Aboriginal community controlled health services are the key to reducing Hep C rates
The peak Aboriginal health organisation will today tell a Senate inquiry today that more must be done to reduce the high rate of Hepatitis C infection among Aboriginal people.
National Aboriginal Community Controlled Health Organisation (NACCHO) CEO Lisa Briggs said the rate of new Hepatitis C infection continues to rise in Aboriginal populations even though it is falling for other Australians, and that Aboriginal Community Controlled Health Services are the are key to reducing infection rates.
“Mainstream services are clearly failing Aboriginal people, who are three times as likely to become infected with Hepatitis C as other Australians,” said Ms Briggs.
“It is clear that more prevention and treatment programs are needed that meet the needs of Aboriginal people,” said Ms Briggs.
She said the main contributors to the increased rate of infection for Aboriginal people are higher rates of unsafe injecting drug use and higher rates of incarceration, with the prevalence of the disease in prisoners who inject drugs above 50%.
“Aboriginal Community Controlled Health Services should play a bigger role in Hepatitis C prevention and treatment programs because they have proven to be the most effective providers of primary health care to Aboriginal people.
“These services need the funds and resources so they can provide prevention programs including needle exchange programs and opiate replacement therapy.
“A commitment to more outreach programs by Aboriginal Community Controlled Health Services into prisons will also help with infection rates in these populations.
“Hepatitis C rarely occurs in isolation. Many patients are likely to have multiple health issues including mental illness, drug and alcohol addiction and type two diabetes. Aboriginal Community Controlled Health Services have proven time and time again to be the best model to provide comprehensive primary health care for these complex needs.
“Hepatitis C infections are decreasing among other Australians and we want to see them decreasing among Aboriginal people, too.
“We look forward to working with the Government to ensure our Aboriginal medical services have the funds and resources to make this happen.”
A peak Aboriginal health organisation has slammed reported changes to employment policy in remote communities calling it bad policy developed in isolation from the reality of community life and likely to worsen already poor health outcomes for Aboriginal people.
“This is poor policy, as thin as the paper it’s written on, and as remote from our people’s lives as Canberra is from the bush,” said Justin Mohamed Chair of National Aboriginal Community Controlled Health Organisation (NACCHO).
“Forcing Aboriginal people to work in “work-like” dole activities to supposedly replicate “real work” means the government is admitting what we all know, that there is a drastic shortage of jobs in these remote areas.
“Jobs will not magically appear because a policy changes.
“What is needed is investment in better infrastructure through local communities to work as the lever to create jobs.
“Adding more punitive measures for non-compliance is also likely to further entrench poverty in remote communities and impact on health – extending the life expectancy gap between Aboriginal and non-Aboriginal people.
“We already witness appallingly high rates of mental health and suicide in these communities and there is no evidence that forcing individuals to do meaningless work for the sake of it does anything to improve their health outcomes.
“This proposed policy thinly resembles a back-to-the future CDEP (Community Development Employment Program) but is bereft of the broader understanding of how community and development influence employment.
“We again see no evidence of understanding the interconnection between social, cultural, health, education and economic factors, and people’s ability to engage in work.
“The biggest employer in many communities is the Aboriginal Community Controlled Health Organisation. ACCCOs provide real employment and on the job training and is the biggest employer of Aboriginal people in some communities.
“A larger investment in infrastructure such as ACCHOs, and expanding them into more communities, will improve health and will also contribute towards the multifaceted employment challenges in remote communities.
“Without this recognition of the systemic and infrastructural barriers to achieving good health and workforce participation in remote communities this policy is unlikely to help Aboriginal employment opportunities in any way.”
The Remote Vocational Training Scheme (RVTS) has opened up for a second round of applications for doctors working in Aboriginal Community Controlled Health Services. 5 positions are still available for 2015 and RVTS is very interested in connecting with doctors working in ACCHSs who may be eligible for the program.
Candidates apply online at www.rvts.org.au and applications close on November 7.
