NACCHO Aboriginal Health :Dr Lesley M Russell: Analysis of Indigenous provisions in the 2015-16 Federal Budget


“Despite the need and the promises, Commonwealth funding for Indigenous Affairs as a percentage of both total outlays and GDP is in decline. And it is disconcerting to see Indigenous voices and input into decision-making being side-lined.  Indigenous groups and spokespeople have called the government on the absence of real engagement and consultation – something which has long been recognised as the key to failure or success in Indigenous affairs. “

Dr Lesley M Russell Adj Assoc Professor, Menzies Centre for Health Policy University of Sydney

It is not credible to suggest that one of the wealthiest nations in the world cannot solve a health crisis affecting less than 3 per cent of its citizens. Research suggests that addressing Aboriginal and Torres Strait Islander health inequality will involve no more than a 1 per cent per annum increase in total health expenditure in Australia over the next ten years. If this funding is committed, then the expenditure required is then likely to decline thereafter.”

Tom Calma, in his role as Aboriginal and Torres Strait Islander Social Justice Commissioner and Race Discrimination Commissioner, pointedly stated in 2008:


This work does not represent the official views of the Menzies Centre for Health Policy or NACCHO


This analysis looks at the Indigenous provisions in the 2015-16 federal Budget. This is done in the light of current and past strategies, policies, programs and funding, and is supported, where this is possible, by data and information drawn from government agencies, reports and published papers.

Similar analyses from previous budgets are available on the University of Sydney e‐scholarship website.[1]

The opinions expressed are solely those of the author who takes responsibility for them and for any inadvertent errors.


The 2015-16 Budget from the Abbott Government has no major announcements on Indigenous issues, and they did not rate a mention in the Treasurer’s budget night speech.

However the Budget is far from benign in its support for Indigenous programs and advocacy groups say   it has failed to undo the damage done  and anxiety caused by funding cuts in last year’s Budget.  Many programs and services must continue to operate with uncertain funding into the future and in the absence of clear strategies and policies from the Abbott Government.

This comes on top of the threat of remote community closures in Western Australia, attempts to weaken protection from racial vilification under the Racial Discrimination Act, and concerns about the implementation of and outcomes from the Indigenous Advancement Strategy (IAS) tendering process.  Indigenous organisations are losing out in the competition for funds to deliver Indigenous programs and services and after last year’s Budget cuts, there is no new funding for key representative groups such as the National Congress of Australia’s First Peoples.

Despite the need and the promises, Commonwealth funding for Indigenous Affairs as a percentage of both total outlays and GDP is in decline. And it is disconcerting to see Indigenous voices and input into decision-making being side-lined.  Indigenous groups and spokespeople have called the government on the absence of real engagement and consultation – something which has long been recognised as the key to failure or success in Indigenous affairs.

In March 2015 the Minister for Indigenous Affairs, Nigel Scullion, took delivery of ‘The Empowered Communities Report’, produced of a group of Indigenous leaders from across Australia brought together by the Jawun Indigenous Partnerships Corporation.  The report outlined ways for Indigenous communities and governments to work together to set priorities and streamline services at a regional level, in line with the Government’s approach. The Minister committed that the Government would consider carefully the report’s recommendations and respond ‘in due course’.  That has yet to happen.

What emerges most strikingly from this year’s Budget analysis is that little has been done over the past twelve months to assess the implications of commissioned reports and reviews, to capitalise on the restructure and realignment of Indigenous programs, to develop promised new policies and to roll them out.  All that has been done to date is to shift responsibility for programs to the Department of Prime Minister and Cabinet and to rebrand programs that may or may not be effective. It’s a policy-free zone, where ad hoc decisions are the norm and budgets continue to be constrained in ways that limit the effectiveness and reach of programs and services.

There are a number of examples where program funding has been provided at the expense of other needed programs – taking $11.5 million from Indigenous Safety and Wellbeing programs to reverse funding cuts to the Indigenous Legal Assistance Program is perhaps the most egregious example.

There are also concerns that proposed changes to mainstream programs such as increased co-payments and safety net threshold in health, reduced Commonwealth funding for public hospitals, increased costs for higher education, and changes to the collection of census data will have a disproportionate impact on Indigenous Australians.

Small wonder then that most Closing the Gap targets remain out of reach and the sector is struggling to keep programs functioning and retain staff.

The inequality gap between Indigenous peoples and other Australians remains wide and has not been progressively reduced. With a significant proportion of Indigenous Australians in younger age groups, and without funded commitments to actions now and into the next several decades to improve their socio-economic status, future demands for services will burgeon.

Implementation of the National Aboriginal and Torres Strait Islander Health Plan

The National Aboriginal and Torres Strait Islander Health Plan 2013-2023 was developed to provide an overarching framework which builds links with other major Commonwealth health activities and identifies areas of focus to guide future investment and effort in relation to improving Indigenous health.

On 30 May 2014 the Assistant Minister for Health, Fiona Nash, announced that an Implementation Plan would be developed for this Health Plan.

This was supposed to be available from 1 July 2015 to enable the progressive implementation of the new funding approach for the Indigenous Australian’s Health Program. The new approach will target funds to those regions whose populations experience high health need and population growth. The Budget Papers explicitly mention NACCHO as the nominated community stakeholders along with States/Territories in the development of this mechanism.

