Outcome 7: Aboriginal and Torres Strait Islander Health
The 1999-2000 Portfolio Budget Statements, informs Senators and Members of Parliament of the proposed allocation of resources to portfolios outcomes and their objectives and targets including the agencies within the Health and Family Services portfolio.
Outcome Summary - The Year Ahead
Mortality and morbidity rates for Aboriginal and Torres Strait Islander people are significantly higher than for other Australians. Diseases of the circulatory system, respiratory illness, injury and cancer are the leading causes of death. Causes of poor health are due to a range of interrelated factors such as economic and social issues. Mental health is a major factor in Aboriginal and Torres Strait Islander health and can impact on physical health.
Structural factors which are significant include financial barriers to accessing health resources, a health workforce which is poorly equipped to work effectively in a cross-cultural context, the lack of a comprehensive primary health care approach, a lack of linkages and integration in the health system, and locational factors especially for rural and remote communities where a significant proportion of the target population live. Specific risk factors include poor nutrition, excessive alcohol consumption in some communities, and tobacco use.
The Department, through the Office for Aboriginal and Torres Strait Islander Health is aware of the need for sustained action coordinated across sectors to achieve improvements over time. The long-term strategy of the Office is to improve the access of Aboriginal and Torres Strait Islander peoples to comprehensive primary health care services within a multi-disciplinary environment. The aim is to provide for coordinated clinical care, population health and health promotion activities to facilitate illness prevention, early intervention and effective disease management. Evidence from Australia and overseas shows that improved access to comprehensive primary health care can make a real and sustainable difference to health status in the longer term.
This strategy is based on the principle of working in partnership with the Aboriginal community controlled health sector, the Aboriginal and Torres Strait Islander Commission (ATSIC), and State/Territory governments.
Activities under Outcome 7 will be directed to:
- developing the infrastructure and resources necessary to achieve comprehensive and effective primary health care for Indigenous peoples;
- improving the evidence base which underpins the health interventions;
- addressing some of the specific health issues and risk factors impacting upon the health status of Indigenous peoples; and
- improving communication with primary health care services, Aboriginal and Torres Strait Islander peoples and the general population.
The Office is progressing work to examine the suitability of existing facilities to provide a wide range of primary health services, and will use this information to improve targeting of capital resources to meet these needs.
Work is being undertaken to develop best practice approaches to the delivery of comprehensive primary health care which includes improving services' capacity to undertake population health and health education activities. For example, the introduction of computer based patient information and recall systems will facilitate improved patient treatment and health planning in the community.
There is clear evidence that Aboriginal and Torres Strait Islander peoples are not accessing health services, such as the Medicare Benefits Scheme and the Pharmaceuticals Benefits Scheme, at a level commensurate with need. The Office is supporting the use and evaluation of innovative service delivery models to improve access to primary health care. These may draw on general practitioners and other mainstream providers and will facilitate better coordination and linkages between services within a region.
The 1999-2000 Budget makes additional resources available to increase access to primary health care services. The new arrangements will provide a framework for the planned and coordinated expansion of comprehensive primary health care services, resulting in funds being increased to levels more commensurate with the health needs of Indigenous people, and invested in areas where health needs, and the capacity to utilise funds effectively, have been identified through completed regional plans or through coordinated care trials.
The capacity of providers to deliver comprehensive and effective services is dependent on their ability to attract and retain high calibre staff with training in Aboriginal and Torres Strait Islander health and service management. Work is being undertaken by the Office in conjunction with stakeholders to identify the current and future needs of health services and establish on-going workforce planning processes, to resource recruitment and support services that provide for health professionals and managers, and to support the establishment of Indigenous health courses as part of the mainstream post-secondary health curriculum for a range of health professionals.
Specialist regional mental health training centres will provide professional support and training to, and facilitate linkages between, Indigenous and mainstream health staff who provide services to address emotional and social well being issues. In addition to these workforce training and support activities, the Office will also direct resources to mental health service provision, including the expansion of the number of mental health counsellors.
Activities to improve the evidence base which underpins health interventions and services include efforts to collect, and improve the quality of, data on Aboriginal and Torres Strait Islander health. Resources will be directed to facilitate the refinement of and reporting against national performance indicators by all government health jurisdictions on efforts to improve Aboriginal and Torres Strait Islander health, Service Activity Reports provided by Commonwealth funded Aboriginal health services on delivery activities and mechanisms, regional plans to identify strategies to meet local needs, research into evidence based approaches to specific disease and risk management approaches, best practice approaches to service delivery, and investigating ways to improve data on Aboriginal uptake of mainstream health services.
