Menzies delivers evaluation of Federal Indigenous chronic disease Package
Primary healthcare policy and planning experts from the Menzies School of Health Research (Menzies) have welcomed the release of the report into the landscape of chronic disease in Aboriginal and Torres Strait Islander Australians.
Chronic disease contributes to two thirds of the health gap between Indigenous and non-Indigenous Australians.
Commissioned by the federal Department of Health and Ageing, the Sentinel Sites Evaluation (SSE) is a holistic evaluation of the $805 m Indigenous Chronic Disease Package (ICDP) ; a federal initiative designed to improve the capacity of primary health care services to more effectively prevent and manage chronic disease among Indigenous populations.
Menzies Senior Researcher and SSE project leader, Professor Ross Baillie said health authorities around the world were struggling to re-orient their health systems to address the epidemic of chronic disease.
“in 2010, the Australian Government engaged Menzies to undertake a comprehensive evaluation of the Indigenous Chronic Disease Package, “Prof Baillie said.
“The evaluation was undertaken to inform ongoing refinements in design and implementation of the program.”
The evaluation was undertaken to inform ongoing refinements in design and implementation of the program.”
The evaluation team conducted 72 community focus groups with a total of 670 participants, and over 700 interviews with key informants from community controlled, government services and GP sectors. Findings were reported back to local health services and to government in six monthly cycles between 2010-2013.
Prof Baillie said the effective completion of the SSE shows Menzies’ capacity to inform and impact national policy with the view to maximise the potential benefit to Indigenous communities across the country.
“The challenges of providing high quality chronic illness care remain complex and will require stakeholders at multiple levels of the system to grapple with new concepts, and develop and implement sophisticated strategies to address health disparity in Australia, “ Prof Baillie said.
Professor Baillie said the implementation of the ICDP to date has shown some notable achievements. These include :
– Improved access to primary health care services and to affordable medication for many Aboriginal and Torres Strait Islander People.
– Improved orientation of the General Practice sector to the needs of Aboriginal and Torres Strait Islander People.
– Significant steps towards the early establishment of a new workforce that is focused on health promotion and in development of local health promotion initiatives
– Increased attention to enhancing access to specialist, allied health and team-based approaches to chronic illness care.
– Professor Baillie emphasised that the evaluation report had been informed by frontline evidence from a variety of healthcare providers and community members. The report provides some direction for how service organisations and policy makers can build on the existing strengths of the ICDP priority areas.
– “It is clear that the evaluation has influenced program refinement and policy discussions within government, particularly with regard to how the wide variation between regions in service capability can be addressed. This is vital to enhancing efforts to improve prevention and management of chronic illness to those Aboriginal and Torres Strait Islander people who are most in need.”
Interviews :
Interviews are available with Professor Ross Baillie. Professor Baillie is the Scientific Director of the Centre for Primary Health Care Systems and leads the NHRMC funded ABCD National Research Partnership on quality improvement in Indigenous primary health care. He is also involved in research on food supply and environmental health and housing in Aboriginal and Torres Strait Islander communities.
Awabakal Newcastle Aboriginal Co-operative and the Hunter Breast Cancer Foundation have formed a partnership that aims to raise awareness of women’s health in the local Aboriginal community.
For a limited time an exclusive Deadly Choices Breast Cancer jersey will be available for Aboriginal women who visit the Awabakal Aboriginal Primary Health Care Centre (AAPHCC) for a women’s health check.
The initiative is part of Awabakal’s Deadly Choices program which was introduced to the Hunter in August this year and aims to improve Aboriginal health by educating and empowering local Aboriginal people to make healthy choices.
Since the program was introduced the organisation has seen a 630% increase in the number of Aboriginal people undergoing health checks. The success of this program can be placed, in part, on the highly-prized and very exclusive Awabakal Deadly Choices jerseys, which can only be claimed following a health check at the AAPHCC.
Awabakal Chief Executive Officer, Don MacAskill, said that the partnership with the Hunter Breast Cancer Foundation would bring breast cancer and women’s health awareness to the forefront of Aboriginal health.
‘Breast cancer is a serious disease with one in eight women diagnosed nation-wide. It doesn’t discriminate between the indigenous and non-indigenous populations, which is why partnerships like this are so important in our attempts to tackle chronic disease in the local Aboriginal community,’ Mr MacAskill said.
Hunter Breast Cancer Foundation President, Rosalie Taggart, said the region would benefit from the additional support of Awabakal and its community to promote health awareness.
‘The Awabakal Deadly Choices program is an excellent model that really encourages people to think about their health and take proactive steps. This is an exciting partnership that we hope will encourage all levels of breast cancer support to work with Awabakal to improve local Aboriginal health,” she said.
The Hunter Breast Cancer Foundation provides grass root support for people undergoing treatment for breast cancer. Since January of this year the Foundation has provided more than 600 post-operative comfort cushions, 178 professional cleaning services and 69 lawn care services. Volunteer drivers have undertaken 338 trips travelling 26,683 kms taking patients to and from treatment appointments.