At June 2015 Senate Estimates PM&C officials said that the implementation plan was still being developed by DoH in collaboration with the National Health Leadership Forum, AIHW and PM&C. Its release was expected within a ‘short period of time’.

The Close the Gap Campaign Steering Committee believes that the Implementation Plan requires the following essential elements:

  • Set targets to measure progress and outcomes. Target setting is critical to achieving the COAG goals of life expectancy equality and halving the child mortality gap;
  • Develop a model of comprehensive core services across a person’s whole of life including end of life care with a particular focus, but not limited to, maternal and child health, chronic disease, and mental health and social and emotional wellbeing; and which interfaces with other key service sectors including, but not limited to, drug and alcohol, aged care and disability services;
  • Develop workforce, infrastructure, information management and funding strategies based on the core services model;
  • A mapping of regions with relatively poor health outcomes and inadequate services. This will enable the identification of service gaps and the development of capacity building plans, especially for ACCHS, to address these gaps;
  • Identify and eradicate systemic racism within the health system and improve access to and outcomes across primary, secondary and tertiary health care;
  • Ensure that culture is reflected in practical ways throughout Implementation Plan actions as it is central to the health and wellbeing of Aboriginal and Torres Strait Islander people;
  • Include a comprehensive address of the social and cultural determinants of health; and
  • Ensure the development and implementation of the National Strategic Framework for Aboriginal and Torres Strait Islander Peoples’ Mental Health and Wellbeing 2014-2019 as a dedicated mental health plan for Aboriginal and Torres Strait Islander peoples, and in coordination with the implementation of the National Aboriginal and Torres Strait Islander Suicide Prevention Strategy and the National Aboriginal and Torres Strait Islander Drug Strategy.
  • Establish partnership arrangements between the Australian Government and state and territory governments and between ACCHS and mainstream services providers at the regional level for the delivery of appropriate health services.

The Health Portfolio Budget Statement says that in n 2015-16, the Government will implement a National Continuous Quality Improvement Framework for Indigenous primary health care through the expansion of the Healthy for Life activity. This will support the delivery of guideline-based primary health care and support improved health outcomes.


There were no specific Indigenous issues included in the Health budget, and there are questions about the future of some programs.

Aboriginal Community Controlled Health Organisations

The Abbott Government has provided $1.4 billion /3 years ($448 million / per year) for Aboriginal Community Controlled Health Organisations (ACCHOs). This will include a 1.5% CPI increase over the 3 year period. NACCHO and Affiliate funding of $18 million is provided for 18 months and in that time DoH will commence a review of NACCHO’s role and function.[2]

NACCHO Budget Analysis HERE

In addition, NACCHO has secured confirmation of an extension of the exemption from Section 19.2  of the Health Insurance Act 1973 which expires on 30 June 2015, which enables ACCHOs to receive financial benefit from Medicare rebates in addition to Government funding.  This extension will be granted until June 2018.

The freeze on MBS rebate indexation will have a significant financial impact on ACCHOs as will any increase in Medicare and PBS co-payments.

Flexible Funds

In combination the 2014-15 and 2015-16 Budgets will cut $500 million / 4 years from 14 of the 16 DoH flexible funds.  There is still no clarity in relation to how these savings are to be achieved, although the Aboriginal and Torres Strait Islander Chronic Disease Fund will not be cut.  However cuts to other funds such as those that support the provision of essential services in rural, regional and remote Australia, that manage responses to communicable diseases and that deliver delivering substance abuse treatment services will affect  Indigenous Australians.

Aboriginal and Torres Strait Islander Chronic Disease Fund

Within the Health portfolio, the Aboriginal and Torres Strait Islander Chronic Disease Fund supports activities to improve the prevention, detection, and management of chronic disease in Indigenous Australians and to contribute to the target of closing the gap in life expectancy. The Fund consolidates 16 existing programs, including the majority of initiatives under the Indigenous Chronic Disease Package, into a single flexible fund. The three priority areas targeted are:

  • Tackling chronic disease risk factors
  • Primary health care services that can deliver
  • Fixing the gaps and improving the patient journey.

The Fund was established in the 2011 Budget and came into operation on 1 July 2011. The funding is $833.27 million / 4 years (from 1 July 2011 to 30 June 2015). The majority of funding has been directly allocated to organisations to support activities under the Fund’s Indigenous Chronic Disease Package programs.

At June 2015 Senate Estimates it was confirmed that most, but not all, of the activities under this fund were continuing.  Local community campaigns and the chronic disease self-management program were named as two programs that were not continued.

Tackling Indigenous Smoking Program

The 2014-15 Budget cut $130 million / 5 years from the Tackling Indigenous Smoking Program, despite the fact that 44% of Indigenous people smoke.    The program was reviewed in 2014 and the DoH website says that this review will “provide the Government with options to ensure the program is being implemented efficiently and in line with the best available evidence. The outcome of the review will inform new funding arrangements from 1 July 2015.” However there were no announcements in the Budget.

The redesigned program was announced on 29 May 2015, but with no increase in funding It is not clear when or if the review of this program, conducted by the University of Canberra, will be released.

