Aboriginal Male Healthy Futures 2013-2030 Register Now #OchreDay2017 Darwin 4-5 Oct: How can we increase positive outcomes for our mob ?

 

” NACCHO has long recognised the importance of an Aboriginal male health policy and program to close the gap by 2030 on the alarming Aboriginal male mortality rates across Australia.

Aboriginal males have arguably the worst health outcomes of any population group in Australia.

To address the real social and emotional needs of males in our communities, NACCHO in 2013 proposed a positive approach to Aboriginal male health and wellbeing.”

At the National Male Health #OCHRE DAY in Darwin October 4-5 Dr Mick Adams will be facilitating discussions around strategies to increase positive Aboriginal Male Health outcomes locally , state/Territory and nationally : see below for full program or

Download the  2 Day Program HERE :

final 2017-Ochre-Day-Program

For more information call 08 8942 5400 or naccho.ochre@ddhs.org.au

The Ochre Day program has now been finalised and registrations are filling fast – register now for Ochre Day 2017

REGISTER HERE

Other Speakers and presenters will include :

  1. Tony Lee – Elder Larrakia Nation
  2. Richard Fejo – Chair Larrakia
  3. Matthew Cooke – NACCHO Chair . Welcome to NACCHO Ochre Day
  4. The Hon Ken Wyatt M.P. Minister for Aged Care and Indigenous Health. An overview of Aboriginal Mens Health : a Government perspective
  5. John Paterson – Amsant – Overview of Aboriginal Mens Health Programs in the N.T.
  6. Joseph Knuth – Danila Dilba Health Services Deadly Choices
  7. David Adams- Danila Dilba Health Services – Mens Clinic
  8. Professor James Ward- S.A. Health and Medical Research Institute
  9. Danielle Dyall – Trauma Informed Care – Transintergenerational Trauma
  10. Sarah Haythronthwaite – AMSANT
  11. Charlie King – No more Campaign – Family Violence
  12. Jack Bulman – No more campaign – Family Violence
  13. Olga Havnen – DDHS – Royal Commission into the Protection and Detention of Children N.T. N.Z- Diversionary Program Proposal
  14. Paul Fong – DDHS- The Role of the Counsellor
  15. Brad Hart- Kornar Winmil Yunti Aboriginal Corporation S.A.- What are Healing Circles
  16. Brad Hart – Kornar Winmil Yunti Aboriginal Corporation
  17. Stuart Mc Minn- Interrelate- The Health and Formation of Adolescent Males
  18. Nathan Rigney- Cancer Council S.A. –
  19. Professor James Ward – S.A Health and Medical research Institute
  20. Glen Poole- Australian Men’s Health Forum –
  21. Nick Espie- Royal Commission into the Protection and Detention of Children N.T.
  22. Joe Williams – Enemy With In – Suicide Prevention and Wellbeing Education

 Background to NACCHO Aboriginal Male Health 10 point Blueprint 2013-2030

NACCHO, its affiliates and members are committed to building upon past innovations and we require targeted actions and investments to implement a wide range of Aboriginal male health and wellbeing programs and strategies.

At the 2013 NACCHO OCHRE DAY in Canberra the delegates called on State, Territory and Federal governments to commit to a specific, substantial and sustainable funding allocation for the NACCHO Aboriginal Male Health 10 point Blueprint 2013-2030

This blueprint as set below highlighted how the Aboriginal Community Controlled Health Services sector could continue to improve our rates of access to health and wellbeing services by Aboriginal males through working closely within our communities, strengthening cultural safety and further building upon our current Aboriginal male health workforce and leadership.

We celebrate Aboriginal masculinities, and uphold our traditional values of respect for our laws, respect for elders, culture and traditions, responsibility as leaders and men, teachers of young males, holders of lore, providers, warriors and protectors of our families, women, old people, and children

The NACCHO 10-Point Blue print Plan is based on a robust body of work that includes the Close the Gap Statement of Intent and the Close the Gap targets, the National Framework for the Improvement of Aboriginal and Torres Strait Islander Male Health (2002), NACCHO’s position paper on Aboriginal male health (2010)  the 2013 National Aboriginal and Torres Strait Islander Health Plan (NATSIHP), and the NACCHO Healthy futures 10 point plan  2013-2030

These solutions have been developed in response to the deep-rooted social, political and economic conditions that effect Aboriginal males and the need to be addressed alongside the delivery of essential health care.

Our plan is based on evidence, targeted to need and capable of addressing the existing inequalities in Aboriginal male health services, with the aim of achieving equality of health status and life expectancy between Aboriginal males and non-Aboriginal males by 2030.

This blueprint celebrated our success so far and proposes the strategies that governments, NACCHO affiliates and member services must in partnership commit to and invest in to ensure major health gains are maintained into the future

NACCHO, our affiliates and members remain focused on creating a healthy future for generational change and the NACCHO Aboriginal Male Health 10 point Blueprint 2013-2030 will enable comprehensive and long-term action to achieve real outcomes.