For information: Awabakal Chief Executive Officer, Don MacAskill, 0408 617 116
Hunter Breast Cancer Foundation President, Rosalie Taggart, 0423 222 059
Need help about breast cancer or the location of your nearest ACCHO on your SMARTPHONE or IPAD
Picture above NT Chief Minister Adam Giles and new Minister the Indigenous Affairs Senator Nigel Scullion visit bush camps at Utopia North East of Alice Springs a remote area in the NT
In a recent article in The Australia outlined that Indigenous Australians are more likely to live in neighbourhoods where the rest of the population is relatively disadvantaged.
More than a third of indigenous Australians (36.6 per cent) live among the most disadvantaged 10 per cent of the population and only 1.7 per cent live among the top 10 per cent.
The paper, by the Australian National University’s Nicholas Biddle, finds that in every area analysed, the Indigenous population had higher levels of socioeconomic disadvantage than the non-indigenous population.
Although disadvantage was generally higher in remote locations, there was wide variation in both urban and remote and regional locations.
The report ranked, in a joint pool, the non-indigenous and indigenous populations of 368 locations around the country based on a socioeconomic measure that incorporated three employment measures, three for education, two for housing and one for income. The non-indigenous and indigenous components of a community were then compared to see whether there was socioeconomic equity.
The average difference was 48.3 percentile places, meaning the non-indigenous population in an area ranked about 48 places (out of 100) higher than the indigenous population in the same area.
The smallest gap between the two populations was in “Sydney — lower north”, where the indigenous population was ranked in the 9th percentile while the non-indigenous population was ranked in the top percentile.
There were three areas where the indigenous population ranked in the 100th (most disadvantaged) percentile while the non-indigenous population ranked in the first (most advantaged percentile): Ramingining-Milingimbi and outstations; Great Sandy Desert; and Kaltukatjara and outstations.
All are in remote Australia, where the gaps between the indigenous and non-indigenous population were greatest.
Between 2006 and 2011, there were eight areas that improved their relative socioeconomic ranking by 20 percentile places or more. Dr Biddle said most of these areas were in remote parts of the country including Bulloo-Quilpie-Barcoo and Nhulunbuy-Gunyangara.
“However, there was also significant improvement in the socioeconomic ranking of the inner suburbs of Darwin,” he said.
There were seven areas that worsened in terms of their socioeconomic rank by 20 percentile places or more.
“The areas that worsened the most tended to be in regional areas, including Atherton in Queensland,” Dr Biddle said. “However, there was also a worsening in the outcomes for the indigenous area of South Perth-Victoria Park.”
Dr Biddle said that possibly the most important finding from the paper was that in every area in Australia, Aborigines had substantially worse outcomes than non-indigenous Australians.
“Indigenous status is only one predictor of disadvantage,” he said.
“However, in every part of Australia indigenous status predicts poorer socioeconomic outcomes and our policy makers, service providers, educators, employers — everyone really — needs to be aware of this.”
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Are you interested in working in Aboriginal health?
NACCHO is the national authority in comprehensive Aboriginal primary health care currently has a wide range of job opportunities in the pipeline.
Australia can break the impasse in combating Aboriginal and Torres Strait Islander disadvantage by identifying and emulating elements of success, instead of constantly focusing on failures to deliver meaningful change.
This is the key finding of a landmark report into the social and emotional wellbeing of Indigenous youth, released at a UNSW research symposium on October 10 2013.
UNSW’s Muru Marri, which looks at Indigenous health and wellbeing, set out to learn from successful public health programs, systematically isolating and analysing the key factors in achieving real progress, to create a blueprint for policy makers, service providers and Indigenous communities.
The work, commissioned by the former Commonwealth Department of Families, Housing, Communities and Indigenous Affairs, includes in-depth case studies, with six outstanding programs across Australia informing the report.
Researchers found the programs shared common processes such as addressing the cause of poverty and other determinants of health as well as current issues; building on the strengths of culture, community and family; using a ‘bottom-up’ approach; and recognising the importance of leadership from Elders.
The report’s lead author, UNSW Associate Professor Melissa Haswell, says the study affirms that programs that authentically embed Aboriginal ways of being and doing could assist youth to achieve profound changes in their life trajectory.
“Based on the evidence in this report, guided by Aboriginal communities themselves, we have to ask ourselves as a society ‘What do we really want for our disadvantaged youth … how committed are we to making appropriate resources available to close the gap in youth opportunity and potential?’” she said.
The Fifth Annual Research Symposium, hosted by the School of Public Health and Community Medicine brings together UNSW, local and international experts on Indigenous public health, including Patricia Anderson, Chairperson of the Lowitja Institute, Professor Michelle Chino, University of Nevada, UNSW’s Professor Lisa Jackson Pulver and other leading researchers from Muru Marri and the School, the Centre for Primary Health Care and Equity, the National Drug and Alcohol Research Centre and the Kirby Institute at UNSW.
Other research topics to be discussed include:
Racism: a public health issue
The social determinants of Indigenous health
A campaign to cut cannabis use among Indigenous young people, the gunja brain story
Sexual health
Aboriginal health and ageing
The social and cultural resilience and emotional wellbeing of Aboriginal mothers in prison
Identification of Aboriginality in general practice
The best way to devise and assess health programs for Indigenous populations
Out thanks to Melissa Sweet for her continued support of NACCHO media
When it comes to improving Indigenous health, what works?