Funding in 2014-15 was $46.4 million; this is reduced to $35.3 million in 2015-16.  Staffing levels have also fallen significantly, from 284 FTEs in May 2014 to 194 FTEs in May 2015. There will be further disruption to this important program as current contracts cease at the end of June 2015 and the 49 organisations that deliver the program must go through the IAS Invitation to Apply Process for further funding.  Transitional funding will be available for the next 6 months.

Australian Nurse Family Partnership Program and New Directions: Mothers and Babies Services

In the 2014-15 Budget there was additional funding for a Better Start to Life will improve early childhood outcomes :

  • $54 million expansion, from 2015-16, of New Directions from 85 to 137 sites (52 additional sites overall) to ensure more Indigenous children are able to access effective child and maternal health programs.
  • $40 million expansion, from 2015-16, of the Australian Nurse Family Partnership Program from 3 to 13 sites (10 additional sites overall) to provide targeted support to high needs Indigenous families in areas of identified need.

In 2015 the Australian Nurse Family Partnership Program will grow from three to five sites and New Directions: Mothers and Babies Services will reach an additional 25 services, bringing the total to 110 services, with an enhanced capacity to identify and manage Fetal Alcohol Spectrum Disorder in affected communities

Prevention – Shingles vaccine

The Budget provides for the listing of Zostavax vaccine for the prevention of shingles to be listed on the National Immunisation Program for 70 year olds from 1 November 2016.  This measure includes a 5-years program to provide a catch-up program for people aged 71-79.

There is concern that the 70-79 year old age cohort largely excludes Indigenous people because of their lower life expectancy.

Pharmaceutical Benefits Scheme

Close the Gap PBS Co-payment

This is an ongoing measure and although it was not mentioned in the Budget, it was stated in Senate Estimates that this would continue as currently.

QUMAX Program

The QUMAX program is a quality use of medicines initiative that aims to improve health outcomes for Indigenous people through a range of services provided by participating ACCHO and community pharmacies in rural and urban Australia. It commenced in 2008 as a two year pilot. It was later approved for a transition year outside the 4th Community Pharmacy Agreement and for a further four years under the  5th Community Pharmacy Agreement.

NACCHO and the Pharmacy Guild of Australia have been negotiating 1 year transition funding of QUMAX to enable development of an Implementation Plan under the 6th Community Pharmacy Agreement.  NACCHO will seek to expand QUMAX from 76 services to 134 services.


MBS Practice Incentive Program (PIP) Indigenous Health Incentive

This is an ongoing program (although it may be subject to an indexation freeze).  It is expected to be considered as part of the new MBS Review.

Healthy Kids Check

The Budget cut Medicare funding for the Healthy Kids Check, a consultation with a nurse or GP to assess a child’s health and development before they start school, on the basis that this measure is a duplication with existing State and Territory based programs.  NACCHO states that this change will not impact ACCHOs or Indigenous children as ACCHOs can continue to bill health assessments through a separate item (MBS item 715).

Primary care – PHN Funding

The current transition of Medicare Locals (MLs) to Primary Health Networks (PHNs) is proceeding slowly and many details relating to specific programs remain unknown, perhaps even undecided.

To date, 21 of 61 MLs outsource the provision of services for Indigenous Australians directly to ACCHOs. The provision of these services will now move to a competitive commissioning process, leading to concerns about issues such as cultural safety and sensitivity.

The Minister for Health, Sussan Ley,  has advised NACCHO that funding for Complementary Care and Supplementary Services will transition to the PHNs.

Mental Health

The Budget has nothing that responds to the National Mental Health Commission’s review of programs and services. The report describes Indigenous mental health as ‘dire’. It’s a dominant over-arching theme throughout, and there is a recommendation to make Indigenous mental health a national priority and agree an additional COAG Closing the Gap target for mental health.

Despite this, the Government has delayed any action and has established an Expert Reference Group to develop implementation strategies.  There is no Indigenous representation on the Reference Group.

Substance and alcohol abuse  

Alcohol abuse

Alcohol abuse has been identified as a major public health concern among Indigenous people, with serious physical and social consequences. Indigenous Australians between the ages of 35 and 54 are up to eight times more likely to die than their peers, with alcohol abuse the main culprit and alcohol is associated with 40% of male and 30% of female Indigenous suicides.

Fewer Indigenous people drink alcohol than in the wider community, but those who do drink do so at levels harmful to their health. Culturally appropriate intervention approaches are needed and ‘dry zones’ are only seen as stop gap measures.

Cuts made in Flexible Funds affect drug and alcohol programs. Professor Kate Conigrave reports that there are now only 5 dedicated Indigenous drug and alcohol services nationally.

Ice campaign

This Budget commits $20 million / 2 years for a new stage of the National Drugs Campaign primarily aimed at the use of ice. No consultation has been undertaken in the lead up to the announcement of this health promotion campaign.

It almost certainly will not achieve tangible outcomes for Aboriginal people, despite concerns about a growing ice epidemic in remote Indigenous communities.

Opal fuel

There are 123 petrol stations selling Opal fuel in remote parts of Australia but some retailers in the roll-out zones don’t and there are pockets of sniffing near state borders. In December 2014 it was announced that a bulk storage tank for low-aromatic unleaded fuel (LAF or Opal ) is to be installed in northern Australia as part of the  roll-out of OPAL in the fight to curb the problem of petrol sniffing.





