satellite-mediated wide-area network environments. A report of key findings produced by RPR Consulting in May 2005 outlines recommendations for policy development within OATSIH for effective deployment of electronic PIRS across networks in very remote localities. The Department is now investigating how the Australian Government might support costeffective implementation of these approaches.
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Risk Assessment Procedures
During 2004-05, the Department successfully implemented the Risk Assessment Procedures in all State and Territory offices. This process is assisting project officers in the early identification of OATSIH funded organisations that are of concern, allowing for earlier intervention and support from OATSIH for organisational development and capacity building. An analysis by OATSIH of the Risk Assessment Procedures commenced in 2004-05 and further consultations with State and Territory Offices will occur in 2005-06 to improve its applicability as a continuous improvement tool.
Addressing Specific Health Issues
Aboriginal and Torres Strait Islander Adult Health Check
Since 1 May 2004, a two yearly adult health check has been available to self-identifying Aboriginal and Torres Strait Islander peoples between the ages of 15 and 54. The purpose of the adult health check is to ensure early detection, diagnosis and intervention for common and treatable conditions that cause considerable illness and early mortality, such as diabetes or cardiovascular disease. The adult health check can be provided by Aboriginal Community Controlled Health Services that access Medicare and by general practitioners in the broader community. As a Medicare item, a rebate is payable through the Health Insurance Commission when a health check is provided to an eligible client. Since its commencement, uptake of the new item has increased from 249 to more than 600 per month (Outcome 2).
Population Health, Prevention and Early Intervention
In June 2005, the Minister announced a new Medicare funded annual health check for Aboriginal and Torres Strait Islander children from birth to 14 years of age. Development of the new item will occur during the 2005-06 financial year (Outcome 2).
Preventable Chronic Diseases
During 2004-05, OATSIH expanded the Continuous Improvement Projects (CIPs) for the early detection and management of chronic disease for Aboriginal and Torres Strait Islander peoples to include an additional four Aboriginal Community Controlled Health Services, bringing the total number of Services participating in the initiative to 13. The CIPs build on current Australian and international research on systematic approaches to chronic disease in the primary health care context.
A Departmental Panel of Quality Improvement Facilitators was established in December 2004 to work with the Aboriginal Community Controlled Health Services participating in the CIPs. The role of the facilitator is to provide support and ongoing development opportunities to build the capacity of the Services to undertake continuous improvement activities specifically related to their chronic disease activity. Early feedback from the Services that are working with the facilitators indicates this approach is effective in providing an additional resource and support to implement their project.
Child and Maternal Health
In 2004-05, a range of continuing and new initiatives were consolidated to improve child and maternal health including:
- a new child and maternal health exemplar site at Durri Aboriginal Corporation Medical Service in Kempsey, New South Wales;
- funding for a Sudden Infant Death Syndrome (SIDS) project, jointly undertaken between the National Aboriginal Community Controlled Health Organisation and SIDS for Kids;
- the production of the fourth (revised) edition of the Women’s Business Manual by Nganampa Health Council and Congress Alukura; and
- funding for Aboriginal and Torres Strait Islander women to participate in the 5th Australian Women’s Health Conference.
The Department entered into a contract with Murdoch Children’s Research Institute in March 2005, to contribute to the Northern Territory Healthy Skin Project over the next three years, through supporting the training and development of community workers and primary health care workers.
The Healthy Skin Project is a large multiorganisation research and service delivery project implemented in 2004-05, in at least six communities of the East Arnhem region of the Northern Territory. The Project aims to reduce the level of scabies and skin sores, which can lead to streptococcal skin infections, rheumatic heart disease and renal disease.
In December 2004, the Department commenced a consultation process on the draft national guidelines for the public health management of trachoma in Australia. Key stakeholders and organisations with an interest in trachoma were invited to provide comments on the guidelines. It is expected that the guidelines will be finalised in 2005 for endorsement by the Communicable Diseases Network Australia (Outcome 1).
In 2004-05, the Department continued to provide funding to support 67 Aboriginal and Torres Strait Islander substance use services nationally.
The Department made important changes to the successful Comgas Scheme that supports wider efforts to combat petrol sniffing. Since its inception in 1998, the Comgas Scheme has been subsidising the use of Avgas (an aviation fuel) as an alternative fuel at participating remote Aboriginal and Torres Strait Islander communities as part of wider efforts to address petrol sniffing. Currently there are 37 Aboriginal and Torres Strait Islander communities registered on the Comgas Scheme.
Avgas previously contained low levels of aromatic hydrocarbons, the component of unleaded petrol that gives the physiological high sought by sniffers, and is suitable as a petrol substitute. Recent changes to Avgas have increased the levels of aromatic hydrocarbons and it can no longer be offered as an alternative fuel. Since February 2005 a new unleaded fuel, Opal, has been developed to replace Avgas under the Comgas Scheme.
