NACCHO This weeks Aboriginal Health #Jobalerts : #Aboriginal Health Workers #Chronic Disease #TacklingSmoking

This weeks #Jobalerts

Please note  : Before completing a job application check with the ACCHO or stakeholder that job is still available

1.Carnarvon Medical Services Aboriginal Corporation : Chronic Disease Coordinator Close 4 August

2.1-2.4  Western Australia : AHCWA members

3.Tackling Indigenous Smoking Support Officer (OVAHS) close 16 August

4.Generalist HR role Central Australian Aboriginal Congress

5. Registered Nurses Brewarrina Aboriginal Health Service Ltd (BAHSL)

6 -7 Jullums Lismore AMS Registered Nurse / Child and Family Nurse and Aboriginal Health Worker/ Practitioner

8. Rekindling The Spirit  : Positions Vacant – Counsellors

9. Nganampa Health Council  :Personal Care Attendant (Remote Area Aged Care Facility)
 
10.Chronic Kidney Disease Educator – Derby (KRS)
 

11.Kimberley Aboriginal Medical Services Ltd  : Deputy Medical Director (KAMS) – Close 31 July

12.Flinders Island Aboriginal Association Inc.Tobacco Action Worker 

 

How to submit a Indigenous Health #jobalert ? 

NACCHO Affiliate , Member , Government Department or stakeholders

If you have a job vacancy in Indigenous Health 

Email to Colin Cowell NACCHO Media

Tuesday by 4.30 pm for publication each Wednesday

1.Carnarvon Medical Services Aboriginal Corporation   :  Chronic Disease Coordinator (Registered Nurse / Aboriginal Health Practitioner) Close August 4

About the Organisation

Carnarvon Medical Services Aboriginal Corporation (CMSAC) is an Aboriginal Community Controlled Health Service established in 1986. CMSAC aims to provide primary, secondary and specialist health care services to Carnarvon and the surrounding region.

For more information please visit http://www.cmsac.com.au

About the Opportunity CMSAC is currently seeking an experienced Registered Nurse or Aboriginal Health Practitioner to join their multidisciplinary team as a Chronic Disease Coordinator.

As the Chronic Disease Coordinator you will be supported by a diverse team of Doctors, Aboriginal Health Practitioners, Nurses, Medical Receptionists and a Clinical Practice Coordinator providing a range of culturally appropriate and comprehensive primary health care services to the local Aboriginal communities.

Your responsibilities will include (but not be limited to) the following:

  • Providing day to day health services to the community in a professional, confidential and culturally safe manner
  • Utilising a holistic approach to assessing clients and their families by supporting and developing patient understanding of their condition, treatment and prevention strategies
  • Conducting opportunistic screening and follow-up of patients
  • Developing and implementing strategies that promote health education to clients, their families and the community with a focus on chronic disease management and health prevention
  • Providing Support and Advice on appropriate levels of follow-up to clients requiring short and long-term pharmaceutical support including instructing client/care givers how to take medication, the correct dosage, storage and security
  • Maintaining accurate documentation and record of all client encounters on the patient information & recall system
  • Maximising Medicare billings through effective patient records processes

To be successful, you will be a Registered Nurse or Aboriginal Health Practitioner, have experience working in a similar role within an AMS or primary health setting. You will have a sound knowledge of general practice, primary health care and the social and emotional wellbeing needs of Aboriginal and Torres Strait Islander peoples.

Your strong interpersonal, communication and organisational skills will enable you to strengthen existing community partnership, establish and sustain stakeholder relationships, determine priorities and manage workloads in order to meet agreed timelines and achieve results.

Most importantly, you must be able to effectively communicate, promote and uphold CMSAC initiatives and values, acting as a role model in the community.

Before applying please visit http://www.ahcwa.org.au/employment to view the full Position Description.

About the BenefitsA generous remuneration package including salary sacrificing options is on offer.

In addition:

  • CMSAC will negotiate relocation assistance with the right candidate
  • You’ll enjoy a fantastic work/life balance, with Monday – Friday hours, 8:30am – 5pm, with no on-call requirements
  • 5 weeks annual leave

**The successful candidate must be willing to undergo a Drug Screen, provide a current Police Clearance and Working with Children Check and possess a C Class Drivers License.

Aboriginal and Torres Strait Islander people are encouraged to apply.

Applications close 5pm, Friday 4 August 2017

 2. Western Australia : AHCWA members

Current Vacancies

If you are passionate about improving the health and wellbeing of Aboriginal and Torres Strait Islander people across Western Australia then the below opportunities may interest you.

 2.1 Aboriginal Health Worker (50d)

Type: Full Time

Location: SWAMS, Bunbury

Closing Date: 5pm Friday, 4th August 2017

Here at SWAMS we have an exciting position available for someone looking to make a difference. As an Aboriginal Health Worker, you will be involved in clinical assessment and treatment, care coordination, client support and advocacy and community development activities.

2. 2 Administration Assistant

Type: Full Time
Location: PAMS, Newman
Closing Date: Wednesday 2nd August 2017, 5pm

PAMS currently has an opportunity for an Administration Assistant and to join their team on a full-time basis.

2.3 Remote Area Registered Nurse

Type: Full Time 6:2 roster

Location: PAMS, Newman

Closing Date: Wednesday 2nd August 2017, 5pm

PAMS has an opportunity for a Remote Area Registered Nurse to join their team on a 6 weeks on, 2 weeks off, fly in, fly out roster

 2.4 Clinical Operations Manager

Type: Full Time
Location: DYHS, Perth WA
Closing Date: 5.00pm, Monday 31 July 2017

DYHS is now looking for an experienced Clinical Operations Manager to join their team in Perth, on a full-time basis.

4.Generalist HR role Central Australian Aboriginal Congress

In the 40 years since it was established, Central Australian Aboriginal Congress (Congress) has become the largest Aboriginal medical service in the Northern Territory.  Congress is one of the most experienced in Aboriginal health in the country, is a national leader in comprehensive primary health care, and is a strong political advocate for the health of Aboriginal people.

Based in Alice Springs and reporting to the General Manager Human Resources, a newly created role has emerged.  The Organisational Capability Manager is a generalist HR role responsible for developing and leading workforce initiatives, strategic projects, building HR capability and workforce training and development.  Specific areas of focus in the first instance include :-

  • leading a refresh of the people performance and management framework;
  • leading the review of the WHS management system;
  • leading talent planning and implementation activities for organisational change projects and workforce development;
  • strengthening a reporting framework that captures meaningful data to promote organisational performance, assist decision making, minimise risk and enable achievement of the broader organisational objectives and priorities.

Applications are invited from experienced HR practitioners with appropriate tertiary qualifications and superior communication, negotiation and strategic thinking skills.  Experience in developing organisational capability for a large, geographically dispersed and multi-disciplinary entity will be highly regarded.  Pragmatism, intuition, commercial acumen, sound judgement, drive, energy, credibility and authenticity are also important qualities sought.

Offered initially on a contract basis for a period of 2-3 years, there is a genuine opportunity for the scope to extend well beyond this timeframe and expand in breadth of responsibility.  An attractive remuneration package commensurate with skills and experience, together with relocation assistance will be offered in order to attract the right candidate.

For a job and person specification, please visit hender.com.au and for further information on our client, please visit caac.org.au

Applications in Word format only should be addressed to Justin Hinora.

Telephone enquiries are welcome on (08) 8100 8849.

APPLY HERE

5.Registered Nurses Brewarrina Aboriginal Health Service Ltd (BAHSL)

About the Organisation

Brewarrina Aboriginal Health Service Ltd (BAHSL) is a non-profit organisation dedicated to improving not only the health but the youth, culture, education and housing of the organisation’s clients and the Brewarrina community in general. Operating with close ties to the accredited Walgett Aboriginal Medical Service, BAHSL services are available to the surrounding communities and small towns in the area, and provide a resource centre for:

  • Health related issues
  • Medical advice and treatment
  • Individual and family counselling
  • Information and advice about issues relating to substance abuse
  • Sexual health services
  • Family violence
  • Children’s health/issues
  • Adolescent health
  • Women’s and men’s health
  • Healthy lifestyle (including healthy eating)
  • Eye Health

About the Opportunity

Brewarrina Aboriginal Health Service Ltd (BAHSL) has an exciting opportunity for a Registered Nurse to join their multidisciplinary team of dedicated health professionals working throughout in Brewarrina, NSW.

In this role, your primary focus will be on planning, implementing, monitoring and evaluating Enhanced Primary Health Care plans for the program’s clients, in collaboration with BAHSL Aboriginal Health Workers.

To be successful in this position, you will be a Registered Nurse (List A) with experience providing Primary Health Care to those suffering from chronic disease and across a range of other settings. You will require experience in working with Aboriginal communities and have an understanding of health issues in rural/remote areas and the impact of socio-economic factors on Aboriginal communities.

Candidates with previous experience in wounds management, community care, and adult immunisation will be highly regarded.

Please note: Candidates are required to hold registration with AHPRA, a working with children check, and a criminal history check.

BAHSL will reward your commitment with an excellent base salary (dependent upon skills and experience) and access to salary sacrificing arrangements!

Applicants currently located outside the Brewarrina region will be considered – and you’ll enjoy assistance with relocation costs (reimbursed after probation period) and help in finding suitable rental accommodation!

Advance your career in Aboriginal health in this varied role – APPLY NOW!

Please note, due to the nature of this position, Aboriginal people are encouraged to apply.

APPLY HERE

6 -7 Lismore AMS Registered Nurse / Child and Family Nurse and Aboriginal Health Worker/ Practitioner

Jullums Lismore AMS is currently looking for the following positions to join the team:

Registered Nurse / Child and Family Nurse

This is an identified position open to Aboriginal & Torres Strait Islander people

However, Registered Nurses who are not indigenous but able to meet the Selection Criteria are encouraged to apply

Aboriginal Health Worker/ Practitioner

This is an identified position, open to Aboriginal and Torres Strait Islander people

Minimum qualifications, Certificate IV

About Us:

Jullums Lismore Aboriginal Medical Service is a not-for-profit Aboriginal Community Controlled Health service under the management of Rekindling the Spirit, providing primary health care services to Aboriginal people throughout the Lismore area. Jullums is committed to promoting health, wellbeing and disease prevention, involving a holistic approach to diagnosis, and the management of illness.

About the Role:

Reporting to the Practice Manager, both these positions are responsible for a high standard of primary health services that focuses on the prevention, early detection and management of health problems for Aboriginal and Torres Strait Islander people. As a member of a multi-disciplinary team these roles ensure effective screening, service delivery and administration practices are delivered in accordance with our patient centred Model of Care.

The ideal candidates will have proven experience in providing health services to Aboriginal and Torres Strait Islander people.

To request a copy of the Position Description and Selection Criteria, or if you wish to apply for the position by sending a covering letter with your CV, please contact

amanda@rubirockservices.com

8 Rekindling The Spirit  : Positions Vacant – Counsellors

Rekindling The Spirit is a Lismore based, community organisation run by Aboriginal and Torres Strait Islander people for Aboriginal and Torres Strait Islander families, who offer a holistic approach to working with those families and communities to support the achievement of positive and lasting changes in their lives.

Rekindling the Spirit supports Aboriginal and Torres Strait Islander men and women to find their own path of empowerment through spiritual and emotional healing, by offering services that can help relieve poverty, distress, sickness, destitution, trans-generational trauma and other misfortunes. Our counselling, assistance, education and supplementary services focus on reducing the occurrence of domestic and family violence plus child abuse through the promotion of healing and wellbeing within families and the community.

Rekindling The Spirit is looking for a number of Full Time Male and Female Counsellors to provide front line, face to face services to support the implementation and ongoing management of a new program for our clients and community.

Ideal candidates will be Aboriginal and/or Torres Strait Islander people with proven experience in providing counselling services to Aboriginal and Torres Strait Islander people. All counsellors with experience providing counseling services to Aboriginal and Torres Strait Islander people are encouraged to apply to ensure Rekindling The Spirit is able to recruit the highest quality candidates to support our community.

As the successful applicant, you will be responsible for a number of aspects of the programs, including:  Conducting client intake and assessments for the RTS DV Perpetrator Program

  •  Provide face to face counseling
  •  Facilitate Rekindling The Spirit group based activities
  • Conduct exit interviews and evaluation of participants
  • Develop and maintain effective referral pathways
  • Arrange and participate in meetings, team activities, community network presentations, special ceremonies and approved events and field work activities as required
  • Participate in program and service planning, review and evaluation, including data collection and documentation of new initiatives

To be successful, you will:

  • hold a minimum of a Diploma or relevant qualifications in Counselling, Substance Misuse, Mental Health, Aboriginal Health Worker, Community Services or another related field or be willing to undertake further study.
  • have proven experience in providing counselling and/or group facilitation experience in, drug and alcohol, domestic violence, health, social and emotional wellbeing counselling to Aboriginal and Torres Strait Islander people;
  • have a demonstrated ability to work appropriately and effectively with Aboriginal and Torres Strait Islander people;
  •  possess high level communication skills and well developed computer skills.

Aboriginal and Torres Strait Islander people are encouraged to apply.

Criminal history screening and working with children/vulnerable persons checks will be carried out prior to commencement of employment.

If you have a strong interest in this role and wish to apply for the position, please send a covering letter with your CV to amanda@rubirockservices.com

9.Nganampa Health Council  :Personal Care Attendant (Remote Area Aged Care Facility)

Nganampa Health Council is an Aboriginal owned and controlled health organisation operating on the Anangu Pitjantjatjara Yankunytjatjara Lands in the far north west of South Australia. Across this area, we operate seven clinics, an aged care facility and assorted health related programs including aged care, sexual health, environmental health, health worker training, dental, women’s health, male health, children’s health and mental health.

When you join Nganampa Health, you are joining a community of primary health care professionals, united by our desire to make a difference. We learn and experience something new every day, and we are supported by the professionalism and spirit of our colleagues and our organisation.

A fantastic opportunity now exists for a full-time Personal Care Attendant to join our dedicated aged care team, based in Pukatja (Ernabella), in remote North West, South Australia.

Working under the direction of the Residential Care Manager, you will be responsible for planning and delivering person centred care to residentsof theTjilpiku Pampaku Ngura aged care facility.

To be successful, you will have demonstrated experience in Australia as a Personal Care Worker, working with frail, aged and disabled people in an aged care setting. You’ll hold a Certificate III or IV in Aged Care, or an equivalent EN qualification. This could also be a great opportunity for an existing EN looking for a change in role or to move away from a traditional hospital environment.

We are seeking an adaptable and flexible individual who can display the initiative, discretion and cultural sensitivity needed to support and drive the organisation’s objectives and values. You must be able to both communicate and participate effectively within a cross-cultural, multi-disciplinary health team.

Why join the Nganampa Health team

As a Personal Care Attendant at Nganampa Health, you will receive an excellent remuneration up to $58,880 (with Certificate IV qualifications), plus super. You will also receive a range of benefits including:

  • Annual district allowance;
  • Furnished rent-free housing including some meals;
  • Penalty & leave loadings and overtime entitlements;
  • Free electricity and subsidised internet and telephone access;
  • Relocation assistance (negotiable);
  • Generous leave provisions: 6 weeks annual leave, 3 weeks recreation leave, 3 weeks sick leave and 2 weeks study leave!
  • Annual airfares; and
  • Salary sacrificing options to greatly increase your take home pay by up to $16,000!

These incredible rewards bring your salary package up to an approximate $133,000 per annum!

APPLY HERE

10. Chronic Kidney Disease Educator – Derby (KRS)
 
About Kimberley Renal Services
Kimberley Renal Services (KRS) includes 4 Renal Health Centres based in Fitzroy Crossing, Broome, Kununurra, and Derby and a mobile prevention unit.The incidence of Kidney Disease in the Kimberley is one of the highest in Australia. Chronic Kidney disease (CKD) and End-Stage Kidney Disease (ESKD) incidence within the Aboriginal population of the Kimberley greatly exceeds the national burden of disease. Dialysis prevalence for this region has more than tripled in the last decade and is increasing at a much faster rate than in the rest of Western Australia (WA).KRS and the regional Aboriginal Community Controlled Health Services (ACCHS) have developed a renal strategic plan to help combat this health crisis. This has enabled many patients to return to the Kimberley from Perth, which is 2,500kms away, to receive their treatment.

About the Opportunity The Kimberley Renal Service has an opportunity for a Chronic Kidney Disease Educator to join their multidisciplinary team based in Derby WA. This role will be offered on a full-time basis.Reporting to the Renal Health Centre Manager, you will be responsible for raising awareness and understanding of the factors which lead to development of chronic kidney disease.

To be successful in this role, you will be an experienced Registered Nurse – eligible for registration with the national nurses board of Australia – and advanced renal clinical skills. You will also have a commitment to the philosophy and practice of Aboriginal Community Control and knowledge of Equal Opportunity and OSH legislation.

KRS is looking for candidates with strong communication, decision-making and problem-solving skills, along with the ability to work both autonomously and as part of a multidisciplinary team. A high level of integrity and a dedication to maintaining patient confidentiality will ensure you flourish in this position.

About the Benefits

KRS is an organisation that truly values its team, and is committed to improving employee knowledge, skills and experience. In addition, staff development programs are not only encouraged but are often paid for by KRS. These are highly attractive opportunities for someone with a desire to develop their professional knowledge and experience in the area of Aboriginal and Torres Strait Islander health!