NACCHO Close the Gap news: AMA and Pharmacy Guild continue to make an important contributions to closing the gap


Community pharmacy continues to make an important contribution to the important national task of closing the gap in life expectancy and health outcomes for Aboriginal and Torres Strait Islander people.

Press release from The Pharmacy Guild

The fact that the Prime Minister, Tony Abbott, reported today that there has been “almost no progress in closing the life expectancy gap” should serve as a call to action to all in the health sector to work towards more effective solutions to this national problem.


Community pharmacists have actively implemented the Close the Gap Pharmaceutical Benefits Scheme arrangements since 2010, helping to deliver quality use of medicines to Aboriginal and Torres Strait Islander people. Increased access to the PBS helps improve the prevention and management of chronic disease for Aboriginal and Torres Strait Islander people.

The cost of medicines has been identified as a significant barrier to improved access to medicines for Aboriginal and Torres Strait Islander people. Despite two to three times higher levels of illness, PBS expenditure for Aboriginal and Torres Strait Islander people is about half that of the non-Indigenous average.

The Executive Director of the Guild, David Quilty, said: “The Guild has a longstanding and proven history of promoting equal access to pharmacy services that are culturally sensitive and appropriate.

“Additionally, the Guild is committed to the development and application of Quality Use of Medicines strategies to improve the health and health infrastructure for Indigenous people.

“That’s why we joined the ‘Close the Gap’ Campaign Steering Committee, which has called for policy continuity in critical areas of the national effort to close the gap, and also for further steps to build on and strengthen the existing platform,” Mr Quilty said.

For example, the Guild’s pre-Budget submission to the Government highlighted the fact that medication adherence is a particular problem in the Aboriginal and Torres Strait Islander population and a modest, funded medication management program to meet their specific needs would improve health outcomes in a cost effective way.


The AMA today commended the Prime Minister on the personal drive and commitment to improve the lives of Indigenous Australians outlined in his Closing the Gap Report, and welcomed the Government’s new target to end the gap between Indigenous and non-Indigenous school attendance.

The AMA also welcomes today’s release of the Close the Gap Campaign Progress and Priorities Report.

AMA President, Dr Steve Hambleton, said both the PM’s Report and the Close the Gap Campaign Report highlight key areas where there has been success in closing the gap and reflect a shared intent to make a real difference to improving the quality of life and health of Aboriginal peoples and Torres Strait Islanders.

Dr Hambleton said the first priority is for all Australian governments to recommit to the COAG National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes for another four years, with current levels of funding.

“The AMA believes that achieving equality in health and life expectancy for Aboriginal and Torres Strait Islander peoples is a national priority,” Dr Hambleton said.

“The Close the Gap Campaign Report provides the Government and stakeholders with independent and informed feedback on how well we as a nation are performing in closing the gap on health inequality.

“The Report makes practical and informed recommendations about what more is needed to achieve health equality.

“These recommendations are made by key Indigenous and non-Indigenous groups, including the AMA, who are directly aware of what is happening or not happening on the ground.

“Importantly, the Report identifies the areas where real needs and real gaps remain to be filled.

“There is evidence of some early successes in closing the gap, particularly reduced smoking rates and maternal and childhood health.

“The AMA welcomes these successes and believes the COAG

National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes, with leadership and funding from all governments, can achieve many more successes with the right funding and commitment.

“All government and stakeholders must work together in partnership to achieve these goals.

“As the Prime Minister said today: ‘ Our job is to break the tyranny of low expectations.’”

In order to make a real difference in closing the gap, the AMA believes an implementation framework must be established for the recently-developed National Aboriginal and Torres Strait Islander Health Plan.

This would involve:

  •  the development of a comprehensive set of measurable targets to be achieved over the next 10 years;
  •  the development and implementation of a service model that will effectively and efficiently achieve those targets;
  •  the development and implementation of a national workforce strategy for existing and emerging areas of need in service provision;
  •  the formulation of a funding and resource model commensurate with health care needs and priorities in Aboriginal and Torres Strait Islander populations over the next 10 years; and
  •  clear, measurable requirements for governments to work together in genuine partnership and with the guidance of Indigenous health leaders and Indigenous communities.

Dr Hambleton said the development of this framework should be undertaken by a newly constituted Stakeholder Advisory Group, which would use the experience and expertise of Indigenous and non-Indigenous groups that have first-hand knowledge of what works, what doesn’t work, and what holds promise and is worth pursuing.

“The AMA strongly believes that getting a healthy early start in life is crucial to leading a healthy later life, which will eventually close the gap across generations,” Dr Hambleton said.

“Aboriginal and Torres Strait Islander children are particularly susceptible to risk factors and stressors that can determine poor outcomes later in life and entrench the intergenerational cycle of ill-health.

“Governments need to focus greater funding on evidence-based best-practice programs in early childhood development that are delivering positive outcomes.

“The AMA outlined some of these programs in its recent Report Card on Aboriginal and Torres Strait Islander Health.”

