NACCHO Aboriginal Health #NTRC : Olga Havnen Danila Dilba AMS and Yothu Yindi Foundation question how the billion of $ dollars Indigenous expenditure is spent

Try go looking for any kind of detail around Indigenous expenditure — it’s completely and utterly opaque,

Is it 50 per cent, is it 60 per cent, is it 70 per cent (that’s being misspent)? I really don’t know. I would say at least 50 per cent.

We call for a 15-year plan guaranteeing long-term investment but also predicted little improvement in results until all organisations submitted to greater scrutiny.

I think we have to include all funding. When I’m talking about transparency and accountability, I’d also be prepared to say that as Aboriginal organisations we too need to be open and transparent about the ways in which we spend public money,”

Olga Havnen, who now heads the Darwin-based Danila Dilba Health Service, yesterday said that almost six years on, it remained impossible to tell where Indigenous dollars were going

 ” A submission to the Productivity Commission’s current inquiry into how the GST is distributed argues that a “pattern of underspending compared to need has become entrenched” and warns that “indigenous Territorians retain unresolved concerns that the Northern Territory government does not fully apply the funds it receives as assessed by CGC for the benefit of indigenous people”.

The submission, by influential northeast Arnhem Land social organisation the Yothu Yindi Foundation, calls for “fundamental reform” of commonwealth-Territory relations, an argument backed up this month by the royal commission into child detention.”

See Part 2 below

Half of Indigenous funding in the Northern Territory is being misspent, says Olga Havnen

From Todays The Australian

At least half of all funding allocated to tackling indigenous disadvantage in the Northern Territory is being misspent, according to the former co-ordinator general for remote services, who issued a scathing report in 2012 and believes little has changed since.

That report found governments could not tell if indigenous Australians were benefiting from extra money because so much of it was being wasted on bureaucracy.

It highlighted excessive focus on “inputs and outputs rather than outcomes”, funding streams that were “fragmented, complex and administratively burdensome” and an “apparent indifference” on the part of public agencies to evaluating their own performance.

The then CLP government abolished the position of co-ordinator-general soon after.

“If you have a look at the budget for Territory Families, there’s an awful lot of money that gets spent on out-of-home care — purchase family-based daycare, for example, is expensive. Is there a better way of getting children looked after in a safe environment at a far cheaper cost?”

Her comments follow stand-offs between the Territory and federal governments over a proposed spending audit and demands for extra money to implement the recommendations of the Royal Commission into the Protection and Detention of Children in the NT.

The federal Social Services minister, Dan Tehan, yesterday promised to work “collaboratively” with the Territory government to address the commission’s recommendations but added it was vital that the $4.2bn in annual funding to Darwin be adequately accounted for.

“The royal commission came out very clearly and said this isn’t an issue about money, this is about how the money is being spent to get outcomes, and that’s why we’re going to get the Productivity Commission to look at how the money is being spent and whether it’s being spent in a way which is getting those outcomes on the ground,” Mr Tehan said.

NT families minister Dale Wakefield wrote to Mr Tehan yesterday saying there was “little appetite in the community for excuses and blame shifting”. She told reporters it was crucial governments work with Aboriginal people design and to implement changes.

However, The Australian has learned that approaching two years after Labor won office, the Gunner government’s new consultation framework has still not passed cabinet or been funded. Ms Wakefield said it was “one of those processes that takes time.”

Opposition leader, Gary Higgins, called the plan “yet another throwaway line”.

“It is pathetic that its much-talked about policy has not even made it to Cabinet, 18 months after being elected,” he said. “There is no excuse for the Gunner government to have not prioritised local decision making for Territory communities.”

A spokesman for the Chief Minister, Michael Gunner, did not respond to questions

Northern Territory cash shuffle sees $2bn taken from Indigenous aid

From the Australian

Successive Northern Territory governments have redirected more than $2 billion in GST intended to address remote and ­indigenous disadvantage, promp­ting new calls for urgent reform in the wake of shocking child abuse revelations in Tennant Creek.