By Lisa Jackson Pulver on behalf of Muru Marri
Given their numbers and the billions of dollars spent on them, it is surprising how little is known in the wider community about the support programs which work in Aboriginal and Torres Strait Islander communities. More important, why they work has rarely been studied.
The report is the result of years of work by Muru Marri at the UNSW at the behest of the former Commonwealth Department of Families, Housing, Communities and Indigenous Affairs.
Too much bureaucratic effort and media attention in Indigenous affairs has focused on the negative: how government programs and policies can fail and why, how resources can be wasted and lives broken. The constant negativity only reinforces the harm being done to Indigenous people.
This report takes the opposite approach. It seeks – at long last, most will say – to identify what exactly makes good programs succeed in supporting and enabling Aboriginal and Torres Strait Islander peoples to thrive and succeed.
Six programs, from Sydney, regional NSW, the Northern Territory, Queensland and South Australia, which have been working successfully for extended periods are analysed in detail, and the factors essential to their success identified.
The report was released on Friday at the University of NSW’s fifth annual symposium on Indigenous health research, Dreaming up the future of Aboriginal and Torres Strait Islander public health.
Associate Professor Melissa Haswell, the report’s lead author, explained the report’s approach: “We already know a lot about negative trajectories that Aboriginal and Torres Strait islander youth are taking.”
But with the programs that work, “what is happening that has helped young people move from the negative to the positive?”
From analysing the six projects, the researchers identified a series of factors critical to success. The projects all did these things – though how they did them sometimes differed in ways appropriate to each one.
The report groups the factors in four concentric layers: from the centre, the way an individual program relates to individual clients, outwards to a program’s sustainability, then to its ability to grow, and last to the outermost layer, the attitude of society as a whole to helping its marginalised members reach their full potential.
Indigenous ways of acting and being are crucial to success.
At the core, for example – the interface between program and client – ten factors are critical to effectiveness. They include:
working from strengths, not seeking to correct deficits
patience in developing a relationship, before using it to move towards positive change
reliability and consistency to build trust
facilitating connections to Aboriginal culture and community, and witnessing examples of Aboriginal leadership
a non-judgmental approach, using mistakes to learn better choices
setting rules and boundaries
allowing scope for choice and exploration
celebrating small achievements and positive changes
fun, creative, enjoyable, inspiring interactions.
Of the four sets of critical factors for success, Melissa Haswell says: ‘You read these and think, “Well, of course.”’
But she says, though they may seem obvious, they can get lost – as the fate of less successful programs shows.
“If we put this list of critical factors first, it will be protected and will guide future programs.”
A keynote address to the symposium from Pat Anderson, chair of the Lowitja Institute, made the case that racism has played a central role in undermining the health system’s performance for Indigenous Australians.
Another keynote speaker, Professor Michelle Chino, from the University of Nevada, Las Vegas, described the health and other challenges facing Native Americans as the result of their history of dispossession and neglect or oppression – challenges which the audience will have recognised only too well from the Australian experience.
My own keynote address covered the many pathways to understanding and progress in Aboriginal and Torres Strait Islander health.
The symposium heard of progress on the Gudaga study – a longitudinal study of Aboriginal children in the Tharawal community in south-western Sydney, which after eight years has now evolved into three separate studies, of crucial importance in understanding the link between early life experience and the transition to school for Indigenous children.
Associate Professor Elizabeth Comino told a seminar session of the lengthy and careful process behind the study – the time taken to win the confidence of the community, involving its members and particularly the mothers participating in the study in decisions about the research.
Other papers covered:
successful programs to increase Indigenous participation in sexual health programs
how well GPs identify the Indigenous status of their patients
Aboriginal child health in cities
the marijuana campaign The gunja brain story
Indigenous and non-Indigenous participation in school studies
the social and cultural resilience and emotional wellbeing of Aboriginal mothers in prison (SCREAM) project
alcohol and drug use among Aboriginal and Torres Strait Islander men in prison
factors influencing access to primary health care for Aboriginal people in contact with the justice system (SPRINT)
Indigenous intervention research, and how it might best be designed
the Koori Growing Old Well Study
the work of the Outback Eye Service
cardiovascular risk among Aboriginal and non-Aboriginal smoking male prisoners.
A panel discussion, chaired by Pat Anderson with five other participants (including this writer) discussed issues facing the Aboriginal and Torres Strait Islander public health workforce.
The list illustrates the strength and the breadth of the research effort now under way into Aboriginal and Torres Strait Islander health at the UNSW. But their impressive variety and wide scope should not divert attention from the truth at their core.
In the papers, in the panel discussion, and in the Social and Emotional Wellbeing report, one theme stood out: the central importance, when researching Aboriginal and Torres Strait Islander phenomena, or devising programs with Aboriginal and Torres Strait Islander people, of valuing, and basing all work on Indigenous ways of learning, knowing and being.
Without that solid foundation, effort and resources will continue to be under-utilised appropriately.
• Professor Lisa Jackson Pulver is Director of Muru Marri Indigenous Health Unit at the University of NSW
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Are you interested in working in Aboriginal health?
NACCHO as the national authority in comprenhesive Aboriginal primary health care currently has a wide range of job opportunities in the pipeline.