The 2013-14 AMA Report Card on Aboriginal and Torres Strait Islander Health,

The Healthy Early Years – Getting the Right Start in Life, is available at here


Congress notes the Prime Minister’s focus on school attendance in his first Closing the Gap report and looks forward to the detail of the new Closing the Gap target.
“Congress believes education is a two way relationship – we want to see as much energy and focus on making schools places that our kids want to go and our families trust and genuinely feel a part of,” said Congress Co-Chair Kirstie Parker.
“Local schools and communities need to be supported through good policy at both a state and a national level to help make this happen; attendance will not rise through punitive measures alone.
“The Abbott Government must continue the work done on developing previously announced disability and justice targets in Closing the Gap.
“The over-representation of our peoples in the criminal justice system – at around 12 times the rate of the rest of the Australian population – is both cause and effect for the poor state of health, education and employment of so many of our families and communities.
“Access to disability services is an important determination of outcomes not just in health, but in education, employment justice and housing,” Ms Parker said.
Co-Chair Les Malezer said, “We urge the Government to show leadership in closing the gap by forging a new National Partnership Agreement on Indigenous Health Outcomes with all states and territories on board.
“We also urge it to work in partnership with Aboriginal and Torres Strait Islander community controlled health organisations and others on implementing the National Aboriginal and Torres Strait Islander Health Plan (NATSIHP) and its vision of the Australian health system being free of racism and its recognition of culture as central to the health of our Peoples and communities.
“Racism within the health sector affects access to health services -our members tell us and this was also confirmed in national NATSIHP consultations.
“Now is the time for the Abbott Government to walk the talk to continue the strong bipartisan support to close the Aboriginal and Torres Strait Islander health and life expectancy gap by 2030,” Mr Malezer said

NACCHO Aboriginal health news : Aboriginal’s in more remote areas would like to ‘take their medicine’


” Many Aboriginal people in remote areas access medicines through Section 100 arrangements but there is often insufficient professional pharmacist advice provided in these settings.

Better funding could allow greater access for these vulnerable Australians to professional pharmacy services the rest of us take for granted.”

The National Rural Health Alliance has published a Discussion Paper about the relatively poor access to medicines and pharmaceutical advice available to people in rural and remote areas.



Tim Kelly, Chairperson of the Alliance, described the situation as an important healthcare deficit which has received insufficient attention – but one that could be resolved with some simple and low-cost changes to programs and regulations.

“The new paper demonstrates the extent to which people in Australia’s rural and remote areas have poorer access to prescribed and non-prescribed medicines, less advice about the use of medicines, and poorer access to professional pharmacy services,” Dr Kelly said.

“As with so many other issues in the rural and remote health sector, there is a gradient of deficit as one moves from major cities through regional areas to remote and very remote places. Our Discussion Paper explores these issues and begins scoping for a project which could advise Australian governments on the best ways to improve the situation.”

The paper describes how and where people access medicines and considers the bottlenecks and inefficiencies that need to be addressed.

Reimbursement through the Pharmaceutical Benefits Scheme (PBS) is the main means by which the Australian Government funds access to medicines and there should be action to bolster the supply of pharmacists (and the services they provide) to rural and remote areas of Australia. For instance there could be scholarships for pharmacy students from rural areas and increased incentives for rural pharmacists to provide training opportunities for pharmacy interns.

The Alliance proposes the investigation of ways to simplify medication prescribing and dispensing legislation and evaluate how such things as pharmacy outposts and telepharmacy can allow more equitable access. Small rural hospitals often do not have the capacity to employ a pharmacist, but they could if the role also provided professional support to local Aboriginal Health Services and professional medicines reviews in the community.

People living outside major cities also have poorer access to advice related to medicines, and this has implications for both the safety of patients and for the effectiveness of their medications. There should be better integration of various programs already in place for the provision of medicines and pharmaceutical advice. By prioritising Quality Use of Medicine initiatives, the government could better manage and reduce chronic disease in rural and remote areas.

Many Aboriginal people in remote areas access medicines through Section 100 arrangements but there is often insufficient professional pharmacist advice provided in these settings. Better funding could allow greater access for these vulnerable Australians to professional pharmacy services the rest of us take for granted.

The Alliance is calling for action on this issue and for further investigation of potential solutions. It is time to ensure that people in rural and remote Australia receive the same level of health care as those in the major cities, including access to medicines.

NACCHO health conference alert: Health Workforce National Conference to discuss Close the Gap initiatives and supporting workforce

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National initiatives to close the gap in Aboriginal and Torres Strait Islander life expectancy and to build the supporting health workforce will be discussed and debated at Health Workforce Australia’s (HWA) 2013 national conference in November.

Information and registrations here

The life expectancy of Aboriginal and Torres Strait Islander people is more than 10 years less than other Australians. In 2008, the Council of Australian Governments (COAG) agreed to close the gap in life expectancy within a generation by 2031.

This commitment affects all health professionals and the way care is provided.


Greg Craven, Deputy Chair of the COAG Reform Council and Adrian Carson (pictured above ), Chief Executive Officer of the Institute for Urban Indigenous Health, will take part in a panel discussion at HWA’s conference, Skilled and Flexible – The health workforce for Australia’s future.

The session will feature a discussion on the progress made to improve health outcomes to close this gap and how Australia is tracking against its commitment. Mr Craven will also focus on flexible service delivery and funding.