The recently published evaluation of the Comgas Scheme found that substituting unleaded petrol with a fuel that does not induce a high when sniffed is a safe, effective and popular intervention in reducing the incidence of petrol sniffing. Petrol replacement is part of a wider strategy to reduce the incidence of petrol sniffing. Complementary community-based diversion activities are an essential part of this strategy.
The Grog Book: Strengthening Indigenous Community Action on Alcohol,
developed in 1998 by Dr Maggie Brady, has been revised with departmental funding and a second edition commissioned. The Grog Book
serves as a practical guide for communities, organisations and advisers dealing with alcohol misuse. Drawing on contributions from Indigenous communities and individuals around Australia, the book highlights prevention, treatment and supply, and demand and harm reduction strategies, many of which have been successfully trialed at the community level.
The Cross Border Reference Group on Volatile Substance Use, a multi-jurisdictional body including the Australian Government and for which the Department currently provides secretariat support, commissioned a formal feasibility study into effective community service models to address volatile substance misuse in the cross-border region of South Australia, Western Australia and the Northern Territory. In April 2005, the Centre for Remote Health in Alice Springs was awarded the contract to undertake this study. The South Australian Government awarded and is managing the contract on behalf of all four governments who each contributed funding for the project.
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In response to the recent evaluation of the National Indigenous Pneumococcal and Influenza Immunisation Program, the Department developed a new immunisation promotion strategy for 2004-05 in which jurisdictional Regional Public Health Units were funded to undertake regional activities to promote adult immunisation in collaboration with other service providers, including Aboriginal Community Controlled Health Services. It is expected the new immunisation promotion strategy will result in greater coordination of regional immunisation service provision.
During 2004-05, the Department developed the National Aboriginal and Torres Strait Islander Sexual Health and Blood Borne Virus Strategy 2005-2008. It is expected to be launched in the first quarter of 2005-06. The Strategy will continue to guide Australia’s response to HIV/AIDS, blood borne viruses and sexually transmissible infections within Aboriginal and Torres Strait Islander populations. The Strategy builds on the work of the National Indigenous Australians’ Sexual Health Strategy 1996-1997 to 2003-04, and has been prepared in parallel with the development of relevant mainstream strategies.
Funding of nearly $300,000 has been provided for a project examining the uptake of the Recommendations for Clinical Care Guidelines on the Management of Otitis Media. The project will develop a collaborative regional program to focus on the management of Aboriginal and Torres Strait Islander children (0-5 years) with otitis media. In addition, over $0.5 million was spent in 2004-05 on training for ear and hearing health training for Aboriginal Health Workers.
Social and Emotional Well-Being
In December 2004, the Australian Health Ministers’ Advisory Council endorsed the National Strategic Framework for Aboriginal and Torres Strait Islander People’s Mental Health and Social and Emotional Well-Being, 2004-2009. This document aims to provide a framework for action by all governments and communities to improve the social and emotional well-being and mental health needs of Aboriginal and Torres Strait Islander peoples. All State and Territory governments are responsible for implementing the Framework, with the Department taking a lead role in auspicing, implementation and monitoring arrangements.
Evidence suggests that mainstream mental health programs have often been inadequate in addressing the needs of Aboriginal and Torres Strait Islander peoples from a culturally appropriate perspective. This has resulted in differences in approaches to addressing social and emotional well-being for Indigenous Australians. The Department’s investment in the Western Australian Aboriginal Child Health Survey has resulted in the publication of a volume of new information focusing on the social and emotional well-being of Indigenous children and young people in the State. This information may have broader national application and will be useful in the future policy responses around social and emotional well-being for Indigenous Australians.
Improved Evidence Base
Service Development and Reporting Framework
In 2004-05, the Department successfully trialled new Service Development and Reporting arrangements in 34 health and substance use services. For the services involved, this meant a considerable reduction in their reporting requirements as well as an opportunity to plan and measure their performance in a more transparent and accountable fashion. Services were required to develop a single, holistic ‘Action Plan’ for all the funds provided through OATSIH, develop performance measures in relation to major activities and report against them in one consolidated report. This approach replaced multiple program allocations and reporting processes that have developed over time in response to specific issues. An independent evaluation managed by the Department found that the trial was successful. Services were positive about the change and welcomed the opportunity to learn about and use the planning and reporting framework. Given the success of the trial the Service Development and Reporting Framework (SDRF) process will be implemented by the Department to all funded services over the next 18 months.
As well, services that participated in the SDRF received funds for Quality Improvement Initiatives which they developed themselves. This created a direct link between the processes of service planning and quality improvement. Services using the SDRF will have access to Quality Improvement Initiative funding once every three years. In 2005-06, the Department will undertake the evaluation of the quality improvement component of the SDRF.