Since the tax began operating in 1999, the NT has received $6.4bn in GST for welfare, housing, family and children’s needs, based on the Commonwealth Grants Commission’s remote and indigenous criteria.

However, because the grants are not tied, just $4.2bn of this has gone to those categories, analysis of the commission’s figures shows, with a large part of the rest ending in consolidated revenue.

Aborigines make up 30 per cent of the Territory’s 245,000 population, with about 80 per cent of these living in ­remote and very remote areas, ­according to the government.

The Northern Territory was allocated $73 million from the first year of GST, but spent just $24m on family and child services — the category in which a significant amount of indigenous disadvantage would be likely to be addressed, though not the only one.

In successive years the total allocation rose in real terms but so did the underspend, peaking after eight years at $126m siphoned off: in 2006-07 just $43m, or 24 per cent, of a total allocation of $179m went to family and child services.

Assessing the figures is complicated by the fact NT governments have imposed a series of changes of reporting categories in the area over almost two decades, as well as by the distorting effect of extra funds coming from a joint commonwealth-Territory remote ­indigenous housing program starting in 2007-08.

However, the trend has continued throughout the period, with the three years from 2013-14 showing an improvement in relative terms over the early years but a significant underspend increase in real terms. In 2015-16, just $285m, or 67 per cent, was spent on the welfare category from an assessed amount of $422m, the previous year $285m of $407m (69 per cent) and in 2013-14 $282m of $381m (74 per cent of the total).

A submission to the Productivity Commission’s current inquiry into how the GST is distributed argues that a “pattern of underspending compared to need has become entrenched” and warns that “indigenous Territorians retain unresolved concerns that the Northern Territory government does not fully apply the funds it receives as assessed by CGC for the benefit of indigenous people”.

The submission, by influential northeast Arnhem Land social organisation the Yothu Yindi Foundation, calls for “fundamental reform” of commonwealth-Territory relations, an argument backed up this month by the royal commission into child detention.

That inquiry recommended a review of commonwealth expenditure in the Territory in the area of family and child services relating to the prevention of harm to children, addressing “co-ordination of programs, funding agreements and selection of service providers”.

Northern Territory Chief Minister Michael Gunner this month slammed the Turnbull government for responding to this with a proposed review of both commonwealth and Territory spending, saying he would “not take a single worker off the frontline” to support it.

About 80 per cent of the Territory’s $5.5bn budget comes from GST receipts and special purpose commonwealth payments. The Gunner government has blamed an estimated $2bn reduction in GST for a hit to its forward estimates, arguing in its Productivity Commission submission this would have “implications for the Northern Territory’s capacity to invest in closing the gap in outcomes between Aboriginal and non-Aboriginal Territorians”.

It has called for separate commonwealth funding to be provided to address Aboriginal disadvantage, outside the GST distribution so that it is upheld “and not redistributed to other states”.

However, Indigenous Affairs Minister Nigel Scullion, a NT senator, hit back yesterday, accusing Mr Gunner of “hiding from transparency around remote education funds and remote policing numbers and (having) refused to participate in a commonwealth review of how federal funds are spent in the NT”.

“He should get his own house in order before demanding other states pay even more for his failures,” Senator Scullion said.

The latest startling figures come as the Turnbull government accuses Labor of frustrating its proposed new position of indigenous productivity commissioner, whose tasks would include examining the indigenous funding regime nationwide.

Malcolm Turnbull announced the position more than a year ago but, since introducing the enabling legislation in September, the government has resisted a Labor push to expand its definition of “indigenous” beyond a dated reference to “race”, so that it also includes now standard self-identification and community acceptance elements.

Aboriginal Health Download NACCHO Pre #Budget2018 Submission : Budget proposals to accelerate #ClosingTheGap in #Indigenous life expectancy


 ” A December 2017 report from the Australian Institute of Health and Welfare (AIHW) shows that the mortality gaps between Indigenous and non-Indigenous Australians are widening, not narrowing.