To close the gap in life expectancy between Aboriginal males and non-Aboriginal within a generation we need achieve these 10 key goals

1. To call on government at all levels to invest a specific, substantial and sustainable funding allocation for the, NACCHO Aboriginal Male Health 10 point Blueprint plan 2013-2030 a comprehensive, long-term Aboriginal male Health plan of action that is based on evidence, targeted to need, and capable of addressing the existing inequities in Aboriginal male health

2. To assist delivering community-controlled ,comprehensive primary male health care, services that are culturally appropriate accessible, affordable, good quality, innovative to bridge the gap in health standards and to respect and promote the rights of Aboriginal males, in urban, rural and remote areas in order to achieve lasting improvements in Aboriginal male health and well-being

3. To ensure Aboriginal males have equal access to health services that are equal in standard to those enjoyed by other Australians, and ensure primary health care services and health infrastructure for Aboriginal males are capable of bridging the gap in health standards by 2030.

4. To prioritise specific funding to address mental health, social and emotional well-being and suicide prevention for Aboriginal males.

5. To ensure that we address Social determinants relating to identity culture, language and land, as well as violence, alcohol, employment and education.

6.To improve access to and the responsiveness of mainstream health services and programs to Aboriginal and Torres Strait Islander people’s health  services are provided commensurate Accessibility within the Primary Health Care Centre may mean restructuring clinics to accommodate male specific areas, or off-site areas, and may include specific access (back door entrance) to improve attendance and cultural gender issues

 7.To provide an adequate workforce to meet Aboriginal male health needs by increasing the recruitment, retention, effectiveness and training of male health practitioners working within Aboriginal settings and by building the capacity of the Aboriginal and Torres Strait Islander health workforce.

8 To identified and prioritised (as appropriate) in all health strategies developed for Aboriginal Community Controlled Health Services (ACCHSs) including that all relevant programs being progressed in these services will be expected to ensure Aboriginal male health is considered in the planning phase or as the program progresses. Specialised Aboriginal male health programs and targeted interventions should be developed to address male health intervention points across the life cycle continuum.

9. To build on the evidence base of what works in Aboriginal health, supporting it with research and data on relevant local and international experience and to ensure that the quality of data quality in all jurisdictions meets AIHW standards.

10. To measure, monitor, and report on our joint efforts in accordance with benchmarks and targets – to ensure that we are progressively reaching our shared aims.

NOTE 2013 : 1.Throughout this document the word Male is used instead of Men. At the inaugural Aboriginal and Torres Strait Islander Male Health Gathering-Alice Springs 1999, all delegates present agreed that the word Male would be used instead of the word Men. With the intention being to encompass the Male existence from it’s beginnings in the womb until death.

2.Throughout this document the word Aboriginal is used instead of Aboriginal and Torres Strait Islander. This is in line with the National Aboriginal Community Controlled Health Organisation (NACCHO) being representative of Aboriginal People. This does not intend to exclude nor be disrespectful to our Brothers from the Torres Strait Islands.

OCHRE DAY Program

 

NACCHO Aboriginal Health ” What Works ” Part 8 : Aboriginal-run services can work but need to prove their worth, Indigenous leaders say

did

“We think it’s also been really important to try to dispel the public perception that somehow spending more money in Aboriginal health isn’t a worthwhile or a viable thing to do.

For every $1 invested we’re delivering a $4.18 return,

“We wanted to be able to show that the Aboriginal community-controlled health sector actually delivers good services and good outcomes, and they are cost-effective.”

Danila Dilba Health Service Darwin  CEO Olga Havnen said she had spent years pushing for evidence-based programs and governments needed to focus on Indigenous-run organisations that proved they could deliver

Photo caption  above from Page 3 NACCHO Aboriginal Health Newspaper out Wednesday 16 November , 24 Page lift out Koori Mail : or download

naccho-newspaper-nov-2016 PDF file size 9 MB

A lack of evaluation of Indigenous-run programs aimed at overcoming disadvantage is placing serious limits on positive outcomes, Aboriginal leaders have warned

Report from the ABC

The comments come after a report by the Productivity Commission found Indigenous Australians are becoming more disadvantaged, citing alarming increases in imprisonment rates, mental health problems and rates of self-harm.

The report also said of the $30 billion budget allocated to overcoming these disadvantages, just 34 of the 1,000 federally funded programs had been properly evaluated.

Northern Territory Aboriginal health service Danila Dilba has engaged a private economics consultancy firm to carry out a cost/benefit analysis of its key primary health care services, CEO Olga Havnen said.

“For every $1 invested we’re delivering a $4.18 return,” she said.

But the report also showed Danila Dilba’s outcomes were not the norm.

Indigenous leaders said the lack of economic evaluation left billions of dollars being spent in areas that may not have been proven effective.

“As a taxpayer you should be concerned that programs for which there is no evidence are being funded,” anthropologist Marcia Langton told the National Press Club.