The RVTS Extension to ACCHS is supported by the National Aboriginal Community Controlled Health Organisation (NACCHO) and is an Australian Government initiative designed to deliver structured distance education and supervision to doctors already providing medical services within ACCHSs.
Doctors receive GP vocational training over a 3 to 4 year period to obtain fellowship of RACGP and/or ACRRM, while they continue to work in the ACCHS. The training is delivered by distance education and remote supervision, and is specifically tailored to doctors working with indigenous communities. I have attached the applicant guide and brochure, further information can be found at www.rvts.org.au
If you have any questions about the program please contact Veeraja Uppal or Jeanette Mclaren on 02 6057 3400.
A peak Aboriginal health body has told a Senate committee that the proposed GP co-payment and changes to the PBS would discourage Aboriginal and Torres Strait Islander patients seeking preventative health care and impact on efforts to close the gap in Aboriginal life expectancy.
The National Aboriginal Community Controlled Health Organisation (NACCHO) submission to the Senate Select Committee on Health also calls for a recommitment to health promotion and early intervention programs and for a particular focus on Aboriginal and Torres Strait Islander-specific health initiatives.
The NACCHO submission said health policy should recognise Aboriginal people’s increasing preference to use Aboriginal Community Controlled Health Services over mainstream services and ensure funding keeps up with demand and inflation.
“As a nation we must look for ways to improve the health of Aboriginal people and invest in programs and services that are working for Aboriginal people,” Mr Mohamed said.
“We must encourage Aboriginal people to get regular check ups, to see their GP and to participate in initiatives that promote healthy lifestyles.
“The introduction of extra expenses such as GP co-payment and a rise in the cost of PBS medicines will discourage Aboriginal and Torres Strait Islander people to seek preventative health care and impact on their long-term health.
“The additional expenses will also seriously affect the long term sustainability of Aboriginal Community Controlled Health Services, most of who will not pass on the charges to patients.
“For the sake of the health of Aboriginal men, women and children, these proposals must be rejected.”
Mr Mohamed urged the Senate committee to focus on preventative health measures which deliver long-term benefits through improved health and wellbeing and reduce the burden on the healthcare system at the tertiary and acute end of care.
“The NACCHO submission also calls for ongoing culturally-appropriate health programs that are specifically designed and run-by Aboriginal people as we know these have the greatest success,” Mr Mohamed said.
“In particular, Aboriginal and Torres Strait Islander-specific population health initiatives and child and maternal health programs must be maintained to ensure we continue to close the gap on life expectancy and infant mortality.”
The most effective and sustainable way to engage Aboriginal people is the community controlled model, underpinned by principles of self-determination and community development. Real savings and progress in healthy outcomes for Aboriginal and Torres Strait Islander people can only be made by shifting expenditure on hospitals to Comprehensive Primary Health Care providers, who deliver preventative treatments.
NACCHO reject proposed additional healthcare costs, in the form of a GP co-payment and a rise in the cost of accessing PBS medicines, which would discourage Aboriginal and Torres Strait Islander patients seeking preventative health care and proactively managing chronic disease. Reducing the Medicare Benefit Schedule (MBS) rebates and incentives would impact the capacity of Aboriginal Community Controlled Health Services (ACCHS) to develop and maintain a sustainable service delivery model.
Recommit to the funding of health promotion and early intervention programs, which deliver long-term benefits through improved health and wellbeing and reduce the burden on the healthcare system at the tertiary and acute end of care. To ensure continued inroads to Close the Gap in overall life expectancy and the infant mortality gap for Aboriginal and Torres Strait Islander children, funding for Aboriginal and Torres Strait Islander-specific population health initiatives and child and maternal health programs must be maintained.
Focus needs to be placed on redirecting the expenditure gap in the mainstream services with relatively lower uptake by Aboriginal and Torres Strait Islander people to the ACCHS sector to better meet demand.