There are also a wide range of fantastic additional benefits for the role, including:

  • Attractive base salary of $84,960 PLUS Super;
  • Accommodation Allowance of $13,000;
  • Electricity Allowance of $1,440; and
  • After 12 months of service, you will receive annual airfares of $1,285.

APPLY HERE

11.Kimberley Aboriginal Medical Services Ltd  : Deputy Medical Director (KAMS) – Identified Position

Job No: 90703
Location: Broome, WA
Employment Status: Full-time
Closing Date: 31 Jul 2017
  • Do you want to really make a difference in your career?
  • Take on this rewarding management role with the region’s leading provider of Aboriginal health services!
  • Attractive remuneration circa $230,000 base, PLUS district allowance AND accommodation allowances!

About the Organisation

Kimberley Aboriginal Medical Services LTD (KAMS) is a well-established regional Aboriginal community controlled health service, founded in 1986, which provides centralised advocacy and resource support for 6 independent member services, as well as providing direct clinical services in a further 6 remote Aboriginal communities across the region.

KAMS has successfully delivered high-quality, accessible comprehensive primary health care services over its 30 years of operation and has provided innovation and national leadership in areas such as health information management and evidence-based best practice in primary health care.

About Broome

Broome is located 2,240km north of Perth and has a permanent population of 14,436. Broome promotes a relaxed and easy-going lifestyle, with nearby shopping centres, Sunday markets as well as a broad range of restaurants and entertainment options. It is founded on the traditional lands of the Yaruwu people and is rich in history, culture and beautiful surrounds.

Broome has a deep history in the pearling industry, spanning back to the 1800’s, with memorials throughout the town to commemorate those lost in the early years of pearling. Cable Beach is also a must-see, being named in honour of the Java-to-Australia undersea telegraph cable that reaches shore there. You can explore its beautiful scenery with a bit of 4WDing at low tide, or you can even take a camel ride every day at sunset!

Roebuck Bay is known as one of the most beautiful beaches that surround Broome, with its “Staircase to the moon” phenomenon drawing food and craft markets each time it occurs. The combination of a receding tide and rising moon create a natural phenomenon that can only be described as breath-taking.

About the Opportunity

Kimberley Aboriginal Medical Services Ltd (KAMS) now has a rewarding opportunity for a full-time Deputy Medical Director to join their team in Broome, WA.

Please note: Due to the nature of this role, applicants are required to be of Aboriginal or Torres Strait Islander descent. This is a genuine occupational requirement for this position, which is exempt under Section 14 of the Anti-discrimination Act.

Reporting to the Medical Director, you’ll be responsible for providing comprehensive primary health care in line with accepted best practice standards.

Some of your key duties will include (but will not be limited to):

  • Assisting in the development and maintenance of high quality health services, ensuring continuous monitoring, quality improvement and innovation in the delivery of comprehensive primary health services;
  • Supporting the education, training and on-site up-skilling of the KAMS primary health care workforce;
  • Acting as a cultural champion for health services in the Kimberley;
  • Leading and participating in clinical audit activities in KAMS and member services
  • Assisting the Kimberley Renal Service with medical cover; and
  • Assisting the Medical Director when required.

To be successful you will need:

  • FRACGP, FACRRM or equivalent, with eligibility for medical registration in WA;
  • Significant experience in the delivery of general practice / primary heath care;
  • The ability to act as an effective member of a multidisciplinary health team;
  • Experience in working effectively with Aboriginal people;
  • The competency required to manage emergencies in a remote setting; and
  • A commitment to the philosophy and practice of Aboriginal Community Control.

KAMS are looking for candidates with well-developed interpersonal and communication skills, along with the ability to maintain client confidentially at all times within and outside the workplace. You will have experience working within an Aboriginal Community Controlled Health Organisation or an Aboriginal or Torres Strait Islander Community Organisation and a strong interest in developing the skills required to lead an Aboriginal Health Organisation.

A ‘C’ Class Driver’s License, Federal Police Clearance, Working with Children Clearance, and willingness to travel often by 4WD vehicles and light aircrafts will be required.

To download a full position description, please click here.

About the Benefits

If you are looking for a change of routine, a change of lifestyle or a new adventure, this is the role for you. You will see and experience more of Australia’s real outback than most people ever will – and get paid to do it!

KAMS is an organisation that truly values its team, and is committed to improving employee knowledge, skills and experience. In addition, staff development programs are not only encouraged but are often paid for by KAMS. This is a highly attractive opportunity for someone with a desire to develop their professional knowledge and experience in the area of Aboriginal and Torres Strait Islander health!

While you will face diverse new challenges in this role, you will also enjoy an attractive remuneration circa $230,000 + super. 

There is also a wide range of additional benefits for the role including:

  • On call allowance – 10% of base salary;
  • District allowances – $2,920 single $5,840 double p.a;
  • Electricity allowance $1,440
  • Accommodation allowance $13,000;
  • Mobile phone allowance $100 per month;
  • 6 weeks’ annual leave & 2 weeks’ study leave;
  • Annual Airfares to the value of $1,285 pa (after 12 months of employment).

Don’t miss this exciting and rewarding opportunity to have a positive impact on the health outcomes of Indigenous communities in the spectacular Kimberley region – Apply Now!

Please note: Candidates must respond to the questions below and attach a current resume to be considered.

Apply HERE

12.Flinders Island Aboriginal Association Inc.Tobacco Action Worker 

Flinders Island Aboriginal Association Inc. (FIAAI) currently have a vacancy for a Tobacco Action Worker within FIAAI’s Tackling Indigenous Smoking Program. Contracted until June 2018 (with the possibility of extension beyond this date), this position presents an opportunity to be part of a small Launceston-based team dedicated to reducing the level of Aboriginal smoking throughout Tasmania.

DOWNLOAD pdf tis_job_ad

Reporting to the local Team Leader, this role is available full time or part time by negotiation.

As the Tackling Indigenous Smoking Program involves collaboration with Aboriginal (and other) organisations, schools and Communities around the state, a willingness to undertake some travel in the role is essential.

A driver’s licence is also essential, and significant connection to Tasmanian Aboriginal Communities is highly desirable.

If you’re interested in making a difference to Tasmanian Aboriginal health outcomes and can demonstrate the above we’d love to hear from you.

For more information about this position and a job description which includes process for applying contact Lee Seymour at the FIAAI

Tackling Smoking office on 6334 5721 or via

email at:

lee.seymour@fiaai.org.au

NACCHO Aboriginal Health Research Alert : Comparisons of the characteristics of care in #ACCHOs and mainstream #PHC Primary Health Care

 ” Implications for public health: To increase utilisation of primary health care services in Indigenous Australian communities, and help close the gaps between the health status of Indigenous and non-Indigenous Australians, Indigenous community leaders and Australian governments should prioritise implementing effective initiatives to support quality health care provision by ACCHOs.

Download this research PDF

NACCHO Download What Indigenous Australian clients value

Abstract

Objective: To synthesise client perceptions of the unique characteristics and value of care provided in Aboriginal Community Controlled Health Organisations (ACCHOs) compared to mainstream/general practitioner services, and implications for improving access to quality, appropriate primary health care for Indigenous Australians.

Method: Standardised systematic review methods with modification informed by ethical and methodological considerations in research involving Indigenous Australians.

Results: Perceived unique valued characteristics of ACCHOs were: 1) accessibility, facilitated by ACCHOs welcoming social spaces and additional services; 2) culturally safe care; and 3) appropriate care, responsive to holistic needs.

Conclusion: Provider-client relationships characterised by shared understanding of clients’ needs, Indigenous staff, and relationships between clients who share the same culture, are central to ACCHO clients’ perceptions of ACCHOs’ unique value.

The client perceptions provide insights about how ACCHOs address socio-economic factors that contribute to high levels of chronic disease in Indigenous communities, why mainstream PHC provider care cannot substitute for ACCHO care, and how to improve accessibility and quality of care in mainstream providers.

Wide disparities remain between the health status of Aboriginal and Torres Strait Islander peoples (hereafter Indigenous Australians) and non-Indigenous Australians.1,2

Chronic diseases, including cardiovascular disease, diabetes and psychosocial illness caused by the history of colonisation, account for the bulk of the disparities.3

Inadequate access to primary health care (PHC) services responsive to Indigenous clients’ holistic needs, modifiable socioeconomic factors including low income, poor education, poor living conditions and social exclusion are principal contributors to the higher chronic disease burden in the Indigenous population.1–3 Increasing Indigenous Australian engagement with effective PHC, conceived in the comprehensive Indigenous Australian sense, is critical to reduce chronic disease in Indigenous communities and mitigate the disparities in health.3,4

Australia’s culturally diverse Indigenous peoples’ understanding of accessible, appropriate, quality PHC is different and broader than Western notions.3,5 From the Indigenous Australian perspective it is care conceived in the holistic Aboriginal way, that incorporates body, mind, spirit, land, environment, custom, socioeconomic status, family and community.5 The Indigenous Australian construct includes essential, integrated care based upon practical, scientifically sound and socially acceptable procedures and technology made accessible to communities as close as possible to where they live through their full participation in the spirit of self-reliance and self-determination and a comprehensive approach to supporting health.5

Importantly, all Indigenous Australians have the right to easily accessible, comprehensive, PHC delivered in a way that is respectful of Indigenous cultures, as well as to be involved in design and delivery of the PHC services they receive.6,7 International evidence investigating factors that increase accessibility and quality of PHC for Indigenous people, points to maximising community ownership and control, a robust indigenous managerial and clinical workforce, and the ability to deliver models of care that embrace Indigenous knowledge systems.3,8

Aboriginal Community Controlled Health Organisations (ACCHOs) are incorporated organisations, governed by boards of members elected by local Indigenous communities that aim to meet basic needs in Indigenous communities.5 ACCHOs function as knowledge and resource bases for Indigenous communities to advocate for their rights.5,9 The first ACCHO was established in 1971 in Redfern, in response to the failure of mainstream services to cater for the needs of its Indigenous peoples’ and desire for self-determination.5,9

By 2015 there were 138 ACCHOs in Australia 10 diverse with respect to their years of operation, budget and workforce sizes, and their governance, funding and service delivery models.10,11 Some ACCHOs employ medical practitioners and other staff, including Aboriginal Health Workers (AHWs) and provide a range of clinical and other services; others do not have a locally based medical practitioner, and rely only on AHWs.5,9,10 Assessments of health care quality based on Western informed measures have established that quality of clinical standards varies across ACCHOs and that many ACCHOs are achieving best practice standards.12

In addition to ACCHOs, state and territory funded Indigenous health organisations, which are concentrated in the Northern Territory and have varying degrees of community control, also play a role in providing culturally appropriate services in Indigenous communities.10 Of the 203 Indigenous PHC organisations in 2014/15, 68% were ACCHOs, 25% were government-run services, and 18% were mainstream non-government organisations.10Recent policy13 for improving Indigenous health in Australia reflects a strong commitment by government to implementing community control to enable better PHC quality and access, as well as to provide ACCHOs with the support they require to help achieve this goal. The policy commitment to building ACCHOs has been in place for more than 25 years.14

However implementation of the policy has been fraught with ongoing difficulties.11,14 ACCHOs rely on government funding, which they receive largely through three main Commonwealth sources: Medicare; contract funding for core PHC services; and contract funding for specific programs. Whilst some ACCHOs access the funding and workforce they require to deliver services that are responsive to community needs, and have been identified as offering exemplar models of care for Indigenous peoples15 the evidence relevant to the implementation of Indigenous control of health care in Australia,11,14,16–18 shows that many, particularly emerging organisations, struggle to navigate complex funding and accountability arrangements.

Evidence points to various inefficiencies in the funding and governance arrangements and questions their ability to support quality care provision that is responsive to each community’s unique needs and meets needs of all clients within communities.14In the context of increasing debate regarding the merits of mainstreaming Aboriginal PHC, we systematically reviewed qualitative evidence to document and understand how ACCHO clients perceive the characteristics and value of care provided by ACCHOs compared to care provided in mainstream PHC.

Our motivation was that the findings from existing qualitative studies, in academic and grey literature, on how ACCHO clients’ experience and perceive the nature and value of care provided in ACCHOs, and compared to in mainstream PHC services, had not yet been synthesised, yet synthesising the qualitative client perceptions might offer insights for health practitioners and policy makers on how best to improve Indigenous Australians’ access to PHC services that offer appropriate, quality care.

MethodThis review forms part of a larger systematic review project.19 We followed Joanna Briggs institute (JBI) guidance for systematic review of qualitative evidence20 and the PRISMA reporting guidelines.21 We took two steps to better align with ethical standards relevant to research involving Indigenous Australians22 and enable Indigenous specific contextual and cultural knowledge to inform the evidence appraisal and interpretation:23,24 1) Indigenous and non-Indigenous personnel were included in the review team; and 2) input was sought, at key stages in the review, from a reference group of Indigenous Australian community leaders and Indigenous people with expertise in PHC service delivery in Indigenous Australian communities.

Population and context: Indigenous clients (including family members, all ages) of ACCHOs.

Phenomena of interest: Perspectives on the characteristics and/or value of care provided by an ACCHO and the characteristics and/or value of care provided by one or more ACCHOs compared to the characteristics and value of care provided by one or more mainstream PHC services. ACCHOs were defined as non-government organisations operated by an Indigenous community, through an elected board of management. Mainstream providers were defined as general practitioner services. A service ‘characteristic’ was defined as a client identified attribute or feature of the PHC service, and a value as a client expressed experience of the worth or impact of the PHC service. Only perspectives evidenced by client voice were included.

Search and study selectionWe searched electronic sources for peer reviewed and grey literature studies meeting the inclusion criteria published in English, between April 1971 (date of first ACCHOs) and 30 April 2015. We searched the following databases using database specific search strings: Pubmed; Scopus; Healthbusinesselite; Econlit and Informit (Indigenous peoples databases).

Using generic search terms, we searched Google Scholar (advanced), Indigenous HealthInfoNet (Health Bibliography and Australian Indigenous Health Bulletin), Australian Policy Online, the Centre for Economic Policy website and Lowitja Institute websites. We hand searched references of two recent literature reviews, and the included studies. The search strategy is provided in Supplementary File 1, available online. The PubMed search string was:((health services, indigenous[mh] OR community health services[mh] OR primary health care[mh] OR rural health services[mh] OR community networks[mh] OR delivery of health care[mh] OR health planning[mh] OR community controlled health service*[tiab] OR indigenous health service*[tiab] OR community health service*[tiab] OR primary health care[tiab] OR rural health services[tiab] OR community networks[tiab] OR delivery of health care[tiab] OR health planning[tiab]) AND ((Aborig*[tw] OR Indigenous[tw] OR (Torres Strait[tw] AND Islander*[tw]) OR Oceanic Ancestry Group[mh] OR koori[tw] OR tiwi[tw]) AND (.au[ad] OR australia*[ad] OR Australia[mh] OR Australia*[tiab] OR Northern Territory[tiab] OR Northern Territory[ad] OR Tasmania*[tiab] OR Tasmania[ad] OR New South Wales[tiab] OR New South Wales[ad] OR Victoria*[tiab] OR Victoria[ad] OR Queensland[tiab] OR Queensland[ad]))) AND ((“1971/01/01”[PDat]: “2015/12/31”[PDat]))The search results were imported into an Endnote database (Thomson Reuters), where duplicates were removed. Title and abstract of the remaining records were then screened by JG for eligibility against the inclusion criteria, and full texts of potentially relevant studies set aside for further examination. JG, OG, DC independently reviewed the full-text articles against the inclusion criteria, noting reasons for exclusions. Uncertainty about whether the organisation was an ACCHO was resolved by contacting authors.

Quality assessment and data extractionWe used the critical appraisal and data extraction tools in the JBI Qualitative Assessment and Review Instrument (JBI-QARI).20 Two of the non-Indigenous authors (JG, DC) independently assessed quality of the studies that met the inclusion criteria, and two of the Indigenous Australian authors (OG, KK) crosschecked a 20% sample of the assessments for uniformity and accuracy. One reviewer (JG) extracted descriptive study data from the included studies. Three non-Indigenous members of the review team (JG, ZM, MS) extracted findings from the included studies for the phenomena of interest. Only client perceptions that were supported by an illustration, in the form of a client voice, were extracted. A 20% sample of the extracted findings was checked for accuracy by two of the Indigenous Australian authors (KO, OG). The confirmation of accuracy ensured that Indigenous Australian perspectives were applied in the quality appraisal and data extraction.

SynthesisWe used meta-aggregation20 to synthesise, separately, the client perceptions on the: 1) characteristics and value of care provided by ACCHOs; 2) characteristics of care provided by ACCHOs compared to mainstream PHC providers; and 3) value of care provided by ACCHOs compared to mainstream PHC providers. Meta-aggregation is grounded in the philosophic traditions of pragmatism and Husserlian transcendental phenomenology. The overall emphasis in this approach is on producing findings from existing studies that are credible in the sense that they reflect the meaning of the included studies, and inform practice-level lines of action that have applicability to healthcare policy or practice. Meta-aggregation embodies the complex nature of critical understanding, while ensuring the findings developed from the synthesis of study findings are meaningful and practical.20 For each synthesis, we followed the two-step thematic analysis approach of meta-aggregation. First, we developed categories of findings with similar meaning, and second, we developed synthesised findings describing the categories. To develop the categories, the first two authors (who led the synthesis), working independently, read and re-read the assembled findings with their supporting illustrations to understand their meaning, and grouped them into categories of similar findings, reflecting the main themes in the findings relating to the phenomena of interest.They then compared and discussed the two interpretations, and developed consensus-based categories of the identified themes.

