Key Strategic Directions for 2005-06
Improved Access to and Responsiveness of the Mainstream Health System
Improved Access to Mainstream Health Financing
On 1 May 2006, the Department introduced a new Medicare item to fund annual health checks for Aboriginal and Torres Strait Islander children from birth to 14 years. This new health check will complement existing MBS-funded Adult Health Checks for Aboriginal and Torres Strait Islander people over 15 years, and the older Australians health check. It encourages doctors to carry out regular comprehensive health checks for Indigenous children, to promote healthy behaviours, prevent illness, and improve the early detection of disease. Together, these items provide a framework for health assessments and health promotion interventions for Aboriginal and Torres Strait Islander people at all stages of life.
The Department also continued to work with Medicare Australia to improve Indigenous Australians’ uptake of Medicare and the Pharmaceutical Benefits Scheme (PBS) and uptake of the voluntary Indigenous identifier. Improved uptake of the Voluntary Indigenous Identifier will enhance the Department’s understanding of the extent and pattern of MBS and PBS uptake and will inform future actions to overcome barriers to access.
The Department renewed exemptions under Subsection 19(2) of the Health Insurance Act 1973
that allow payment of Medicare rebates for services provided in 116 Aboriginal and Torres Strait Islander health services and in agreed State and Territory government-funded health services in remote areas of the Northern Territory and Queensland. These exemptions are granted in recognition of the comparatively low use of Medicare benefits by Aboriginal and Torres Strait Islander people. The Department completed reviews of access to MBS funding under these arrangements in approved Queensland and Northern Territory health services. The Department also worked with Medicare Australia to complete a joint project to research current barriers to the major health programs, such as Medicare and the PBS, at a national level.
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The supply of Indigenous health professionals has increased with the graduation of 15 Puggy Hunter Memorial Scholarship Scheme recipients in 2005. A further 69 full-time equivalent scholarship recipients commenced studies in 2006 (29 nursing, eight medicine, 25 allied health, 11 Aboriginal and Torres Strait Islander Health Work and two health management). A total of 103 students were supported by these scholarships in 2005-06. The Department provides scholarship funding and the administration is contracted to the Royal College of Nursing Australia.
In 2005-06, the Department completed the first of two streams of Aboriginal and Torres Strait Islander Health Worker competencies and qualifications. The Primary Health Care Practice stream is an important step in developing a professional Aboriginal and Torres Strait Islander Health Worker workforce. The package, which also includes the Primary Health Care Community Care stream, is expected to be endorsed by the National Quality Council and State and Territory Ministers for Vocational Education and Training.
The Department agreed to fund the Leaders in Indigenous Medical Education (LIME) Connection to bring together key stakeholders and assist in the implementation of the Indigenous Health Curriculum Framework being undertaken by the Committee of Deans of Australian Medical Schools (CDAMS). The group will also develop a comprehensive approach to Indigenous health within medical education more generally. The LIME Connection will contribute to the reduction of barriers that limit Indigenous participation in medical education.
Complementary Action through Aboriginal and Torres Strait Islander-specific Health and Substance Use Services
Indigenous-specific Health Service Delivery
During 2005-06, the Department increased access to primary health care services providing funding for over 40 additional health service delivery staff, including seven general practitioners (GPs), 18 nurses and 16 Aboriginal and Torres Strait Islander Health Workers. In addition, over 50 capital works projects were approved, including 30 projects to enhance existing and establish new facilities, and 22 staff houses in remote areas.
The Department provided additional funding in 2005-06, under the Improved Primary Health Care initiative, specifically to provide substantially increased health care services in four remote and less accessible locations. The four sites have been selected at Toomelah, New South Wales; Wadeye, Northern Territory; Wheatbelt, Western Australia; and Cape York, Queensland. Funding was provided in 2005-06 to suitable auspicing organisations in the four areas to undertake community consultations, engage a range of health professionals and administrative staff, and plan for additional infrastructure to support the additional services.
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Focus on Improving Efficiency and Effectiveness
The Department helped reduce red-tape and administrative burden for Aboriginal and Torres Strait Islander Health Services in 2005-06, through refinements to the Single Funding Agreement and the Service Development Reporting Framework (SDRF). Significant work by the Department has been undertaken to analyse and collate the data for the SDRF reports. These reports are providing valuable qualitative data to improve the effectiveness, range and quality of services being delivered by Indigenous-specific health services.