Prime Minister Tony Abbott will today announce the appointment of Mr Forrest to run the review which will be required to report back to him by April 7 next year according to reports in NEWS LTD
INDIGENOUS Australians are suffering “the racism of low expectations” about their job prospects, billionaire miner Andrew Forrest has claimed after taking the reins of a review of Federal Government Aboriginal employment programs.
The review will provide recommendations to ensure indigenous training and employment services are run to connect unemployed indigenous people with real and sustainable jobs.
It will also consider ways that training and employment services can better link to the commitment of employers and end the cycle of indigenous disadvantage.
Mr Forrest said that while indigenous Australians “continue to suffer the racism of low expectations”, they could make the greatest social and economic contribution to workplaces and the nation when given the opportunity.
“I am looking forward to hearing from as many people as possible throughout this review, to ensure all successful models of training that lead to employment are fully considered,” he said.
“I have seen in my own company Aboriginal people who have turned their lives around when given the guarantee of a job at the completion of training.”
Mr Abbott said the review delivered on an election commitment and showed his government was committed to boosting job opportunities for indigenous Australians.
“Too often, employment and training programs provide ‘training for training’s sake’ without the practical skills that people need to fill the jobs that exist,” he said.
“It is important that attention be given not just to skills training, but practical life education and ongoing mentoring to make sure jobs are lasting and careers are developed for indigenous Australians.”
Mr Abbott has promised to spend a week every year in an indigenous community as Prime Minister.
Mr Forrest said the review would throw open the books of government funding.
“We cannot measure the impact of labour market interventions without examining them from a systems perspective,” he said.
“By understanding the way they connect, and where the gaps are, we can inform policies that will provide holistic support for indigenous jobseekers so they can add value to the workplace on day one of the job.”
NACCHO JOB OPPORTUNITIES
Are you interested in working in Aboriginal health?
NACCHO as the national authority in comprenhesive Aboriginal primary health care currently has a wide range of job opportunities in the pipeline.
Relationships built on trust, integrity and respect are crucial for effective engagement with Indigenous communities, according to two papers released today on the Closing the Gap Clearinghouse website.
Engaging with Indigenous Australia—exploring the conditions for effective relationships with Aboriginal and Torres Strait Islander communities reviews the evidence on engagement and outlines the conditions required for effective engagement.
The evidence shows that engaging successfully with Indigenous communities requires:
an appreciation of the historical, social, cultural and political complexity of specific Indigenous contexts
active Indigenous participation from the earliest stage of defining the problem to be solved and defining aspirations, through to implementing the program and evaluating the results
long term relationships of trust, respect and honesty, as well as accessible and ongoing communication and clarity about roles and responsibilities
genuine efforts to share power, including through negotiated agreements
clarity about the purpose of and scale for engagement and appropriate timeframes
attention to strengthening governance and capacity within both the Indigenous community and governments themselves, and good leadership
negotiation of clear and agreed outcomes and indicators of success with monitoring and evaluation processes that meet each parties’ needs.
This paper says evidence shows that effective engagement requires strong and strategic Indigenous and government leadership and adequate governance, and that hurried one-off ‘consultations’ that are organised without Indigenous input do not work.
Fragmented arrangements, where each agency tries to engage with the same Indigenous people and organisations, place unnecessarily heavy burdens on Indigenous people.
These findings are consistent with the findings of the second paper, Engagement with Indigenous communities in key sectors. This paper reviews evidence from studies of Indigenous engagement in early childhood services, environmental and natural resource management activities, and health programs at local, regional, state and national levels.
It outlines the common lessons on different levels of engagement from local engagement through to regional, state-wide and national engagement.
The Closing the Gap Clearinghouse is jointly funded by all Australian governments and provides an online source of information on what works to close the gap in Indigenous disadvantage. It is delivered by the Australian Institute of Health and Welfare (AIHW) and the Australian Institute of Family Studies (AIFS).
NACCHO team member Arika Errington’s 10-year journey to become a University of Canberra graduate is a story of true perseverance.
An Aboriginal woman who grew up in Canberra, Ms Errington graduated with a Bachelor of Arts after having been diagnosed with depression and anxiety while studying and moving from Queensland to Tasmania and Melbourne before settling back in Canberra.
“It doesn’t quite feel real, I also feel relieved … it was a rough 10 years of starting, leaving, changing disciplines, illness, and self doubt,” Ms Errington said of graduating in a ceremony at Parliament House on 25 September.
“My aim is to one day be a voice for my people, to teach others about who we are as a community and the oldest living culture on earth … I want to change the assumptions/judgements people automatically make about Aboriginal people rather than judging them on their actions as human beings.”
Arika Errington pictured at her University of Canberra graduation ceremony at Parliament House. Photo: Michelle McAulay
The 29-year-old said she was “proud to even be offered the opportunity” to go to the University, majoring in journalism to follow in the footsteps of her father, William Errington, a former press photographer. Her mother Tjanara Goreng Goreng is an assistant professor at the University’s Ngunnawal Centre, which provides support and education programs for Indigenous students. Ms Errington said she has been inspired by her parents.
“I’m only attending my graduation so my mum and dad can see. I did it all for them, they have given me nothing but love and respect my entire life, whilst dealing with their own personal traumas,” she said.
