Medicare Locals and the Aboriginal Community Controlled Health Sector: Where are we? Where are we going?

Published in CROAKEY 12 November 2012: Melissa Sweet editor

The National Primary Health Care Conference has just wrapped up in Adelaide, and you can get an idea of some of the wide-ranging discussions from the #nphcc Twitter stream.(refer NACCHOAustralia TWITTER)

One of the obvious implications is that we must hope Medicare Locals are skilled in the art and science of setting and implementing priorities, given the smorgasbord of expectations upon them.

Engaging with the Aboriginal community controlled health sector should be a priority, suggests NACCHO’s senior policy officer on health reform, James Lamerton.

In the article below, he has some practical suggestions for how Medicare Locals can go about this.

Medicare Locals and the Aboriginal Community Controlled Health Sector: Where are we? Where are we going?

James Lamerton writes:

At the National Primary Health Care Conference in Adelaide last week the daunting terrain that Medicare Locals are expected to navigate was on display.

Medicare Local CEOs and directors must be tearing their hair or turning to drink after hearing, on the first day, from the Department of Health and Ageing’s David Butt and, on the final day, from the Coalition’s Andrew Southcott; both confirmed that the ML ground will be not only rugged but continually shifting.

One thing, however, does offer the Medicare Locals some degree of certainty and considerable promise; the ongoing presence, in the primary health care environment, of the Aboriginal Community Controlled Health Service (ACCHS) sector that has been providing comprehensive primary health care, based on the social determinants of health thinking, for forty years.

Though Aboriginal health was not a theme at the conference, those representatives of the sector present made it clear that partnerships between Aboriginal Community Controlled Health Service and Medicare Locals are not only possible but highly desirable.

From population health planning, through treatment of chronic conditions to primary mental health care initiatives like the Access to Allied Psychological Services and Partners in Recovery programs, the Aboriginal Community Controlled Health Service sector will be an essential, effective and enduring partner for Medicare Locals.

Examples of high functioning partnerships between Aboriginal Community Controlled Health Services and Medicare Locals abound.

From the Pilbara to the NT; from Brisbane to NSW’s northern rivers and Sydney’s western suburbs, these two crucial players in the primary health care environment have carved out partnerships that are not only rolling out Aboriginal health programs and initiatives together but are also building respect and trust between and within communities.

Meanwhile, many Medicare Local CEOs at the conference, whose organisations do not have formal partnerships with the Aboriginal Community Controlled Health Service within their footprint, showed that they were open to partnering but may need support and guidance.

Tips for engagement

So is there a sure-fire, foolproof recipe that Medicare Local CEOs and their teams can follow that will lead to a successful partnership?

The short answer is no – or, at least, not that I know of – but following are some basic tips that should help.

Research the Aboriginal Community Controlled Health Service in your area and get your head around its operating environment – in other words, show an interest.

Have a look at the constitution, find out who the board members are and where they come from. What programs/projects does the Aboriginal Community Controlled Health Service run, and what is it really good at? What are its pressure points? Maybe in those pressure points there’s a potential partnering opportunity.

Ensure that your local Aboriginal Community Controlled Health Service is a member of your Medicare Local. Why not even look at Aboriginality and experience in the community controlled sector as essential skills for at least one of your directors?

Meet. Get a knock down to the Aboriginal Community Controlled Health Service CEO this week and follow it up, as soon as possible, with a Chair & CEO to Chair & CEO meeting.

Is it possible for the two boards to come together? Not only can this be an excellent trust-building opportunity but it’ll also allow your board members to hear the voice of the Aboriginal community directly (NB be prepared to hear some confronting messages).

Don’t rush it. If you’re building a new relationship or repairing an old one, it’ll most likely take time.

To you and your team, it might seem that things move at a glacial pace within your local Aboriginal Community Controlled Health Service, but this is usually because it is using its community feedback loops to see what people think.

It might be frustrating but this is where the strength of the Aboriginal Community Controlled Health Service lies; see what you can learn from it and extrapolate to your relationships with your traditional and emerging constituencies. (NB: These feedback loops will invariably appear idiosyncratic and puzzlingly opaque: stay cool, they’ve been in place and working pretty well for 60,000 years).

Remember Grandma’s advice: you were born with two ears and one mouth – there’s a reason for that. Active and appreciative listening to a problem will often produce the seeds of a solution. In the Aboriginal Community Controlled Health Service environment, silence not only implies consent but also shows respect.

Start with something small and achievable. We’re not going to close the gap in one fell swoop; agree a project that you can work on together (truly ‘work on together’), even if there are some residual trust issues, and see it through to its conclusion – come hell or high water.

Jointly evaluate it, pick the eyes out of it and carry the characteristics of the relationship into something new. Initial success may prove to be sub-optimal but cast your mind back to when you were learning to swim. That’s right, you started out simply trying not to drown and eventually ended up swimming to Rottnest Island.