The head of the Prime Minister’s Indigenous Advisory Council, Warren Mundine, said measurable data offered guidance for funding targets.

“It should be clear that you don’t get funding forever just for the sake of funding, you actually have to get clear outcomes, and outcomes that are successful,” he said.

There should be a real evaluation program in place if the federal government is “handing out taxpayers’ money”.

“We’ve got to totally revamp the way the evaluations are done and make them real so we get measurable data — and we can do that tomorrow morning,” Mr Mundine said.

Better evidence needed on program outcomes: Scullion

A spokesperson for Federal Indigenous Affairs Minister Nigel Scullion admitted there was a need for more evidence to demonstrate which programs were working.

“Minister Scullion acknowledged that in the areas of incarceration, domestic violence, mental health and substance misuse, increased effort was required to improve outcomes — and better evidence was needed to drive this progress,” the spokesman said in a statement.

Public sector governance expert Steven Bartos said allocating funds without evidence created a false economy.

“When you don’t know anything about any of the programs then you’re just relying on gut feelings, and that’s not good enough,” he said.

“The measurement of outcomes, the framework for doing that, has to come from Indigenous communities themselves.”

Danila Dilba Health Service Darwin 25 years strong

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Photo caption  above from Page 3 NACCHO Aboriginal Health Newspaper out Wednesday 16 November , 24 Page lift out Koori Mail : or download

naccho-newspaper-nov-2016 PDF file size 9 MB

The 8th of November, 1991 was a day of great pride for Darwin’s Aboriginal community with the official opening of Danila Dilba Health Service.

Its beginnings as an Aboriginal community controlled health organisation go back to the 1970s — a time of great activism for Indigenous people across Australia.

After Cyclone Tracy hit in 1974, Darwin people were evacuated to southern cities where local Aboriginal medical services had started. People from the local Aboriginal community were impressed with the services and wanted their own one.

Danila Dilba grew out of the community, with people holding meetings, lobbying government, lodging petitions and even holding a ‘sit-in’ at government offices for a culturally appropriate primary health service for Indigenous people.

The name Danila Dilba Biluru Butji Binnilutlum was given to the service by the local Larrakia traditional custodians.

In the Larrakia language Danila Dilba means ‘dilly bag used to collect bush medicines’ and Biluru Butji Binnilutlum means ‘Aboriginal people getting better from sickness’.

Our logo reflects this meaning and was designed by Larrakia elder, the Reverend Wally Fejo.

The service was friendly, comfortable and provided holistic care. Danila Dilba was a safe place for Indigenous people to raise their concerns and find solutions to their health concerns.

Danila Dilba has grown significantly in size and capacity, from eight staff and one building in 1991 to five clinics, including separate men’s and women’s clinics, mobile and dental clinics, community programs and a staff of over 130 serving almost 12,000 clients in 2016.

Our Aboriginal Health Practitioner First policy, where new clients see an AHP before a GP, and our large Indigenous staff are the core of our culturally appropriate care.

 

 

 

 

NACCHO #NTRC Aboriginal Health : Two NT #ACCHO ‘s funded for support services for people impacted by the Commission.

royal-commission

 ” The Commonwealth Department of Social Services has announced that funding has been provided for support services for children, young people, their families and others impacted by the Commission.

Royal Commission website

Discussing experiences of the child protection system or time spent in youth detention can be difficult. This is especially so for people who experienced abuse and are telling their story for the first time.”

The Territory-wide Helpline is 1800 500 853

  • This is a free helpline which will be answered locally, available 9am to 5pm Monday to Friday
  • Experienced and qualified staff can refer people to a range of services including counsellors, therapeutic support, and health professionals
  • Calls made from a mobile phone may incur additional costs

Update : CANCELLATION OF HERMANNSBURG COMMUNITY MEETING

The Commission confirms that tomorrow’s proposed community in Hermannsburg (20 October 2016) has been cancelled due to other business in the community.

Details of the individual services funded and how to contact them directly are

Danila Dilba Health Service – services include:

  • trauma-informed and culturally safe face to face and telephone counselling and support services delivered by psychologists and qualified counsellors
  • practitioners experienced in pre, during and post Royal Commission counselling and support;
  • therapeutic group services
  • culturally safe support and advocacy services to young people impacted by youth detention delivered by experienced Youth Support and Engagement practitioners
  • a broad suite of primary health care services tailored for men, women and children delivered by Aboriginal Health Practitioners, GP’s and maternal, paediatric and allied health, etc, specialists;
  • Alcohol and Other Drugs services
  • chronic disease care coordination; and health education and promotion

Phone

(08) 8942 5400 Darwin, Palmerston and Malak

Website www.daniladilbaexperience.org.au/about-us.html

Relationships Australia NT – services include:

  • trauma-informed culturally appropriate support and information on how to engage with the Royal Commission and what to expect from the enquiry process
  • face to face and telephone counselling by qualified counsellors
  • support through legal processes
  • referrals to legal and advocacy services
  • pre and post counselling support to those directly affected who are giving evidence as well as their families
  • mentoring by Aboriginal and Torres Strait Islander cultural advisors, and healing camps on Country.

