In July 2003, all Australian governments endorsed the National Strategic Framework for Aboriginal and Torres Strait Islander Health (NSFATSIH). The key goal of the NSFATSIH is: ‘To ensure that Aboriginal and Torres Strait Islander peoples enjoy a healthy life equal to that of the general population that is enriched by a strong living culture, dignity and justice’ (NATSIHC 2003, p7).
In December 2007, the Council of Australian Governments (COAG) agreed to a partnership between all levels of government to work with Indigenous communities to close the gap in Indigenous disadvantage. In recognition that outcomes for Indigenous Australians remain well below those of non-Indigenous Australians, COAG agreed to six targets:
- closing the life expectancy gap within a generation (see measure 1.17)
- halving the gap in mortality rates for Indigenous children under five within a decade (see measure 1.19)
- ensuring all Indigenous four year olds in remote communities have access to early childhood education within five years
- halving the gap for Indigenous students in reading, writing and numeracy within a decade (see measure 2.04)
- halving the gap for Indigenous people aged 20–24 in Year 12 attainment or equivalent attainment rates by 2020 (see measure 2.05)
- halving the gap in employment outcomes between Indigenous and non-Indigenous Australians within a decade (see measure 2.07).
- early childhood
- education and supporting school attendance
- access to primary health care
- economic participation and active welfare
- healthy home environments
- safety and freedom from violence
- leadership and governance.
- The National Partnership Agreement on Indigenous Early Childhood Development— with joint funding of around $564 million over six years to address the needs of Indigenous children in their early years.
- The National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes—with funding of $1.6 billion over four years, centred on five priority areas: tackling smoking, providing a healthy transition to adulthood, making Indigenous health everyone’s business, delivering effective primary health care services, and better coordinating the patient journey through the health system. This Agreement acknowledges that to overcome Indigenous health disadvantage, a holistic life stage approach is required that builds sustainable social change and embeds system reform. The Commonwealth's contribution is an $805.5 million Indigenous Chronic Disease Package that aims to reduce chronic disease risk factors; encourage earlier detection and better management of chronic disease in primary health care services; improve follow-up care; and increase the capacity of the primary care workforce to deliver effective health care to Aboriginal and Torres Strait Islander peoples across Australia. The objectives of this Agreement will be supported by the successful implementation of other Indigenous initiatives including early childhood reforms, broader health system changes and measures to address the under-lying social determinants of poor health.
- The National Partnership Agreement on Remote Service Delivery—which commits governments to work together with Indigenous communities to improve Indigenous Australians’ access to government services, including early childhood, health, housing and welfare services in selected remote communities.
- The National Partnership Agreement on Closing the Gap in the Northern Territory—provides for the continuation until 30 June 2012 of a number of measures commenced in 2007 under the Northern Territory Emergency Response. Its objectives include the improvement of the health and wellbeing of Aboriginal and Torres Strait Islander people, particularly that of children.
- be shaped around the health needs of individual patients, their families and communities;
- focus on the prevention of disease and injury and the maintenance of health, not simply the treatment of illness;
- support an integrated approach to the promotion of healthy lifestyles, prevention of illness and injury, and diagnosis and treatment of illness across the continuum of care; and
- provide all Australians with timely access to quality health services based on their needs, not ability to pay, regardless of where they live in the country.
At the COAG meeting on 13 February 2011, the Commonwealth and all states and territories signed a Heads of Agreement on National Health Reform. Under the Heads of Agreement, the Commonwealth will increase its contribution to efficient growth funding for hospitals to 45% from 1 July 2014, increasing to 50% from 1 July 2017. A guaranteed additional $16.4 billion will be provided by the Commonwealth for public hospital services under this new agreement up until 2019–20. This funding is additional to the level of funding that the Commonwealth would have otherwise provided.
Governance of the health and hospitals system will devolve to new local institutions—Local Hospital Networks (LHNs) and Medicare Locals. Aged care one-stop shops will be established and will work with LHNs and Medicare Locals. This will ensure care is integrated at the local-level across the acute, primary health and aged care sectors.
The Australian Government has negotiated these national reforms with the states and territories to ensure that the health system is put on a more financially sustainable footing, with an increasing share of public hospital costs being met by the Commonwealth into the future, more locally responsive planning and management of health services, an increased focus on safety and quality, and better publicly available information on the performance of health services. In combination, these reforms will improve timely access for people to high quality care in and out of hospital.
The Aboriginal and Torres Strait Islander Health Performance Framework (HPF) is being used to inform the development of these policies and also in monitoring how we are tracking in closing the gap in Indigenous disadvantage. The HPF recognises that an effective, efficient and equitable health system is an essential component for any whole of government effort that seeks to address Indigenous health. In addition, action is required in areas such as education, employment, transport and housing to achieve sustainable health gains.