To develop the synthesised findings, which in meta-aggregation represent overarching descriptions of the categories20, these same authors (OG and JG) first worked individually, and then together. OG’s interpretation of category meanings, and appropriate synthesised findings was privileged to ensure that the synthesised findings were informed by unique knowledge of Aboriginal and Torres Strait Islander culture and the context surrounding Aboriginal PHC, held by Indigenous Australians. AB guided the first author through the process of identifying the key cross-cutting themes in the synthesised findings, thereby ensuring that the second level analysis was also informed by Indigenous Australian expert knowledge. The draft categories, synthesised findings and interpretation of the themes emergent in the synthesised findings, were reviewed by all the other authors.
Results

Description of studies

Our search identified 4,405 records. From these, 816 duplicates were removed, leaving 3,589 for title and abstract screening against the review eligibility criteria. We excluded 3,468 of these for not meeting the inclusion criteria, leaving 112 for full text examination. Of these, six were not accessible, 19 did not offer findings for the phenomena of interest, 36 did not use qualitative methods, and for 51 we were uncertain whether participants were ACCHO clients. This left nine articles reporting nine studies. An additional article reporting one of the nine studies was identified in the references of one included article, resulting in 10 included articles,25,34 reporting nine studies. Supplementary file 2 provides the search results and study selection. The list of citations excluded at full text examination is available from the corresponding author.The results from the methodological quality assessment are provided in Supplementary file 3.

One was rated high quality,28 seven were rated good quality,27,29,34 and one, reported in two articles, was rated moderate quality.25,26 A lack of clarity about how researchers’ values and prior knowledge influenced studies was the main methodological concern potentially undermining the credibility of the findings that informed our syntheses. It is not possible without further information to comment on whether researchers’ values and knowledge enhanced the validity of findings or introduced bias.Details on the characteristics of each included study are provided in Supplementary File 4. All the studies were published between 2004 and 2014. Six used mixed methods.25–27,30,31,33,34 Four used focus groups and interviews,27,31–33 four used only interviews,25,26,28,30 and one used only focus groups. 34 Five of the studies adjusted their methodology to align with the unique ethical and methodological standards relevant to research with Indigenous Australians.28–30,33,34 Based on an estimation of 75 participants in one study that employed focus groups,27 a total of 811 study participants informed the meta-syntheses (including 640 from one study).31 There was good geographic representation in the ACCHO sample.

Synthesised findingsA diagrammatic representation of the three meta-aggregations of the ACCHO client perceptions is provided in Supplementary File 5.

Care in ACCHOsOur synthesis of the client perceptions on the characteristics and value of ACCHO care, extracted from the nine included studies,25–34 produced four synthesised findings.

Synthesised Finding 1: ACCHOs’ accessibility was highly valued. Clients identified ACCHOs’ transport services, proactive service provision, culturally safe care, range of services and welcoming environment as contributing to ACCHOs’ accessibility. Five categories informed this synthesised finding; each of them described a different characteristic that, from the clients’ perspective, contributed to accessibility. Proactive service provision was described as ACCHOs having outreach services (e.g. home visits), staff who were easily contactable, and staff meeting patients in public areas such as shopping centres.25–27 Culturally safe care was described as care delivered by providers who were good,28 who understood clients and knew how to meet their needs,29 who spent sufficient time with patients and who respected culture,29 in an environment that made clients feel comfortable.34 ACCHOs’ welcoming environment was described as including an emotional and relational dimension.27,29,33 The relational dimension was reflected in clients’ relating how they felt welcome in ACCHOs because they saw people who were familiar to them, and who understood them, both in the waiting room and in the clinical space.27,28 Clients indicated that they valued this because it gave them a sense of belonging.27,28 The emotional dimension of the welcoming environment was evidenced in descriptions of ACCHOs as social meeting places, where friends offered and received support.28,29 The following client voices are illustrative of how clients described ACCHOs’ welcoming environment:

“I just, just ah come here on my one day off and sit out here, have a talk with my mates…there’s always someone you know here… it’s a social event too…”29(p200)

“We share a lot. You know when you meet people you talk about things…If we go in and I know someone we’ll have a good yarn…?”29(p200)

Synthesised Finding 2: The way ACCHOs delivered care was highly valued. Clients valued staff taking the time to know and care for clients; personalised care tailored to self-perceived need; continuity of care; and appropriate communication. Clients related that they experienced feelings of belonging and confidence when accessing services with these service qualities. Four categories of findings informed this synthesised finding. The first was that clients experienced and valued staff, including doctors, taking their time with them.29 In the words of one client: “That’s the thing AMSs do really well, they take their time. There are not time limits”.29 ACCHOs providing healthcare in a personalised way tailored to client needs was the second category. These findings indicated that clients perceived ACCHOs as delivering care in a way that was responsive to their background27 by people who understood them.29 Clients also reported that the way staff provided care made them feel: known;29,33 less isolated (belonging);29,33 more confident;28 less anxious;30 cared for;30 accepted;28,29,30 supported;29 and encouraged.30 The third category was provision of information in a way that was understandable.27,30 Continuity of care was the last category, described as ongoing care and support for various problems in a client’s life over time.27,29

Synthesised Finding 3: Particular qualities of ACCHO staff were highly valued. These included Aboriginal identity of some of the ACCHO workforce, including AHWs; and staff who understood Indigenous clients and therefore behaved respectfully. Two categories informed this synthesised finding. The first was that clients valued the following behavioural qualities of staff: respectful and non-judgemental behaviour;27 staff taking time to know the client’s background and listen to their needs;29 sensitivity, kindness and reassurance;25,26 and trustworthiness.28,29 One said the way ACCHO staff allowed clients to talk about anything made you “feel at home”.27 The second category concerned how clients valued the Aboriginal identity of some ACCHO staff29,33 and the employment of AHWs.28 The following client voice illustrates how some clients described the value of AHWs:

“It was a whole new world…she was like a social worker I guess, we could talk to them individually, she was lovely. She explained everything, she took you in to how you know it all worked and was going to happen…you couldn’t have found so much difference between her, and the doctors who just tell you.”28(p6)

Synthesised Finding 4: A comprehensive, holistic approach to PHC was highly valued. The inclusion of non-clinical care, such as community events, group activities and enhanced supports available through community networks, had a positive impact on peoples’ wellbeing. Two categories informed this synthesised finding. The first was that non-clinical services, including ACCHOs’ social services, cultural events,33 and group activities such as diabetes camps30 and bush camps,33 were a valued characteristic. Clients pursued the opportunity group programs gave them to spend time with people who shared similar experiences, and to connect with community and culture.30,33 One client described the group-based activities as “a really great healing process”.33(p359) The second category of findings acknowledged and described perceived positive impacts of ACCHOs on client wellbeing.27,28,30,32 The impacts identified were: increased confidence;27,28 enhanced knowledge about how to manage conditions and actively engage in health decision making;30 pride in being part of the local Aboriginal community and its health service; better health;28,32 and better mental health.32

Comparisons of the characteristics of care in ACCHOs and mainstream PHC

Synthesis of the findings from three included studies contrasting the client perceptions of the characteristics of care in ACCHOs and mainstream PHC produced one synthesised finding which identified two differences between ACCHOs and mainstream PHC providers.28,29,33Synthesised Finding 5: While relationships were characterised by respect and understanding in ACCHOs, in mainstream services there was often a lack of respect and no shared understanding between providers and clients, or among clients. ACCHO clients described being discriminated against (also couched as being treated “differently”),28 patronised,28 assaulted and threatened29 by staff in mainstream services and contrasted this with staff in ACCHOs, including “behind the door in the clinical consultation space”,29 treating clients with respect and understanding rather than challenging or denying cultural identity.29 The second category was client-provider and provider-provider relationships in ACCHOs being characterised by high levels of trust,29 shared similar meanings29 and caring supportive relationships33 contrasting with a lack of mutual understanding and an absence of trust in the relationships within mainstream services.29
Comparisons of valued characteristics of care in ACCHOs and mainstream

Synthesis of findings from six of the included qualitative studies contrasting the value of care across the two sectors, identified three unique highly valued characteristics of care provided by ACCHOs compared to mainstream PHC providers.27–29,32–34

Synthesised Finding 6: ACCHO clients identified three unique highly valued characteristics of ACCHOs compared to mainstream PHC services: (1) accessibility, which clients described in terms of welcoming and safe spaces; (2) the way ACCHOs delivered care, in a culturally safe way tailored to need; and (3) comprehensive holistic care. The first point was that clients preferred ACCHOs because of their greater accessibility, which was related to additional services and their more welcoming environment.27,29,32,34 Clients described ACCHO waiting rooms as meeting and speaking environments “where people happen to be sick”,29 contrasted with mainstream services’ waiting rooms, described as quiet, formal sick places where you felt isolated.29 Clients signalled that relationships and support associated with companionship experienced in ACCHOs’ and Aboriginal staff were key to why ACCHOs were more accessible.32

“I used to go…all the way into [suburb] to see the AMS workers, and um I’d see a lot of people, it’s a great place to get together with a lot of people, a special place, and you see different ones, and have a yarn to…I’ve been away for a while, and um I always come back… In the [non-Indigenous] service you’re in, you’re out. There’s no friendliness…”28(p4–5)

“There’s always someone that you know, another family member or an old school chum or people you’ve played football with, and you’ve got that companionship there. If you were to go to the doctor’s surgery uptown and then just sitting there, oh god, I’m wishing to get out of there super quick.”33(p358)

“I was going to a doctor in Cleveland, and I didn’t feel comfortable there, but being here, where there’s other people around, yeah I felt comfortable when I came here the first time…there were Aboriginal nurses as well…and you could relate to them a bit more.32(p.6)

The second and third categories informing synthesised finding six, concerned differences in the way care was delivered across the two settings.27,29,3

Clients indicated they valued how staff in ACCHOs understood their holistic health care needs – signalled for example by references to be able to “talk to the AMS staff about anything and everything”– and were respectful,29(p202) and contrasted this with experiencing lack of understanding and inadequate care in mainstream PHC services.

Discussion

Our systematic review identified a small body of studies reporting qualitative data on client perceptions that when synthesised offers useful insights into how Indigenous clients view the nature and value of care provided in ACCHOs, and comparison to in mainstream PHC providers. Importantly, the findings from the syntheses contrasting care across the sectors mirrored those from the synthesis of clients’ perceptions of ACCHOs’ characteristics and value. Overall, our synthesis points to three unique, highly valued characteristics of care provided in ACCHOs compared to in mainstream providers. The first is ACCHOs’ unique accessibility. Clients perceive ACCHOs’ welcoming environment, which includes a social, emotional and physical aspect and supports cultural safety; ACCHOs’ flexible, responsive and proactive approach to care provision; and ACCHOs’ additional services, including transport and outreach as factors contributing to ACCHOs unique accessibility. The second unique, highly valued ACCHO characteristic is ACCHOs’ culturally safe care. This was described by clients as care delivered by staff, many Aboriginal, who feel known to clients, understand client needs and respect culture, in an environment where clients feels comfortable, supported and that they belong. The third was comprehensive care, that is, care responsive to holistic health needs.

Relationships, understanding and respect for culture central to clients’ view of accessible, appropriate, quality health care

High levels of trust and mutual understanding in the relationships between clients and health care providers, as well as close relationships between clients, were central themes in our syntheses. The presence of people from the local community, and involvement of Indigenous people in the service, was also central themes. Our synthesis therefore reinforces existing literature that has highlighted relationships,3,35 respect for culture and for Indigenous knowledge, and the involvement of Indigenous people in providing care, as central to Indigenous clients’ perceptions of accessible, appropriate and quality health care.

Why care provided by mainstream PHC providers will not substitute for ACCHO care

The description of ACCHOs’ characteristics and value compared to mainstream PHC providers highlights two distinct but equally important reasons why the care provided by mainstream providers cannot serve as a substitute for the care provided by ACCHOs for Indigenous clients. First, as has been previously noted,3 the characteristics of accessible and culturally safe care are such that mainstream PHC providers cannot achieve them using a tick-box approach and without fundamental change. Key elements, including the support offered by relationships amongst clients, will be difficult for mainstream providers to replicate. Second, mainstream services are not perceived by all Indigenous Australians as offering care that is responsive to holistic health needs. Moreover, mainstream PHC providers are ill-equipped to provide clients with a broad range of PHC programs tailored to self-perceived holistic health needs. They are focused on delivering clinical services designed largely to meet the needs of the majority, non-Indigenous population and to meet business objectives, and they are unlikely to transition to providing the additional services Indigenous Australians seek.

Additional insights on how ACCHOs improve Indigenous health

Our findings offer additional insights into the way ACCHOs contribute to improving the health and wellbeing of Indigenous Australians. Moreover, the clients’ references to positive impacts of ACCHOs on their confidence;27,28 on their knowledge about how to manage conditions and actively engage in health decision making;30 on their pride in being part of the local Aboriginal community and its health service; and on their mental health32 supports the conclusion of a recent review on ACCHOs’ impacts on Indigenous health,36 that ACCHOs are important not only because their health care helps to improve Indigenous Australians’ health, but also because of how they help to address the socioeconomic factors that contribute to high levels of chronic disease in Indigenous communities.

Strengths and limitations

The overall quality of the included studies was good. A second strength of our review is the steps we took to align our review methodology with the ethical and methodological requirements relating to research involving Indigenous Australians. These steps are important because they are called for by the unique standards for ethical research with Indigenous Australians, and because incorporating local contextual and cultural knowledge specific to Indigenous people adds to the credibility and relevance of the review findings and should aid their transferability into practice and policy.20,21

The small number of studies contributing to the syntheses, particularly the two comparing care across the sectors, is a limitation of our review. Neither the included ACCHO population nor the ACCHO client population were representations of their diverse total populations in Australia, potentially limiting the transferability of the findings. Another limitation relates to our inability (given data constraints) to explore potential variations in the perspectives of clients with different characteristics, e.g. males versus female, people of low and high socio-economic status. Third, whilst we did not extract findings from studies in which it was clear that the comparator was care in the hospital setting, we cannot be certain that references to “mainstream services” did not include this setting. We did not consider how clients’ perceptions of the characteristics and value of ACCHOs’ care compare with their perceptions of characteristics and value of other Indigenous PHC provider types. It is expected that Indigenous services, with high levels of local community involvement in the planning and delivery of their services, may be perceived by clients as having similar characteristics and value as ACCHOs. Fifth, there may be studies published since the end date of our search, that meet our review inclusion criteria, which may offer unique additional insights about how ACCHO clients perceive the characteristics and value of care provided by ACCHOs, and compared to mainstream providers, or they may confirm our synthesised findings.

Implications

Mainstream practitioners that seek to improve the accessibility and quality of their care for Indigenous peoples should: 1) invest in understanding Indigenous clients’ needs and learn how to be respectful of Indigenous clients’ culture; 2) adopt a flexible and proactive approach to providing care for Indigenous people (for example, they need to be prepared to meet clients outside of normal operating hours and engage in outreach activities); and 3) invest in making the clinic welcoming for Indigenous clients, for example, by putting up posters and other artefacts that are representative of Indigenous culture. However, for many Indigenous Australians, the care provided by mainstream PHC providers will not be a substitute for ACCHO care tailored to meet holistic health needs of Indigenous clients and their communities. Australian governments therefore should remain committed to the implementation of community control and should prioritise reforms to make the funding and accountability arrangements more enabling of rapid growth in the ACCHO sector and more supportive of high-quality, comprehensive, effective service provision by ACCHOs. To this end, government should look to the recommendations offered by recent research on barriers and facilitators regarding implementing Indigenous community control in PHC which offers useful guidance on reforms required in funding and accountability frameworks.11,14,16–18 In addition to building better funding and accountability arrangements for the ACCHO sector, governments need to continue to prioritise initiatives, for example best practice guideline development and dissemination, that enable all relevant treatments for comprehensive holistic health care being informed by scientific evidence. Ensuring that all ACCHOs have access to, and have the capacity to use, appropriate continuous quality improvement systems, for identifying their strengths and where system change is required to further strengthen the service and improve the health outcomes for clients accessing these services, is also important.37

Conclusion

The qualitative evidence on how Indigenous Australian ACCHO clients perceive the characteristics and value of care provided by ACCHOs, and compared to in mainstream PHC providers facilitates understanding why mainstream PHC provider care cannot be a substitute for ACCHO care. It also offers insights into how ACCHOs address socioeconomic factors that contribute to chronic disease in Indigenous communities. This sends a cautionary note to policy makers intent on mainstreaming Aboriginal PHC and underscores the importance of implementing the reforms to the funding and accountability arrangements for ACCHOs, that have been identified as important to support ACCHOs’ delivering quality services that are effective and meet holistic needs of clients in Indigenous communities. Mainstream PHC practitioners can learn from best-practice examples in the ACCHO sector how to improve the accessibility and quality of their care for Indigenous clients.