“My mob are called the Wakka Wakka and Wulli Wulli people from Queensland and I’ve always known my culture growing up, my parents both made sure I knew who I was and where I was from, my mum used to sing me songs in language and I hope one day I’m blessed enough to share those to my children so some of our language can continue.”
Ms Errington moved to Queensland for a while in her teen years before her mother encouraged her to do the Ngunnawal Centre’s foundation program to prepare her to study at the University of Canberra, a program she later ended up teaching in, saying “all I wanted was to help students who were like me succeed”.
Despite calling Canberra home, Ms Errington has moved around a lot in her life, including living in a rainforest at a place called Main Arm Upper in NSW.
“We lived on the land without electricity, running water, and a makeshift toilet out the back, checking myself for leaches and ticks at the end of each day.”
Moving back to Canberra to start her studies, she took a break from university to work in Melbourne for a few years before returning to the University of Canberra, where she spent some time living on campus.
“I had no idea what I wanted to do, but I knew I wanted to finish something I started. I completed a literature class but I was really unhappy (I eventually was diagnosed with depression/anxiety which I didn’t know about at the time) and moved to Tasmania where my mum was working at a university to have a break and be with my family,” she said.
“I then moved to Melbourne in 2005 and started a job, got my own place, and began finding out who I was and who I wanted to be, then in 2006 I woke up one day and decided to leave behind my life in Melbourne, and finish uni.”
Since 2012 she has worked in the National Aboriginal Community Controlled Health Organisation as a project coordinator on the ‘Talking About the Smokes’ research project – designed to help Indigenous people quit smoking – in partnership with Menzies School of Health Research in Darwin.
“I’m extremely grateful to have been given this opportunity because it has helped me grow as a person, and understand my true value, and also I get to show other Aboriginal people how to gather data for our project, the youngest I’ve trained to be a research assistant was 17, and the eldest 72, it’s really helping our communities and mob and showing them that anything is possible, no matter where you live or how old you are, it’s been great seeing different communities, community control at its finest.”
She also recently began a communications officer position with the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM), allowing her to draw on her journalism skills.
“I really respect what CATSINaM does for our people and for the Indigenous health sector and I enjoy being a part of two National Aboriginal and Torres Strait Islander peak bodies.”
She was also recently awarded a scholarship to attend the ‘She Leads’ program run by the YWCA of Canberra in a Diploma of Management with leadership as a main focus.
There are over 155 Aboriginal or Torres Strait Islander students currently studying at the University
NACCHO JOB Opportunities:
Are you interested in working in Aboriginal health?
NACCHO as the national authority in comprenhesive Aboriginal primary health care currently has a wide range of job oppportunities in the pipeline.
“Funding responsibility for most Indigenous health services remains in the Health Department, to be coordinated by a new Indigenous Health Service Delivery Division (which replaces OATSIH).”
As previously noted, in both Croakey and NACCHO Aboriginal Health Alerts there has been a deal of uncertainty about the fate of Indigenous health programs and services administered by the Federal Health Department and the Office of Aboriginal and Torres Strait Islander Health (OATSIH) under the new Federal Government.
While no doubt there are still issues to resolve, at last there is some news – some programs will transfer to the Department of Prime Minister and Cabinet, as outlined below.
But funding responsibility for most Indigenous health services remains in the Health Department, to be coordinated by a new Indigenous Health Service Delivery Division (which replaces OATSIH).
No doubt many will be interested in the prediction that the new arrangements will mean less red tape for service providers.
The departmental statement below has been distributed to the major stakeholders.
“A number of stakeholders have been asking how OATSIH is affected by the Machinery of Government (MoG) changes announced by the Prime Minister recently.
The Prime Minister has indicated that Indigenous affairs will be a significant priority for this Government and has decided to bring together many of the Indigenous policies and programmes under his own Department.
The Health Department has now received clarity on the changes and I am able to confirm that the following programmes or functions will move from Health to the Department of Prime Minister and Cabinet:
A number of strategic policy functions including responsibility for the health performance framework, health expenditure analysis, and life expectancy modelling
Bringing them Home and Expanding Link-up programmes
Combating petrol sniffing–expanding the supply and uptake of low aromatic fuel Indigenous Drug and Alcohol treatment services (including staff working on these programmes in State and Territory Offices)
Stronger Futures NT Mobile Outreach Service Plus
National Sorry Day Committee
Indigenous Sport and Active Recreation Programme currently managed by the Sport Branch (previously in the Department of Regional Australia, Local Government and Sport).
The funding responsibility for the majority of Indigenous health services remains in the Health department, to be coordinated by a new Indigenous Health Service Delivery Division (which replaces OATSIH).
This decision recognises the importance of the critical links between Indigenous health programmes and mainstream health structures.
While there are a number of structural changes required as part of the movement of policies and programmes to PM&C, the key priority for Government is to continue to deliver uninterrupted services to Indigenous people.
It will be business as usual with service providers and funding arrangements during this transition period from both the Health Department and PM&C.
The consolidation of policies and programmes into PM&C will provide significant opportunities, including reducing the red tape burden on service providers.”
Croakey and NACCHO will be interested to hear your response to these changes.
Please leave comments below.
NACCHO JOB Opportunities:
Are you interested in working in Aboriginal health?