Urgent action is needed to reverse these trends to have any prospect of meeting the Council of Australian Governments’ goal to Close the Gap in life expectancy within a generation (by 2031).

The following submission by the National Aboriginal Community Controlled Health Organisation (NACCHO) in relation to the Commonwealth Budget 2018 aims to reverse the widening mortality gaps.”

Download the full NACCHO submission HERE


Also read NACCHO Aboriginal Health @AMAPresident Download AMA Pre-Budget Submission 2018-19 #Indigenous health reform – needs significant long-term investment

Widening mortality gaps require urgent action

The life expectancy gap means that Indigenous Australians are not only dying younger than non-Indigenous Australians but also carry a higher burden of disease across their life span, impacting on education and employment opportunities as well as their social and emotional wellbeing.

Preventable admissions and deaths are three times as high in Indigenous people yet use of the main Commonwealth schemes, Medicare Benefits Scheme (MBS) and Pharmaceutical Benefits Scheme (PBS) are at best half the needs based requirements.

It is simply impossible to close the mortality gaps under these conditions. No government can have a goal to close life expectancy and child mortality gaps and yet concurrently preside over widening mortality gaps.

Going forward, a radical departure is needed from a business as usual approach.

Funding considerations, fiscal imbalance and underuse of MBS/PBS

The recent Productivity Commission Report found that per capita government spending on Indigenous services was twice as high as for the rest of the population.

The view that enormous amounts of money have been spent on Indigenous Affairs has led many to conclude a different focus is required and that money is not the answer.

Yet, the key question in understanding the relativities of expenditure on Indigenous is equity of total expenditure, both public and private and in relation to need.

In terms of health expenditure, the Commonwealth spends $1.4 for every $1 spent on the rest of the population, notwithstanding that, on the most conservative assumptions, Indigenous people have at least twice the per capita need of the rest of the population because of much higher levels of illness and burden of disease.

This represents a significant market failure. The health system serves the needs of the bulk of the population very well but the health system has failed to meet the needs of the Indigenous population.

A pressing need is to address the shortfall in spending for out of hospital services, for which the Commonwealth is mainly responsible, and which is directly and indirectly responsible for excessive preventable admissions funded by the jurisdictions – and avoidable deaths.

The fiscal imbalance whereby underspending by the Commonwealth leads to large increases in preventable admissions (and deaths) borne by the jurisdictions needs to be rectified.

Ultimately, NACCHO seeks an evidenced based, incremental plan to address gaps, and increased resources and effort to address the Indigenous burden of disease and life expectancy.

The following list of budget proposals reflect the burden of disease, the underfunding throughout the system and the comprehensive effort needed to close the gap and ideally would be considered as a total package.

NACCHO recommends initiatives that impact on the greatest number of Indigenous people and burden of preventable disease and support the sustainability of the Aboriginal Community Controlled Health Organisation (ACCHO) sector – see proposals 1. a) to e) and 3. a) and b) as a priority.

NACCHO is committed to working with the Australian Government on the below proposals and other collaborative initiatives that will help Close the Gap.

National Aboriginal Community Controlled Health Organisation

NACCHO is the national peak body representing 144 ACCHOs across the country on Aboriginal health and wellbeing issues

. In 1997, the Federal Government funded NACCHO to establish a Secretariat in Canberra, greatly increasing the capacity of Aboriginal peoples involved in ACCHOs to participate in national health policy development.

Our members provide about three million episodes of care per year for about 350,000 people. In very remote areas, our services provided about one million episodes of care in a twelve-month period.

Collectively, we employ about 6,000 staff (most of whom are Indigenous), which makes us the single largest employer of Indigenous people in the country.

The following proposals are informed by NACCHO’s work with Aboriginal health services, its members, the views of Indigenous leaders expressed through the Redfern Statement and the Close the Gap campaign and its engagement and relationship with other peak health organisations, like the Australian Medical Association (AMA).