Acknowledgements

Judith Gomersall (JG), Odette Gibson (OG), Judith Dwyer (JD), Alex Brown (AB) and Edoardo Aromataris (EA) led the conceptualisation of the review. JG and OG led the writing of the protocol. The research governance group established to guide the work of the NHMRC Centre of Research Excellence in Aboriginal Chronic Disease Knowledge Translation and Exchange (CREATE) reviewed the protocol. JG performed the search and abstract review. OG, Drew Carter (DC) and EA conducted the full text examination. EA, an experienced systematic reviewer, provided oversight during the search and study selection process. EA and Zachary Munn (ZM) provided technical advice about appropriate review method. Two non-Indigenous Australian members of the review team, DC and JG, assessed the quality of studies. Their assessments were reviewed by two Indigenous Australian members of the team, OG and Kootsy Kanuto (KK). Matthew Stephenson (MS), ZM and JG (all non-Indigenous Australians) extracted the data from the included studies. Two Indigenous members of the review team, OG and Kim O’Donnell (KO), reviewed their data extraction. KO, OG, MS, JG and DC participated in a workshop convened to develop an initial set of categories for the meta-aggregation. OG and JG then worked together on the meta- aggregation with OG’s perspective being privilege due to her unique insider Aboriginal knowledge. AB, a senior Indigenous Australian health researcher with expert knowledge of Aboriginal health and the Aboriginal health sector, guided JG through the second level analysis, the interpretation of the synthesised findings. JG, OG JD and EA led the writing of the paper, which was reviewed by all authors. The findings of the review were presented to representatives of the CREATE leadership group prior to submission of this article for publication, and feedback received integrated. The authors thank the participants of the CREATE leadership group for the invaluable guidance and time they provided during this review. We also thank Harold Stewart and Stephen Harfield for participating in the workshop held at the beginning of the synthesis stage of the review. Finally, we thank Sandeep Moola for assistance during the data extraction stage of the review.

Funding

The NHMRC (GNT1061242) supported this project. The contents of the published material are solely the responsibility of the Administering Institution, a Participating Institution or individual authors and do not reflect the views of NHMRC.

NACCHO Aboriginal Health : Our #ACCHO Members Deadly Good News Stories from #ACT #WA #VIC #NSW #QLD #NT #TAS @KenWyattMP

1.Winnunga ACCHO elders garden has healthy future for community

2. SA : Nathan Krakouer  no more bad choices now Deadly Choices

3.1 The new Murray PHN Indigenous Health Advisory Council will bring together six different ACCHO’s  across North East Victoria

3.2 VAHS hosts Oxfam International Executive Director Winnie Byanyima 

4.AHCWA calls for “ICE “ intervention and prevention ACTION

5.1 NSW 60 Students graduate AHMRC Aboriginal Health College

 5. 2 NSW Awabakal’s Tackling Indigenous Smoking program hits the road.

 6.QLD ‘No Smokes’ one-day training 

7. NT Uncle Jimmy and NT ACCHO’S helps to stop Trachoma

8.Tasmania Culture Centre employment assistance service

How to submit a NACCHO Affiliate  or Members Good News Story ? 

 Email to Colin Cowell NACCHO Media     Mobile 0401 331 251

Wednesday by 4.30 pm for publication each Thursday

 

1.Winnunga ACCHO elders garden has healthy future for community

When you think of a garden and gardening, most of us wouldn’t think of it as a gift of life. But for 74 year old Uncle Brian Demery this is exactly what it did for him. ‘I went to Winnunga coz I was sick but when I went to Winnunga a new chapter of my life was opened. Winnunga just cares, not only about me but about lots of our Elders’ Uncle Brian said.

Twelve years ago Uncle Brian and his late wife, who passed away 11 years ago, operated a community garden but when the funding stopped, the couple found themselves struggling to keep it going due to the ongoing costs.

‘I was speaking to Julie Tongs at Winnunga. I told her, what had happened and how I was paying for it out of my own pocket. Julie said ‘how can we help you’, Uncle Brian explained. ‘I couldn’t do it without Winnunga. It’s expensive with the seeds and punnets’ he added.

From humble beginnings in its current Queanbeyan location, the Winnunga Elders Garden became what it is today – a thriving community garden with a variety of seasonal vegetables such as cabbage, broccoli, cauliflower, peas, beans, capsicum, lettuce, corn, turnips, chilli’s and some grapes.

The Ngemba Elder from Bourke said although it’s a lot of hard work taking care of 10 large garden beds, a green house, a number of sleepers and five trellises, he said it gives him a purpose, a reason to get up each morning. ‘I just love it, it’s satisfying. You just feel good within yourself. If you don’t do anything, you get bored, you drink, you do bad stuff but this keeps you on track. It’s also good exercise’ Uncle Brian explained.

Uncle Brian who works in the garden two hours a day and for four to five hours on a Saturday and Sunday was keen to describe the feeling he gets from seeing the plants grow. ‘You put the seeds in and wait to see it grow, see it sprout. Every day, it’s exciting. You then get to pick it and taste it’ he said.

Those who know the keen golfer, father of two, a grand-father and great-grandfather, can’t speak highly enough of his character. One of these people is Ian Bateman, Manager of Winnunga’s Social Health Team. ‘Uncle Brian is not only a great role model but also an interesting character with a great sense of humour. He brings a lot of knowledge and passion and we couldn’t think of a better person for the garden. It’s also good to see someone his age still being so active. He gives back to the community’ Mr Bateman said.

The Elders Garden has had a significant impact on the community.

‘I do up vegetable packages for families and Elders. There are about 15 families with kids, we give to. I like helping these families and Elders as they are battling to make ends meet, it saves them money’ Uncle Brian said. Mr Bateman also echoed Uncle Brian’s thoughts on the important role of the garden. ‘It’s a big benefit to the community. There are people struggling especially our Elders and pensioners. A lot of the pensioners are supporting extended families with serious social issues. So the garden and its produce are of a great benefit to the community’ Mr Bateman explained.

Uncle Brian also added ‘People are so grateful. For me, it’s mainly for the kids. Everything I grow isn’t sprayed, no pesticides, it’s all organic. This way, they get fresh vegetables, it encourages the kids to eat vegetables’ he said. Uncle Brian said although he is getting on in age, he still plans to keep working the garden for a little longer but welcomes any volunteers to help him out.

‘I reckon I’ve got two years left in me to keep doing this. It’s getting hard but I’ll still do it. I’d love to hear from any Koori fellas who’d like to help out. They could start out with one garden bed, I’ll help. I’ll give them the seeds’ he said.

If you would like to assist with the Winnunga AHS Elders Garden, please contact the Social Health Team at Winnunga on 02 6284 6222.

2. SA : Nathan Krakouer  no more bad choices now Deadly Choices

Port Adelaide Power journeyman Nathan Krakouer opens up on bad choices that almost ended his life READ Story Here

Nathan Krakouer speaks out about his past choices and how he turned his life around. Now Nathan wants to help others by using his lessons from binge drinking and drugs to advise indigenous youth to not go down the path he did.

Power signs on to boost health care

PORT Adelaide will have its indigenous players — such as Nathan Krakouer — become powerful role models in Aboriginal communities to promote better health.

And Power chief executive Keith Thomas explains the bold move from “the core business of football” as part of the Port Adelaide Football Club taking on greater responsibility with indigenous issues.

“We have a role to play in Aboriginal health care,” said Thomas, who this week challenged the AFL and its clubs to broaden the indigenous agenda beyond a celebration of Aboriginal culture with the Sir Doug Nicholls Round.

Port Adelaide yesterday signed an agreement with the Aboriginal Health Council of SA to be part of the “Deadly Choices” program that will encourage indigenous communities to have health checks.

The Deadly Choices program aims to advise indigenous youth the impact of poor lifestyle decisions by empowering them to make healthy decisions for themselves and their families.

The Deadly Choices team from Queensland were in Adelaide last week to bump heads with us before the big launch day on July 1st.

(L-R) Thomas Gilles, Ian Lacey, Wade Thompson, Trent Wingard, Nathan Appo, Marlon Motlop

Deadly Choices is a school-led, 8-week health and lifestyle program will encourage young people make the right choices to look after their own health.

And if they complete the health check at one of our member clinics, they will be able to win the Deadly Choices Guernsey.

Our member clinics are at Pipalyatjara, Amata, Umuwa, Fregon, Ernabella, Mimili, Indulkana.

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3.1 The new Murray PHN Indigenous Health Advisory Council will bring together six different ACCHO’s  across North East Victoria

Six Aboriginal Community Controlled Health Organisations will collaborate with Murray PHN to help improve access to health services and health outcomes for Aboriginal and Torres Strait Islander people in our area.

They will form the newly-established Murray PHN Indigenous Health Advisory Council, committed to improving indigenous health outcomes in the region, in line with the operational principles of the National Aboriginal and Torres Strait Islander Health Plan 2013-2023.

Matt Jones, CEO of Murray PHN, said the organisation was the first Primary Health Network in Australia to establish an Indigenous Health Advisory Council.

“Our goal is to ensure that primary health services and the health service system across the Murray PHN catchment area are responsive to the needs of our Aboriginal and Torres Strait Islander communities,” Mr Jones said.

“This is part of wider efforts to close the gap in life expectancy and health outcomes in the Indigenous population.

“As a representative voice for Aboriginal and Torres Strait Islander people in our region, the Indigenous Health Advisory Council will allow for the authentic participation of indigenous people in designing and developing models of care,” he said.

The Murray PHN Advisory Council membership will consist of:

  • Albury Wodonga Aboriginal Health Service (AWAHS)
  •  Bendigo and District Aboriginal Cooperative (BDAC)
  •  Mallee District Aboriginal Service (MDAS)
  •  Mungabereena Aboriginal Corporation
  •  Murray Valley Aboriginal Cooperative (MVAC)
  •  Njernda Aboriginal Corporation
  •  Murray PHN

Improving Aboriginal and Torres Strait Islander health is one of the key health priorities for the region. Murray PHN has more than 14,800 people who identify as Aboriginal and Torres Strait Islander (14,800+), and whose health status continues to be considerably lower than the wider population.

Aboriginal and Torres Strait Islander people experience a burden of disease two-and-a-half times that of other Australians, with 70 per cent of the health gap due to chronic diseases such as cardiovascular disease, diabetes, cancer, chronic respiratory disease, chronic kidney disease and mental health issues.

The Murray PHN Indigenous Health Advisory Committee will meet quarterly.

3. VAHS hosts Oxfam International Executive Director Winnie Byanyima 

 

“What inspires me and what I’m taking away is the love, I always have faith In community. Its powerful and has touched my heart and I’m taking that away with me.

I felt the love of community in this building and in this work, faith/belief in community, past present and future, I felt that within myself powerful. 

Oxfam fights alongside Indigenous communities. The power is in the love of community.”

After hearing Gary Foley’s  powerful recount of the rich and proud history of VAHS , Oxfam International Executive Director Winnie Byanyima made this statement to the VAHS board, staff and community.

Thank you to Uncle Bill Nicholson, Aunty Janice Austin, Gary Foley, Jimmy Peters and the Board, Uncle Phil Ah Wanh, and Ngarra, Justin and the Oxfam team for making today happen.

4.AHCWA calls for “ICE “ intervention and prevention ACTION

The Aboriginal Health Council of Western Australia has called for better access to early intervention and prevention programs to help address increasing methamphetamine (ice) use in regional WA. AHCWA chairperson Michelle Nelson Cox said “beggared belief” that there had not been any significant investment into grassroots community intervention programs despite ice use continuing to increase over the past decade.

“It is frustrating that despite several state and federal strategies highlighting the need to increase investment in community-led and culturally appropriate early intervention prevention, treatment and support services, we are yet to see any significant amounts of funding directed to our sector and other Aboriginal community-controlled organisations, “she said.

Ms Nelson Cox said there had been a concerning shift with ice use overtaking excessive alcohol use in some communities, resulting in services being unprepared and lacking the appropriate programs and services to provide care to those using the illicit drug.

“There is a growing presence of illicit drugs in the regions,” she said.

“While there is evidence that alcohol use is still higher than methamphetamine use, from the Aboriginal community perspective we are certainly seeing methamphetamine use becoming just as significant as alcohol use.

“Our people are crying out for help. They want community-led solutions and want to work with government departments but all they are getting is lip service.”

Ms Nelson Cox said there was no conclusive evidence that cashless welfare cards had made any impact in minimising drug use.

“Our Elders are gravely concerned about the impact of the cashless welfare card. There is no significant evidence to suggest that cashless welfare cards lead to any reduction in drug use in our regional communities”, she said.

“What we have seen in certain towns is an increase around elder abuse, black market trades of the cards for cash, reports of prostitution and a rapid rise in crime.

“Regional communities are trying to take practical approaches and strategies to deal with this problem.

“Penalising people through their Centrelink payments is not the solution. This approach will not deal with the crux of the problem. It will not empower our people and we are also yet to see investment into additional support services as was promised with its introduction.”

AHCWA is the peak body for Aboriginal health in WA, with 22 Aboriginal health services currently members.

5.1 NSW 60 Students graduate AHMRC Aboriginal Health College

 

A big day for 60 Students graduating today from courses at the AHNMRC Aboriginal Health College. Aboriginal health in Aboriginal hands

Congratulations Aboriginal Health College 2017 graduates. Equals more Aboriginal health workers & culturally appropriate care

5.2 NSW Awabakal’s Tackling Indigenous Smoking program hits the road.

Awabakal’s Tackling Indigenous Smoking program hit the road last week with the help of some familiar faces.

We ran a workshop with the students to educate them about smoking and the effects the habit can have.

We would like to say a big thank you to our special guests for the day who were on hand to share some important messaging – George Rose, Samantha Harris, Latrell Mitchell, Connor Watson and Will Smith.

 6.QLD ‘No Smokes’ one-day training 
 

Please see the attached invitation to ‘No Smokes’ one-day training which will be delivered at Apunipima Cairns office on Thursday 15 June 2017 from 9.00am to 3.30pm.

The training provides an introduction to the ‘No Smokes’ resources, which include a variety of Aboriginal and Torres Strait Islander specific tools, as well as resources to inform people of the dangers of smoking and to assist them to quit.

The main resource used with the training will be a flipchart, which can be viewed here: http://nosmokes.com.au/wp-content/uploads/2015/02/TobaccoFlipchart_Sept2012_A4.pdf

The training is FREE and lunch and morning tea will be provided.

Please RSVP to Nina Nichols nina.nichols@apunipima.org.au or Kelly Franklin kelly.franklin@nintione.com.au.

7. NT Uncle Jimmy and NT ACCHO’S helps to stop Trachoma

 

Day one of the Barkly Desert Culture tour in Tennant Creek…For the past three years local artists the E town Boyz, Hill Boyz and The Sand Hill Women have been making inspirational music under the mentorship of Monkey Marc, Beatrice Lewis and Sean Spencer with support of the Barkly Shire Council.

The artists have collaborated to write and perform a great song to make their community aware of Trachoma and how to stop it.

Here is a sneak preview of the song and video that we will share with you all very soon.

OR WATCH VIDEO HERE

The tour goes to Elliott tomorrow, then Alpurrulam, Ampilatawatja, Ali Curung, Alparra and a big finale concert in Alice Springs on June 16th. Clean Faces, Strong Eyes Indigenous Eyehealth Caama Alice Springs CAAMA Music See Desert Hip Hop for all tour dates…..

8.Tasmania Culture Centre employment assistance service

“Interested in these jobs at IBIS Styles Hobart, or other jobs coming up?

Not sure how to apply?

Come along to the Aboriginal Health Service this Friday June 9 from 10.30 am to get some tips and help with updating your resume, writing your application and get some interview tips.

Let Sally know if you are interested in attending.. hobart@tacinc.com.au or ring 62340700”

NACCHO Aboriginal Mental Health : Download report “Mental health in remote and rural communities “

 ” The poorer mental health of remote and rural Indigenous Australians is also impacted by the social determinants of Indigenous health, which are well recognised nationally and internationally.

These relate to the loss of language and connection to the land, environmental deprivation, spiritual, emotional and mental disconnectedness, a lack of cultural respect, lack of opportunities for self-determination, poor educational attainment, reduced opportunities for employment, poor housing, and negative interactions with government systems

The relationship of remoteness to health is particularly important for Indigenous Australians, who are overrepresented in remote and rural Australia (Australian Institute of Health and Welfare, 2014a).

The National Mental Health Commission (2014a, p. 19) identified that “the mental health needs of Aboriginal and Torres Strait Islander people are significantly higher than those of other Australians.”

Photo above

“ The women of Inkawenyerre, a small settlement in the Utopia community four hours by road north of Alice Springs, regularly take part in a different kind of mental health therapy, known as ‘narrative therapy.’

Narrative therapy taps into the centuries-old tradition among Aboriginal people of story-telling and expression through art. At the family Urapuntja Clinic, both women and children take part in narrative therapy.

They recreate what is commonly seen on any given evening in an Aboriginal community—people sitting around the fire, relating to one another and telling stories.

The activity is enjoyable for participants with group members often laughing and supporting one another as they tell stories and work on their painting—all while promoting good mental health living practice,”

Lynne Henderson, former RFDS Central Operations mental health clinician.