NACCHO as the national authority in comprenhesive Aboriginal primary health care currently has a wide range of job oppportunities in the pipeline.
“An Aboriginal community controlled comprehensive primary health care service?
A bloody mouthful of a description, but nonetheless a symbol and practical evidence of what Aboriginal people and their supporters have achieved—and continue to achieve.”
Chips Mackinolty NT Aboriginal health legend (Ex AMSANT)
Photograph by Therese Ritchie
This is a guest post by Chips Mackinolty that was first published, in edited form, in the NT News on 7 September 2013
NACCHO would also like to acknowledge a pay tribute to the support Chips has given NACCHO over the years
After more than 30 years in the Territory, Chips Mackinolty is taking a year off: for “a pre-pension gap year” as he describes it. After all, he says, “gap years are wasted on the young”.
Across most of that time he has worked for organisations which haven’t allowed him to have a public personal opinion. This has included working for Aboriginal organisations, writing as an interstate journalist for both Fairfax and Murdoch, designing for private enterprise clients, and even a stint as a Labor Party ministerial appointee. For the last four years he has worked for the Aboriginal Medical Services Alliance Northern Territory [AMSANT].
Apart from an irreverent political approach in his artwork, which has occasionally been touted by the NT News, Mackinolty has pretty much stayed out of the world of public opinion.
A day after quitting AMSANT, he writes an opinion piece for the NT News on an ongoing commitment: Aboriginal health. It is published on the day of the Federal election, but with no intent to influence votes. In his words, “that’s deliberate: whoever wins the election today must commit to the most successful bipartisan strategy in recent Territory history, closing the gap in Aboriginal health outcomes”. He tells a story that suggests that the Territory is hitting well above its weight.
But it’s not as simple as that, as he tells us.
Four or five years ago I made the decision to pretty much stop going to funerals. Of course since then I have been to many—too many. There came a time when it had got too much, with the vast majority of funerals for Aboriginal people. And the people were dying younger.
It was a difficult decision, for many were from the Katherine region. It might sound peculiar to readers, but Katherine was where I “grew up”. I got there in the early ’80s in my late 20s. An evening of fireworks for the third celebration of Self Government in Darwin then, bizarrely a day or so later for the final shoot in Mataranka of We of the never never with Aboriginal artists I then spent the next four years with.
But nevertheless it was a town, at that age, in which I “grew up”. Whatever I thought I had learnt on the streets of inner city Sydney were, frankly, SFA when it came to the Territory.
Most of that learning was with Aboriginal people across an area greater than Victoria: from Borroloola to Elliot; to Lajamanu and Kalkarindji and west to the Kimberley: Halls Creek, Kununurra and Wyndham. And then across via Timber Creek to Bulman, Numbulwar and Angurugu, south through Numbulwar to Ngukurr and back up through Jilkminggan, Barunga, Manyallaluk and Wugularr. It was an astonishing education in land, language and law. But it was a period I spent far too much time learning about death: the death of the artists I worked with, their families, and their children.
But I also learnt from whitefellas in Katherine: from the legendary Judy King and John Fletcher; from Francesca Merlan, Paul Josif, Mick Dodson and Toni Bauman, to Anne and John Shepherd and John O’Brien.
In different ways they, and many others, all taught me about living in the Territory.
In the late 1990s the CEO of the Jawoyn Association, the late Bangardi Lee, recruited me, Jawoyn woman Irene Fisher and Dr Ben Bartlett to put together a seemingly endless series of submissions that resulted—some years later—in the establishment of the Sunrise Health Service: an Aboriginal community controlled comprehensive primary health care service.
An Aboriginal community controlled comprehensive primary health care service? A bloody mouthful of a description, but nonetheless a symbol and practical evidence of what Aboriginal people and their supporters have achieved—and continue to achieve.
Across the NT, from remote clinics such as that run by the Pintupi Homelands Health Service to Danila Dilba in Darwin, the Aboriginal community controlled primary health sector serves roughly half our Aboriginal population, the rest through NT Government health services.
Over time, the process of privatising into the community controlled health sector will increase as services are devolved from government. It’s not been an easy process—and slower than many of us want. Nevertheless, it has had bipartisan support federally and locally for more than a decade. Famously, former CLP health minister Steve Dunham “rescued” the Sunrise Health Service in its early development stage when it met resistance from some health bureaucrats. His intervention saved what is now one of the NT’s great success stories.
The evidence, internationally, nationally and locally is that community controlled primary health care is more efficient and effective in delivering the goods.
According to recent data produced by COAG, the Northern Territory is the only jurisdiction in Australia on track to meet the closing the gap target of reducing the difference in life expectancy between Aboriginal and non-Aboriginal people. This is a good news story that has been barely reported in the NT outside the pages of this newspaper.
There are a number of reasons for this success. The last decade has seen a dramatic rise in hospital spending; more importantly greater resources have been distributed more equitably to the bush. The increased resources to primary health care through the Intervention, now known as Stronger Futures, has been a prime reason this has been possible.
But we are also doing it better—and in many instances better than anywhere else in the nation. For example, childhood immunisation rates in the community controlled sector is better than in many affluent suburbs down South.