Meet 2. Arrange informal but regular meetings between your clinicians and those of the Aboriginal Community Controlled Health Service. It’s amazing what can be shared and learned by both groups in an environment of enquiry.

Own what’s yours but respect what isn’t. Enough said.

The mixed Medicare Local messages coming from Government and Opposition are certainly testing the patience and resolve of the Medicare Local movement; it’s hard to plan when the map is redrawn regularly.

However, the opening whistle’s blown and it’s game-on.

This reform agenda presents us with a potentially epoch-altering opportunity to make serious inroads into comprehensive primary health care and public health thinking based on a ‘rights’ ethos.

To the politicians, the future of Medicare Locals may appear uncertain but the only infallible way for us to predict the future is for us to create it.

More reading: Mark Metherell’s report for Croakey from day one of the conference on the need to shift the funding imbalance between hospitals and primary health care.

Press release NACCHO and Medicare Locals at the table to Close the Gap

Picture above  NACCHO Chair, Mr Justin Mohamed, stated it was very important that as respective national peak bodies both NACCHO and AML Alliance need to demonstrate sound leadership and model collaboration if genuine partnership is to be achieved.

Australia’s Medicare Locals and the National Aboriginal Community Controlled Health Organisation (NACCHO) will draw on their respective strengths in primary health care to share in the best way forward to achieve improved health outcomes for Aboriginal and Torres Strait Islander Peoples from the National Health Care Reforms.

In the lead up to a Close the Gap symposium at the National Primary Health Care Conference, AML Alliance Chair, Dr Arn Sprogis said it’s national sessions like these that enable organisations to work cooperatively to develop tangible opportunities for the Close the Gap agenda.

“This session will convene some of the best thinkers and advocates for primary health care in the Aboriginal and Torres Strait Islander health sector to generate the big ideas,” Dr Sprogis said.

“We want the ripple effect: to see good policy lead to better service delivery.

There is a well-earned respect between the two sectors and what they can do for Aboriginal and Torres Strait Islander people, however integrating their systems and thinking is what will expand the opportunities immeasurably.

“We’re determined to pursue the best possible outcomes for Aboriginal and Torres Strait Island Peoples from the National Health Care Reforms,” Dr Sprogis said.

NACCHO Chair, Mr Justin Mohamed, stated it was very important that as respective national peak bodies both NACCHO and AML Alliance need to demonstrate sound leadership and model collaboration if genuine partnership is to be achieved.

“This symposium will allow a full and open discussion of how our sectors view the future and for both to explore and forge new ways of working together as we strive towards true and meaningful partnerships,” Mr. Mohamed added.

“Both sectors independently face challenging futures, so this will be an opportunity for both NACCHO and our members and the AML Alliance to begin to lay stable foundations as we work towards improved collaborative relationships.

Through improved partnerships and Aboriginal leadership there is a real opportunity to produce realistic and achievable policy recommendations to government,” Mr. Mohamed said.

Mr Mohamed encouraged all attendees to approach the symposium as a blank sheet where we can map a way forward that ensures the best possible health outcomes are achieved for our people and their communities.

National Primary Health Care Conference – Healthy Communities, Healthy Nation

From Transition to Action: Integrating Primary Health and Social Care

Adelaide Convention Centre

Close the Gap Symposium

Strength in Integration – Saturday November 10


NACCHO report from the World Health Care Networks Conference, Cairns

World Health Care Networks Conference,

Cairns 26th to 28th July 2012

From James Lamerton, NACCHO Senior Policy Advisor – Health Reform

It is surprising and disappointing that, at an international conference held here in Australia and focussing on comprehensive primary health care, the role of the Aboriginal Community Controlled Health Service (ACCHS) sector was not acknowledged or, in fact, mentioned.

NACCHO Note: “Cultural village “image used to promote conference (see link below)

Australian Medicare Local Alliance chair, Dr Arn Sprogis, explained that that the lack of acknowledgement was not an oversight but was due to the fact that the ACCHS sector’s philosophy of service design and delivery had already been “mainstreamed”, presumably arguing that mainstream service providers, such as Medicare Locals, have already adopted the ACCHS methodology.

However, Australian General Practice Network (AGPN) chair, Dr Emil Djakic, in a simple, eloquent and moving statement which drew sustained applause from conference-goers, distanced AGPN and the organisers of the conference from this view.

He apologised for the glaring oversight and gave an undertaking that future conferences would place Aboriginal and Torres Strait Islander health at their centre.

The AML Alliance will host another primary health care conference in Adelaide in November 2012: we wait with interest to see how Aboriginal health and the ACCHS sector fares there. 