Based on some of this research, a range of multifaceted health strategies will provide support to health services to address some specific health risk areas which contribute to excess mortality and morbidity rates. These include sexual health, otitis media, eye health, diabetes, nutrition, and emotional and social well being.
A National Aboriginal and Torres Strait Islander Health Communication Strategy will be developed to contribute to improved intersectional action, improved communication with stakeholders to community participation at all levels of policy development and planning, and the dissemination of good practice approaches to Aboriginal and Torres Strait Islander health care.
Budget Measures Affecting Outcome 7Top of page
Improving access to health services for Aboriginal and Torres Strait Islanders
|Department of Health and Aged Care|
This measure will take forward the Government's commitment to address the poor health of Aboriginal and Torres Strait Islander people by enabling better access to comprehensive primary health care services. This measure is expected to make a sustainable difference to the health of Aboriginal and Torres Strait Islander people in the longer term.
This measure provides for the establishment of a framework for a planned and coordinated expansion of comprehensive primary health care services which includes clinical care, population health and education and health promotion activities. Funds will be invested in areas where needs have been identified through completed joint Commonwealth/State/community regional health plans or where existing coordinated care trials have established that there is both a need and capacity to utilise funds effectively to deliver the required mix of services (including clinical care, population health and education and health promotion activities).
The new arrangements will involve continuing collaboration with the Aboriginal community controlled health sector, State and Territory governments, general practice and other health professionals. They will bring about a better integration of general practice and mainstream health providers in delivering services for Indigenous people.
This Commonwealth funding will be conditional on States and Territories providing resources to meet their funding obligations in this area, and will be subject to output-based accountability arrangements.
Improved living conditions in remote communities
|Department of Health and Aged Care|
|Aboriginal and Torres Strait Islander Commission|
The Government will continue the Army/ATSIC Community Assistance Programme (AACAP) as part of a coordinated approach to provide environmental and health infrastructure to remote Aboriginal and Torres Strait Islander communities. This measure will extend the AACAP project for another four years. The extension of this programme meets an election commitment made by the Government to improve the basic infrastructure available in remote Indigenous communities.
Work to be undertaken will include improvements to water, sewerage, and power systems, the construction and upgrade of community housing and facilities, and improvements to roads and airstrips for an additional four or five remote Aboriginal communities.
Funding made available through this initiative will be matched by existing funds from ATSIC's National Aboriginal Health Strategy. The Army will contribute personnel, the use of construction equipment and expertise to the venture.
Performance Information and Resource Allocation
The following indicators are designed to measure how effectively this outcome has been achieved.
The first of these indicators is designed to provide information against the ultimate goal of improved health status - a reduction in mortality rates. It must be recognised, however, that the causes of excess mortality and morbidity are complex and that improvements will depend on a coordinated and sustained approach across a range of sectors including Commonwealth agencies, State/Territory agencies and the community sector. Changes in this indicator are expected to be demonstrated in the longer term.
|Indicator 1:||Life expectancy at birth by sex (National Performance Indicator 1.1).|
|Target:||Consistent with a 20% reduction in age standardised all causes mortality rate ratios over ten years.|
|Info source/rept freq:||Registered deaths and population estimates from reports against the National Performance Indicators provided by State Governments to the National Health Information Management Group. Annual update and three-year trend analysis.|
|Indicator 2:||Per capita funding for primary health care for Aboriginal and Torres Strait Islander peoples across all government programs.|
|Target:||Ratio of per capita funding by all jurisdictions for primary care to secondary care of 3:4 with an increase in future years of spending on primary care as a proportion of all health care spending.|
|Info source/rept freq:||Expenditures on Health Services for Aboriginal and Torres Strait Islander People report by the Department of Health and Aged Care, the National Centre for Epidemiology and Population Health, and the Australian Institute of Health and Welfare. Biennial.|
|Indicator 3:||Proportion of Commonwealth funded services routinely implementing: a) guidelines and clinical protocols arising from the specific health strategies developed by the Office for Aboriginal and Torres Strait Islander Health to address eye health, otitis media, sexual health, and diabetes: and b) population health and health promotion and education programs.|
|Target:||All over 5 years. By June 2000, 50% of services.|
|Info source/rept freq:||Service Activity Reports provided by services to the Department of Health and Aged Care and the National Aboriginal Controlled Community Health Organisation. Annual.|
