Online version of the 2012-13 Department of Health and Ageing Annual Report

Outcome 8: Indigenous Health

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

Page last updated: 29 October 2013

Major Achievements

  • The Indigenous Chronic Disease Package is now fully implemented. All initiatives to boost the health workforce have been rolled out to improve Aboriginal and Torres Strait Islander peoples’ access to health services, including primary health care, follow-up, and coordinated, multidisciplinary care.
  • A total of 87,741 health assessments have been provided to Aboriginal and Torres Strait Islander people 15 years and over from July 2012 to June 2013 – an increase of 26% over 2011-12. Since the first year of the Indigenous Chronic Disease Package, the uptake of Aboriginal and Torres Strait Islander health assessments has increased by more than 277%.
  • A total of 44,663 Indigenous specific follow-up services have been provided by Aboriginal health workers and practice nurses to Aboriginal and Torres Strait Islander people 15 years and over from July 2012 to June 2013 – more than double the number of services in 2011-12.
  • Service providers are better able to focus on tailoring services for communities, with the launch of a new web-based reporting tool.
  • We are on track to halve the gap in child mortality by 2018. There has been significant improvement in Indigenous child mortality from 1998 to 2011, with the Indigenous child mortality rate declining by 29%.

Challenges

  • Chronic disease remains a major cause of the life expectancy gap. Programs to improve the prevention, detection and management of chronic disease will continue to be a significant focus.
  • Continue the momentum to halve the child mortality rate by 2018.
  • Encourage uptake of governance reform within the community controlled Aboriginal and Torres Strait Islander health services sector.
  • Ensure quality data is provided by streamlining reporting arrangements which also enables services to focus on delivering care to patients.

Performance

This is a doughnut chart and a table that summarises the results for all deliverables and key performance indicators in outcome 8 during 2012-13. The results show that 100% were met compared with 86.7% met, 11.1% substantially met and 2.2% not met in 2011-12.

100% MET

0% SUBSTANTIALLY MET

0% NOT MET

Period Met Substantially met Not met
2012-13 100% 0.0% 0.0%
2011-12 86.7% 11.1% 2.2%

Program contributing to Outcome 8

Trends

Figure 8.1 shows that from 1998 to 2010 there has been a statistically significant decrease in chronic disease mortality rates in both Indigenous and non-Indigenous populations. There has been no statistically significant change in the gap between the two populations over this period. However, the trend from the 2006 baseline to 2010 has shown a small but statistically significant decrease in the gap.

Figure 8.1: Chronic disease mortality rates from 1998 to 2031 required to close the gap72

The figure is a line graph depicting the declining mortality rates for Indigenous and Non−Indigenous people from 1998 to 2031 as well as target mortality rates for the two populations. The y-axis represents deaths per 100,000 individuals and the x-axis denotes the period from 1998 to 2031.
Text Alternative: Figure 8.1: Chronic disease mortality rates from 1998 to 2031 required to close the gap

Figure 8.2 and related statistical analysis shows that from 1998 to 2010 there has been a statistically significant decrease in child mortality rates under five years of age in both, Indigenous and non-Indigenous populations. The gap between the two populations has shown a statistically significant decrease and is within the range required to meet the 2018 target.

Figure 8.2: Child mortality rates from 1998 to 2018 required to halve the gap73

The figure is a line graph depicting the declining mortality rates for Indigenous and Non−Indigenous children under five years of age from 1998 to 2018 as well as target mortality rates for the two populations. The y-axis represents deaths per 100,000 children under the age of five and the x-axis denotes the period from 1998 to 2018.
Text Alternative: Figure 8.2: Child mortality rates from 1998 to 2018 required to halve the gap

Outcome Strategy

Outcome 8 aims to improve access for Aboriginal and Torres Strait Islander people to effective health care services essential to improving health and life expectancy, and reducing child mortality. In 2012-13, the Department worked to achieve this Outcome by managing initiatives outlined below.