ACCHS provide a long-term employment pathway for Aboriginal and Torres Strait Islander people, but uncertainty discourages greater uptake of positions in the sector. Greater funding commitments are required to facilitate pathways for Aboriginal and Torres Strait Islander people to become health professionals across a diverse range of professions, such as clinical workers, administrative officers and in management.
Funding for ACCHS should be at a minimum indexed for population growth, demand for services and inflation.
The shift away from National Partnership Agreements and the defunding of the COAG Reform Council challenges the transparency and independence of measuring progress in Closing the Gap targets. Renewed commitments are needed to ensure monitoring of outcomes and allocation of resources remains equitable and relevant.
Aboriginal health services today called on the Federal Government to consult more widely on the impact of the GP co-payment before it is put to the Senate.
The National Aboriginal Community Controlled Health Organisation (NACCHO) Deputy Chairperson Matthew Cooke said the dealing apparently going on behind closed doors without input from the Aboriginal health sector was cause for concern.
“The fact is, the introduction of a GP co-payment is poor health policy for all Australians,” Mr Cooke said.
“Abolishing free universal health care will introduce a dangerous disincentive for people to seek the medical attention they need until their health conditions are advanced and need more invasive and costly attention.
“When applied to Aboriginal health its impact is likely to be magnified.
“We have made some gains in improving the health of Aboriginal people but we still have a long way to go to close the appalling health gap between Aboriginal and other Australians.
“We need our pregnant women to attend check ups, we need our children to be immunized, we need our young men to have access to mental health services.
“We simply can’t put any barriers in the way of Aboriginal people seeking health care or we risk the gains we are making in Aboriginal health. The GP co-payment is a significant barrier.”
Mr Cooke said speculation about exemptions from the GP co-payment for particular groups would only go part of the way to addressing the issues.
“Although we applaud the AMA’s efforts to work with the Federal Government to resolve the impact of a GP co-payment on vulnerable Australians, an exemption for Aboriginal Medical Services is not the silver bullet.
“The majority of our Services would have waived the co-payment for their patients, which would effectively have meant a cut in their funding, so in this regard it would be of benefit for our Services.”
“However, many Aboriginal people do not have access to Aboriginal Community Controlled Health Services because of where they live.
“There are 150 Aboriginal Community Controlled Health Services across Australia, providing primary health care to over half Australia’s Aboriginal population.
“But we don’t have national coverage so that would leave a lot of Aboriginal people using mainstream services still subject to the GP co-payment.”
Mr Cooke said he was also concerned about the additional pressures on Aboriginal Community Controlled Health Services if the exemption only applied to these Services.
“Demand for our Services is growing at a rate of about six per cent a year. Aboriginal people are already travelling large distances to seek out our Services as they prefer to be treated by someone who understands their culture and community.
“The co-payment exemption is likely to increase demand even further and would be a challenge for our Services to manage within their existing budgets and resources.”
Successes in improving the health of Aboriginal people, to be showcased over the next three days at an Aboriginal health summit in Melbourne, will highlight the importance of ongoing investment in Aboriginal Community Controlled Health Services and programs.
Justin Mohamed, Chair of the National Aboriginal Community Controlled Health Organisation (NACCHO) said the 2014 NACCHO Health Summit will feature innovative and creative approaches to Aboriginal health, driven by Aboriginal people, which are achieving results.
“The Federal Budget has taken a huge chunk of funding out of Aboriginal health programs,” Mr Mohamed said.
“Given the incredible work being done by our sector to improve the lives of Aboriginal and Torres Strait Islander people, through prevention, early detection and health promotion, it simply doesn’t make economic sense to cut front line Aboriginal health programs.
“We still have a long way to go close the huge gap in life expectancy between Aboriginal and other Australians but we are on the right track to reaching our targets by 2031.
“It’s critical we maintain the momentum and continue to give Aboriginal people control over their own health – funding programs run by Aboriginal people – since that is where we will have the biggest effect.”