“People who live in the country get less access to care. And they become sicker,”

To increase the access to care, the RFDS said it needed a massive increase in funding. Country Australians see mental health professionals at only a fifth the rate of those who live in the city,

So there should be a five-fold increase in access to mental health care for country Australians.”

RFDS CEO Martin Laverty see story Part 2 below

Mental health in remote and rural communities

Mental health disorders are not more common in rural and regional Australia than they are in Australia’s cities, according to a new report from the Royal Flying Doctor Service (RFDS), but they are a lot harder to treat.

The report, Mental Health in Remote and Rural Communities, found about one in five remote and rural Australians — 960,000 people — experience mental illness.

Download the report HERE

RN031_Mental_Health_D5

But a combination of lack of access to facilities, social stigma, and cultural barriers present challenges to getting people the help they need.

AHCRA believes that’s something that everyone should be concerned about, with access to care regardless of location.

 

Part 1  Indigenous mental health and suicide

Data from the 2011 Australian Census demonstrated that 669,881 Australians, or 3% of the population, identified as Indigenous (Australian Bureau of Statistics, 2013b), and that 142,900 Indigenous Australians, or 21% of the Indigenous population, lived in remote and very remote areas (Australian Institute of Aboriginal and Torres Strait Islander Studies, 2014).

Around 45% of people in very remote Australia (91,600 people), and 16% of people in remote Australia (51,300 people) were Indigenous (Australian Bureau of Statistics, 2013b; Australian Institute of Aboriginal and Torres Strait Islander Studies, 2014).

In 2011–2012 around one-third (30%) of Indigenous adults reported high or very high levels of psychological distress—almost three times the rate for non-Indigenous Australians (Australian Bureau of Statistics, 2014).

In 2008–2012, in NSW, Queensland (Qld), WA, SA and the NT, there were 347 Indigenous deaths11 from mental health-related conditions (Australian Institute of Health and Welfare,

2015a). Specifically, age-standardised death data demonstrated that Indigenous Australians (49 per 100,000 population) were 1.2 times as likely as non-Indigenous Australians (40 per 100,000 population) to die from mental and behavioural disorders (Australian Institute of Health and Welfare, 2015a). Age-standardised deaths from mental and behavioural disorders increased with increasing age in both Indigenous and non-Indigenous Australians in 2008–2012.

Very few Indigenous and non-Indigenous Australians under the age of 35 years died as result of mental and behavioural disorders in 2008–2012. However, Indigenous Australians aged 35 years or older were more likely to die from mental and behavioural disorders than non-Indigenous

Australians in 2008–2012. Specifically, Indigenous Australians (7.2 per 100,000 population) aged 35–44 years were 5.7 times as likely as non-Indigenous Australians (1.3 per 1200,000 population) to die from mental and behavioural disorders (Australian Institute of Health and

Welfare, 2015a). In 2008–2012, Indigenous Australians (14.7 per 100,000 population) aged 45–54 years were 4.9 times as likely as non-Indigenous Australians (3.0 per 100,000 population) to die from mental and behavioural disorders (Australian Institute of Health and Welfare, 2015a).

In 2008–2012, Indigenous Australians (18.3 per 100,000 population) aged 55–64 years were 2.7 times as likely as non-Indigenous Australians (6.9 per 100,000 population) to die from mental and behavioural disorders (Australian Institute of Health and Welfare, 2015a). In 2008–2012,

Indigenous Australians (91.2 per 100,000 population) aged 65–74 years were 2.9 times as likely

as non-Indigenous Australians (31.3 per 100,000 population) to die from mental and behavioural disorders (Australian Institute of Health and Welfare, 2015a).

Further exploration of death data from mental and behavioural disorders illustrates the significant impact of psychoactive substance use (ICD-10-AM codes F10–F19) on Indigenous mortality (Australian Institute of Health and Welfare, 2015a). In 2008–2012, 29.1% of Indigenous deaths due to mental and behavioural disorders were the result of psychoactive substance use, such as alcohol, opioids, cannabinoids, sedative hypnotics, cocaine, other stimulants such as caffeine, hallucinogens, tobacco, volatile solvents, or multiple drug use. During this period, Indigenous Australians (7.3 per 100,000 populations) were 4.8 times as likely as non-Indigenous Australians to die as a result of psychoactive substance use (Australian Institute of Health and Welfare, 2015a).

Similarly, in 2006–2010, there were 312 Indigenous deaths from mental health-related conditions (Australian Institute of Health and Welfare, 2013a). Indigenous Australians living in NSW, Qld, WA, SA and the NT were 1.5 times as likely as non-Indigenous Australians to die from mental and behavioural disorders in 2006–2010 (Australian Institute of Health and Welfare, 2013a).

11 Deaths from mental and behavioural disorders do not include deaths from intentional self-harm (suicide). Intentional self-harm is coded under ICD-10-AM Chapter 19—Injury, poisoning and certain other consequences of external causes.

Age-standardised death data demonstrated that Indigenous males (49 per 100,000 population) were 1.7 times as likely as non-Indigenous males to die from mental and behavioural disorders. Indigenous females were 1.3 times as likely as non-Indigenous females to die from mental and behavioural disorders (Australian Institute of Health and Welfare, 2013a).

The greater number of deaths from mental and behavioural disorders with age may also represent the impact of conditions associated with ageing, such as dementia. For example, in 2014, Indigenous Australians (50.7 per 100,000 population) in NSW, Qld, SA, WA and the NT were 1.1 times as likely as non-Indigenous Australians (45.3 per 100,000 population) to die from dementia (including Alzheimer disease) (Australian Bureau of Statistics, 2016a).

In 2014–2015, Indigenous Australians (28.3 per 1,000 population) were 1.7 times as likely as non-Indigenous Australians (16.3 per 1,000 population) to be hospitalised for mental and behavioural disorders (Australian Institute of Health and Welfare, 2016a).

In 2011–2013, 4.2% of Indigenous hospitalisations were for mental and behavioural disorders (Australian Institute of Health and Welfare, 2015a). Age-standardised data demonstrated that Indigenous Australians (27.7 per 1,000 population) were twice as likely as non-Indigenous Australians (14.2 per 1,000 population) to be hospitalised for mental and behavioural disorders in 2011–2013 (Australian Institute of Health and Welfare, 2015a).

In 2008–2009, Indigenous young people aged 12–24 years (2,535 per 100,000 population) were three times as likely to be hospitalised for mental and behavioural disorders than non-Indigenous young people (Australian Institute of Health and Welfare, 2011).

 

The leading causes of hospitalisation for mental and behavioural disorders amongst Indigenous young people were schizophrenia (306 per 100,000 population), alcohol misuse (348 per 100,000 population) and reactions to severe stress (266 per 100,000 population) (Australian Institute of Health and Welfare, 2011).

A preliminary clinical survey of 170 Aboriginal and Torres Strait Islander Australians in Cape York and the Torres Strait, aged 17–65 years, with a diagnosis of a psychotic disorder, was undertaken to describe the prevalence and characteristics of psychotic disorders in this population (Hunter, Gynther, Anderson, Onnis, Groves, & Nelson, 2011).

Researchers found that: 62% of the sample had a diagnosis of schizophrenia, 24% had substance-related psychoses, 8% had affective psychoses, 3% had organic psychoses and 3% had brief reactive psychoses; Indigenous Australians aged 30–39 years were overrepresented in the psychosis sample compared to their representation in the population (37% of sample versus 29% of population) with slightly lower proportions in the 15–29 years and 40 years and older age groups; almost three-quarters (73%) of the sample were male (versus 51% for the Indigenous population as a whole); Aboriginal males (63% in the sample compared to 46% for the region as a whole) were overrepresented; a higher proportion of males (42%) than females (5%), and Aboriginal (44%) than Torres Strait Islander patients (10%) had a lifetime history of incarceration; comorbid intellectual disability was identified for 27% of patients, with a higher proportion for males compared to females (29% versus 20%) and Aboriginal compared to Torres Strait Islander patients (38% versus 7%); and alcohol misuse (47%) and cannabis use (52%) were believed to have had a major role in the onset of psychosis (Hunter et al., 2011).

In 2015, Indigenous Australians (25.5 deaths per 100,000 population) in Qld, SA, NT, NSW and WA were twice as likely as non-Indigenous Australians (12.5 deaths per 100,000 population) to die from suicide (Australian Bureau of Statistics, 2016b). In their spatial analysis of suicide, Cheung et al. (2012) concluded that higher rates of suicide in the NT and in some remote areas could be explained by the large numbers of Indigenous Australians living in these areas, who demonstrate higher levels of suicide compared with the general population.

The poorer mental health of remote and rural Indigenous Australians is also impacted by the social determinants of Indigenous health, which are well recognised nationally and internationally.

These relate to the loss of language and connection to the land, environmental deprivation, spiritual, emotional and mental disconnectedness, a lack of cultural respect, lack of opportunities for self-determination, poor educational attainment, reduced opportunities for employment, poor housing, and negative interactions with government systems

Part 2 Flying Doctors fight barriers to treat mental illness in rural Australia

Source ABC

Like so many in the bush, Brendan Cullen has a lot on his plate.

He manages a 40,000-hectare property south of Broken Hill. There are 8,000 sheep to keep track of. And that’s just a fraction of the number he looked after previously at another station.

A few years ago, the mustering, the maintenance, juggling bills and family — it all caught up to him.

“You just bottle stuff up. And sometimes you can’t find an out,” he said.

“In the bush you have a lot of time by yourself.”

He spent a lot of that time thinking about his problems. But Mr Cullen was lucky.

He heard about a mental health clinic being run by the Royal Flying Doctor Service (RFDS) in a nearby community and decided to go along.

“Catching up with one of the mental health nurses gave me the tools to be able to work out how I go about living a day-to-day life,” he said.

“My life’s a hell of a lot easier now than what it used to be.”

Mental health disorders are not more common in rural and regional Australia than they are in Australia’s cities, according to a new report from the RFDS, but they are a lot harder to treat.

The report, Mental Health in Remote and Rural Communities, found about one in five remote and rural Australians — 960,000 people — experience mental illness.

But a combination of lack of access to facilities, social stigma, and cultural barriers present challenges to getting people the help they need.

“People who live in the country get less access to care. And they become sicker,” RFDS CEO Martin Laverty said.

To increase the access to care, the RFDS said it needed a massive increase in funding.

“Country Australians see mental health professionals at only a fifth the rate of those who live in the city,” Mr Laverty said.

“So there should be a five-fold increase in access to mental health care for country Australians.”

The impact of distance and isolation when it comes to treating mental disorders can be seen in suicide rates. In remote Australia, the rate is nearly twice what it is in major metropolitan areas — 19.6 deaths per 100,000 people.

The suicide rate is even greater in very remote communities.

If you or anyone you know needs help:

The RFDS has responded by increasing its mental health outreach. In communities like Menindee, about an hour’s drive from Broken Hill in the far west of New South Wales, a mental health nurse is on call once a fortnight.

“I have needed them in the past. I got down to rock bottom at one stage. Even now I appreciate that support,” Menindee resident Margot Muscat said.

Ms Muscat plays an active role in the remote community. But she has also felt pressure in the past to manage that role, her work, and family commitments.

Mental health counselling has given her a valuable outlet.

“Just to know that I wasn’t alone. And that you don’t have to take the drastic step of suiciding, so to speak,” Ms Muscat said.

Some the RFDS’s mental health counselling is done over the airwaves. From its regional base in Broken Hill, mental health nurse Glynis Thorp counsels patients over the phone. Often calls are simply people checking in.

“It’s critically important…often there might only be two people on the property. So no one to talk to maybe,” she said.

“We might get out to a clinic every fortnight, but we might have follow up phone calls to check how people are going. For myself it’s probably a ratio of four to one.”

The RFDS report reveals every year hundreds of serious mental illness incidents require airplanes to be dispatched to remote areas to fly patients out for treatment.

Over three years from July 2013 the RFDS conducted 2,567 ‘aeromedical retrievals’.

The leading causes for evacuation flights due to mental disorder are

The RFDS also uses airplanes to carry its mental health nurses to very remote areas. On a typical day in Broken Hill, the medical team takes off just after dawn to head to three communities hundreds of kilometres away: Wilcania, White Cliffs and Tilpa.

In the opal mining town of White Cliffs, the mental health nurse sees patients at the local clinic. One is “Jane”, who doesn’t want her full name used.

“Without them, we would really be lost here,” she said.

Jane has been counselled by the RFDS and was recently directed to mental health treatment in Broken Hill. But she’s still reluctant to talk openly in town about the help she’s getting.

“In a small community it’s not wise to talk to other people in town,” she said. “And mental health, it does carry a stigma.”

Back on his station south of Broken Hill, Mr Cullen believes that stigma over mental health is slowly changing in the bush.

“People get wind that someone’s had a mental health problem, people talk now. As opposed to, let’s go back five years even, 10 years. It was a closed book,” he said.

“With these clinics, once upon a time you might have had a dental nurse, a doctor, and the like.

“But now you have a mental health nurse…And these clinics are close by. So you’re able to go to them. They come to you.”

NACCHO Aboriginal Health #WorldNoTobaccoDay : Cape York mob are saying “Don’t Make Smokes Your Story.”


“Wasting a lot of money to buy cigarettes and it was making me sick, coughing a lot, and getting up late, and it smells on your clothes a lot. So I said to myself I would have to cut down smoking.”

“You don’t have to buy cigarettes, you don’t have to afford cigarettes for other people, you don’t have to get cigarettes. Just be strong and stand up for yourself and say no!”

Selena Possum, who has lived in Pormpuraaw for the last 20 years, is now a non-smoker. She says smoking affected her a lot

NACCHO Aboriginal Health #smoking #ACCHO events 31 May World #NoTobacco Day #QLD #VIC #WA #NT #NSW

May 31st is World No Tobacco Day and people from Cape York are saying “Don’t Make Smokes Your Story.”

Apunipima Cape York Health Council Tackling Indigenous Smoking (TIS) staff have been engaging with Cape York communities to develop an anti-smoking campaign.

The locally appropriate ‘Don’t Make Smokes Your Story’ campaign aims to raise awareness of the harms of smoking and passive smoking, the benefits of a smoke-free environment, and available quit support.

The Cape York ‘Don’t Make Smokes Your Story’ Campaign enables community members to share on film their stories about quitting, trying to quit and the impact of smoking on families and communities. It is hoped that by sharing their stories, others will be encouraged to share their stories too.

Coen local Amos James Hobson has never smoked in his life. He sees many young people start smoking “Just to be cool, to pick up a chick.” He says to all the young people out there, “Our people didn’t smoke, don’t smoke, it’s not good. It’s not our culture and it’s not our way.”

WATCH AMOS VIDEO STORY HERE HERE

Thala Wallace from Napranum has tried to quit three times and says “Every time it gets easier.” Her strategy is to “Try to find ways to occupy myself, snack-out on fruit or go to the gym, getting out and hanging out more with people who don’t smoke.”

Watch Thala story video here

The stories, as well as posters, social media posts and radio advertisements will be released from May 31st as Apunipima launches the Cape York ‘Don’t Make Smokes Your Story’ campaign.

The videos, including those featuring Amos, and Thala, will be distributed on the ‘What’s Your Story, Cape York?’ Facebook page and will be available on the Apunipima YouTube Channel here.

Apunipima received a Tackling Indigenous Smoking (TIS) Regional Tobacco Control Grant as part of the National Tackling Indigenous Smoking program.

To effectively reduce smoking rates in Cape York, Apunipima TIS staff have been engaging with communities to develop and implement a locally appropriate social marketing campaign to influence smoking behaviours and community readiness to address smoke-free environments. The Cape York campaign will align with a national ‘Don’t Make Smokes Your Story’ campaign.

NACCHO Aboriginal Health #RHD : AMA Report Card on Indigenous Health highlights need for Aboriginal community controlled services

ama

With Aboriginal and Torres Strait Islander Australians still 20 times more likely to die from RHD, the AMA’s call for firm targets and a comprehensive and consultative strategy is welcome. We encourage governments to adopt these recommendations immediately.

“As noted by the AMA, it is absolutely critical that governments work in close partnership with Aboriginal health bodies. Without strong community controlled health services, achieving these targets for reducing RHD will be impossible.

While this is a long term challenge, the human impacts on Aboriginal and Torres Strait Islander communities are being felt deeply right now. Action is required urgently.

NACCHO is standing ready to work with the AMA and governments to develop and implement these measures. We have to work together and we have to do it now.”

National Aboriginal Community Controlled Health Organisation (NACCHO) Chairperson Matthew Cooke pictured above at Danila Dilba Health Service NT with AMA President Dr Michael Gannon (right ) and the Hon Warren Snowdon MP Shadow Assistant Minister for Indigenous Health (left )

cyekeo-usaaa_k7

” RHD, which starts out with seemingly innocuous symptoms such as a sore throat or a skin infection, but leads to heart damage, stroke, disability, and premature death, could be eradicated in Australia within 15 years if all governments adopted the recommendations of the latest AMA Indigenous Health Report Card.

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AMA President, Dr Michael Gannon see full AMA Press Release below

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 ” We have many of the answers, we just need commitment from Govt to help implement necessary changes

Ms Olga Havnen is the CEO of Danila Dilba Biluru Binnilutlum Health Service in Darwin

NACCHO Press Release

The peak Aboriginal health organisation today welcomed the release of the Australian Medical Association’s Report Card on Indigenous Health as a timely reminder of the importance of community controlled services.