“Any effort to close the gap must acknowledge that Aboriginal and Torres Strait Islander Health Workers make an invaluable contribution,” HWA Acting Chief Executive Ian Crettenden said.

“They are often the first point of contact because Aboriginal and Torres Strait Islander people find it easier to access healthcare services from someone who they can relate to, who understands them and their culture.”

Janine Headshot

Romlie Mokak, Chief Executive of the Australian Indigenous Doctor’s Association, and Janine Milera (pictured above) , Chief Executive of the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives, will reveal initiatives underway to help increase the numbers of Aboriginal and Torres Strait Islander health professionals in the Australian health workforce.

Murra Mullangari – Pathways Alive and Well is a national Aboriginal and Torres Strait Islander health careers development program, established by the Australian Indigenous Doctors’ Association to encourage Indigenous senior secondary school students to remain in school and pursue health careers.

Ms Milera will describe initiatives to overcome the challenge of many Aboriginal and Torres Strait Islander people being uncomfortable using mainstream healthcare services.

More than 50 local and international speakers will explore the latest ideas on leadership, innovation and workforce reform at the event at the Adelaide Convention Centre from 18 to 20 November.

Registrations are now open for this year’s conference.

Concession tickets cost $350 and full price tickets are $600.

To attend the conference and find out more visit

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NACCHO funding alert:QUMAX registrations for the 2013-2014 are now open:closes April 12


 All services are invited to register to participate in the QUMAX Program.  The QUMAX (Quality Use of Medicines Maximised for Aboriginal and Torres Strait Islander Peoples) Program provides services with funding to assist with improving the way medicines are used to maximise the benefits to the client.  

A range of initiatives may be eligible for funding under all or some of seven categories.

 Possible initiatives may include;-

  • the supply of delivery devices such as spacers for asthma medications,
  •  transport to collect medicines,
  • dose administration aids to help with compliance,
  • education tools such as Ibera software licences and medicines reference texts,
  • medication education for staff,
  • cultural training for pharmacists and pharmacy staff and
  • facilitation of medication reviews for clients.

The QUMAX program has been running since 2008 and has guaranteed funding to 30th June, 2015 under the Fifth Community Pharmacy Agreement. Administration of the program is shared between NACCHO, The Pharmacy Guild of Australia and the Department of Health and Ageing.

Participation in QUMAX requires an annual registration process. This is done online using the NCN a custom built program for the administration of QUMAX. Patient numbers and the number of services registered are used to allocate the annual QUMAX budget.

Services will be notified of their budget and be asked to complete a workplan shortly after the close of registrations.

You may access the NCN through NACCHO’s website. Most services will already have staff that have been provided with usernames and passwords that enable them to logon and complete the registration form.

If you are new to the NCN or QUMAX please contact the QUMAX Program Manager at NACCHO to arrange access to the NCN. See contact details below

An alternative to accessing the NCN through the NACCHO website is to follow the link.

Registrations close on Friday 12th April, 2013 (late registrations will not be accepted).

To be eligible to register for the QUMAX program a service must meet the eligibility criteria:

• Employ a General Practitioner(s);

• RRMA classification of 1-5 (i.e. a non-remote location) (1991 Census Edition);

• Not currently eligible for the Section 100 Pharmacy Support Allowance Program;

• Agree to the QUMAX Program Specific Guidelines; and

• Be funded by OATSIH for the provision of primary healthcare services to Aboriginal and Torres Strait Islander peoples.

Additional program specific details may be found at the following link.


If a service is auspiced the auspicing body must register and include the auspiced service’s patient numbers in their registration. A budget allocation will be made to the auspicing body.

If you have any queries or require further information about QUMAX or the registration process

Please email the QUMAX Program Manager

  or call 02 6246 9310

Improving identification of Aboriginal patients in general practice


The access of Aboriginal and Torres Strait Islander patients to medications is improving, but more could be done to identify Aboriginal (Indigenous ) patients in general practice, says Jill Dixon, a project manager working in Indigenous health.

Access to primary health care outside the community controlled primary health care services requires patients to be identified and recorded as being of Aboriginal and/or Torres Strait Islander heritage by the general practice to receive access to the closing the gap prescription co-payment relief measure.

General practice also needs to be registered for the Indigenous Health Incentive, Practice Incentive Payment, to be eligible to provide co-payment relief prescriptions

Improving identification of Aboriginal patients in general practice

Our thanks to Jill Dixon for permission to republish:

And the continued support of  Melissa Sweet CROAKEY

Photo above supplied by Wayne Quilliam Photography

A recent issue of Australian Doctor (8 November 2012) reported that a significant number of GPs did not know about a scheme that enables eligible Aboriginal and Torres Strait Islander patients to receive free or cheaper PBS medications.

The cost of medications has been identified as a key factor that prevents many Aboriginal and Torres Strait Islander people from obtaining optimum healthcare.

The PBS co-payment measure was introduced in 2010 to address this financial barrier and is a key measure to help close the inequity gap between Aboriginal and Torres Strait Islander people and non-Indigenous people.

The scheme has been successful beyond all projections in providing Indigenous access to vitally needed medications, especially for people with chronic conditions who previously could not afford to fill their prescriptions.