Mr Mohamed said some of the examples which will be shared at the 2014 NACCHO Health Summit include:
• The Victorian Aboriginal Health Services Healthy Lifestyles and Tackling Tobacco Team has implemented a range of different health promotion strategies to engage members of the community from children to elders in physical activity, quit and healthy lifestyles programs. Successful initiatives over the last 12 months include: fun runs, yoga, hypnotherapy, social marketing, a comedy show and more recently the VAHS Tram taking the Australian public along for the ride.
• Wuchopperen Health Service ‘Community Controlled Health Services have to prove their value contribution in an increasingly competitive landscape. Wuchopperen has survived three decades of funding uncertainty. Wuchopperen has enacted a multi-faceted strategy to ensure long term sustainability and self-determination – with self-sufficiency a possible endpoint within a decade. Leveraging MBS income streams Wuchopperen has facilitated an increase in staff numbers from 135 to 180 over three years, maintaining a proportion of 80 per cent Aboriginal and Torres Strait Islander Staff. All funds generated have been reinvested into further services to the community, including expanded allied health services and optometric care facilitating on-site eye-testing and dispensing of spectacles.’
• ABS presentation (funded by ABS/ Dept of Health/ National Heart Foundation) ‘The 2012-2013 Australian Aboriginal and Torres Strait Islander Health Survey (AATSIHS) is the largest and most comprehensive survey of the Aboriginal and Torres Strait Islander community ever undertaken. This survey provides a platform for a range of new research into health determinants and patters, supporting assessment of of progress in closing the gap in health outcomes.’
• Walgett AMS Accreditation Experience, Fifteen Years and Still Going Strong ‘In 1987 the CEO and Board of WAMS became concerned about changes to AMS funding conditions. In order to prepare for the possibility WAMS investigated agencies which accredited health services. In 2013 WAMS gained it’s fifth round of accreditation and in 2014 will work to bring it’s Dental Clinic into the process. Accreditation assists in improving client services and also enables the service to stand as equals with other Health Services and Medicare Locals’.
• John Patterson AMSANT CQI ‘The life expectancy gap between Aboriginal and other Australians in the NT is the widest in the nation, but it is also closing at the fastest rate. NT is the only jurisdiction on track to close the life expectancy gap by 2031. AMSANT believe that the implementation of the CQI programs has been pivotal to improving the Aboriginal PHC contribution to closing the gap.’
Mr Mohamed said “The summit will be the Centre of Excellence in Aboriginal Community Controlled Health and the best demonstration of Aboriginal Health in Aboriginal Hands.”
Media contacts: Olivia Greentree 0439 411 774 / Jane Garcia 0434 489 533
Investing in Aboriginal Community Controlled Health Services will help address the increasing gap in employment outcomes between Aboriginal and non-Aboriginal people as revealed in the new report released by the COAG Reform Council.
Justin Mohamed, Chairperson of the National Aboriginal Community Controlled Health Organisation (NACCHO) said the COAG Reform Council report showed encouraging gains are being made in areas such as life expectancy, child mortality and immunisation, but unemployment and obesity rates needed greater attention.
“This is yet another report to add to the many before it which demonstrate that massive inequalities still exist between Aboriginal and non-Aboriginal people,” Mr Mohamed said.
“The take home message is that we can’t shift focus or we risk reversing the gains we have made. There is still a long way to go before Aboriginal people can expect the same levels of health, employment and education as other Australians.
“It’s pleasing to see Aboriginal child mortality rates are decreasing but Aboriginal kids are still twice as likely to die before they are five than non-Aboriginal children. As adults we still have a life expectancy more than ten years less than non-Aboriginal people.
“That’s why we need to keep up the investment in programs and services that are making a difference.
“Aboriginal Community Controlled Health Services are making huge contributions towards closing the gap across a range of indicators and demand for our services is growing.
“In addition to these significant health gains, our 150 health services employ more than 3,200 Aboriginal people – one of the largest employers of Aboriginal people in the country.
“Governments at all levels need to look to supporting and expanding the Aboriginal Community Controlled Health sector if they are committed to improving the health and employment outcomes of Aboriginal and Torres Strait Islander people.”