|Indicator 4:||Number of health professionals (doctors, nurses and health workers) in Aboriginal Health Services, State/Territory Health Aboriginal health services and other health services which provide care to Aboriginal and Torres Strait Islander people; and the number of health professionals who have graduated from or are currently undertaking training in accredited Indigenous post secondary health courses.|
|Target:||By June 2000, national summary of workforce supply and demand characteristics developed to establish base line data.|
|Info source/rept freq:||Department of Health and Aged Care records. One-off report updated annually.|
|Indicator 5:||The proportion of research projects undertaken consistent with the Strategic Research Framework for Indigenous health research.|
|Target:||All research projects provide information on priority issues/areas identified under the Strategic Research Framework.|
|Info source/rept freq:||Department of Health and Aged Care records. Annual.|
|Indicator 6:||Data on the performance of government programs to improve the health status of Aboriginal and Torres Strait Islander people available from a comprehensive range of data sets and of sufficient quality to support policy development.|
|Target:||Refinement of the National Performance Indicators and Targets by February 2000.|
|Info source/rept freq:||National Performance Indicators held by the National Health Information Management Group.|
The allocation of resources for Outcome 7 is described in the following two Tables:
- Table C7.1 describes the relationship between the appropriation structure for Outcome 7 and the 1998-99 appropriation structure; and
- Table C7.2 sets out the allocation of resources across administered items and output groups for the Department for Outcome 7.
Table C7.1 Relationship between the old appropriation structure and the new Outcome structure for Outcome 7Top of page
|7. Improved health status for Aboriginal and Torres Strait Islander peoples.||3. Aboriginal and Torres Strait Islander Health|
Appropriation Bill 1
Appropriation Bill 1
Health services program (340.9.01)
Substance abuse services (340.9.02)
Running Costs, including Section 31 receipts (340.1) (p)
Appropriation Bill 2
Health infrastructure for indigenous communities (890.1.03)
Combatting infectious diseases of indigenous peoples (892.0.05)
Appropriation Bill 1
Compensation and legal expenses (340.2.01) (p)
Table C7.2 Resource Summary
In order to achieve this outcome the Government has decided to spend $182m. Funding will be provided to organisations providing or brokering comprehensive primary health care services, specialist services and substance misuse residential rehabilitation services. Infrastructure to support the development and operation of high quality services will also be funded, and includes workforce development; specific health strategies; data, evaluation and research; and support for advocacy and representation.
The Office is continuing to work to strengthen the partnership between the Federal, State and Territory governments, Indigenous communities and research institutions to address the national responsibility of improving the health and wellbeing of Aboriginal and Torres Strait Islander people. This partnership approach is supported through the Office's leadership role in pursuing a consultative approach to the design of national data collections, national policy development and coordinated service delivery.
Achievements in Aboriginal and Torres Strait Islander health have often been overshadowed by media coverage of the poor health status of Aboriginal and Torres Strait Islander communities. A key strategy of the Office for Aboriginal and Torres Strait Islander Health is to inform the public of efforts and achievements of governments and Aboriginal and Torres Strait Islander communities in improving the health and wellbeing of Aboriginal and Torres Strait Islander people.
Supporting this strategy is Office for Aboriginal and Torres Strait Islander Health's role in disseminating evidence-based best practice approaches to health care for Aboriginal and Torres Strait Islanders amongst health professionals.
High quality and timely policy advice to Ministers and Parliament is provided by the Office to support well-informed decision making on resource allocations in relation to need. Grant administration and contract management services are provided by the Office to ensure that allocated resources are utilised to achieve effective, cost efficient service provision.
The following performance information provides a comprehensive overview of the administered items and departmental outputs together with performance measures for these items and outputs.
Table C7.3: Performance Information for Administered Items
|1. Services in Aboriginal and Torres Strait Islander communities which provide:
||Quantity: At least 190 organisations providing and or purchasing primary health care and related health services. These services include: clinical care and health education, promotion, screening, immunisation and counselling, as well as specific programs such as hearing health, sexual health, substance misuse and mental health.
At least 30 organisations offering regional ophthalmological and optometrical specialist services.
At least 3 specialist service pilots funded in the Northern Territory and Queensland to provide ear, nose and throat, and respiratory paediatric services.
At least 27 organisations providing substance misuse residential rehabilitation programs.
Building improvements in at least 10 existing services and construction of at least 5 doctor's houses.
Quality: Level of access by clients to services.
