- First Nations people 16 years+ eligible for COVID-19 vaccine
- New model for rural and remote health care
- Barriers in obtaining birth certification
- ORCHID Study: diagnostic criteria for GDM
- Indigenous policy codesign: risks and opportunities
- Remote Health: going the extra mile
First Nations people 16 years+ eligible for COVID-19 vaccine
From today 8 June 2021, Aboriginal and Torres Strait Islander peoples who are 16 years and older are now eligible for a COVID-19 vaccine. This news was announced following the National Cabinet meeting last Friday by the Aboriginal and Torres Strait Islander Advisory Group on COVID-19 (Taskforce) co-chaired by NACCHO and the Australian Government Department of Health.
Also included in today’s expanded eligibility are all NDIS participants aged 16 and up, as well as NDIS carers.
The AstraZeneca vaccine is preferred for adults aged 50 years and over. The Pfizer vaccine has been approved for adults 16 years and older. Vaccines are available through Aboriginal Community Controlled Health Organisations (ACCHOs), Commonwealth vaccine clinics, general practices, state and territory health services and clinics.
The extended approved storage period of the unopened thawed Pfizer vaccine vials at 2–8°C of up to one month enables much greater flexibility in the distribution of the vaccine and will have a significant positive impact on the roll out of the vaccine across Australia, including to Aboriginal and Torres Strait Islander people and remote communities.
The Taskforce has convened a working group to provide advice on supporting ACCHOs to deliver Pfizer and other future vaccines as they become available to the program.
The Commonwealth Government will work closely with the ACCHO sector to ensure all ACCHOs currently participating in the COVID-19 vaccination program will have the option to administer Pfizer vaccine.
To book your COVID-19 vaccination, contact your health clinic or find a vaccination site near you through the Clinic Finder.
You can read the announcement here.
New model for rural and remote health care
The National Rural Health Alliance (NRHA) is proposing a new model of care for rural and remote Australia primary health care.
Australians living in rural and remote areas have shorter lives, higher levels of disease and injury and poorer access to and use of health services compared to people living in metropolitan areas. Governments have pursued a range of strategies to address these poorer health outcomes over many years. However, trend data reveal that these interventions are having limited success.
There are a range of drivers for the poor health outcomes for rural and remote Australians:
- difficulty in attracting and retaining health professionals to rural areas
- lack of access to services due to distance, lack of transport, income, health literacy and attitudinal barriers
- social determinants of health issues including low socio-economic status, lower education outcomes, higher levels of disability and chronic disease and older population.
What are the barriers to attracting and retaining a rural health workforce?
- Professional – career limitations, networking opportunities, clinical experiences, supervision, professional isolation and lack of support from peers, work life balance issues
- Financial – practice financial viability, need to work across multiple settings, multiple sources of funding both government and private, administrative burden, business acumen requirements
- Social – family and friendship networks, social isolation, cultural and recreational limitations, partner’s concerns including careers and children’s education
Models of care which work for metropolitan areas do not work in rural Australia. NRHA is proposing a locally-based model of health delivery aimed at addressing the key barriers to attracting a rural workforce.
You can read more about the NRHA proposal here.
Barriers in obtaining birth certification
In Australia, the birth certificate is of fundamental importance as the document that unlocks all the rights and privileges of citizenship. While the national rate of birth registration and certification is very strong, this is not the case for a number of Aboriginal and Torres Strait Islander communities. In Queensland for example, births are under-registered and under-certified at a rate of 15–8% compared to non-Indigenous births at 1.8%. WA’s statistics are similar, with almost one in five Indigenous children under 16 years of age having unregistered and uncertified births.
Birth under-registration and under-certification are generally most prevalent in disadvantaged and minority groups, such as Indigenous Australians, children in out-of-home care, and children from culturally and linguistically diverse backgrounds. It is also more likely in births occurring in rural hospitals; where the mother smoked or had an alcohol-related diagnosis during pregnancy; and where the mother’s own birth was unregistered, and she had no private health insurance.
To reduce the rates of birth under-registration and under-certification, especially within minority and marginalised communities, the government must improve awareness and education surrounding the important purposes formal birth registration serves. It must also work to increase its accessibility, and broaden exemptions, such that birthplace, skin colour and parent circumstances cease to be barriers individuals cannot overcome.