Guiding principles

Specialised health services for Indigenous people are essential to closing the gap as it is impossible to apply the same approach that is used in health services for non-Indigenous patients.

Many Indigenous people are uncomfortable seeking medical help at hospitals or general practices and therefore are reluctant to obtain essential care. Access to healthcare is often extremely difficult due to either geographical isolation or lack of transportation.

Many Indigenous people live below the poverty line so that services provided by practices that do not bulk bill are unattainable. Mainstream services struggle to provide appropriate healthcare to Indigenous patients due to significant cultural, geographical and language disparities: ACCHOs attempt to overcome such challenges.

An ACCHO is a primary health care service initiated and operated by the local Aboriginal community to deliver holistic, comprehensive, and culturally appropriate health care to the community which controls it, through a locally elected Board of Management.

They form a critical part of the Indigenous health infrastructure, providing culturally safe care with an emphasis on the importance of a family, community, culture and long-term relationships.

Studies have shown that ACCHOs are 23% better at attracting and retaining Indigenous clients than mainstream providers and at identifying and managing risk of chronic disease.

Indigenous people are more likely to access care if it is through an ACCHO and patients are more likely to follow chronic disease plans, return for follow up appointments and share information about their health and the health of their family.

ACCHOs provide care in context, understanding the environment in which many Indigenous people live and offering true primary health care. More people are also using ACCHOs.

In the 24 months to June 2015, our services increased their primary health care services, with the total number of clients rising by 8%. ACCHOs are also more cost-effective providing greater health benefits per dollar spent; measured at a value of $1.19:$1.

The lifetime health impact of interventions delivered our services is 50% greater than if these same interventions were delivered by mainstream health services, primarily due to improved Indigenous access.

If the gap is to close, the growth and development of ACCHOs across Australia is critical and should be a central component to policy considerations.

Mainstream health services also have a significant role in closing the gap in Indigenous health, providing tertiary care, specialist services and primary care where ACCHOs do not exist.

The Indigenous Australians’ Health Programme accounts for about 13% of government expenditure on Indigenous health.

Given that other programs are responsible for 87% of expenditure on Indigenous health, it reasonable to expect that mainstream services should be held more accountable in closing the gap than they currently are.

Greater effort is required by the mainstream health sector to improve its accessibility and responsiveness to Indigenous people and their health needs, reduce the burden of disease and to better support ACCHOs with medical and technical expertise.

The health system’s response to closing the gap in life expectancy involves a combination of mainstream and Indigenous-specific primary care providers (delivered primarily through ACCHOs) and where both are operating at the highest level to optimise their engagement and involvement with Indigenous people to improve health outcomes.

ACCHO’s provide a benchmark for Indigenous health care practice to the mainstream services, and through NACCHO can provide valuable good practice learnings to drive improved practices.

NACCHO also acknowledges the social determinants of health, including housing, family support, community safety, access to good nutrition, and the key role they play in influencing the life and health outcomes of Indigenous Australians.

Elsewhere NACCHO has and will continue to call on the Australian and state and territory governments to do more in these areas as they are foundational to closing the gap in life expectancy.

Addressing the social determinants of health is also critical to reducing the number of Indigenous incarceration. Comprehensively responding to the Royal Commission into the Protection and Detention of Children in the Northern Territory must be a non-negotiable priority.


The following policy proposals are divided into four areas below and summarised in the following table:

  1. Proposals that strengthen and expand ACCHOs’ capacity and reach to deliver health services for Indigenous people
  2. Proposals that improve responsiveness of mainstream health services for Indigenous people
  3. Proposals that address specific preventable diseases
  4. Proposals that build in an Indigenous position into policy considerations that impact on health.

NACCHO is committed to working with the Australian Government to further develop the proposals, including associated costings and implementation plans and identifying where current expenditure could be more appropriately targeted

Continued HERE NACCHO-Pre-budget-submisison-2018