And we are doing it smarter: led by the Aboriginal community controlled health sector, there has been an increased use of electronic data collection and analysis. Clinical Information Systems are used at the individual patient level to keep up-to-date, easily accessible health histories, as well as to alert clinicians to possible allergies, and efficiently prompt clinics to recall patients for regular checks as well as follow ups.
The data analysed can be tailored by individual health services, but all clinics in the NT now contribute the to Northern Territory Aboriginal Health Key Performance Indicators, which have a commonly shared set of clinical measures. Access to this data is strongly protected through privacy protocols.
The big picture of this is the capacity for these systems to allow for public health data to be analysed at a community and regional level, and for subsequent follow up. For example, a regular system of patient interaction through Child and Adult Health Checks has the capacity to identify “spikes” in particular conditions such as childhood and maternal anemia or otitis media in children.
This not only keeps an individual clinic alert to changes in local health, but also in ways to respond. This is achieved through a process called Continuous Quality Improvement [CQI], and is carried out by all clinicians at a service and the data collected is a key part of this process. For example, with otitis media it will guide individual treatment (are we always checking following the national guidelines? what evidence-based treatments are we giving? are we referring the patients to specialist diagnosis and care?), but also to the community as a whole (are we working with the council, school and families? what sort of other public health campaigns might we undertake?)
At regional level this data can be very powerful. As well as the regional Aboriginal Community Controlled Health Services we already have, such as Katherine West Health Board and the Sunrise Health Service, other regions are now working together through Clinical and Public Health Advisory Groups [CPHAGs]. The CPAHGS meet regularly and work cooperatively to share experiences and data, and ways to do things better. Some have identified particular regional health problems which would otherwise might be “lost” in large scale data bases.
The Northern Territory is the first jurisdiction in Australia in which all remote clinics now have electronic health records for their patients.
Further to this, our sector, along with government clinics, has pioneered the idea of a “shared electronic health record”. Over half the Aboriginal people in the NT have signed up to such a record, and we are in the process of readying the system so as to be part of a national network. This allows, with full permission from the patient or carer at every consultation to update their health record to a data base that can then be accessed by other clinics and hospitals. For example, a patient at Ngukurr may fall ill at another community, and get the appropriate treatment through their shared electronic health record. A hospitalisation will allow the clinicians to see someone’s record, know what medications they are on, and past conditions. After discharge from hospital, the health records are updated, and an electronic discharge summary is available to the home clinic.
These and many other innovations are behind the improved statistics—but there is a long way to go. It’s a welcome trend—but the good results will flatten out and perhaps reverse if we do not tackle the other social determinants of health. These include housing, education, early childhood development, substance abuse, food security, incarceration rates and social exclusion. It is reckoned that health services alone will only be able to deal with about 25 per cent of “the gap”: the rest is down to the other social determinants.
And that’s where governments of all stripes come in, and where the need for truly bipartisan approaches must prevail. Whatever the result of today’s election, Aboriginal health remains the Territory’s major challenge. Aboriginal children yet to be born will benefit if only our politicians are working, in the words of the AMSANT slogan, “together for our health”.
TONY Abbott announced a $5 million funding commitment to the Jawun Empowered Communities Initiative in Sydney yesterday backing a radical plan devised by indigenous leader Noel Pearson to improve governance in indigenous communities.
Mr Abbott declared, in the announcement, that “the first priority of an incoming Coalition government in this area will be to get the kids to school, parents into work and the ordinary law of the land being observed
Here is Tony Abbotts speech in full
Thanks very much Noel and thanks everyone. Thanks Shane for the welcome. This is a very significant gathering. Shane alluded to the fact that on the 26 th of January 1788, not far from here, modern Australia had its formal beginnings. A lot has gone right.
Some things have gone wrong.
But as we all know, modern Australia never quite got right the relationship with the First Australians and what’s happening here today is an important new beginning which accepts our history, which accepts the good and the bad in the past but which tries to build a better future with the Indigenous people and the rest of our community, opening our hearts to each other in a way that we haven’t always been able to do in the previous 200-odd years of our national existence.
So I am very honoured to be here and I was thrilled to put my signature on the Jawun Declaration underneath that of Jenny Macklin because it is important that we try to go forward together on something as important as this. It’s always a real thrill to be in the company of my friend Noel Pearson.
Noel and my relationship didn’t really get off to an auspicious beginning. It was back in 1998. Noel didn’t know me and I hadn’t met him. But I went to a very, very rowdy public meeting at Mosman in my electorate at the Mosman RSL and I could hardly get in. I hadn’t actually been invited as such because it was a meeting that was, frankly, pretty hostile to the Howard Government in which I was then a Parliamentary Secretary.
There were a series of speakers and the last speaker was Noel and Noel made an extraordinary, extraordinary oration. The first two-thirds of it was brilliant and I agreed with every word of it.
The last third of it was brilliant and I had a bit of trouble with it because he concluded with the phrase, “Let us get rid of this putrid government.”
I’m not going to adapt that phrase for any current purposes, but Noel – it was a very, very powerful affirmation of the need for change and it was a very powerful assault on a Government which, at that stage of its life, was still feeling its way forward when it came to Indigenous issues. Now, I’m pleased to say that, led by the former Prime Minister John Howard, we did grow very considerably in the years after 1998 and it was in fact, no less a person than the then Prime Minister who again proposed Indigenous recognition in the Constitution not long before the 2007 election.