You can read the full story in Lawyers Weekly here.
ORCHID Study: diagnostic criteria for GDM
Following a large international study on Hyperglycaemia and Adverse Pregnancy Outcome (HAPO) diagnostic criteria for gestational diabetes mellitus (GDM) were changed in WA in 2015. The ORCHID Study (Optimisation of Rural Clinical and Haematological Indicators of Diabetes in pregnancy) was designed to help simplify screening for GDM in rural and remote WA. Their first paper showed that it can be difficult to do this test. Their second paper showed that two-thirds of women with GDM who do the test are missed due to blood glucose sample instability. The third paper showed that this glucose instability means that they miss identifying women at risk for large babies.
Now that the issue with glucose stability has been sorted, this paper looks at the utility of glycated haemoglobin (HbA1c) in early pregnancy for identifying women at high risk for large babies. The study found that:
- Almost three-quarters (71.4%) of Aboriginal women with early HbA1c ≥5.6% went on to have a positive OGTT. These women may have had prediabetes going into pregnancy.
- There were clear differences between Aboriginal and non-Aboriginal women: 16.3% v 5.2% had elevated HbA1c (pre-pregnancy prediabetes) whereas 12.4% v 29.6% developed GDM during pregnancy. This suggests fewer non-Aboriginal women had prediabetes going into pregnancy compared to Aboriginal women.
- The risk of having a large baby was twice as high in women with an early HbA1c ≥5.6% compared to women with an early HbA1c <5.6% and without GDM (21.4% v 10.5%). This suggests that women with prediabetes in early pregnancy have high-risk for a large baby.
For more information on this study you can download the following documents:
- Download Prediabetes and pregnancy: Using early pregnancy HbA1c to find Aboriginal women with high-risk of diabetes in pregnancy (GDM) and having babies that grow too big.
- Download Prediabetes and pregnancy: Early pregnancy glycated haemoglobin identifies Australian Aboriginal women with high-risk of gestational diabetes mellitus and adverse perinatal outcomes.
- Download Prediabetes and pregnancy: Early pregnancy HbA1c identifies Australian Aboriginal women with high-risk of gestational diabetes mellitus and adverse perinatal outcomes.
- Download Supplementary tables.
Indigenous policy codesign: risks and opportunities
In a discussion paper by the Centre for Aboriginal Economic Policy Research, Australian National University (ANU), Canberra, the mainstream literature on co-design and collaborative governance is surveyed and considered, as a means of identifying the essential characteristics of effective co-design policy and program processes.
In recent years, the requirement for First Nations participation through co-design has emerged as a key prerequisite of policy legitimacy in the Indigenous policy domain. In this discussion paper, the mainstream literature on co-design and collaborative governance is surveyed and considered, as a means of identifying the essential characteristics of effective co-design policy and program processes. The literature survey identifies two strands: one that asserts the merits and opportunities inherent in policy and program co-design, and a second that highlights the risks and challenges.
Two nationally significant current and ongoing Indigenous policy development processes that have been described as co-design processes are then analysed and assessed. The paper concludes that co-design involves more than consultation, and ideally requires shared decision-making. Further, in relation to policy co-design processes, the literature and cases studies suggest the core design features that are required to ensure the processes contribute to creating public value and maintaining trust in democratic public policy institutions.
Remote Health: Going the extra mile
The National Rural Health Alliance (NRHA) has an upcoming webinar on Remote Health: Going the extra mile.
Remote Australia features some of the most stunning landscapes in the world. However, delivering health services in this environment brings with it unique and challenging circumstances. With a small and geographically dispersed population base, ensuring remote Australia has access to high quality healthcare, requires an innovative and flexible approach. This webinar explores the challenges and opportunities in delivering health services to these unique communities, including the experience of working remotely, the critical role of aeromedical support, and how to enhance the medical workforce training experience through remote placements. Get a better understanding of the remote health delivery experience – register for this webinar today.
Date: Thursday 17 June 2021
Time: 12:30 – 1:30 pm (AEST)
Cost: $45.00 (complimentary for NRHA Board, Council and Friends members)
Click here for more information and to register for the webinar.