40% of primary health care services that use recorded client information to provide coordinated health care and population health planning.
50% of substance misuse rehabilitation services for which reviews are being implemented.
|2. Infrastructure to support the development and operation of high quality health care services for Aboriginal and Torres Strait Islander people, including:
||Quantity: At least 77 organisations funded to provide training and education programs, recruitment and support services.
At least 6 specific health strategies.
At least 25 projects to provide information and/or improve the quality of data on Aboriginal and Torres Strait Islander health and mental health client needs and/or service provision issues.
At least 5 organisations or official forums supported to provide stakeholder participation in advocacy.
Quality: Increased availability of accredited Indigenous health or mental health courses in post secondary health courses across health professional groups.
Reduction in the number of funded services having difficulty in managing human or financial resources, or equipment.
Increased proportion of primary health care services implementing screening as a priority.
80% of 15-50 year old Aboriginal and Torres Strait Islander people considered at risk, and 80% of all Aboriginal and Torres Strait Islander people over 50, vaccinated for pneumoccal disease and influenza.
Quality: 50% of services using evidence based approaches to address specific Aboriginal and Torres Strait Islander health and/or service delivery issues.
Increased availability of information on current and future workforce needs.
Increased availability of reliable statistics.
Increased stakeholder participation in major health policy committees.
Table C7.4: Performance Information for Departmental Outputs
|1. Policy advice to the Ministers and Government in relation to:
||Quality: A high level of satisfaction of the Ministers and Offices with the relevance, quality and timeliness of policy advice provided.
Quantity: Policy, research and advice service commensurate with the funds allocated.
|2. Services to the Ministers and Parliament.||Quality: A high level of satisfaction of the Ministers and Parliament with the relevance, quality and timeliness of services provided.
Agreed timeframes met for responses to ministerial correspondence, Question Time Briefs, Parliamentary Questions on Notice and ministerial requests for briefings.
Quality: Commonwealth response to the House of Representatives Inquiry into Aboriginal and Torres Strait Islander Health by March 2000.
Quantity: Number of responses to ministerial correspondence, Question Time Briefs, Parliamentary Questions on Notice and ministerial requests for briefing will collected in 1999-00 and used as a future benchmark.
Services to the Minister and the Parliament commensurate with the funds allocated.
|3. National leadership, including:
||Quality: Stakeholder satisfaction with the quality and timeliness of Commonwealth inputs to national policy, planning and strategy development and implementation.
Stakeholder satisfaction with consultative arrangements and effectiveness of the Memorandum of Understanding arrangements with ATSIC, the Aboriginal and Torres Strait Islander Health Council and State Forums.
Australian Health Ministers' Advisory Council endorsement to the refinement of the National Performance Indicators for Aboriginal health.
Quantity: National leadership service commensurate with the funds allocated.
|4. Information to stakeholders and the general community concerning Aboriginal and Torres Strait Islander health.||Quality: Stakeholder satisfaction with relevance, quality and timeliness of the available information.
Development of communication mechanisms by March 2000.
Establishment of the Office's Internet homepage by January 2000.
Quantity: Published strategies distributed to all service providers and stakeholders, including:
|5. Contract administration and funds management:
||Quality: Stakeholder satisfaction with planning and implementation of new service/project development.
100% of payments are made accurately and on time.
100% of acquittals completed on time.
Budget estimates are met and actual cash flows vary by less than 5% from predicted cash flows.
Quantity: Administration of funding to at least 200 organisations providing integrated health and health related programs across rural/remote and urban Australia.
Grant administration and funds management service commensurate with the funds allocated.
Performance Assessment: Evaluations and Reviews
1. Recruitment and Promotions Services Project
The effectiveness and appropriateness of the project is being examined to inform decisions about the funding, objectives and options for the recruitment of services project. The evaluation is to be completed by July 1999.
2. The performance of the Department of Health and Aged Care in Aboriginal and Torres Strait Islander Health
An integral part of the decision to transfer responsibility for Aboriginal and Torres Strait Islander health from the Aboriginal and Torres Strait Islander Commission to the Department of Health and Aged Care in 1995 was that performance of the Department be evaluated. This evaluation will draw on the Report No. 13 of the Australian National Audit Office on the Aboriginal and Torres Strait Islander Health Programs of the Department of Health and Aged Care, and the report of the House of Representatives Standing Committee on Family and Community Affairs Inquiry into Indigenous Health. Issues raised in the evaluation will feed into future policy development. The evaluation is to be completed by June 2000.