The 2016 Report Card on Indigenous Health focuses on the enormous impact that Rheumatic Heart Disease (RHD) is having on Aboriginal and Torres Strait Islander people in Australia with a ‘Call to Action to Prevent New Cases of RHD in in Indigenous Australia by 2031’.

DOWNLOAD the Report Card here :

2016-ama-report-card-on-indigenous-health

AMA RELEASES PLAN TO ERADICATE RHEUMATIC HEART DISEASE (RHD) BY 2031

AMA Indigenous Health Report Card 2016: A call to action to prevent new cases of Rheumatic Heart Disease in Indigenous Australia by 2031

The AMA today called on all Australian governments and other stakeholders to work together to eradicate Rheumatic Heart Disease (RHD) – an entirely preventable but devastating disease that kills and disables hundreds of Indigenous Australians every year – by 2031.

AMA President, Dr Michael Gannon, said today that RHD, which starts out with seemingly innocuous symptoms such as a sore throat or a skin infection, but leads to heart damage, stroke, disability, and premature death, could be eradicated in Australia within 15 years if all governments adopted the recommendations of the latest AMA Indigenous Health Report Card.

The 2016 Report Card – A call to action to prevent new cases of Rheumatic Heart Disease in Indigenous Australia by 2031 – was launched at Danila Dilba Darwin  Friday 25 November

Dr Gannon said the lack of effective action on RHD to date was a national failure, and an urgent coordinated approach was needed.

“RHD once thrived in inner-city slums, but had been consigned to history for most Australians,” Dr Gannon said.

“RHD is a disease of poverty, and it is preventable, yet it is still devastating lives and killing many people here in Australia – one of the world’s wealthiest countries.

“In fact, Australia has one of the highest rates of RHD in the world, almost exclusively localised to Indigenous communities.

“Indigenous Australians are 20 times more likely to die from RHD than their non-Indigenous peers – and, in some areas, such as in the Northern Territory, this rate rises to 55 times higher.

“These high rates speak volumes about the fundamental underlying causes of RHD, particularly in remote areas – poverty, housing, education, and inadequate primary health care.

“The necessary knowledge to address RHD has been around for many decades, but action to date has been totally inadequate.

“The lack of action on an appropriate scale is symptomatic of a national failure. With this Report Card, the AMA calls on all Australian governments to stop new cases of RHD from occurring.”

RHD begins with infection by Group A Streptococcal (Strep A) bacteria, which is often associated with overcrowded and unhygienic housing.

It often shows up as a sore throat or impetigo (school sores). But as the immune system responds to the Strep A infection, people develop Acute Rheumatic Fever (ARF), which can result in damage to the heart valves – RHD – particularly when a person is reinfected multiple times.

RHD causes strokes in teenagers, and leads to children needing open heart surgery, and lifelong medication.

In 2015, almost 6,000 Australians – the vast majority Indigenous – were known to have experienced ARF or have RHD.

From 2010-2013, there were 743 new or recurrent cases of RHD nationwide, of which 94 per cent were in Indigenous Australians. More than half (52 per cent) were in Indigenous children aged 5-14 years, and 27 per cent were among those aged 15-24 years.

“We know the conditions that give rise to RHD, and we know how to address it,” Dr Gannon said.

“What we need now is the political will to prevent it – to improve the overcrowded and unhygienic conditions in which Strep A thrives and spreads; to educate Indigenous communities about these bacterial infections; to train doctors to rapidly and accurately detect Strep A, ARF, and RHD; and to provide culturally safe primary health care to communities.”

The AMA Report Card on Indigenous Health 2016 calls on Australian governments to:

Commit to a target to prevent new cases of RHD among Indigenous Australians by 2031, with a sub-target that, by 2025, no child in Australia dies of ARF or its complications; and

Work in partnership with Indigenous health bodies, experts, and key stakeholders to develop, fully fund, and implement a strategy to end RHD as a public health problem in Australia by 2031.

“The End Rheumatic Heart Disease Centre of Research Excellence (END RHD CRC) is due to report in 2020 with the basis for a comprehensive strategy to end RHD as a public health problem in Australia,” Dr Gannon said.

“We need an interim strategy in place from now until 2021, followed by a comprehensive 10-year strategy to implement the END RHD CRC’s plan from 2021 to 2031.

“We urge our political leaders at all levels of government to take note of this Report Card, and to be motivated to act to solve this problem.”

The AMA Indigenous Health Report Card 2016 is available at https://ama.com.au/article/2016-ama-report-card-indigenous-health-call-action-prevent-new-cases-rheumatic-heart-disease

TIME TO TAKE HEART

Labor calls on the Turnbull government to take heart and address Rheumatic Heart Disease, an entirely preventable public health problem which is almost exclusively affecting First Nation Peoples.

Labor welcomes the release of the Australian Medical Association’s 2016 Aboriginal and Torres Strait Islander Health Report Card, A Call To Action To Prevent New Cases Of Rheumatic Heart Disease In Indigenous Australian By 2031.

Poor environmental health conditions, like overcrowded housing remain rampant in Aboriginal and Torres Strait Islander communities, devastating families and the lives of young people.

As the AMA’s report card suggests, we must build on the success of the 2009 Commonwealth Government Rheumatic Fever strategy, established to improve the detection and monitoring of Acute Rheumatic Fever and Rheumatic Heart Disease.

Funding under the Rheumatic Fever strategy is uncertain after this financial year,” Ms King said.

The Productivity Commission’s report Overcoming Indigenous Disadvantage [OID] released last week found 49.4% of Aboriginal and Torres Strait Islander peoples in remote communities live in overcrowded housing. Additionally, the report details no significant improvement in Aboriginal and Torres Strait Islander Peoples access to clean water, functional sewerage and electricity.

“We know Rheumatic Heart Disease is a disease of poverty and social disadvantage, which is absolutely preventable. Aboriginal and Torres Strait Islander communities, especially in the Top End of the Northern Territory, suffer the highest rates of definite Rheumatic Heart Disease,” Mr Snowdon said.

Labor applauds the work of the Take Heart Australia awareness campaign, and their work to educate and advocate putting Rheumatic Heart Diseases on the public health agenda.

“Like always, Aboriginal and Torres Strait Islander communities need to be front and centre in taking action. The most positive outcomes will come through communities working with Aboriginal and Community Control Health Organisations to design and deliver programs tailored to their needs,” Senator Dodson said.

The National Aboriginal and Torres Strait Islander Health Plan 2013-2023 noted more than three years ago the association of RHD with ‘extremes of poverty and marginalisation’, these conditions remain and are almost exclusively diseases of Indigenous Australia.

If we are serious about closing the gap, we must take heart, and address this burden of Rheumatic Heart Disease facing First Nation Peoples.

ACTION TO END RHEUMATIC HEART DISEASE (RHD) IN 15YRS

The Heart Foundation has today supported the Australian Medical Association (AMA) call for governments to work together to eliminate Rheumatic Heart Disease (RHD) in 15 years, by 2031.

Heart Foundation National CEO, Adjunct Professor John Kelly (AM) said RHD was an avoidable but widespread disease that kills and harms hundreds of Indigenous Australians every year.

“Considering how preventable RHD is, it is a national shame that our Indigenous population are left languishing.

“The Heart Foundation has strongly advocated from the RHD strategy. We continue to call on the government to fund the National Partnership Agreement on Rheumatic fever strategy and Rheumatic Heart Disease Australia (RHD Australia) with a $10 million over 3 years’ commitment, “Adj Prof Kelly said.

With the AMA predicting that RHD could be eradicated in Australia within 15 years if all governments adopted its recommendations, the time to act is now.

“We need to boost funding for the national rheumatic fever strategy. New Zealand is allocating $65 million over 10 years. A robust approach can put an end to RHD as a public health issue within 15 years,” Adj Prof Kelly said.

This call to action was part of the release of the AMA’s 2016 Indigenous Report Card – A call to action to prevent new cases of Rheumatic Heart Disease in Indigenous Australia by 2031.

“We want a strong and robust strategy to tackle this challenge. We will be working with the AMA to support and advocate for these recommendations which include:

  • A commitment to a target to prevent new cases of RHD among Indigenous Australians by 2031, with a sub-target that, by 2025, no child in Australia dies of ARF or its complications; and
  • Working in partnership with Indigenous health bodies, experts, and key stakeholders
  • to develop, fully fund, and implement a strategy to end RHD as a public health problem in Australia by 2031.

 

NACCHO Health News : How could Public Health Networks ( PHN’s ) improve health care coordination in partnership with Aboriginal communities ?

 

WQ

“This article outlines how PHNs might support health services to systematically and strategically improve their responsiveness to Aboriginal and Torres Strait Islander peoples within their boundaries according to ten proposals.

These best practice models and examples can assist PHNs to adapt their strategic plans to optimally respond to this priority.”

Picture above : “Aboriginal health in Aboriginal hands ” : Susan Leslie-Briggs and Lisa Tighe in Moree NSW

Photo Wayne Quilliam from NACCHO TV series / photo exhibition touring Australia from May 2016

One of six priorities set by the Australian Government is for Primary Health Networks (PHNs) to focus on the health of Aboriginal and Torres Strait Islander peoples.1 Announced in the 2014–15 federal Budget, PHNs aim to coordinate primary health care provision especially for those at risk of poor health outcomes.

There are 31 PHNs across Australia with several formed from consortia of Local Hospital Networks (LHNs). Operational and flexible funding of up to $842 million was committed for PHNs over 3 years from 2015–16.2

It is timely for PHNs to consider how they will improve health care coordination in partnership with Aboriginal and Torres Strait Islander communities in their respective regions.

Efforts to reduce the high hospitalisation rates of Aboriginal and Torres Strait Islander people will require PHNs to build formal participatory structures to support best practice service models. Comprehensive primary health care can then be shaped by the needs of the community rather than by ad hoc factors or reactions to financial incentives and health care funding arrangements.3,4 Collaborations with Aboriginal community controlled health services (ACCHSs) within PHN regions have been recommended.5,6

This article outlines how PHNs might support health services to systematically and strategically improve their responsiveness to Aboriginal and Torres Strait Islander peoples within their boundaries according to ten proposals. These best practice models and examples can assist PHNs to adapt their strategic plans to optimally respond to this priority.

Summary

  • The Australian Government has established that the health of Aboriginal and Torres Strait Islander peoples is a priority for the newly established 31 Primary Health Networks (PHNs). Efforts to reduce the high hospitalisation rates of Aboriginal people will require PHNs to build formal participatory structures with Aboriginal health organisations to support best practice service models.
  • There are precedents as to how PHNs can build formal partnerships with Aboriginal community controlled health services (ACCHSs), establish an Aboriginal and Torres Strait Islander steering committee to guide strategic plan development, and work towards optimising comprehensive primary care.
  • All health services within PHN boundaries can be supported to systematically and strategically improve their responsiveness to Aboriginal and Torres Strait Islander people by assessing systems of care, adopting best practice models, embedding quality assurance activity, and participating in performance reporting.
  • PHNs can be guided to adopt an Aboriginal and Torres Strait Islander-specific quality improvement framework, agree to local performance measures, review specialist and other outreach services to better integrate with primary health care, enhance the cultural competence of services, and measure and respond to progress in reducing potentially preventable hospitalisations.
  • Through collaborations and capacity building, PHNs can transition certain health services towards greater Aboriginal community control.
  • These proposals may assist policy makers to develop organisational performance reporting on PHN efforts to close the gap in Aboriginal health disparity.
  1. Collaborate with ACCHSs

ACCHSs are authorities on comprehensive primary health care matters at the local level4,7 and do much more than just cure illness.8 As authentic representational advocates, they can guide PHN responsiveness to Aboriginal and Torres Strait Islander health issues and, with more than 150 services across Australia, there are ACCHSs within the regional boundaries of every PHN.

The predecessors of PHNs — the Medicare Locals — were expected to engage with ACCHSs for many Closing the Gap initiatives, such as the Indigenous Chronic Disease Package (ICDP), from 2008.9 Where meaningful partnerships between ACCHSs and Medicare Locals were established in the delivery of these programs, health outcomes for Aboriginal people substantially improved (Box 1).10

  1. Establish an Aboriginal and Torres Strait Islander steering committee

PHNs can foster meaningful Aboriginal community engagement by establishing an Aboriginal and Torres Strait Islander steering committee (and Aboriginal) representation on the PHN board) with membership led by ACCHSs representatives inclusive of other Aboriginal health service organisations. Similar partnership forums established between the ACCHS, general practice sectors, and state and territory governments have set Aboriginal health priorities at the jurisdictional and regional level for decades.11 The steering committee aims might be modelled on current partnerships between the LHN and ACCHSs (Appendix 1) to develop a strategic plan across the life course.

  1. Establish formal agreements to support the strategic plan

PHNs should aim for partnerships to reorient health services from reactionary care to comprehensive primary health care. For example, in remote Western Australia, a partnership agreement between an ACCHS and state government health services was associated with a reversal of the increasing trend in hospital emergency department attendances among other substantial health improvements in only 6 years12 (Box 2).

Partnership agreements between PHNs, ACCHSs and other agencies should support Aboriginal leadership, quality care, accountability and patient-centredness, and should be formalised from non-binding memoranda of understanding to binding contracts (Box 1 and Box 2) to support a long-term vision for core activity that is flexible to local priorities.

  1. Support health services to assess their systems of care

There are now health system assessment tools specifically adapted to optimise the primary health care of Indigenous Australians based on the Chronic Care Model.13 Over 200 Aboriginal primary health care services have used such tools (Appendix 2). Many ACCHSs self-audit their performance using clinical audit tools for chronic disease, maternal and child health and other health priorities, and undertake generic health systems assessment as part of continuous quality improvement (CQI).14

Health system assessment and audits of actual practice against best practice standards should be used to guide PHN (and LHN where there is conjoint responsibility) priorities to systematically enhance quality care within all primary care services in PHN boundaries. Barriers to and enablers for systems improvement, and gaps in health service responsiveness to Aboriginal health needs, will be clearer. These include improving systems for follow-up of patients, use of electronic registers and recalls, Aboriginal community engagement and leadership, the commitment of workforce and management, service infrastructure, and staff training and support.14,15

  1. Embed quality assurance activity within primary health care services

A commitment to CQI is a key strategy for disease prevention (Appendix 3) and the prevention of avoidable hospitalisations (Appendix 4), and should be a universal feature of primary health care services providing care to Aboriginal and Torres Strait Islander peoples.15

A national Aboriginal and Torres Strait Islander CQI framework supported by the Australian Government will shortly be released to guide jurisdictions to assess and deliver better quality primary health care.16 PHNs should endorse and adapt this framework to coordinate efforts and develop CQI implementation plans. For example, most state and territory affiliates of the National Aboriginal Community Controlled Health Organisation provide support to ACCHSs for CQI activities; and in some jurisdictions (Queensland and the Northern Territory), CQI support programs are well developed.14

PHNs will need to engage with existing programs to identify strategies for and barriers to CQI. Supporting CQI within the network boundary will require regional facilitators, trained staff, the coordinated use of shared electronic medical records and use of local information management systems by all providers (including locums and visiting services), regular monitoring of CQI indicators, performance reporting, and agreements on data use, ownership and reporting.14

  1. Expand primary health care performance reporting

All primary health care services within each PHN delivering care to Aboriginal people (and especially in receipt of financial grants or incentives specific to Indigenous Australians) should be required to undertake CQI, and to participate in regional or centralised performance reporting which can be disaggregated by Aboriginality. Primary health care performance should be a core responsibility of quality, safety and risk subcommittees of both PHNs and LHNs.3 Aggregated CQI data at PHN levels can identify health service gaps and areas that need to be improved.16

The Australian Government reporting framework for PHNs will include national, local and organisational performance indicators.17 National indicators for PHNs will include primary and community health indicators such as potentially preventable hospitalisations (these will be sourced from existing datasets such as the National Hospital Morbidity Database) not unlike what is currently reported for LHNs. Potentially preventable hospitalisations are an indirect measure of whether people are receiving adequate primary health care. The disproportionately high rate of illness affecting Aboriginal people and their poorer access to primary health care explains higher potentially preventable hospitalisation rates independent of age, sex and remoteness (Appendix 4). Age-standardised potentially preventable hospitalisation rates within PHN boundaries should be disaggregated by Aboriginality and incorporated as a performance indicator within PHN strategic plans.

The selection of local and organisational performance indicators by PHNs should be guided by the Aboriginal steering committee. Benchmarking PHN progress using Aboriginal and Torres Strait Islander national key performance indicators18 should be considered. National key performance indicators serve as both a CQI tool and performance measure in the provision of primary health care to Indigenous Australians. For example, ACCHSs are required to report on 19 key performance indicators through a standardised portal supported by the Australian Government.7 Organisational performance reporting of PHN activity should quantify the allocation of funds towards Aboriginal programs and contractors and whether they are ACCHSs or other services.

  1. Align and endorse PHN and LHN strategic plans

Commitment to region-specific Aboriginal primary health care strategic plans should be the goal for both PHN and LHN boards so that actions are informed by both and integrated to avoid cross purposes.3 These linkages might be streamlined in regions where PHNs have been established by LHNs. However, it is unclear how many LHNs have established Aboriginal health subcommittees or effective and formalised Aboriginal community engagement mechanisms to facilitate endorsement of strategic plans.