Program 8.1: Aboriginal and Torres Strait Islander Health

Program 8.1 aims to improve access for Aboriginal and Torres Strait Islander people to effective primary health care services, maternal and child health services, and social and emotional wellbeing services, as well as promoting the prevention and management of chronic disease.

Improve social and emotional wellbeing

The Social and Emotional Wellbeing Program supports Aboriginal and Torres Strait Islander people affected by past government removal policies. It provides family tracing, reunion, counselling services and workforce support through the network of eight Link Up services, nine Workforce Support Units, nine Indigenous Registered Training Organisations and counsellors in more than 90 Aboriginal and Community Controlled Health Organisations (ACCHOs) across Australia.

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Reduce chronic disease

Aboriginal and Torres Strait Islander people experience more than twice the burden of disease than other Australians. The Indigenous Chronic Disease Package aims to address this burden, and was the Commonwealth’s contribution to the $1.6 billion National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes. The package is a comprehensive set of inter-related initiatives designed to improve the prevention, early detection and ongoing management of chronic diseases that are the main causes of mortality for Aboriginal and Torres Strait Islander people.

The Commonwealth has committed $777 million over three years (to 30 June 2016) to continue programs to improve Indigenous health under a further National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes. When MBS and PBS estimates are taken into account, the Commonwealth contribution will be around $992 million over three years.

Regional Tackling Indigenous Tobacco and Healthy Lifestyle Teams

Tobacco smoking is a major cause of chronic disease among Aboriginal and Torres Strait Islander people. The Regional Tackling Indigenous Tobacco and Healthy Lifestyle Teams continue to work with local communities to address high smoking rates and develop health promotion activities that promote smoke free lifestyles, improved nutrition and increased physical activity. The program has significantly increased the focus on preventive health and is now funded to provide national coverage in 57 regions. In 2012-13, the Department funded the third tranche of Regional Tackling Smoking and Healthy Lifestyle Teams, including 18 Regional Tobacco Coordinators, 49 Tobacco Action Workers and 37 Healthy Lifestyle Workers. This brings the total number of workers funded under this element of the package to 58 Full-time Equivalent (FTE) Regional Tobacco Coordinators, 168 FTE Tobacco Action Workers, and 118 FTE Healthy Lifestyle Workers.

Coordinated primary health care

The Indigenous Chronic Disease Package has improved access to well-coordinated, multi-disciplinary primary health care services. Initiatives in this area include funding for Aboriginal and Torres Strait Islander Outreach Workers, additional primary health care staff and a Care Coordination and Supplementary Services program. More than 100 Full-time Equivalent (FTE) Care Coordinators have been employed and assist Aboriginal and Torres Strait Islander patients with chronic disease to access specialist and allied health services.

More than 85,000 care coordination and supplementary services were delivered from June 2010 to 31 December 2012. In addition a boost to funding for outreach services through the Medical Outreach – Indigenous Chronic Disease program has meant 1,141 services, involving 39,086 patient contacts, in 320 locations were delivered nationally between 1 July 2012 and 31 December 2012.

The Department also continued to fund 101.75 FTE Indigenous Health Project Officers to improve access to mainstream primary care.

Funding for 88 FTE Aboriginal and Torres Strait Islander Outreach Workers and 90 FTE Indigenous Health Project Officers in Medicare Locals has helped reduce many of the barriers Aboriginal and Torres Strait Islander people experience in accessing primary health care, delivering better health outcomes.

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Practice Incentives Program

In addition, the Practice Incentives Program (PIP) Indigenous Health Incentive was introduced to encourage primary health care services to register eligible Aboriginal and Torres Strait Islander patients for chronic disease management. Further incentives are paid for providing a targeted level of care (Tier 1) to a registered patient, and for providing the majority of care (five or more eligible MBS services) in a calendar year to a registered patient (Tier 2).