Phone

(08) 8923 4999 Darwin and Katherine office with outreach to other areas

(08) 8950 4100 Alice Springs office with outreach to other areas

Website www.nt.relationships.org.au/locations/darwin

The Central Australian Aboriginal Congress – services include:

  • trauma-informed and culturally safe counselling and support services for Aboriginal children, young people and families affected by the events and stories of the Royal Commission in Youth Detention
  • a holistic suite of primary health care services for men, women, young people and children
  • Alcohol and Other Drugs services
  • youth mental health services
  • Family Support Programs
  • chronic disease care coordination; sexual health and health promotion

Phone

(08) 8959 4750 Alice Springs and surrounding areas

Website www.caac.org.au

other support

Hearing and talking about child protection and kids in detention can be hard for young people, parents, families and communities.

There are a number of other  services available which can provide support wherever you are in the NT. If you need support you can call the following services:

Lifeline Freecall 13 11 14
Kids Helpline 1800 551 800
NT Mental Health Help Line 1800 682 288
Headspace (12-25 years)     1800 659 388 or 8931 5999
Beyond Blue 1300 224 636

NACCHO health news: The role of Aboriginal Community Controlled Health Services in Indigenous health

imagesCAPSBRXS

“Our right to take back responsibility.” Noel Pearson, 2000 [1]

This emotive aphorism by Pearson embodies the struggle of Australia’s Indigenous people to gain control of their destiny, which for generations has been wrested from them into the power of governments.

Although his statement was primarily directed toward welfare, the same right of responsibility can be applied to health, perhaps the gravest challenge facing the Aboriginal population.

Article by: Michael Weightman
Sixth Year Medicine (Undergraduate)
University of Adelaide

As Pearson alluded to, the only way to solve the health crisis is by enabling local communities to take charge of their own affairs.

This principle of self-determination has led to the creation of Aboriginal Community Controlled Health Services (ACCHS), which has allowed over 150 Aboriginal communities throughout Australia control over their healthcare. [2] This article describes the founding principles behind community controlled health centres in Aboriginal communities through considering several different ACCHS and the unique challenges they face.

The fundamental concept behind each ACCHS – whether metropolitan, rural or remote – is the establishment of a primary healthcare facility that is both built and run by the local Aboriginal people “to deliver holistic, comprehensive, and culturally appropriate health care to the community which controls it.” [2] This is based upon the principle of self-determination and grants local people the power to achieve their own goals. From the beginning ACCHS were always intended to be more than exclusively a healthcare centre and each ACCHS has four key roles: the provision of primary clinical care, community support, special needs programmes, and advocacy.

ACCHS endeavour to provide primary healthcare as enshrined by the World Health Organization in the 1978 Declaration of Alma-Ata. This landmark international conference defined primary healthcare as:

“essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and the country can afford to maintain… in the spirit of self-determination.” [3]

Although conceived subsequent to the advent of the community controlled healthcare movement in Australia, this definition echoes many of the underlying principles upon which ACCHS were founded, including the most important aspect – local control. Indeed, it is widely accepted throughout the literature that the community itself must identify its needs and problems so an effective and appropriate course of action can be undertaken. [4-7]

This principle is espoused in the National Aboriginal Health Strategy’s frequently quoted statement that “Aboriginal health is not just the physical well-being of an individual but the social, emotional and cultural well-being of the whole community in which each individual is able to achieve their full potential thereby bringing about the total well-being of their community.” [8] The notion of ‘community’ is an essential component of the Indigenous view of the self and therefore strongly related to health and well-being. Accordingly, ACCHS have a holistic view of healthcare, recognising that Indigenous healthcare needs to be multi-faceted and focus on cultural complexities that may not be appreciated by mainstream health services. As each Aboriginal community across the country has a distinct culture and language, [9] local control is paramount.

The concept of community control is not new. It can be traced back to early nineteenth-century America, where such services were used with success for improving the health of the poor and recent migrants. [4] The first ACCHS was established in the inner city Sydney suburb of Redfern in 1971. [10] Known as the Aboriginal Medical Service (AMS), it pioneered the concept of community controlled healthcare in Australia and, from modest beginnings, has now expanded into a major, versatile healthcare facility that provides free medical, dental, psychological, antenatal and drug and alcohol services to the large Aboriginal community in Sydney. Redfern’s AMS overcame struggles against an initially distrustful and paternalistic government through the dedication of visionary Indigenous leaders and support of benevolent non-Indigenous Australians. [10,11]

Specialised Indigenous policies are essential, as it is impossible to apply the same approach that is used in health services for non-Indigenous patients. Many Indigenous people are uncomfortable with seeking medical help at hospitals or general practices and therefore are reluctant to obtain essential care. [12] In addition, access to healthcare is often extremely difficult due to either geographical isolation or lack of transportation. Many Indigenous people live below the poverty line, so the services provided by practices that do not bulk bill are unattainable. Mainstream services struggle to provide appropriate healthcare to Aboriginal patients due to significant cultural and language disparities; [5,13] the establishment of ACCHS attempts to overcome such challenges.