But I concluded on that particular night in Mosman Town Hall that Noel Pearson was a person of enormous substance, great charisma and very possibly a prophet for our time and I decided that I would do my best to get to know this man and I would do my best, where I could, to work with this man and see what we could do together.
So, a couple of years later, I was in Mossman in far north Queensland on my first trip to Cape York as Minister for Employment and Minister with whole of Government responsibility for Cape York and I went into the back of a meeting of the Mossman Community Centre about half the people in that room were whitefellas, about half the people in that room were blackfellas – about 200, 300 people and Noel took to the stage.
And again it was an extraordinarily powerful presentation delivered without a note, and Noel said, look sure we were ripped off sure this was our country and it was taken away and yes we feel bad about that and yes there was an injustice about it and we should always fight for justice we should always fight for recognition but we have got to fight to live in the country that we have we have to be able live and work in Australia as it is not as it might have been but as it is, and it was a very bracing and powerful message. And I could tell that while some people in the room were warming to Noel – not everyone was
I first discovered in my own life how prophets don’t always have universal honour in their own country because why Noel was from that country, was well known from early childhood to many of the people there – not everyone agreed.
But that is the lot of someone who proposes change that is the lot of a real leader. Sometimes people who should be their best friends are not their best friends and this is the loneliness and difficulty of true leadership, and I won’t to congratulate Noel for being prepared to set out on that very lonely path which he was well and truly embarked upon back in those days.
So, throughout that period in government I stayed in close contact with Noel, made trips to the Cape, camped out on at least on occasion with the boys from the bush, Noel and we spent a couple of days trying to harvest tea tree leaves for our friend Milton to turn into tea tree oil. And then of course we lost the election and I found myself unexpectedly the Shadow Minister for Indigenous Affairs.
I rang Noel in the February of 2008 and said look mate in the years since I have been in Parliament I have visited dozens of Aboriginal Communities but I have never spent more than 18 hours at a time in one – in my judgment the key problem this whole area is not lack of good will, not lack of spending, but lack of involvement and engagement at a personal level and please would it be possible for me to spend some significant time and be useful, not just a glorified tourist, so in 2008 I was a teacher’s aide for three weeks at the school in Coen.
In 2009 I was a truancy assistant for 10 days at the school in Aurukun, an election happened in 2010 and wasn’t able to get up to Cape York then. In 2011 I spent three or four days in and around Hopevale doing the bush building program. In 2012 quite a few people of great prominence went to Aurukun and we did the books and mortar project to refurbish the library for four days, and it is my commitment that as long as my public life lasts,
I will spend a week in an Indigenous community because if it is good enough for Australians to live in it should be good enough for a Prime Minister to stay in, and it should be good enough for members of the Government to be there too. But one of the things that I became acutely conscious of with growing force through that period of Government and then over the last few years in Opposition, is this whole issue of governance in remote Indigenous communities in particular.
Aurukun is a village of about 1,500 people and there must be over 100 governmental, semi-governmental and non-governmental organisations working there, all doing in their own way an excellent job, but often tripping over each other and the poor people spend their whole life going to meetings rather than getting on with their life.
One of the shining examples of doing things differently, however, was the Family Responsibilities Commission which was working there and in three other Cape York communities thanks to the work of Noel and the Cape York Institute.
As most of you would know, this is an entity established to take charge of the welfare reform process, where a respected former magistrate advised by respected local elders, makes binding decisions on a consensus basis about what should happen to the welfare entitlements of people who, for various reasons, are not quite hitting the mark in terms of observing their responsibilities to their friends, their neighbours and their families.
And I thought to myself, “This is a very powerful lesson which, may well have applicability in other places around Australia.” I think it’s great that this Jawun process is now looking at how the lessons of Cape York and elsewhere might usefully be applied to governance more generally in the remote parts of our country.
It’s terrific to have a very geographically disparate group of people here today and it’s really encouraging to new consensus on display here today from Indigenous leaders from right around our country, different generations, the new consensus that we have to move forward in a different way. And that we need to take
responsibility for our lives. The kids need to go to school. The adults need to go to work. The ordinary law of the land needs to be respected. If all of that happens, then the oldest living cultures on this earth have a fighting chance of survival, but there is no serious chance of survival, if the people who live the life fall into this pit of despair, this pit of hopelessness, which has for so many people beckoned over the last couple of generations.
So, I think this is a very encouraging development today. I’m very blessed because over the last few years, I have become friendly with some really outstanding Indigenous people – Noel, Warren Mundine who is here today, Alison Anderson who has done such remarkable work in the Northern Territory – and as I tried to say in my talk at Garma a couple of weeks ago, I do believe that the only future for this country, is a future where black and white Australians walk forward together arm in arm.
That’s the future for our country.
I think there is a better prospect of that happening now than at any previous time in our national existence. There has been so much dirty water under the bridge. There have been so many disappointments. There have been so many false starts and yet we have made progress, progress is undeniable, but now let’s try to accelerate it, let’s try to do so much better in the next five years than we have in the last fifty.
I think we can do it. I think we can do it. I dedicate myself to working with you to try to bring this about.