The recently released Aboriginal and Torres Strait Islander Health Performance Framework 2012 Report says that, by June 2012 approximately 150,000 Aboriginal and Torres Strait Islander people (compared to an anticipated number of 70,000) had accessed the initiative.

Ninety-six per cent of pharmacies participated in the scheme, dispensing 2.7 million prescriptions during that time.

This translates to a significant increase in the number of Aboriginal and Torres Strait Islander people being better treated for the prevention or management of chronic disease.

However, the report also claims that, while the gap is closing, there is still more to be done in ensuring access to medicines through the PBS Co-payment scheme for all Aboriginal and Torres Strait Islander people.

The most recent data (2008-2009) shows that benefits paid through the PBS scheme were about 74% of the level of expenditures for non-Indigenous people, and total expenditure was only 44% of that for non-Indigenous people.

Surprisingly, the gaps between expenditures for Aboriginal and Torres Strait Islander people and non-Indigenous people are greatest in non-remote areas, because of special provisions for pharmaceutical services for those living in remote and very remote areas.

In addition to cost, another barrier is the extent to which Aboriginal and Torres Strait Islander people access – or are known to access – primary and specialist health care services in the first place.

Mentioned in the above report is the importance of the identification of Aboriginal and Torres Strait Islander patients in those services. After all, how can a GP provide prescriptions under the PBS Co-payment measure if they don’t know that their patient is of Aboriginal and/or Torres Strait Islander origin?

Another recently released report provides some useful information here. The Bettering the Evaluation and Care of Health (BEACH) Report states that Aboriginal and Torres Strait Islander people, who constitute about 2.5% of the total population, were identified at only 1.6% of total GP encounters.

This is only marginally better than findings from 10 years ago, in the 2002-3 BEACH report, which found identification occurring at 1.2% of encounters. See the comparisons here.

We now know that the vast majority of pharmacists actively support the PBS Co-payment Measure.

However, we have no equivalent information on the percentage of general practices that identify the Indigenous status of their patients, thereby helping to start their Aboriginal and Torres Strait Islander patients on the pathway to better health outcomes.

The BEACH data suggest that routine identification in general practices is low, and this would then lead to the generally low uptake of Aboriginal and Torres Strait Islander specific health interventions.

There are many reasons for the low rates of Indigenous identification in general practice.

One is that many GPs and practice staff believe that they don’t have any Aboriginal and/or Torres Strait Islander people amongst their patient group. This is often an assumption based on the location of the practice, or that their patients ‘don’t look Aboriginal’.

Some practice staff believe that Aboriginal and Torres Strait Islander people should be treated just the same as non-Indigenous patients, and so should not receive any special services earmarked for them.

The gap between the health outcomes and life expectancy rates of Aboriginal and Torres Strait Islander people is now well known, and the government Closing the Gap health initiatives are intended to address this shameful discrepancy.

All GPs and practice staff are strongly urged to participate in these measures, starting with routinely identifying the Indigenous status of their patients.

The Australian Institute of Health and Welfare (AIHW) publication National best practice guidelines for collecting Indigenous status in health data sets is the place to start.


The RACGP Standards for General Practices (4th edition) require general practices seeking accreditation to demonstrate that they ‘routinely record Aboriginal and Torres Strait Islander status in (their) active patient health records’. See the RACGP position statement.

The PBS Co-payment Measure is intended for Aboriginal and Torres Strait Islander people of any age who present with an existing chronic disease or are at risk of chronic disease and in the opinion of the prescriber would experience setbacks in the prevention or ongoing management of chronic disease if they did not take the prescribed medicine and are unlikely to adhere to their medicines regimen without assistance through the Measure. For more information, see here.

NACCHO pharmacist joins live and interactive TV Rural Health Channel 16 October

Do you take your heart tablets everyday as directed by the doctor?

If you don’t, you are not alone.

Research has shown that patients don’t take their heart medicines properly and this has become a significant burden on the health care budget.

Heather Volk, pharmacist with NACCHO joins a panel with Dr Rob Grenfell, Dr Christine Connors and Ms Megan MacDonald, chaired by Dr Norman Swan to discuss some of the reasons for non-adherence to cardiovascular medicines.

Join the Rural Health Education Foundation live interactive panel discussion.

Details of the live broadcast are below.

Non-adherence to cardiovascular medicines has become a large burden on the healthcare system budget; 30% of all prescriptions dispensed in community pharmacies are for CVD, and 20% are for hypertension.

Adherence to cardiovascular medicines ranges from 11% to 83%, depending on the condition being treated and medicine type

  • Some level of nonadherence is to be expected
  • Poor adherence has a direct impact on patients’ absolute CVD risk levels
  • Health professionals can positively impact patients behaviour
  • Collaborative decision making with patients improves adherence

This program examines the underlying issues as to why patients struggle to adhere to medications and lifestyle changes.

Hear the latest evidence on strategies that have been proven to help and learn what you can do to improve your patients’ adherence and achieve better health outcomes for them.

Live Interactive Panel Discussion

Chair: Dr Norman Swan

Dr Rob Grenfell – Rural GP and Clinical Director Heart Foundation

Dr Christine Connors – Chronic Conditions Unit, NT Health

Ms Heather Volk – QUMAX Program Manager,NACCHO

Ms Megan MacDonald – Registered Nurse, SA

Accredited with ACRRM, RACGP & RCNA.