For example, the Inala Indigenous Health Service in south-west Brisbane performed extensive market research to determine the factors keeping Aboriginal patients from utilising the mainstream health service. The results showed that several simple measures were highly effective in engaging the local community, such as employing an Indigenous receptionist and making the waiting room more culturally appropriate through local art or broadcasting an Aboriginal radio station. [12] In the five years following implementation of these strategies, the number of Indigenous patients at Inala ballooned from 12 to 899, and an average of four consultations per patient per year was attained, compared to the national Indigenous average of fewer than two. [14] A follow-up survey attributed patient satisfaction to the presence of Indigenous staff and a focus on Indigenous health. [12]

Nevertheless, the consequence of  longstanding obstacles to Indigenous access to mainstream healthcare is manifest in the stark inequity between the health outcomes of Indigenous and non-Indigenous Australians. The most recent data from the Australian Institute of Health and Welfare (AIHW) shows that the discrepancy in life expectancy between Aboriginal Australians and their non-Indigenous counterparts remains unacceptably high, at 11.5 years for males and 9.7 for females. [15] Moreover, studies demonstrate that Aboriginal people have significantly worse outcomes in key health indicators, including infant mortality, diabetes, heart disease, infectious disease and mental illness. [5,12,13,16] Such disparities indicate that a novel, tailored approach to Indigenous health is required.

Cultural understanding is essential, as demonstrated by the example of the Anyinginyi Health Aboriginal Corporation in the Northern Territory. Anyinginyi serves the twelve remote Aboriginal communities within a 100km radius of Tennant Creek and its name comes from the local Warumungu language, meaning ‘belonging to us’ [17] emphasising the community’s control of, and pride in, this service. Anyinginyi has always strived to be more than just a health service and has evolved to deliver many other community programmes. This is embodied by Anyinginyi’s insistence on ‘culturally appropriate’ healthcare for Aboriginal people. In addition to medical advice, the local Aboriginal community is offered support through various programmes that range from employment services to cultural and spiritual activities promoting Indigenous language and culture. One such social service is the ‘Piliyintinji-Ki Stronger Families’ initiative, which assists community members through access to support services relating to issues such as family violence and the Stolen Generations. [17] Indeed, ACCHS such as Anyinginyi have the additional benefit of providing employment opportunities for community members, as the vast majority of the employees are Indigenous. All new staff members participate in a Cross Cultural Workshop, as one of Anyinginyi’s goals is to ensure that the local Aboriginal cultures are respected and continue to thrive.

The other important arm of healthcare in ACCHS relates to population health, with initiatives ranging from education campaigns to immunisations and screening for diseases. [2] One of the first large-scale community health promotion campaigns run specifically for Aboriginal people was conducted by the Redfern AMS between 1983-1984 to encourage breast-feeding among the local Koori mothers. [11] It achieved such stunning success that it set a precedent for all future ACCHS to continue in the important area of preventative medicine, with similar campaigns for sexual health and safe alcohol consumption having been undertaken subsequently.

Moreover, each ACCHS runs special services that are dictated by local needs and priorities. In some instances, there is a specific health problem that needs to be addressed, such as poor nutrition or substance abuse. Other programmes are directed at specific groups, such as young mothers or the elderly. The flexibility of these special services allows each ACCHS to identify and address the most significant problems within its area – problems that can only be identified by the community itself. For example, the Danila Dilba Health Service in Darwin runs a programme called ‘Dare to Dream’ that provides support and counselling for young Indigenous people suffering from mental illness. [18] It is an early intervention programme that intends to identify and support adolescents exhibiting early signs of both behavioural and mental health problems. To this end, school visits are undertaken to promote awareness of mental health issues to students and staff, as well as the services that Danila Dilba has to offer. A ‘chillout’ centre has been set up in Darwin as a safe place for young people to come and allows the community workers to refer those who present to appropriate counselling services. As such, Danila Dilba is empowered to proactively address an important local issue in the most culturally-appropriate way.

ACCHS are also active in the area of advocacy. This involves providing a voice for the community so that their needs can be expressed. Although each ACCHS operates autonomously, they form a national network with their collective interests represented both on a state/territory level and also nationally. Each of the eight states and territories has a peak representative body that acts on behalf of all ACCHS within that jurisdiction. [2] Examples of these organisations include the Aboriginal Health & Medical Research Council of New South Wales and the Aboriginal Medical Services Alliance Northern Territory. At the national level the umbrella body overseeing all the different stakeholders across the country is the National Aboriginal Community Controlled Health Organisation (NACCHO). [2] Individual ACCHS, as well as NACCHO and the affiliated state or territory peak bodies, lobby all levels of government for increased funding and greater recognition of the issues facing Aboriginal communities. The collective weight of NACCHO as a national advocate allows each community’s needs to be heard.