Forty-five additional Indigenous health services across Australia undertook Quality Improvement activities funded by the Department to enhance the quality and effectiveness of their health service delivery to Aboriginal and Torres Strait Islander peoples.
Improving the efficiency of Indigenous-specific health services has been a primary focus for the Department during 2005-06. Whilst most organisations are well managed, ongoing refinement and application of the Risk Assessment Procedures has enabled early identification of crucial risk factors. The risk assessment and analysis process allowed the Department to identify areas of potential risk, target specific strategies to address these areas, and respond in a timely manner with appropriately targeted interventions and levels of support to assist organisations. During 2005-06, the Department identified governance and financial management as potential risk factors and provided additional funding to support organisations to address these issues at the local level. A new support mechanism is the Advisory and Development Panel which will provide expertise across a range of business disciplines and clinical services with the primary purpose of providing immediate assistance and capacity development in effective management of organisations. The tender process for this panel has commenced.
In 2005-06, the Department successfully completed the roll-out of funding for implementation of Patient Information Recall Systems (PIRS) by eligible services, and provided funding for extension, enhancement, training and support to existing systems within services.
The Department also undertook a national stocktake to identify the level of existing PIRS resources within funded services, and to provide the Department with ‘point in time’ information to assist with future information technology development activities in Indigenous health sites.
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Targeting Community Health Priorities
Healthy for Life, announced in the 2005-06 Budget, provides funding over four years to improve the health and wellbeing of Aboriginal and Torres Strait Islander mothers, babies and children, and those affected by chronic disease. The program complements and builds on existing Indigenous specific and mainstream primary health care services for Aboriginal and Torres Strait Islander people. The Department advertised a national call for applications for Healthy for Life funding in September 2005 and 116 applications were received. Implementation of the program is ahead of schedule with 53 sites approved for Healthy for Life activities at the end of 2005-06.
The Department developed a strategy to improve access to asthma spacers for clients of Aboriginal and Torres Strait Islander health services, by negotiating discounted rates with the industry, introducing a streamlined ordering and distribution system for Department-funded services, and arranging access to training and educational support for consumers and health service staff. The Asthma Foundation of Australia has agreed to manage the ordering and distribution system.
During 2005-06, the Department and the Indigenous Australians’ Sexual Health Committee finalised the National Aboriginal and Torres Strait Islander Sexual Health and Blood Borne Virus Strategy 2005-2008, and developed an implementation plan for the first two years. The strategy and implementation plan will guide Australia’s response to HIV/AIDS, blood borne viruses and sexually transmitted infections within Aboriginal and Torres Strait Islander populations. The strategy was launched by the Minister in October 2005, and the implementation plan is expected to be publicly available in late 2006.
During 2005-06, the Department and the Indigenous Australians’ Sexual Health Committee developed an implementation plan for the strategy in consultation with the Ministerial Advisory Committee on AIDS, Sexual Health and Hepatitis, the Intergovernmental Committee on AIDS, Hepatitis C and Related Diseases, and other key stakeholders. The implementation plan will guide action in this area for the next two years. It is expected that the implementation plan will be publicly available in late 2006.
In 2005-06, the Department continued to fund a range of programs to reconnect families and provide social and emotional wellbeing and mental health services and workforce support to Indigenous Australians. These include the Bringing Them Home Counsellors, Link Up Services, Social and Emotional Well-Being Regional Centres and Mental Health Services Projects. During 2005-06, the Department engaged a consultant to undertake an independent evaluation of these programs. The evaluation is expected to be finalised by the end of December 2006.
The Department continued to provide funding to support 64 Aboriginal and Torres Strait Islander substance use services nationally, including 41 specific Aboriginal and Torres Strait Islander substance use services, 28 of which are residential and 13 are non-residential. The remainder are funded as part of Indigenous primary health care services. The Department also provided further funding to several national projects supporting the substance use services. These included Substance Use Sector Annual Workshops, which bring together key stakeholders and service providers in each jurisdiction and activities undertaken by funded services nationally during National Drug Action Week (18-24 June annually.)