To receive Tier 1 payments, a service provider must develop either a GP Management Plan (GPMP) or Team Care Arrangement (TLA) for a registered patient, and monitor the plan regularly. These plans aim to improve the management of chronic disease by documenting and arranging for the health services required by the patient, such as specialist and allied health services.

The number of Aboriginal and Torres Strait Islander patients registered under the program increased from 31,646 in 2010 to 52,321 in 2012 – a 65% increase. Over this period, the proportion of registered patients who triggered a Tier 2 payment has been consistently high, at around 70%. The proportion of the patients triggering a Tier 1 payment was initially very low, at 5% in 2010. However, the number has steadily increased to about 16% in 2012 (Figure 8.3).

Figure 8.3: Patients triggering an outcome payment under the Practice Incentives Payment Indigenous Health Incentive program

The figure is a stacked column chart and shows the number of patients (denoted as percentage on y-axis) triggering a Tier 1 payment, Tier 2 payment and patients triggering neither payment during the years 2010 to 2012 (denoted on x-axis). Each column is sub-divided into three stacks accounting for Tier 1 payment, Tier 2 payment and neither payment.

*includes the number of patients triggering a Tier 1 as well as a Tier 2 payment.
Source: PIP Indigenous Health Incentive data, Department of Health and Ageing.

All jurisdictions demonstrated an increase in patients triggering Tier 1 payments between 2010 and 2012. The NT had the highest proportion of patients triggering a Tier 1 payment. This is consistent with the growth in the proportion of Aboriginal and Torres Strait Islander patients in the NT with GP Management Plans and/or Team Care Arrangements in place, representing better management of chronic disease.

Figure 8.4 shows the significant increase in the percentage of Aboriginal and Torres Strait Islander patients with Type II diabetes and/or coronary heart disease getting the target level of care between 2010 and 2012. This achievement reflects the success of programs including the PIP Indigenous Health Incentive and concerted efforts by the Department, the NT Department of Health, and the ACCHOs to improve chronic illness care. This partnership has implemented the NT Aboriginal Health Key Performance Indicator system along with a continuous quality improvement strategy to help health services improve chronic illness care.

Figure 8.4: Growth in the proportion of Indigenous patients with Type II diabetes and/or coronary heart disease with GPMP or TCA in NT, between 2010 and 2012 who are receiving the target level of care74

The figure is a line chart showing the percentage (denoted on the y-axis) of Indigenous patients with GPMP or TCA in NT between 2010 and 2012 (denoted on the x-axis). The chart shows an increase in the percentage of patients with GPMP and TCA from 2010 which was 43% and 31% respectively to 62% and 50% respectively in 2012.

Improve child and maternal health

The Department aims to improve the health of Aboriginal and Torres Strait Islander mothers and children. There is a particular focus on improving access to, and uptake of, maternal and child health services, starting pre-pregnancy, protecting the health and wellbeing of Aboriginal and Torres Strait Islander families and enhancing early childhood development.

In 2012-13, the Department worked closely with the Department of Education, Employment and Workplace Relations in implementing and evaluating the Indigenous Early Childhood Development National Partnership Agreement (IECD-NPA), due to be completed in 2014. The Department also worked with the Australian Institute of Health and Welfare to prepare the first report on the IECD-NPA health key performance indicators. Following endorsement by Health Ministers, this report will be released in 2013-14.

The Department worked closely with the ACCHOs and primary health care providers to continue implementing New Directions: Mothers and Babies Services in 85 sites. This program provides families with access to antenatal care; information about baby care; practical advice and assistance with breastfeeding, nutrition and parenting; monitors developmental milestones, immunisation status and infections; and undertakes health checks for Indigenous children before starting school.

Improve remote service delivery and access to effective health services

The Department aims to deliver prevention, treatment and integrated long-term management of the health needs of Aboriginal and Torres Strait Islander people, particularly focusing on delivering services in remote areas.

In 2012-13, the Department provided grant funding to 278 organisations to provide primary and allied health care services to meet the needs of Indigenous communities in urban and regional areas, with a specific focus on remote areas. These grants delivered clinical services for the treatment of illnesses and management of chronic conditions, as well as a range of population health programs.