Inevitably, the scope of the services each ACCHS can provide is restricted by funding, most of which comes from the Commonwealth or State and Territory Governments. [2] More money continues to be spent per capita on mainstream health services than on Aboriginal health, despite the great dichotomy in health outcomes. Indeed, the 2012 Indigenous Expenditure Report published figures showing that for every dollar spent on healthcare subsidies for non-Indigenous health, only $0.66 is spent on Aboriginal health. [19] This statistic covers all the key areas of healthcare expenditure, such as Medicare rebates, the pharmaceutical benefits scheme (PBS) and private health insurance rebates. Therefore, Indigenous patients are not receiving the same level of health service delivery, including clinical consultations and treatment, compared to their non-Indigenous counterparts. However, it is propitious to note that the funding bodies have recognised the value of the public health efforts of ACCHS, as the spending in this area is a $4.89 to $1.00 ratio in favour of Indigenous health. [19] Nevertheless, the priority needs to be placed on ensuring that sufficient funding exists to allow Indigenous patients to access health care subsidies as required.

In addition to inadequate funding, another major obstacle that ACCHS face is the difficulty in attracting and retaining doctors and allied health professionals. According to the AIHW’s most recent report, only 63% of Indigenous health services currently employ a doctor. [20] Consequently, a significant increase in the number of general practitioners working with Indigenous patients is required simply to provide adequate services. There is additionally a severe lack of Aboriginal medical students and general practitioners, which limits the opportunities for Indigenous professionals to provide culturally-appropriate care to their own communities. Census data from 2006 found that there were 106 Indigenous doctors nationally, accounting for only 0.19% of all medical practitioners. [21] These shortages are compounded further for ACCHS in rural and remote areas. By 2011, further data from Medical Deans demonstrated that the numbers had increased to 153 Indigenous medical practitioners nationally, along with 218 enrolled Indigenous medical students. Although promising, these numbers remain grossly inadequate to fulfil workforce demand. [22]

Services become stretched due to perpetual resource inadequacies. Understandably, the remoteness of some communities makes service delivery challenging, yet even major metropolitan areas with large Indigenous populations can struggle to adequately provide for those in their catchment area. Under-resourcing places major constraints on service delivery and different ACCHS throughout the country exhibit significant variation in the level of services offered. Some are large, employ several doctors and provide a wide range of services; others are much smaller and operate without doctors. [20] These rely on Aboriginal health workers and nurses to provide the bulk of primary healthcare.

As such, the success of the ACCHS concept would not have been possible without the contribution of Aboriginal health workers. The role of Aboriginal health workers, who are often sourced from the local community, is to provide the primary healthcare that ACCHS offer. [23] This involves assessing patients and then coordinating or providing the medical attention required. Health workers are able to treat certain conditions with the help of standard treatment guidelines and provide a selection of important medications to patients. Importantly, Aboriginal health workers have a liaison role between medical professionals and Aboriginal patients. They are often required to act as an interpreter between the patient and health professional, thus providing an intermediary for cross-cultural interactions, and therefore improving the quality of healthcare provided to the local community.

Due to the often quite remote locations of ACCHS and the scarcity of doctors and nurses, Aboriginal health workers perform many clinical tasks that would be provided by a medical professional in mainstream health services. Aboriginal health workers bear much greater responsibility than their colleagues in the public sector and often learn a wide range of procedural skills including how to perform standard health checks, vaccinations and venepuncture. [23] Indeed, some choose to specialise in a specific area (such as diabetes, pregnancy or infant care) thus gaining additional skills and responsibilities. Still others take on managerial responsibilities. This is in contrast to the public sector, where health workers are often fixed to one routine area or even to non-clinical work such as transportation or social assistance. [23] Without Aboriginal health workers performing these additional tasks, ACCHS would not be able to provide a sufficient level of service for the community. For this reason, Aboriginal health workers are rightly considered the backbone of community controlled health services.

As one example, the Pika Wiya Health Service in the South Australian town of Port Augusta runs two outreach clinics for communities in Copely and Nepabunna. Due to the shortage of doctors, these clinics are staffed entirely by Aboriginal health workers. Their invaluable contribution is evident, with 695 clinical encounters performed by health workers during 2008, [24] ensuring that the absence of doctors did not deny the local people the chance to receive healthcare. Whilst the major health issues faced by Indigenous people are broadly similar between urban and remote communities, these problems are often compounded by the remoteness of the location. Although these are challenges that Copely and Nepabunna will continue to have to face, the empowerment of Aboriginal health workers has helped redefine the direction of Pika Wiya’s outreach health services.