All PHNs are expected to complete baseline needs assessment and strategies to respond to service gaps.19 If these submissions pertain to the Aboriginal and Torres Strait Islander population, they should be accompanied by evidence of endorsement by the Aboriginal representative bodies in their region.

  1. Strengthen the primary health care service model

Many visiting health providers can overburden Aboriginal people in remote communities with overlapping and poorly explained services.20 A core priority for PHNs is to review the coordination of care and improve clinical pathways in all geographic regions. PHNs will need to review the efficiency of current services including generalist and specialist outreach if they are to avoid duplication, foster local or residential health services,21 and sustain local CQI systems.

Specialist outreach should complement local health services through a bottom-up approach integrated with primary health care. Specialist outreach services operating independently of existing primary health care services will need review. Service reforms might mean building hub-and-spoke models involving ACCHSs, supporting regional Aboriginal health networks (Box 1), using telehealth adapted for Aboriginal and Torres Strait Islander settings, renegotiating clinical pathways, empowering local outreach coordinators of hospitals to support primary health care models, substituting workforce tasks through nurse and Aboriginal and Torres Strait Islander health practitioners, rural generalists and physician assistants,22 and reorienting health services towards primary health care (Box 2, Appendix 5).

  1. Enhance cultural competence of PHC services

Strategies to merely increase the awareness of non-Indigenous health staff to Aboriginal cultural protocols are often recommended to reduce Aboriginal health disparities, but may not lead to cultural competence.23 Some staff still struggle with how to make services culturally responsive beyond the posting of Aboriginal artwork.20 The ICDP invested in cultural awareness training of over 6000 general practice staff but change in practice was not universally embraced.8,15

Enhancing the cultural competence of health services within PHN boundaries will require strategies best managed by the Aboriginal steering committee and may include subcontracting ACCHSs and expanding their outreach role, person-centred and family-oriented care, fostering a culturally identified workforce that reflects the patient population and health needs, staff training in cultural safety, performance measures for cultural competence, and future planning.

  1. Transition primary health care services to Aboriginal community control

PHNs are to be the health “providers of last resort and their decision to directly provide services should require the approval of the Department of Health”.3 Agreement from local ACCHSs in the region should be required if a PHN opts to directly provide health services to Aboriginal communities rather than make purchasing arrangements with existing Aboriginal services (Box 1). ACCHSs should also be supported to choose their involvement in programs within the PHN boundary.

Coalitions of Aboriginal organisations have advised that future funding on Indigenous health programs be prioritised to ACCHSs being better placed to meet Aboriginal health needs with better returns on investment.24 For example, according to the ICDP evaluation, it was unclear whether Closing the Gap measures (such as financial incentives to general practices) increased the provision of services to Aboriginal people who are “hard to reach” or increased their access to primary health care.9,15 For PHNs, it makes sense to direct Aboriginal health strategies to health services with the desire and potential to provide quality care to Aboriginal patients, which is also more cost-effective.15

The Queensland and Northern Territory governments have commenced processes to transition certain health services in remote areas to Aboriginal community control.25,26 The aim is to reform remote area services from doctor-focused, illness-centred, acute hospital-based primary care services to community-engaged, comprehensive, preventive and responsive systems. Policy frameworks propose staged approaches and capacity building of existing ACCHSs. Strategic plans developed by PHNs should consider transitioning health services and responding to existing transition plans26 to ensure alignment with them.

Conclusion

These proposals offer policy makers and PHNs a framework for health service planning within newly established boundaries, and may inform PHN organisational performance reporting on efforts to close the gap in Aboriginal health disparity.

Australians report that our health system is not sufficiently patient focused. Primary care is reactive and episodic, funding structures support providers and not patients, and there is little accountability for health outcomes.4 Through existing and better targeted additional investments, PHNs can offer Aboriginal and Torres Strait Islander people some hope towards reforming access to and quality of primary health care in their localities, but only if programs and systems can better fit in with community needs. To close the gap, PHNs need to support Aboriginal communities towards greater participation in primary health care, ultimately through the expression of community control.

Acknowledgements: We acknowledge the assistance of Shaun Solomon, Head of Indigenous Health at the Mount Isa Centre for Rural and Remote Health, James Cook University, for reviewing an early draft.

Competing interests: No relevant disclosures.

Provenance: Not commissioned; externally peer reviewed.

Author details

Sophia Couzos FAFPHM, FACRRM, FRACGP1 3

Dea Delaney-Thiele PGDipHlthMgt, MPH, Doctoral Candidate UNSW. 2

Priscilla Page BASc1 3

1 College of Medicine and Dentistry, James Cook University, Townsville, QLD.

2 Nepean Aboriginal Health Service , Penrith, NSW , Sydney, NSW.

  1. Anton Breinl Research Centre for Health Systems Strengthening, Townsville, Qld.

sophia.couzos@jcu.edu.au

doi: 10.5694/mja15.00975

References

References

  1. Ley S. New Primary Health Networks to deliver better local care. Department of Health, Australian Government. 2015; 11 April. http://www.health.gov.au/internet/ministers/publishing.nsf/Content/health-mediarel-yr2015-ley036.htm (accessed Aug 2015)
  2. Department of Health. Primary Health Networks: grant programme guidelines. Canberra: Australian Government, 2014. https://www.health.gov.au/internet/main/publishing.nsf/Content/00069147C384180DCA257F14008364CB/$File/guidelines.pdf (accessed Feb 2016)
  3. Horvath J. Review of Medicare Locals. Report to the Minister for Health and Minister for Sport. Australian Government, Canberra, 2014. http://www.health.gov.au/internet/main/publishing.nsf/content/review-medicare-locals-final-report (accessed Aug 2015)
  4. Australian Government. Reform of the Federation. Discussion Paper. Australian Government, 2015 https: //federation.dpmc.gov.au/sites/default/files/publications/reform_of_the_federation_discussion_paper.pdf (accessed Nov 2015)
  5. Australian Healthcare and Hospitals Association. Primary Health Network discussion paper series: Paper three. Aboriginal and Torres Strait Islander health. AHHA, Canberra, 2015. https: //ahha.asn.au/primary_health (accessed Nov 2015)
  6. United General Practice Australia. Principles for Primary Health Networks. UGPA, 2015. https: //gpra.org.au/ugpa/ (accessed Aug 2015)
  7. Panaretto KS, Wenitong M, Button S, Ring IT. Aboriginal community controlled health services: leading the way in primary care. Med J Aust 2014; 200: 649-52
  8. Baba JT, Brolan CE, Hill PS. Aboriginal medical services cure more than illness: a qualitative study of how Indigenous services address the health impacts of discrimination in Brisbane communities. Int J Equity Health 2014; 13: 56: 1-10.
  9. KPMG Australia. National Monitoring and Evaluation of the Indigenous Chronic Disease Package: Summary Report. Australian Government Department of Health, Canberra, 2014. http://www.health.gov.au/internet/main/publishing.nsf/Content/icdp-national-monitoring-evaluation (accessed Nov 2015)
  10. Institute for Urban Indigenous Health. 2013-14 Annual Report. IUIH, Brisbane, 2014: 16. http://www.iuih.org.au/Portals/0/PDF/AnnualReport_2014.pdf (accessed Nov 2015)
  11. Close the gap steering committee for Indigenous health equality. Partnership position paper. Oxfam Australia, 2010 https: //www.humanrights.gov.au/sites/default/files/content/pdf/social_justice/health/partnership_position_paper.pdf (accessed Nov 2015)
  12. Reeve C, Humphreys J, Wakerman J et al. Strengthening primary health care: achieving health gains in a remote region of Australia. Med J Aust 2015; 202: 483-7.
  13. Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness. JAMA 2002; 288: 1775-9.
  14. Wise M, Angus S, Harris E, Parker S. National Appraisal of Continuous Quality Improvement Initiatives in Aboriginal and Torres Strait Islander Primary Health Care. The Lowitja Institute, Melbourne, 2013. https: //www.lowitja.org.au/sites/default/files/docs/National-Appraisal-of-CQI-FINAL.pdf (accessed Nov 2015)
  15. Bailie R, Griffin J, Kelaher M et al. Sentinel Sites Evaluation: Final Report. Report prepared by Menzies School of Health Research for the Australian Government Department of Health, Canberra. 2013 http://www.menzies.edu.au/icms_docs/189996_Sentinel_Sites_Evaluation_Final_Report.pdf (accessed Nov 2015)
  16. Lowitja Institute. Recommendations for a National CQI Framework for Aboriginal and Torres Strait Islander Primary Health Care. Australian Government, Department of Health. Canberra, 2014. http://www.health.gov.au/internet/main/publishing.nsf/content/cqi-framework-atsih (accessed Aug 2015)
  17. Department of Health. Primary Health network performance framework. Australian Government, Canberra, 2015. http://www.health.gov.au/internet/main/publishing.nsf/Content/phn-performance (accessed Nov 2015)
  18. Australian Institute of Health and Welfare. Healthy Futures- Aboriginal Community Controlled Health Services: Report Card (Cat. no. IHW 150). AIHW, Canberra, 2015 http://www.aihw.gov.au/publication-detail/?id=60129550479 (accessed Nov 2015)
  19. Australian Government. Health Portfolio Budget Statements 2015-16. Outcome 5- Primary Health Care. Department of Health, Canberra, 2015. http://www.health.gov.au/internet/budget/publishing.nsf/Content/2015-2016_Health_PBS (accessed Nov 2015)
  20. McBain-Rigg KE, Veitch C. Cultural barriers to healthcare for Aboriginal and Torres Strait Islanders in Mt Isa. Aust J Rural Health 2011; 19: 70-74.
  21. House of Representatives Standing Committee on Regional Australia. Cancer of the bush or salvation for our cities? Fly-in, fly-out and drive-in, drive-out workforce practices in regional Australia. Parliament of Australia,Canberra, 2013. http://www.aph.gov.au/parliamentary_business/committees/house_of_representatives_committees?url=ra/fifodido/report.htm (accessed Aug 2015).
  22. Productivity Commission. Efficiency in Health, Commission Research Paper, Canberra, 2015. http://www.pc.gov.au/research/completed/efficiency-health (accessed Nov 2015)
  23. Durey A. Reducing racism in Aboriginal health care in Australia: where does cultural education fit? ANZJPH 2010; 34: S87-92
  24. Close the Gap Campaign Steering Committee for Indigenous Health Equality. Progress and Priorities Report 2015. Australian Human Rights Commission, 2015. https: //www.humanrights.gov.au/sites/default/files/document/publication/CTG_progress_and_priorities_report_2015.pdf (accessed Nov 2015)
  25. Department of Health and Ageing. Section 5.5- Regionalisation and Aboriginal community control. In: Evaluation of the Child Health Check Initiative and the Expanding Health Service Delivery Initiative: Final report. Australian Government. Canberra, 2011. https: //www.healthstarrating.gov.au/internet/publications/publishing.nsf/Content/oatsih-chci-ehsdi-toc~oatsih-chci-ehsdi-5~oatsih-chci-ehsdi-5-5 (accessed Nov 2015)
  26. Queensland Health. Transition to Aboriginal and Torres Strait Islander community control of health in Queensland: A draft strategic policy framework. Queensland Government. [Undated] https: //www.health.qld.gov.au/atsihealth/transition_cc.asp (accessed Aug 2015)

[Boxes]

1 Example: collaboration between Medicare Locals and Aboriginal community controlled health services

In 2008, to close the gap in Aboriginal health disparity, the Indigenous Chronic Disease Program funded the Care Coordination and Supplementary Services (CCSS) program. The program supports Aboriginal and Torres Strait Islander patients with complex care needs, by coordinating clinical care and providing supplementary funding for allied health, specialists, transport services and medical aids. Implementation required collaborations between Aboriginal and mainstream health services. In South-East Queensland, the Metro North Brisbane Medicare Local (MNBML) was funded to deliver the CCSS program on behalf of four other Medicare Locals in South-East Queensland. A consortium of ACCHSs — the Institute for Urban Indigenous Health (IUIH) — was subcontracted by the MNBML to implement the program in 2013–14. IUIH employed a manager to oversee the program delivered by 20.5 full-time equivalent care coordinators.

The IUIH reported that subcontracting delivered significantly more services to significantly more Indigenous Australians with complex chronic conditions than any other part of the country: “In 2013–14 IUIH and members [ACCHSs] delivered over 57 000 episodes of care via the CCSS Program. The delivery of intensive case management and access to a comprehensive range of specialist and allied health services and medical aides for this population has avoided costly hospital admissions for Government and significantly improved the health and wellbeing of some of our most vulnerable and unwell patients.”10

2 Example: a partnership to reorient acute care to comprehensive primary health care

Clinic services in the very remote Fitzroy Valley in Western Australia are delivered by state government health services (Fitzroy Crossing Hospital and the Kimberley Population Health Unit for community health services). Non-clinical health services are delivered by the Aboriginal community controlled health service (Nindilingarri Cultural Health Services) to a population of 3500 (80% Aboriginal). These services comprise healthy lifestyle programs designed around Aboriginal culture. A formal agreement between the agencies was negotiated in 2006 to form a single governance structure to allocate funding, share an e-health record, and coordinate health promotion, cultural safety, acute inpatient care, primary care and specialist care, and population-based screening. Commonwealth funding supported the development of a shared e-health record for quality improvement and additional staff (through the Healthy for Life and Indigenous Chronic Disease programs), and provided Medicare rebates to patients for primary care services delivered at the hospital clinic (an exemption from section 19(2) of the National Health Insurance Act 1973). Medicare billings were reinvested to support this reorientation under the guidance of the partners.

This reorientation enhanced health promotion programs and was associated with a reversal of the increasing trend in emergency department attendances. In the primary care clinic, there was a substantial increase in the number of patients seen, the number of health checks, the detection of risk factors, the proportion of patients with diabetes having care plans, transport provision, cultural security and follow-up attendances in only 6 years.12

KME623p037 naccho V2

Out 6 April as a FREE  24 Page lift out in the Koori Mail

Election 2016, it’s time to encourage all political parties to focus on Aboriginal health

With an early Federal Election looking likely, it’s time to encourage all political parties to focus on Aboriginal health and the critical role of the community controlled sector in improving services and health outcomes for Aboriginal and Torres Strait Islander people.

The Turnbull Government has flagged it will call a Double Dissolution Election on July 2 if the Senate refuses to pass the Australian Building and Construction Commission (ABCC) Bill, targeting unions. The Prime Minister has until May 11 to call the poll.

A decade after governments agreed to bipartisan support for the Close the Gap agreement, the National Aboriginal Community Controlled Health Organisation (NACCHO) Chairperson, Matthew Cooke, said long term commitment from politicians to strengthen and grow the community controlled sector, through partnership with it, must be a priority for all political parties.

“One of the principles that is espoused by all levels of government on Aboriginal issues is that engagement with Aboriginal communities and organisations is the only way to successfully close the gap,” Mr. Cooke said.

“Time and again we see evidence that supports that principle.

“Our own sector, managed by Aboriginal people for Aboriginal people, is making the biggest in-roads against the Closing the Gap health targets.

“Our services provide over two million episodes of care nationally each year and have made the biggest gains against the targets to halve child mortality and improve maternal health. “

“Indeed, our services have successfully contributed to the Close the Gap targets that have reduced child mortality rates by 66% and overall mortality rates of Aboriginal and Torres Strait Islander people by 33% over the last two decades.

Read more in NACCHO Aboriginal Health Newspaper

NACCHO #closethegap Suicide: Lifeline calls for specialist hotline to address high Indigenous suicide rates

 

274179-suicide

“There are some communities out there were there are a multitude of both state and federal services and showing very little for all the effort and the money,”

“The question is why? And I think part of the answer is that there needs to be much more involvement of Aboriginal people through governance structures that are appropriate to have a say how those resources are used.

“It’s important because many Aboriginal people will not be comfortable ringing a general service and speaking to a non-Aboriginal person.

“There needs to be, and I have seen this over my almost 40 years now in Aboriginal affairs, a specific service that is culturally appropriate.”

New South Wales parliamentarian and former state Labor leader Linda Burney said the Federal Government should seriously consider the proposal.

Ms Burney, who is a Wiradjuri woman and will be making a tilt at federal politics in the upcoming election, said a national, Aboriginal-led initiative was needed to address many of the issues surrounding mental health and disadvantage.

“Child suicide was a growing problem in indigenous communities. Children’s exposure to family violence was a “major contributor” to the mental health of young people.  services needed more funding for mental health, with remote communities having limited access through Aboriginal Medical Services and the Royal Flying Doctor Service. 

“We must be delivering services to the people, not (forcing) them to come to the services because Aboriginal people in remote communities are on the lowest incomes in the country.”

Sandy Davies, the deputy chairman of the National Aboriginal Community Controlled Health Organisation :Picture above : Indigenous children up to 14 years were nine times more likely to kill themselves than non-indigenous children

Crisis support service Lifeline is calling for the Commonwealth to support an Aboriginal-specific arm of the hotline, to tackle the high rates of suicide in Aboriginal communities.

Lifeline Central West, which covers about one third of New South Wales, has proposed establishing a national call centre in the central west city of Dubbo run by Aboriginal counsellors.