Mr Mohamed said NACCHO has concerns that we still do not have any concrete commitment of the future of the Close the Gap “National Partnership Agreement” or an alternative structure. This concern is further heightened by the fact that the COAG Reform Council will be abolished come 30 June.
“We are extremely concerned that the millions of dollars being cut from across Aboriginal affairs at the Federal level, plus the introduction of new arrangements in accessing primary health care and changes to unemployment benefits, could potentially push the closing the gap targets even further from reach.
“Yet at the state and territory level we also see apparent indifference to the challenges at hand.
“It’s now been more than twelve months since the National Partnership Agreement has lapsed and we still don’t have any clear advice how states, territories and the commonwealth plan to coordinate addressing the closing the gap targets. The Nation needs a long term agreement that has full support and buy in from all levels of Government.
“NACCHO also questions what replacement reporting mechanisms will be put in place to continue this specific, detailed state and territory reporting given the abolishment of the COAG Reform Council next month. These reports provide a level of accountability to the actions of the different levels of government which needs to be retained. ”
Deputy NACCHO chair Matthew Cooke, Chair Justin Mohamed and board member John Singer launching Blueprint
Photo Wayne Quilliam
NACCHO has long recognised the importance of an Aboriginal male health policy and program to close the gap by 2030 on the alarming Aboriginal male mortality rates across Australia.
Aboriginal males have arguably the worst health outcomes of any population group in Australia.
To address the real social and emotional needs of males in our communities, NACCHO proposes a positive approach to Aboriginal male health and wellbeing
NACCHO, its affiliates and members are committed to building upon past innovations and we require targeted actions and investments to implement a wide range of Aboriginal male health and wellbeing programs and strategies.
We call on State, Territory and Federal governments to commit to a specific, substantial and sustainable funding allocation for the NACCHO Aboriginal Male Health 10 point Blueprint 2013-2030
This blueprint sets out how the Aboriginal Community Controlled Health Services sector will continue to improve our rates of access to health and wellbeing services by Aboriginal males through working closely within our communities, strengthening cultural safety and further building upon our current Aboriginal male health workforce and leadership.
We celebrate Aboriginal masculinities, and uphold our traditional values of respect for our laws, respect for elders, culture and traditions, responsibility as leaders and men, teachers of young males, holders of lore, providers, warriors and protectors of our families, women, old people, and children
The NACCHO 10-Point Blue print Plan is based on a robust body of work that includes the Close theGap Statement of Intent and the Close the Gap targets, the National Framework for the Improvement of Aboriginal and Torres Strait Islander Male Health (2002),NACCHO’s position paper on Aboriginal male health (2010) the 2013 National Aboriginal and Torres Strait Islander Health Plan (NATSIHP), and the NACCHO Healthy futures 10 point plan 2013-2030
These solutions have been developed in response to the deep-rooted social, political and economic conditions that effect Aboriginal males and the need to be addressed alongside the delivery of essential health care.
Our plan is based on evidence, targeted to need and capable of addressing the existing inequalities in Aboriginal male health services, with the aim of achieving equality of health status and life expectancy between Aboriginal males and non-Aboriginal males by 2030.
This blueprint celebrates our success so far and proposes the strategies that governments, NACCHO affiliates and member services must in partnership commit to and invest in to ensure major health gains are maintained into the future
NACCHO, our affiliates and members remain focused on creating a healthy future for generational change and the NACCHO Aboriginal Male Health 10 point Blueprint 2013-2030 will enable comprehensive and long-term action to achieve real outcomes.