Aboriginal health workers face many difficulties. Perhaps the most significant is that, until recently, there had been no national qualifications or recognition of the skills they developed. [23] The introduction of national registration for Aboriginal health workers (from July 1 2012) and the new qualification of Certificate IV in Aboriginal and Torres Strait Islander Primary Health Care (Practice) have revolutionised the industry. [25] This has had the benefit of standardising the quality and safety of the Aboriginal health worker labour force. However, as the changes will increase the required length and standard of training, there is the potential for current or prospective health workers to be deterred by the prospect of undertaking study at a tertiary level, particularly if they have had limited previous education. Nevertheless, national registration is a positive step for recognising the important work done by Aboriginal health workers, and in providing them with the training to continue serving their communities.

In addition to doctors, nurses and health workers, medical students are also important stakeholders in Indigenous health. First, much has been done in recent years to increase the numbers of Indigenous medical students. For example, the University of Newcastle has been the first medical school to make a dedicated attempt at training Indigenous doctors and has produced approximately 60% of Australia’s Indigenous medical practitioners. [26] This achievement has been based on a “strong focus on community, equity and engagement by the medical profession.” [26] Encouraging community members to enter the profession can be an important way of addressing both the lack of doctors in Indigenous communities and paucity of doctors of Indigenous background. The benefits are broader than this, as Indigenous doctors provide strong role models for young Indigenous people and also have the opportunity to contribute with advocacy and leadership within Indigenous health.

Secondly, the medical student population as a whole is exposed to increasingly more Indigenous health as part of the core curriculum at university following adoption of the updated Australian Medical Council accreditation standards from 2007. [27] Additionally, some students even have the opportunity to spend time in an ACCHS and experience first-hand how the system works. There has been some criticism of these ‘fly in, fly out’ medical electives, where students are sent to ACCHS for short periods and then leave. [28] Whilst this model may be beneficial for the student, it fails to engage the local community as they are unable to build meaningful or lasting relationships with the student.

Better models allow for a longer-term placement and immersion in the community. These include the John Flynn Placement Programme where some students are able to spend a fortnight annually in an ACCHS in the Northern Territory over a period of four years. [29] Another example is the Northern Territory Clinical School, which allows third-year medical students from Flinders University to spend a whole year of study in Darwin, providing the opportunity for increased contact with local Indigenous communities. [30] Initiatives such as these help to build a relationship with the community, and allows for increased acceptance of the medical student. Additionally, the student is able to make a more meaningful contribution to various client’s healthcare. Prolonged or longitudinal attachments have also been shown to increase the likelihood of students returning as a doctor. [31] Certainly, there is much scope for the contribution of medical students to be harnessed more effectively.

It is abundantly apparent that any solution to address the health inequalities of Aboriginal people will only be effective if it recognises that the local Aboriginal communities must control the process of healthcare delivery. This is the principle upon which ACCHS were founded and can be attributed to their many successes, as demonstrated through the examples of Redfern’s AMS, Inala, Anyinginyi, Danila Dilba and Pika Wiya. In spite of the challenges posed by inadequate funding, under-staffing and often remote locations, these organisations strive to uphold the ideals of self-determination and community control. It is hoped that wider adoption of these principles by national governing bodies together with improved financial support will enable Indigenous Australians control over their lives and destinies, leading to better health outcomes.

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NACCHO health news:Healing the Fault Lines: uniting politicians, bureaucrats and NGOs for improved outcomes in Aboriginal Health.

olga-havnen

Prominent Aboriginal Territorian and the current CEO of Danila Dilba Health Service Olga Havnen argues that the “fault lines” between politicians, bureaucrats and NGOs and the Aboriginal Community Controlled Health sector must unite to make a real difference.

A little known positive aspect of the Northern Territory Intervention was a significant increase in resources to Aboriginal Comprehensive Primary Health Care.

This, along with parallel initiatives under Closing the Gap, gave some hope that the decades long demands from our sector for substantial extra resources in primary health care was at last being heard.

However, while we have been making some advances in the Northern Territory, we face the potential for a “race to the bottom” in Aboriginal health where the interests of politicians, bureaucrats and NGOs potentially outweigh the evidence of Aboriginal community control.

 Prominent Aboriginal Territorian and the current CEO of Danila Dilba Health Service Olga Havnen argues that the “fault lines” between these groups and the Aboriginal Community Controlled Health sector must unite to make a real difference.

Extract from the 16 pages speech which can now be download from NACCHO

I am currently the CEO of Danila Dilba Health Service in Darwin, which has not long ago celebrated its 20th anniversary. We are an Aboriginal Community Controlled Health Service—and part of a broader, national movement of community controlled comprehensive primary health care that has its origins in Redfern some 42 years ago.

At the core of what we have achieved over those many years has been an aggressive approach to basing our work on evidence. Our accumulated achievements have always been based on what works—in clinical as well as social practice.

At the heart of what we have strived to achieve is the development of a practice—both clinical and social—that displays our strong and central commitment to comprehensive primary health care.

