Everything you always wanted to know about Medicare Locals amd Indigenous health but were afraid to ask
To mark the first anniversary of the Australian Medicare Local Alliance (AML Alliance), Croakey contributors including NACCHO were asked to suggest questions they’d like answered about the organisation and the country’s 61 Medicare Locals more broadly.
Once again we must thank Melissa Sweet for her ongoing support of NACCHO and members
Their questions broadly fell into six categories:
• Where is the value? • What about Indigenous health? • Governance and resourcing issues • What about population health? • Some rural health concerns • What about mental health?
You can read Indigenous Health below
Many thanks to the AML Alliance and CEO Claire Austin (pictured) for taking the time to answer the questions. It was no small effort!
Questions around Indigenous health
Q: Aboriginal partnership – what structures does AMLA have in place to ensure national partnerships with Aboriginal community controlled health services (ACCHs)? How does this work and is there a formal alliance with NACCHO?
Claire Austin: The AML Alliance is working on a Letter of Agreement with NACCHO. This engagement is paramount to the primary health care sector and will be a key focus of the AML Alliance. The signals from both sides have been all about cooperation and partnership and it is definitely a space to watch in terms of progressive opportunities between the two agencies.
Q: Aboriginal accountability – how does AMLA show real accountability to Aboriginal and Torres Strait Islander people, with how they are providing effective services and use of Closing the Gap money? Is this on their website? Not inputs but programs and numbers of Aboriginal and Torres Strait Islander people accessing services?
Claire Austin: Data on the number of Aboriginal and Torres Strait Islander people accessing Closing the Gap services are provided to the funding bodies through regular reporting.
Details of the Closing the Gap programs coordinated by the AML Alliance are available on the AML Alliance website. Similarly, details of the Closing the Gap programs run locally by MLs are available on their respective websites.
It is imperative that we keep the dialogue flowing with other peak bodies like NACCHO and the Indigenous Health Leadership Group and respect the partnerships to maintain constructive progress in Indigenous health. That is what I want to see and I expect to see improvements in Indigenous health, now that an organised and systematic approach to primary health care, underpinned by culturally safe programs, is underway. Accountability is paramount but our accountability will be ultimately measured by the gains we can contribute towards closing the gap in life expectancy and disadvantage for Indigenous Australians.
Q: How many MLs have formal robust partnerships with Aboriginal and Torres Strait Islander ACCHS?
Claire Austin: Working with the Aboriginal Medical Services (AMS) and Aboriginal Community Controlled Health Services (ACCHS) sectors is paramount for MLs, and many have strong working partnerships in this regard – for example, the Aboriginal Medical Services Alliance Northern Territory (AMSANT) is a founding member and partner of the Northern Territory Medicare Local. AML Alliance and MLs are working with the Indigenous health sector to build on the gains made to date.
Q: Aboriginal investment – How many MLs are working in collaboration and subcontracting to ACCHSs to improve coordination and health outcomes? How are MLs deciding when this subcontracting is appropriate?
Claire Austin: MLs work in partnership with AMSs, ACCHSs and the broader Indigenous community to conduct their population health needs assessments and to subsequently develop local population health plans. These partnerships allow for the needs of Aboriginal and Torres Strait Islander peoples to be well defined and for the resulting services to be comprehensive and targeted in meeting those needs.
MLs subcontract health providers subject to that provider’s proven ability to most efficiently and effectively meet the needs of the Indigenous community. It is important to note that subcontracting is only a small way in which MLs engage Indigenous health providers. Genuine partnership (formal and informal) in the design, delivery and coordination of Aboriginal and Torres Strait Islander services proves a very effective means through which to best meet the health needs of Aboriginal and Torres Strait Islander people.
Q: What percentage of Aboriginal health outcomes is directly attributed to MLs?
Claire Austin: It is important for AML Alliance and MLs to be guided by Aboriginal and Torres Strait Islander health organisations and peoples as to what they consider are the appropriate measures for Aboriginal health outcomes. We are currently guided in this respect with the health issues addressed under national Closing The Gap initiatives.
Some of the initiatives MLs are running to contribute to Aboriginal health outcomes include:
• Working with Aboriginal and Torres Strait people and/or organisations to encourage Aboriginal people to self-identify with mainstream services so that they can receive culturally safe care and gain access to Indigenous health services and benefits.
• Educating and training non-Indigenous health providers around cultural safety and informing them of Indigenous entitlements to specific programs and benefits.
• Supporting Indigenous chronic disease management through the Care Coordination and Supplementary Services program.
• Delivering an Otitis Media program for Indigenous communities.
• Employing and supporting Indigenous project officers and outreach workers in Indigenous communities.
Q: There are specific issues related to primary healthcare service delivery between urban, rural and remote areas including the islands of the Torres Strait. What are the highlights, challenges and risks for MLs, especially in remote areas where the divisions of general practice had no footprint?
Claire Austin: MLs are governed locally and they have the remit and flexibility to respond directly to local needs. This means remote residents are shaping their services in accordance with local context. Supporting this is MLs’ mandate to build and maintain local partnerships which are necessary for meeting those needs.
The challenges associated with this are often going to revolve around funding and capacity, so as long as MLs are sufficiently supported by all levels of government and their local communities then they will be well-positioned to overcome these challenges.
Q: How many Aboriginal and Torres Strait Islander staff are employed across Australia by MLs or within AMLA? And how many at manager or higher-level management?
Claire Austin: We know that at least 80 FTE Aboriginal and Torres Strait Islander Outreach Workers (ATSIOWs) and 80 FTE Indigenous Health Project Officers (IPHOs) are employed/funded through MLs.
It is important to note though that MLs do not report to AML Alliance so this type of information is not readily available.
The AML Alliance is privileged to have Uncle Brian Grant as its Special Adviser on Closing the Gap. Uncle Brian is an Elder of the Merriganoury Clan of the Wiradjuri Nation and is a Member of the Council of Elders of the Wiradjuri Nation. Brian provides national leadership advice, assistance and support to the Chief Executive Officer, the AML Alliance Board and operations to assist AML Alliance achieve its aims through the Closing the Gap initiative.
***** Q: It is very rare for a national peak body to receive the Government funding at the level provided to the AML Alliance. Most rely on subscriptions from their member organisations. Why do you merit such special treatment? Wouldn’t the AML Alliance speak with greater authority if it was more obviously accountable to those it purports to represent?
Claire Austin: The Commonwealth is cognisant of the value that the AML Alliance provides to MLs as a peak body. It acknowledges that investment in AML Alliance is helping to meet the health needs of Australians by offering leadership, coordination and support of health system reform.
Many peak bodies receive government funding so I am not sure how our case can be construed as ‘special treatment’.
Our funding requirements very clearly state our duty to serve and support the work of MLs, and our governance arrangements have been set up to ensure we perform this task in the absence of undue influence.
The Alliance is committed to supporting and enabling capacity development and excellence for service delivery in primary care through the ML network. It also has a role in identifying opportunities for policy and program improvement at the national scale.
In addition, it should be noted that the Not for Profit Sector Freedom to Advocate Bill 2013 was passed on 5 June, safeguarding the ability of Not-For Profit entities to advocate freely on behalf of the community – which impacts on Commonwealth agreements. The Act invalidates or prohibits clauses that restrict or prevent NFPs from commenting on, advocating support for, or opposing changes to Commonwealth Law, policy or practice.