In 2012-13, the Department, through the Stronger Futures in the Northern Territory initiative, continued to improve the health and wellbeing of Aboriginal and Torres Strait Islander people in the NT, working in partnership with the NT Government and the ACCHOs. This was achieved through a range of programs including: integrated hearing and oral health programs for Aboriginal children under 16; child abuse trauma counselling and support services for Aboriginal children under 18 and their families in remote communities; a Territory-wide integrated and comprehensive primary health care system; and continuing reform of the Aboriginal primary health care system.

Through this initiative, the Department continued to fund the Continuous Quality Improvement (CQI) Investment Strategy for Aboriginal and Torres Strait Islander primary health care services in the NT. This involved employing CQI specialists who work with service providers in each region to identify opportunities and strategies to improve access to and delivery of primary health care. The CQI strategy has led to increased interpretation and use of clinical data at the health service level. Services are beginning to share, compare and benchmark data at a regional level. This has led to changes and improvements in processes resulting in the delivery of better targeted health care.

Good corporate governance plays a crucial role in the efficiency, effectiveness and sustainability of the ACCHOs. As such, identifying, promoting and supporting best governance practice is a key element for success. The Governance Enhancement Working Group reported to the Government on recommended changes and enhancements to improve corporate governance. The Working Group’s report and recommendations will be the basis for discussions with the ACCHOs to continue the improvement in governance in 2013-14.

The Department continued to fund the Remote Area Health Corps to recruit urban-based health professionals for short-term deployments to help meet workforce shortages in remote locations in the NT. Over the year, 548 health professionals were deployed to remote communities for a combined total of 1,923 weeks of service delivery.

Investment in Indigenous health infrastructure is critical to support the quality health care needed to prevent and treat the chronic and complex health conditions. During 2012-13, 21 capital infrastructure projects totalling $33.8 million (GST exclusive) were completed. This has included six clinics and 15 dwellings for health professionals with most of these works conducted in remote areas where there is limited infrastructure. Major achievements included the completion of the health clinic in remote Western Australia at Wiluna and the substance use day care centre at Coober Pedy in central remote South Australia.

Online community health reporting environment

In 2012-13, further enhancements were made to the web-based reporting tool – known as OCHREStreams. This will streamline the reporting process for health services, reducing administration and increasing the time available for service delivery.

OCHREStreams enables services to generate regular and ad hoc reports on demand to support continuous quality improvement and management planning. Services are able to identify health and demographic trends and use that information to shape and improve service delivery.

OCHREStreams has made reporting obligations easier for funded health services while providing high quality health outcome and service provision data to the Australian Government.

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Outcome 8 – Financial Resource Summary

Program (A) Budget Estimate 2012-13
$’000
(B) Actual 2012-13
$’000
Variation (Column B minus Column A)
$’000
Program 8.1: Aboriginal and Torres Strait Islander Health 1
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1) 701,959 693,057 ( 8,902)
Departmental Expenses
Departmental Appropriation 2 46,809 45,246 ( 1,563)
Expenses not requiring appropriation in the current year 3 1,484 2,300 816
Total for Program 8.1 750,252 740,603 ( 9,649)
Outcome 8 Totals by appropriation type
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1) 701,959 693,057 ( 8,902)
Departmental Expenses
Departmental Appropriation 2 46,809 45,246 ( 1,563)
Expenses not requiring appropriation in the current year 3 1,484 2,300 816
Total expenses for Outcome 8 750,252 740,603 ( 9,649)
Average Staffing Level (Number) 327 325 ( 2)
  1. This program includes National Partnerships paid to state and territory governments by the Treasury as part of the Federal Financial Relations (FFR) Framework.
  2. Departmental appropriation combines 'Ordinary annual services (Appropriation Bill 1)' and 'Revenue from independent sources (s31)'.
  3. 'Expenses not requiring appropriation in the budget 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.

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