CPD points also available from other professional organisations.

 This program is funded by MSD Australia

Rural Health Channel

Tuesday 16th October, 2012

Watch live: Channel 600 on VAST

8:00pm NSW, ACT, VIC & TAS

7:30pm SA

7:00pm QLD

6:30pm NT

5:00pm WA

Watch again:

Thursday 18th October 2pm (AEDT)

& online

Sydney Pharmacy Indigenous Camp Jan 2013 application open

What is the Sydney Pharmacy Indigenous Camp (SydPIC)?

SydPIC is a camp that incorporates pharmacy workshops, laboratory sessions and field trips that will give you a taste of university education and a career in pharmacy.

It will be held from Sunday 20 January to Thursday 24 January 2013 for up to 15-25 Aboriginal and Torres Strait Islander students, male and female, from Years 10 and 11 in this current year. The SydPIC program will run over four days during which you will be introduced to the University, campus life and pharmacy.

Is Pharmacy for me?

If you…

  • are good at maths and science
  • enjoy working with people
  • like working as part of a team
  • like to tackle challenging problems

…then pharmacy may just be what you’re looking for!

What will I do at SydPIC?

You will tour the university campus, live on-site in college accommodation; participate in challenging workshops and fun team-building exercises including working in the laboratory to prepare creams and lotions, make tablets and extract the active ingredients from medicines. In addition you will learn about the benefits and harmful effects from commonly used medicines.

Guided by your tutors – pharmacy teachers and a practising indigenous pharmacist – you will visit and speak with hospital and community pharmacists, and be introduced to the science and practice of pharmacy. You will also have the opportunity to meet current students to find out firsthand what it is like to study pharmacy at the University of Sydney.

You will also have the opportunity to discover more about the city of Sydney via a night out on a harbour cruise.

If you would like to know more about the study camp, please read our brochure.


SydPIC is a fully sponsored event by the Faculty of Pharmacy. All your travel costs to and from Sydney, as well as accommodation, tuition, insurance and food will be covered. The only money you many require is pocket money when travelling and during your stay in Sydney.


If you wish to apply for SydPIC you will need to complete an application form. Applications need to be submitted by 26 October 2012. Further details can be found on the application form.

Or for more information, please contact:
SydPIC coordinator
Faculty of Pharmacy
T +61 2 9036 7647
SydPIC is associated with the University of Sydney Wingara Mura-Bunga Barrabugu Indigenous strategy.

Press release 27 March 2012:Aboriginal Community Controlled Health Services and the Pharmacy Guild continue to Close the Gap in access to medicines

 A continued robust partnership between the National Aboriginal Community Controlled Health Organisation (NACCHO) and The Pharmacy Guild of Australia will see vast improvements in Aboriginal and Torres Strait Islanders getting the prescription medicines they need, along with tailored advice and assistance

 At a national joint QUMAX and S100 forum in Melbourne this week over 250 delegates discussed the need to integrate three vital programs that support medicines access and quality use of medicines for the Aboriginal and Torres Strait Islander population.

 Justin Mohamed, the Chair of NACCHO said that all delegates supported the three programs as working well within their services and providing substantial benefits to the Aboriginal community nationwide. The three programs being the  section 100 supply and support programs for remote area Aboriginal health services, the QUMAX program for non-remote Aboriginal Community Controlled Health services, and the closing the gap PBS co-payment relief measure.

 “This forum proved that the networking of Aboriginal health services with prescribers, pharmacies and allied health professionals will produce outcomes to progress the continued improvement of these programs towards quality use of medicines for the Aboriginal and Torres Strait Islander communities and that will be one more step to Close the Gap” Mr Mohamed said.

  “These programs are an example of a true partnership to Close the Gap. It demonstrates the significant impact that Aboriginal Community Controlled Health services can make in improving Aboriginal people’s access to health care, in partnership with industry and Government. If access to medicines is improved, then chronic disease can be reduced, and we can start to see some improvements in Aboriginal people’s life expectancy.”

 “To close the gap we need to also help those patients who are the most needy and hard to reach. Our member services are able to do that because our services know the community and they are run by the community, for the community,” Mr Mohamed said.

Feb 2012 CEO report -QUMAX

Forum: The Department of Health & Ageing is funding a joint QUMAX/S100 Forum on the 26th & 27th March 2012. One funded position is available for each participating ACCHS and all NACCHO Affiliates. This symposium is for all ACCHSs and remote area Aboriginal Health Services. NACCHO is a core partner in developing the Forum and Marilyn is participating. Forum Presenters include the NACCHO Chairperson, NACCHO PHMO, Senior Policy Officer and others.

 Participation: 71 ACCHS are currently participating in QUMAX. ACCHS Work plans are submitted via the National Communication Network (NCN) and each work plan is approved on the system by NACCHO, PGoA and DoHA. The NCN logs the submission and approval dates. The first ACCHS submitted work plan was on 16 June 2011 and the last submission date for an approved work plan was 17 January 2012. All but 2 work plans have been approved to date, funding is contingent upon submission and approval of work.