It has written a letter to the Federal Minister for Indigenous Affairs Nigel Scullion, asking for financial support for the so-called YarnUp Confidential service.

It was hoped the call centre would take up to 70,000 calls per year and create 118 new Aboriginal jobs in Dubbo, costing about $10 million to run annually.

Australian Bureau of Statistics figures released this week showed suicide rates among Indigenous people were about twice those of non-Indigenous people.

Lifeline Central West executive director Alex Ferguson said the rates would only continue to rise unless the Commonwealth took urgent action.

Mr Ferguson said while similar services were run locally in some communities, there was a need for a unified service based on the Lifeline model.

“Look at the scorecard and I think you’ll find their policies are either misdirected or failing,” Mr Ferguson said.

“At the moment we don’t have dialogue and we need to have a dialogue within the Aboriginal community and the broader regional communities.

“The idea is simply to put an Aboriginal feeling, a wash, a spirit through the Lifeline model, so that we can actually have Aboriginals working with Aboriginals under a properly trained and structured environment.”

‘They don’t trust us, in many cases they don’t like us’

Mr Ferguson said many Aboriginal people did not feel comfortable conveying their concerns to non-Indigenous counsellors.

“They don’t trust us, in many cases they don’t like us, and that’s why the YarnUp model is based on Aboriginals working with Aboriginals, but doing it in a very structured way, which is the Lifeline training and telephony model,” Mr Ferguson said.

Mr Ferguson said there had been an “uninspiring” response from the Government, and was disappointed it had not offered an alternative solution.

“Nobody has put up anything else to either push YarnUp our of the way and or has actually ever criticised the content of YarnUp,” Mr Ferguson said.

“By the time you keep going around this sort of ‘it’s not in my backyard’ type argument, there is the continual flow of death and the resultant trauma in the community.”

The Federal Member for Parkes Mark Coulton said the broadly supported the model and will next week lobby the Indigenous Affairs Minister Nigel Scullion for a trial.

But he said many local organisations were already doing similar work and there was a risk of duplicating services.

“I was in Bourke a couple weeks ago and there was another group there that has got a mental health program for school-aged students,” Mr Coulton said.

“This is not an empty field, there are a lot of people out there in this space.

“But I think the Lifeline model has worked well and I think to extend that into a specialised service for Aboriginal people will be I think a worthwhile exercise.”

Need for national, culturally appropriate approach

If you or anyone you know needs help, you can call Lifeline on 13 11 14.

Get your Message Across to our 302 Clinics and our 100,000 readers of the Koori Mail

Aboriginal Health Newspaper Closes March 16

NACCHO #CTG10 Reports : NT intervention ‘fails on human rights’ and closing the gap

NT

“There have been some improvements to Indigenous child mortality with this target on track to be met by 2018. However, despite narrowing the gap in life expectancy, the rate of improvement is far too slow to close the gap. The situation is particularly bad for Indigenous people living in the Northern Territory, whose life expectancy is nearly 15 years shorter than non-Indigenous Australians

SEE HEALTH AND LIFE EXPECTANCY REPORT CARD

The Northern Territory intervention has failed to deliver substantial reform in any of the areas covered by the Close the Gap goals and has also failed to meet Australia’s international human rights obligations, an independent report has found.

 in The Guardian reports

Nearly a decade after the Northern Territory intervention, residents of Indigenous town camps in Alice Springs are fighting to regain control of their lives as they wrestle with longstanding social problems

Photo above: Aboriginal children playing at one of the town camps in Alice Springs when the intervention started in 2007. An independent report shows the strategy has failed to deliver substantial reform in any target area. Photograph: Anoek de Groot/AFP/Getty Images

The report, by the Castan Centre for Human Rights at Monash University, rated the intervention, which was rebadged in 2012 and now operates as the “stronger futures” policy, four out of 10 for its general human rights performance and failed it against seven other human rights measures, including the right to self-determination.

It also gave fail marks to every Close the Gap measure except education – which it scored at five out of 10 for improvements in primary school attendance – and urged the government to include incarceration rates as a new Close the Gap target, pointing to an “increasing and inordinate amount of Indigenous Australians being incarcerated”.

Malcolm Turnbull is set to deliver his first update on the Closing the Gap targets on Wednesday.

The national targets were set by the Council of Australian Governments in 2008, a year after the NT intervention began, and, according to the most recent update delivered by the then prime minister Tony Abbott in February 2015, most are not on track to be met.

The target of getting all Indigenous four-year-olds in remote communities into early childhood education was missed in 2013, with just 85% instead of the target of 95% enrolled.

The 2015 update, which Abbott described as “profoundly disappointing”, said the targets of closing the life expectancy gap between Indigenous and non-Indigenous Australians within a generation, halving the gap in literacy and numeracy by 2018, and halving the gap in employment outcomes by 2018 were not on track. Literacy and numeracy rates had not improved since 2008 and Indigenous employment had fallen.

Two more targets, to halve the gap in child mortality rates by 2018 and to halve the gap in year 12 completion rates by 2020, were listed as on track.

However, the author of the Castan Centre report said it appeared unlikely that any of the targets would be met in the Territory.

Close the Gap and Closing the Gap – what’s the difference?

Two similarly named programs are working towards the same goal of reducing inequality between Indigenous and non-Indigenous Australians

“The intervention was meant to improve the lives of Indigenous people in the Northern Territory, but at this rate the gap between Indigenous and non-Indigenous people may never close in many areas,” Dr Stephen Gray said.

He urged the government to adopt a new target of reducing Indigenous incarceration rates, as was recommended by the Close the Gap steering committee in 2014.

According to the latest Australian Bureau of Statistics data, Indigenous people made up 3% of the population but 27% of the prison population, and 52% of all young people in detention. In the NT, Aboriginal and Torres Strait Islander peoples make up 86% of the adult prisoner population and 96.9% of young people in detention. Incarceration rates are up 41% since the start of the intervention.

In November, the Australian Medical Association called rates of Indigenous imprisonment a “health and justice crisis”.

“I think there’s a perception that because family violence is such a crisis, because assault rates and child abuse are at such a crisis, we should not be always going on about Aboriginal imprisonment rates,” Gray said. “That sense that you can’t improve one without worsening the other is false.”

Amnesty International agreed, telling Guardian Australia that “any efforts at Closing the Gap cannot ignore these areas of massive inequality and the role that law and justice policy play in disadvantage.”

Reports of child abuse in the NT have decreased since 2010, but there has been a 500% increase in reports of self harm or suicide by Indigenous children and a sharp rise in the number of Indigenous children in care.

Gray said it was difficult to unpick the complicated mass of policy that governed the lives of Indigenous people in the NT, and that made it difficult to evaluate.

The intervention began with bipartisan support under the Howard government in 2007 as a response to a report about horrific levels of child sexual abuse in some Aboriginal communities, and was delivered as a complex suite of laws that altered everything from welfare payments to land tenure.

There was this presumption of rampant child sexual abuse in Aboriginal communities,” Gray told Guardian Australia. “It has been the excuse for a large number of other reforms that don’t really relate to child sexual abuse or family violence at all, like land reforms. It’s got very little to do with the original goals of the intervention.”

In 2008, the Rudd government reshaped it to focus on the new Closing the Gap targets but punitive measures remained, including more police, the removal of customary law and cultural practices from consideration in sentencing, quarantining welfare payments of those judged to have “neglected” their children, and tough penalties for possessing alcohol or pornography, as did the suspension of the Racial Discrimination Act.

The Northern Territory National Emergency Response Act expired in 2012 and was extended by the Gillard government until 2022, under the new name of the Stronger Futures in the Northern Territory Act. The Racial Discrimination Act was reintroduced but the percentage of an individual’s welfare payments that could be quarantined under the BasicsCard increased to 70%, and penalties for possessing porn or alcohol in dry communities, including a single can of beer, increased to six months’ jail.

By then the government had produced 98 reports and seven parliamentary inquiries into the intervention, a weight of information Gray said obscured its negative effects, particularly the impact on human rights.

“There’s a danger that things get out of check because of the swift pace of apparent change,” he said. “Because wheels keep turning, another policy gets rebadged, funding gets moved, but the real pace of life in Aboriginal communities remains the same.”

The result, the report said, was that many of Australia’s international human rights obligations, including the right of Indigenous peoples to self-determination, continued to be “directly and knowingly violated or ignored”.

Prof Jon Altman, from the Alfred Deakin Centre for Citizenship and Globalisation, said the Castan Centre’s evaluation of the intervention was too generous. The government deserved a zero out of 10, he said, for its attempts to improve education, and a negative score on employment rates which had gone backwards since the decision to abolish the community development employment projects (CDEP) program, which employed about 33,000 Indigenous people, particularly in remote communities.

Altman, who has spent 40 years working in Aboriginal communities in the NT in particular, said the services previously delivered by community-led CDEP organisations were now being done by non-Indigenous organisations, while many who had worked under CDEP remained on “passive welfare”.

Aboriginal people are exceptional. When we can all acknowledge that, the gap will close

Chris Sarra

 

Despite the dire outcomes of the Closing the Gap report, there is great potential in Indigenous communities. Our greatest challenge might be in believing that

“The state needs to admit that it’s actually doing worse than Aboriginal community-based organisations,” he said

Altman argued the Close the Gap program should be abolished, saying it was assimilationist, had alienated Aboriginal and Torres Strait Islander people and had produced no significant benefits.

“It’s all based on a policy, an ideology, that progress in closing the gap will require people to adopt western norms,” he told Guardian Australia. “And that’s a pretty hard line. It really doesn’t leave people much wiggle room if they don’t want to be changed.

“My advice to the prime minister is to stop talking about closing the gap and start talking about improving people’s wellbeing and livelihoods, because those things are taking a hammering.”

 

 

NACCHO Good News: Home grown Derby girl to be towns first Aboriginal doctor

 

Inspire 2

If I could inspire one person to become a doctor, or to finish high school, to go on to higher education regardless of whether it’s medicine or not, then that’s amazing.”

Vinka Barunga was one of those kids who always wanted to put on Band-Aids and take temperatures. She doesn’t remember a time when she didn’t want to be a doctor.

For the past four years, Vinka has been studying medicine at the University of Western Australia in Perth. This year, she’s back in Derby for a 12-month placement with the Rural Clinical School. Living with two other medical students, she’ll divide her time between the local Hospital and the Derby Aboriginal Health Service.

For Vinka, her patients are more than names on a chart. In many cases, they’re family and friends. The young doctor-in-training is lucky to walk through the waiting room without being held up by at least one relative eager for a chat.

Derby has never had a full-time Aboriginal doctor, and many of the locals are excited to see a home-town girl on her way to graduating from medicine.

Derby’s health services cater primarily for Indigenous patients. Diabetes, kidney disease and heart disease are among the most common health issues. Children are often treated for ear or skin infections.

These conditions are largely caused, or complicated by, substance abuse, poverty and overcrowding. For visiting doctors, the reality can be confronting. For Vinka, it’s all too familiar.

Vinka’s story is featured on Living Black: Kimberley Healing this week.  Tuesday at 9PM on NITV. Story by :  Ella Archibald-Binge

WATCH VIDEO and more info here

She’s a capable netballer, a volunteer fire fighter with a weakness for mango ice-cream, a reluctant fisher-woman who hates throwing a line but loves eating the catch. She laughs easily, watches Grey’s Anatomy and reads Women’s Health.

“I think I was always a little bit medically-inclined,” Vinka says, smiling as she casts her mind back to the day her mother bought her a plastic stethoscope as a toy.

“I was always that kid who wanted to put bandaids on and take someone’s temperature when they’re sick.”

The 26-year-old is perched cross-legged on a dining room chair. Her tribe’s name is etched along her foot in bold, slanted black ink: Worora. Her long brown hair is swept back into a ponytail, which hangs over one shoulder. Head tilted, she gazes upwards as she reminisces about her childhood days, spent running with the neighbourhood kids, usually wearing nothing but underpants.

“Everyone knows everyone in Derby,” Vinka says. “There would be someone that knew where you were and who you were with, so you were always quite safe.”

&Dr Isaac Hohaia shows Vinka and two other medical students how to react in an emergency.

Dr Isaac Hohaia shows Vinka and two other medical students how to react in an emergency.

Derby is a small town sitting at the gateway to the Kimberley region of Western Australia. About a two hour drive from Broome, the town greets you with blue sky, red dirt and an unrelenting sun. There’s no such thing as winter in Derby – only wet and dry seasons. The temperature generally hovers just shy of 40 degrees. The 5000-strong town draws many visitors from the surrounding Aboriginal communities. The closest community, about 10 kilometres out of town, is Mowanjum, where Vinka was raised.

Most of her early memories involve water: running through sprinklers, mud sliding on the marshlands, swimming in the river (the locals are quick to shrug off warnings about crocodile country).

<img height=”525″ width=”700″ alt=”Mowanjum locals fish for Barramundi at May River, near Derby. Vinka spent much of her childhood splashing in the water at May River.” title=”Mowanjum locals fish for Barramundi at May River, near Derby. Vinka spent much of her childhood splashing in the water at May River.” class=”media-element file-body-content” src=”http://www.sbs.com.au/news/sites/sbs.com.au.news/files/styles/body_image/public/edos_fishing_pic.jpg?itok=si3Dn58V&mtime=1430702601″ itemprop=”image” />Mowanjum locals fish for Barramundi at May River, near Derby. Vinka spent much of her childhood splashing in the water at May River.

Mowanjum locals fish for Barramundi at May River, near Derby. Vinka spent much of her childhood splashing in the water at May River.

But Vinka has other, not-so-fond memories, too: little ears irreparably damaged by chronic infections, bodies and minds ruined by alcohol, young lives taken too soon…  It’s a combination of the happy and sad memories that have brought her back to her home town – this time as a medical student.

For the past four years, Vinka has been studying medicine at the University of Western Australia in Perth. This year, she’s back in Derby for a 12-month placement with the Rural Clinical School. Living with two other medical students, she’ll divide her time between the local Hospital and the Derby Aboriginal Health Service.

For Vinka, her patients are more than names on a chart. In many cases, they’re family and friends. The young doctor-in-training is lucky to walk through the waiting room without being held up by at least one relative eager for a chat.

Derby has never had a full-time Aboriginal doctor, and many of the locals are excited to see a home-town girl on her way to graduating from medicine.

“I hope it makes them think ‘oh she’s done it, I can tell my grandchildren that I went to hospital and saw an Aboriginal doctor’,” Vinka says.

Derby’s health services cater primarily for Indigenous patients. Diabetes, kidney disease and heart disease are among the most common health issues. Children are often treated for ear or skin infections. These conditions are largely caused, or complicated by, substance abuse, poverty and overcrowding. For visiting doctors, the reality can be confronting. For Vinka, it’s all too familiar.

“We learn a lot about Aboriginal health issues and we learn about the really high alcohol and drug use and we learn about the domestic violence,” she says, her voice soft and serious.

“We learn about the chronic ear infections in children and hearing problems in later life and mental health issues as a result of forced removal of children and forced removal from country.

“I guess it’s something that everyone can learn in theory, but to go and see it is a completely different story.”

Vinka has fond memories of playing with her cousins at Mowanjum.

Vinka’s seen a lot in her 26 years. In 2012, her community of Mowanjum reached crisis point after a spate of youth suicides.

“You grow up in a community where you see domestic violence and you see people drinking and you think that that’s the way of life”

“You grow up in a community where you see domestic violence and you see people drinking and you think that that’s the way of life,” she says.

“There have been moments when I’ve felt that as well.”

The past few years haven’t been easy for Vinka. During her time at university, she’s lost both parents to illness. But she hasn’t lost sight of her goal, and she finds daily inspiration in her patients.

“You learn a lot from people in medicine… talking to them about what they’ve done and the struggles they’ve had,” Vinka says.

“I guess I think that everyone’s life is hard.”

In medicine, Vinka has found something to aim for – and now she hopes to inspire other young people in her community to set goals of their own. She believes it’s crucial to empower the next generation to create a healthy community. A community free from chronic disease; a community where people have a steady income, and a solid purpose – rather than “just existing”. A community where projects are developed by the people, for the people. A community that celebrates culture, cares for country and builds opportunities. It’s a vision shared by many at Mowanjum, and Vinka is determined to turn it into a reality.

“If I could inspire one person to become a doctor, or to finish high school, to go onto higher education – regardless of whether it’s medicine or not – then tat’s amazing,” she says.

It’s this passion for her culture and community that keeps the young doctor-in-training so driven. When I ask Vinka how her culture influenced her upbringing, she laughs and takes a big breath.

“I always struggle answering this question,” she replies with a smile that says she’s been asked the same thing a thousand times.

“It’s really hard to remove myself from it and say how it’s impacted my life, because I guess it impacts every aspect of my life.”

I curse myself for my clumsily-worded question, but generously Vinka gives me an answer, and a powerful one at that.

“I think my culture has instilled an immense pride in myself and in my people, so that makes up a lot of who I am and why I want to do what I’m doing, and become a doctor and give back to the people who have taught me so much about who I am and where I belong.”

Vinka Barunga is many things: a student, a role model, a natural-born swimmer. But above all, she’s a proud Worora woman, determined to be the first Aboriginal doctor in her community – but definitely not the last.

Vinka’s story is featured on Living Black: Kimberley Healing this week. Watch it on Mo Tuesday May 5 at 9PM on NITV.

 

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