Online version of the 2012-13 Department of Health and Ageing Annual Report
- 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%.
- 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.
0% SUBSTANTIALLY MET
0% NOT MET
|Period||Met||Substantially met||Not met|
Program contributing to Outcome 8
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
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
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.
Deliverable: Provide high quality social and emotional wellbeing services
2012-13 Reference Point: Revised program manuals distributed and in use across funded services
- Revised program manuals for Link Up, counselling and workforce support and training organisations funded through the Social and Emotional Wellbeing Program were distributed, are in use and are helping organisations to provide improved culturally appropriate and nationally consistent services.
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.
Yamba the Honey Ant’s Healthy Living Roadshow
Pre-school Aboriginal and Torres Strait Islander children are learning about the importance of healthy lifestyles with the aid of a television character, Yamba the honey ant.
A popular character on the Indigenous television network, Imparja, Yamba and her “handler” and best friend Jacinta Price tour communities across Queensland and the Northern Territory to spread positive health messages in a fun and entertaining way.
Musical performances featuring song, dance and actions have been presented to thousands of children since February 2011. They promote proper nutrition and hygiene, regular physical activity, trachoma prevention, ear and nose health and use of primary health care services.
A set of 15 animated advertisements featuring Yamba and encouraging healthy lifestyle behaviours have also been produced. They are used as Community Service Announcements on Imparja Television and in “Yamba’s Playtime” broadcast on Nine Network’s digital channel, GO!
The shows have received a rapturous response at communities including Mornington Island, Doomadgee, Mt Isa, Cloncurry, Normanton, Karumba, Burketown, Gregory Downs, Charleville, Roma, Mitchell, St George, Cunnamulla, Quilpie, Bollon, Blackall, Barcaldine, Longreach and Winton.
Yamba and Jacinta are ANTastically excited about their roadshow and will hit the road again in Queensland throughout 2013 and 2014, to help children stay healthy and strong.
Their roadshow is funded by the Department through the Local Community Campaigns to Promote Better Aboriginal and Torres Strait Islander Health Program. This is one of 14 measures in the Commonwealth’s Indigenous Chronic Disease Package, to help close the gap in Indigenous health outcomes.
Local Community Campaigns projects are grass roots, culturally appropriate projects to raise awareness within Aboriginal and Torres Strait Islander communities that conditions such as heart disease, diabetes, kidney disease and stroke are preventable, and to encourage them to use health services.
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.Top of Page
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
*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
Deliverable: Additional staff working on the prevention and management of chronic disease including Aboriginal and Torres Strait Islander outreach workers, practice managers and other health professionals75
2012-13 Target: 242
2012-13 Actual: 246.65
- In 2012-13, the Department funded 246.65 FTE additional workforce positions for the prevention and management of chronic disease (173.25 FTE Aboriginal and Torres Strait Islander Outreach Workers, 41.4 FTE Practice Managers and 32 FTE additional health professionals).
KPI: Chronic disease related mortality rate per 100,00076
Rate Difference: 346-448
Rate Difference: 428
- The 2010 Indigenous chronic disease mortality rate (897 per 100,000) was within the target range for 2010 (819-920 per 100,000). The difference between the Indigenous and non-Indigenous chronic disease mortality rates for 2010 (428 per 100,000) was also within the target range for 2010 (346-448 per 100,000). Over 1998-2010, there has been no statistically significant change in the gap between the two populations.
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.
Deliverable: Number of organisations funded to provide New Directions: Mothers and Babies Services
2012-13 Target: 82
2012-13 Actual: 85
- Due to the cost per service being less than originally anticipated, the Department exceeded the target and funded a total of 85 New Directions services in 2012-13. Organisations undertake activities in a variety of service delivery models, including home visiting, out reach models, provision of antenatal classes, and education and awareness about early childhood development. The New Directions: Mothers and Babies Services program is part of the Australian Government’s contribution to the IECD-NPA.
The Department continued to implement the Australian Nurse Family Partnership program in three sites in the NT, NSW and Qld. This is an evidence-based program that aims to improve pregnancy outcomes by helping women engage in good preventive health practices, support parents to improve their child’s health and development, and help parents develop a vision for their own future, including continuing education and finding work.
KPI: Child 0-4 mortality rate per 100,00077Top of Page
Rate Difference: 54-130
Rate Difference: 108
- The 2010 Indigenous child mortality rate (203 per 100,000) was within the target range for 2010 (152-226 per 100,000). The difference between the Indigenous and non-Indigenous child mortality rates for 2010 (108 per 100,000) was also within the target range for 2010 (54-130 per 100,000).
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.
Deliverable: Number of organisations funded to provide Indigenous specific primary health care and social and emotional wellbeing services
2012-13 Target: 260
2012-13 Actual: 278
- The Department exceeded the target and funded a total of 278 organisations in 2012-13. Of these, 172 (62%) were ACCHOs.
Through these services, the Department funds a broad range of comprehensive primary health care services enabling Aboriginal and Torres Strait Islander people to access timely and effective health care.
KPI: Percentage of organisations funded to provide Aboriginal and Torres Strait Islander-specific services which have action plans in place
2010 Target: 100%
2012-13 Actual: 100%
- In 2012-13, all organisations which received funding to provide Aboriginal and Torres Strait Islander-specific services had action plans in place.
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.
The Australian Government released a National Aboriginal and Torres Strait Islander Health Plan (the Health Plan). The Health Plan was developed as a collaborative effort, and was informed by advice from the National Aboriginal and Torres Strait Islander Health Equality Council and the Stakeholder Advisory Group established to guide the development of the Health Plan. Throughout 2012-13, the Department engaged with the community through 17 nation-wide community consultations, including a specific youth forum, an online submissions process, and expert roundtables to provide an opportunity for all points of view in the community to be heard and considered throughout the development of the Health Plan. The Health Plan is intended to guide policy and program development to improve Aboriginal and Torres Strait Islander health over the next ten years.
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.Top of Page
(A) Budget Estimate 2012-13
(B) Actual 2012-13
Variation (Column B minus Column A)
|Program 8.1: Aboriginal and Torres Strait Islander Health 1|
|Ordinary Annual Services (Annual Appropriation Bill 1)||701,959||693,057||( 8,902)|
|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|
|Ordinary Annual Services (Annual Appropriation Bill 1)||701,959||693,057||( 8,902)|
|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)|
- This program includes National Partnerships paid to state and territory governments by the Treasury as part of the Federal Financial Relations (FFR) Framework.
- Departmental appropriation combines 'Ordinary annual services (Appropriation Bill 1)' and 'Revenue from independent sources (s31)'.
- '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.