About the WHCN Conference 2012

Connecting Globally, Achieving Locally

Common health system challenges and an international commitment to reach the Millennium Development Goals (MDGs) are helping to drive solidarity and cohesion within the global health community – particularly under the auspice of a renewed comprehensive primary health care agenda. World Health Care Networks (WHCN) was created to foster and promote this solidarity and synergism between national and international stakeholders by facilitating and promoting linkages and partnerships.

In achieving this, the WHCN 2012 Conference will act as a platform for you to meet, connect and build prosperous relationships with global health and social care leaders who share a common interest in improving health outcomes for the world’s population, rich and poor.

Specifically, WHCN 2012 will:

  • Connect the leaders who practice in multi-lateral approaches to health service delivery;
  • Share in the knowledge that makes a difference to multi-lateral health service delivery;
  • Promote understanding and the value of networks in enhancing multi-lateral health service deliver.

WHCN is for those who want to engage in a meaningful exchange of ideas and developments in the primary health care sector and to improve the networking capacity of the sector for the benefit of improving health systems both locally and globally.

Clinically-led and organised general practice and primary health care systems are expanding and progressing significantly and effectively re-modelling health services to improve health and system outcomes. In recognising this fundamental shift in health service delivery, the Australian General Practice Network (AGPN) and General Practice New Zealand (GPNZ) formed WHCN as the international platform for health and social service leaders to share their knowledge, expertise and experiences and in turn develop the international networks that can make a difference to health outcomes.

NACCHO MEDICARE LOCAL PRESS RELEASE:Recognition of Aboriginal health as ‘core business’ for Medicare Locals.

The Aboriginal Community Controlled Health Service sector congratulates  Australian Medicare Local Alliance (AML) Alliance Chair, Dr Arn Sprogis, on his clear and unambiguous statements regarding the centrality of Aboriginal and Torres Strait Islander health to the current health reform agenda  and for the recognition of Aboriginal and Torres Strait Islander health as ‘core business’ for Medicare Locals.

Speaking after attending NAIDOC celebrations  in Hobart, NACCHO chair, Mr Justin Mohammed, said that NAIDOC week reminds us all that much has been gained by the Aboriginal and Torres Strait Islander community but there still exists much work to  be done to ensure that the health needs and the health aspirations of Aboriginal peoples are met.

The increase in the Aboriginal & Torres Strait Islander population, as reflected in the recently release Census data, is a testament to the dynamic nature of our culture, Mr Mohamed said.

 However, since the vast majority of the population growth is due to a healthy increase is the Aboriginal & Torres Strait Islander birth rate, the data also underlines the need for well-planned and culturally delivered health services that comprehensively address the needs of all members of extended Aboriginal & Torres Strait Islander  families, he said.

While NACCHO recognises and encourages people to identify as Aboriginal and/or Torres Strait Islanders when engaging with mainstream health services, this will only happen in environments where Aboriginal people feel safe and where their input and their decisions will be respected, Mr Mohamed continued.

While the numbers of Aboriginal & Torres Strait Islander people identifying at mainstream health services continues to grow, there is concern that the uptake of Aboriginal-specific Medicare Benefits Schedule (MBS) item numbers has shown no significant growth as a result of these increased registrations and remains alarmingly low overall, he said.

It is no longer appropriate to see Aboriginal and Torres Strait Islander people’s health as simply a matter of ‘access’, Mr Mohamed said.

Our people’s health must now be framed around assurances of high-quality and evidence-based services that are firmly grounded within the concept of the social determinants of health and which recognise the influence the social gradient has upon the health status of Aboriginal & Torres Strait Islander people. Health is a human rights issue, not just a medical one, Mr Mohamed pointed out.

Mr Mohamed said NACCHO is the peak body representing almost 150 Aboriginal Community Controlled Health Services (ACCHS) across the country. Our member services have extensive experience and expertise in the design, delivery and evaluation of comprehensive primary healthcare services to Aboriginal  people and the communities where they live; this experience and expertise has been built up over forty years of Aboriginal communities  delivering health services.

Our sector stands ready to work with Medicare Locals in a genuine partnership as they begin their long but ultimately rewarding journey in addressing  and improving comprehensive primary healthcare for all Australians. Working in a spirit of cooperation and collaboration, we can ensure Medicare Locals  bring about the necessary reforms to clinical and support systems within mainstream services that will bring benefits to the entire community, not just to Aboriginal and Torres Strait Islander peoples.

These are testing times for all of us involved in health, Mr Mohamed said. With the continued shrinking of already finite health resources, we must ensure that we work in genuine partnership and not in competition: competition will simply weaken us all and bring negative impacts to our respective communities, he said.

 NACCHO and its members look forward to playing a strong role in the new and emerging health environment and to working to ensure that Aboriginal peoples receive the highest-quality health services that are the right of all Australians, Mr Mohamed concluded.

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National Media and Communications Advisor

0401 331 251

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