At the same time, OATSIH has made progress in the development of a Single Funding Agreement. From 2005-06, those services using the SDRF will be able to receive their funds as a ‘global allocation’ within a single contract with OATSIH. This will streamline administration and create the opportunity for services to operate as robust business entities.
Aboriginal and Torres Strait Islander Health Performance Framework
In January 2005, the Australian Health Ministers’ Council approved in principle the Aboriginal and Torres Strait Islander Health Performance Framework. Using this framework, the Australian Government and State and Territory governments will monitor the impact of policies contained in the National Strategic Framework for Aboriginal and Torres Strait Islander Health on over 90 measures of health status, the social determinants of health, and the performance of the health system in meeting the needs of Aboriginal and Torres Strait Islander peoples. The first report against the Health Performance Framework is due in 2006. It will replace the Biennial Report of National Performance Indicators for Aboriginal and Torres Strait Islander Health and complement jurisdictions’ Implementation Plans which are to be submitted under the reporting requirements of the National Strategic Framework. During 2004-05, OATSIH worked with the Standing Committee on Aboriginal and Torres Strait Islander Health to develop the framework, commence the task of specifying each of the performance measures in detail, and mapping the measures to the objectives and strategies of the National Strategic Framework for Aboriginal and Torres Strait Islander Health and other national policies that explicitly target the health of Indigenous Australians.
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Trends in Mortality
The Department continued to base policy and programs on sound information on national trends in vital health statistics on the health of all Australians. However, similar information on the Aboriginal and Torres Strait Islander population cannot be derived from these data sets because of the poor and variable extent to which the data collected on Aboriginal and Torres Strait Islander peoples are identified. For example, recent estimates of Aboriginal and Torres Strait Islander peoples’ coverage in the mortality data show that only 60 per cent of Aboriginal and Torres Strait Islander deaths are accurately identified as Indigenous Australian.
Under the aegis of the National Advisory Group on Aboriginal and Torres Strait Islander Health Information and Data, OATSIH continued to promote and provide secretariat facilities for the Technical Advisory Group on Indigenous Mortality Trends, which provides expert analysis and advice on what can defensibly be derived from the analysis of existing data sets. Papers produced by this group in 2004-05 underpin the mortality trends reported in 2005 edition of the Health and Welfare of Australia’s Aboriginal and Torres Strait Islander Peoples
Promotion of the Use of Effective Policy
The Department has continued to work on improving its capacity to develop effective policy for Aboriginal and Torres Strait Islander health through a range of strategies, including:
- the coordination of Aboriginal and Torres Strait Islander health through the cross-departmental Working Group on Indigenous Health;
- the annual Portfolio Business Plan for Aboriginal and Torres Strait Islander Health; and
- the delivery of staff development programs on cross-cultural awareness and Indigenous health policy issues.
New Arrangements for Indigenous Affairs
During 2004-05, the Department was involved in policy and program development work related to the new arrangements for Indigenous affairs. Work has continued, for example, on harnessing mainstream programs to gain better outcomes for Aboriginal and Torres Strait Islander peoples. The Department has contributed to policy development related to the priorities of the Ministerial Taskforce on Indigenous Affairs, created in May 2004, and on policy work in further developing the concept of shared responsibility.
The Department has contributed to the implementation of the new arrangements through engaging with Indigenous Coordination Centres, particularly around the development of Shared Responsibility Agreements (SRA). As at 30 June 2005, the Department has contributed financially to two signed SRA and was involved in the negotiation of more than 20 other SRA.
During the year, the Department began work on the process of establishing a Solutions Brokers network to support the Department’s engagement in SRA and Regional Partnership Agreement.
The Department is now represented on the National Indigenous Drug and Alcohol Committee overseeing a whole-of-government approach on the harmful effects of alcohol and other drugs in Indigenous communities.
Substance misuse is now recognised as a priority policy issue under the new Indigenous affairs arrangements. The formulation of new policies around this area and an increase in representational roles has seen a realignment of resources away from specific projects and a delay in finalising key projects. The development of a policy framework for the Substance Use Program will take account of the new policy priorities and will respond to the changed policy environment, including a need for a whole of government approach.
The Department has continued its communication strategy to provide health information and improve links with the public and stakeholders in urban and remote locations. In 2004-05 initiatives undertaken include:
- the printing and distribution of the biannual newsletter Indigenous Health Matters;
- continued support for the internet site Australian Indigenous Health InfoNet based at Edith Cowan University, Western Australia;
- continued support for the Touch and See (and Hear) network project, a health promotion initiative utilising touch-screen technology in Indigenous settings; and
- maintenance of OATSIH web pages within the Department’s web site.