In 2005-06, the Department expanded the availability of Opal
fuel to an additional 21 remote Aboriginal communities bringing the total number of remote communities participating in the Petrol Sniffing Prevention Program to 59. In addition, the Department and the Office of Indigenous Policy Coordination developed an eight point plan to address petrol sniffing in a designated region of Central Australia. The plan was agreed by relevant State and Territory governments, and set out a comprehensive strategy for preventing and managing petrol sniffing in the region. In accordance with this plan, in 2005-06 the Department held multilateral and bilateral discussions with state and territory health authorities to improve rehabilitation and treatment services for Indigenous communities in the designated zone.
A challenge in achieving the rollout of Opal
fuel to commercial premises was the range of issues, both real and perceived, around the safety and efficacy of the fuel. These included pricing, the perception of lack of take up by the public and misinformation about possible damage to equipment. The Department has responded to these issues through a number of public consultations involving fuel wholesalers and roadhouse operators together with continued individual consultations with stakeholders. Thirteen commercial premises in and around the designated region of the Central Desert are now selling Opal
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Improved Service Delivery and Outcomes through Collaboration with Government and the Health Sector
Council of Australian Governments Whole-of-Government Trials
The Department continued in its lead role for the Council of Australian Governments (COAG) Trial site on the Anangu Pitjantjatjara Yankunytjatjara (APY) Lands in South Australia.
Two specific projects, the Mai Wiru Regional Stores Policy, and the PY Ku Network, which were previously endorsed by the APY Lands COAG Steering Committee and reflect the priorities identified in the draft APY Lands Shared Responsibility Agreement (SRA), continued to be developed in 2005-06. Funding has been provided by this Department, and the Office of Indigenous Policy Coordination, the Department of Employment and Workplace Relations, the Department of Education, Science and Training, the Department of Transport and Regional Services, the Department of Communications, Information, Technology and the Arts, and the South Australian Government. Both projects also improved training and employment opportunities for communities on the APY Lands, with seven local people being employed.
In 2005-06, the Mai Wiru Regional Stores Policy focused on improving the availability and affordability of healthy food supplies. A public health nutritionist commenced work in May 2006 at the Nganampa Health Service and community stores to work with the community to increase availability and encourage consumers to purchase healthy foods.
The PY Ku Network of transaction centres located in each community, focused on improving access to a wide range of social and community services on the APY Lands. An accommodation business was also being established, with the purchase of 14 ex-Commonwealth Games accommodation units.
Six SRAs were signed on the APY Lands COAG Trial site in 2005-06, focusing on improving housing infrastructure, early childhood, employment and health outcomes.
The Tjungungku Kuranyukutu Palyantjaku (TKP) Regional Forum, consisting of representatives from local Anangu service providers, the Australian Government and the South Australian Government, provides guidance for the COAG trial and other whole-of-government activities. In 2005-06, the TKP employed an APY Lands Services Coordinator and two Regional Services Coordinators and agreed on a workplan to focus on issues and priorities. The TKP also focused on the development of a Regional Partnership Agreement to replace the previous draft SRA.
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Australian Government’s Indigenous Affairs Arrangements
During 2005-06, the Department continued to be involved in policy and program development work relating to the Australian Government’s Indigenous affairs arrangements, including engagement with Indigenous Coordination Centres (ICC). Work has continued, for example, on harnessing mainstream programs to gain better outcomes for Aboriginal and Torres Strait Islander people. The Department contributed to policy development related to the priorities of the Ministerial Taskforce on Indigenous Affairs, the work of the Violence Summit and also on policy work to further developing, and contributing to, the SRAs.
The Department contributed to the Indigenous affairs arrangements through engaging with ICCs, particularly around the development of SRAs. As at 30 June 2006, the Department had contributed financially to 14 signed SRAs, and provided non-financial contributions to others. The Department was also involved in negotiating Regional Partnership Agreements.
The Department continued to increase its engagement with ICCs. Coverage of all ICCs is being achieved through a hub and spoke model with solution brokers being placed either in an ICC or located within the Department’s State and Territory Offices in an outreach capacity to several ICCs.
The Department was also actively involved with the Office of Indigenous Policy Coordination in determining ways to align administrative processes, such as the use of a single funding agreement for co-funded organisations, aligning more closely the analysis processes across agencies and identifying and addressing issues of governance within funded organisations.