To close the gap in life expectancy between Aboriginal males and non-Aboriginal within a generation we need achieve these 10 key goals
1. To call on government at all levels to invest a specific, substantial and sustainable funding allocation for the, NACCHO Aboriginal Male Health 10 point Blueprint plan 2013-2030 a comprehensive, long-term Aboriginal male Health plan of action that is based on evidence, targeted to need, and capable of addressing the existing inequities in Aboriginal male health
2. To assist delivering community-controlled ,comprehensive primary male health care, services that are culturally appropriate accessible, affordable, good quality, innovative to bridge the gap in health standards and to respect and promote the rights of Aboriginal males, in urban, rural and remote areas in order to achieve lasting improvements in Aboriginal male health and well-being
3. To ensure Aboriginal males have equal access to health services that are equal in standard to those enjoyed by other Australians, and ensure primary health care services and health infrastructure for Aboriginal males are capable of bridging the gap in health standards by 2030.
4. To prioritise specific funding to address mental health, social and emotional well-being and suicide prevention for Aboriginal males.
5. To ensure that we address Social determinants relating to identity culture, language and land, as well as violence, alcohol, employment and education.
6.To improve access to and the responsiveness of mainstream health services and programs to Aboriginal and Torres Strait Islander people’s health services are provided commensurate Accessibility within the Primary Health Care Centre may mean restructuring clinics to accommodate male specific areas, or off-site areas, and may include specific access (back door entrance) to improve attendance and cultural gender issues
7.To provide an adequate workforce to meet Aboriginal male health needs by increasing the recruitment, retention, effectiveness and training of male health practitioners working within Aboriginal settings and by building the capacity of the Aboriginal and Torres Strait Islander health workforce.
8 To identified and prioritised (as appropriate) in all health strategies developed for Aboriginal Community Controlled Health Services (ACCHSs) including that all relevant programs being progressed in these services will be expected to ensure Aboriginal male health is considered in the planning phase or as the program progresses. Specialised Aboriginal male health programs and targeted interventions should be developed to address male health intervention points across the life cycle continuum.
9. To build on the evidence base of what works in Aboriginal health, supporting it with research and data on relevant local and international experience and to ensure that the quality of data quality in all jurisdictions meets AIHW standards.
10. To measure, monitor, and report on our joint efforts in accordance with benchmarks and targets – to ensure that we are progressively reaching our shared aims.
About NACCHO and Aboriginal Male health:
NACCHO is the national authority in comprehensive primary Aboriginal healthcare .
The National Aboriginal Community Controlled Health Organisation (NACCHO) is the national peak Aboriginal health body representing 150 Aboriginal Community Controlled Health Services (ACCHS).
This is achieved by working with our Affiliates, the State and Territory peak Aboriginal Community Controlled Health bodies, to address shared concerns on a nationally agreed agenda for Aboriginal and Torres Strait Islander health and social justice equality.
NACCHO and the Aboriginal community controlled comprehensive primary health care services, which are NACCHO members are enduring examples of community initiated and controlled responses to community issues.
NACCHO’s Strategic Directions focus on three central areas that are consistent with its constitutional objectives.
Strategic Direction 1: Shape the national reform of Aboriginal health.
Strategic Direction 2: Promote and support high performance and best practice models of culturally appropriate and comprehensive primary health care.
Strategic Direction 3: Promote research that will build evidence-informed best practice in Aboriginal health policy and service delivery.
The NACCHO HEALTHY FUTURES 10-point plan 2013-2030 provides our sector, stakeholders, partners and governments with a clear set of priorities and strategies that will result in improvements in Aboriginal health outcomes and is the foundation for this NACCHO Aboriginal Male Health 10 point Blueprint plan 2013-2030
NOTE : Throughout this document the word Male is used instead of Men. At the inaugural Aboriginal and Torres Strait Islander Male Health Gathering-Alice Springs 1999, all delegates present agreed that the word Male would be used instead of the word Men. With the intention being to encompass the Male existence from it’s beginnings in the womb until death.
Throughout this document the word Aboriginal is used instead of Aboriginal and Torres Strait Islander. This is in line with the National Aboriginal Community Controlled Health Organisation (NACCHO) being representative of Aboriginal People. This does not intend to exclude nor be disrespectful to our Brothers from the Torres Strait Islands.