This model was codified at an international level at Alma Ata in 1978, and subsequently endorsed by the World Health Organisation (WHO) and the United Nations:

Primary health care is essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination.

Primary health care is socially and culturally appropriate, universally accessible, scientifically sound, first level care.

You can download  Olga Havnen full speech 16 pages here

PRESS Coverage below and picture from the Australian May 29

REMOTE indigenous communities are suffering from a government culture of “risk intolerance” which has diverted funding from community-led organisations, a leading Aboriginal figure has said.

Olga Havnen, the Northern Territory’s former co-ordinator general for remote services, last night attacked successive governments for choosing large non-government organisations for service delivery ahead of smaller indigenous-led organisations.

Ms Havnen said many community-led service delivery organisations had “disappeared” since the Northern Territory Emergency Response in 2007.

“Aboriginal control of service delivery in many areas has withered on the vine,” she said in the Lowitja O’Donoghue Oration at the University of Adelaide.

“Despite jurisdictional, national and international evidence that community control over service delivery achieves better results, with control being a key element in the social determinants of health, for example, we have gone backwards.”

 Ms Havnen, whose position in the Territory was abolished by the new Country Liberal Party government in October, said there had been a “massive expansion” of NGO involvement in service delivery with “many millions of dollars” flowing to non-indigenous NGOs and multinational NGOs, regardless of their effectiveness.

She said in the past decade, only one new community controlled health service had been established in the Territory and only two remote health clinics handed across to community control.

“It is a process which has allowed government agencies to quarantine themselves from what they too often ascribe as risk in funding Aboriginal organisations,” she said.

“By this I mean that nothing is done, or can be done, that might in any way shape or form come back to haunt politicians or bureaucrats at a Senate estimates hearing or their state and territory equivalents.”

Ms Havnen, who is now chief executive of the Danila Dilba Health Service in Darwin, an Aboriginal community controlled health service, said that there needed to be a fundamental change in the relationship between Aboriginal service delivery in the Territory and elsewhere, and politicians, bureaucrats and NGOs who were involved in the process.

“The politicians and public servants can be agents of innovation and change if they abandon risk intolerance,” she said.

“Similarly, the response of NGOs to the last decade or so of reaping the benefits of government funding into Aboriginal service delivery must also change.

“Risk intolerance cannot be part of Closing the Gap.”

Ms Havnen said she remained concerned about many elements of the 2007 intervention into Northern Territory communities, which would continue to have a psychological impact “for many years”.

NACCHO members take out Chronic Diseases Network Recognition Awards

 Danila Dilba Health Service and Central Australian Aboriginal Congress

The dedication and leadership of Northern Territory health professionals working in the field of chronic diseases has been celebrated in Darwin this evening.

Minister for Health David Tollner hosted the Chronic Diseases Network Recognition Awards, one of the highlights of the 16th Annual Chronic Diseases Network Conference, which opened today.

“The Chronic Diseases Network Recognition Awards are an opportunity to identify and celebrate the innovation, leadership and achievements of the Northern Territory’s chronic diseases health professionals,” Mr Tollner said.

“Individuals, teams and organisations from across the Territory have been nominated by their peers, colleagues and clients for their contributions to tackling chronic diseases in the NT.

“The awards are testament to the great work being done to improve the health of Territorians and to reduce the likelihood of chronic diseases in our younger generation and generations to come.

“Tonight’s function is also a chance to welcome experts and health workers from across the Territory and Australia to Darwin where they will share their knowledge and skills during the two-day conference.

“It is with great pleasure that I congratulate all of the hardworking health professionals nominated for awards, those highly commended and especially the award winners for their valued contribution to fighting chronic diseases.”

The theme of this year’s conference and awards is ‘Promoting Healthy Childhood – Preventing Chronic Conditions’ and focuses on childhood links to chronic diseases.

2012 Chronic Diseases Network Recognition Awards Winners:

Chronic Disease Health Promotion/Program Delivery (team or organisation)

Award Winner: Health Promotion Team, Casuarina Community Care Centre

Highly Commended: Milikapiti Primary Health Care Team

Aboriginal and Torres Strait Islander Health and Leadership

Award Winner: Barbara Cox, Strong Women Strong Babies Strong Culture Coordinator, Top End West, Department of Health

Highly Commended: Sally Ann Sherman, Manager of the Mobile Health Service, Danila Dilba Health Service

Outstanding Contribution to the Field of Chronic Disease (individual)

Award Winner: Robyn Williams, Senior Lecturer, Charles Darwin University

Highly Commended: Kraut Hauth, Renal Case Manager at Central Australian Aboriginal Congress

CDN Conference Theme ‘Promoting Healthy Childhood – Preventing Chronic Conditions’

Award Winner: Pre-school Readiness Program at Central Australian Aboriginal Congress

Highly Commended: Beatrice Parry, Child Health Aboriginal Health Practitioner, Nauiu Health Centre