Associate Professor Ted Wilkes, Chair of the National Indigenous Drug and Alcohol Committee (NIDAC), (pictured above right ) extends an invitation to people involved in addressing harmful alcohol and other drug use by Aboriginal and Torres Strait Islander Peoples to attend one of the following consultations that are being held to inform the development of the National Aboriginal and Torres Strait Islander Peoples Drug Strategy (NATSIPDS):
NACCHO is a member of NIDAC
Port Augusta, SA
Mon 20 May
10.00am – 1.00pm
By COB Wed 15 May
Tues 21 May
1.00pm – 4.00pm
By COB Wed 15 May
Mt Isa, QLD
Thurs 23 May
10.00am – 1.00pm
By COB Wed 15 May
Mon 27 May
10.00am – 1.00pm
By COB Wed 22 May
Tues 28 May
10.00am – 1.00pm
By COB Wed 22 May
Alice Springs, NT
Thurs 30 May
10.00am – 1.00pm
By COB Wed 22 May
NIDAC has been engaged by the Intergovernmental Committee on Drugs National Aboriginal and Torres Strait Islander Peoples Drug Strategy (NATSIPDS) Working Group to undertake consultations in six locations in Australia to inform the development of the NATSIPDS.
The NATSIPDS will replace the current Aboriginal and Torres Strait Islander Peoples Complementary Action Plan and will be a sub strategy of the National Drug Strategy.
If you are involved in minimising the harm of alcohol and other drug use on Aboriginal and Torres Strait Islander people and their communities this is your chance to have your voice heard in the development of this important document.
A report containing the major findings and a summary of the key themes from the consultations will be provided to the NATSIPDS Working Group after the consultations have been completed.
A Background Paper which will provide context and guidance for the consultations will be available from the NIDAC website prior to the consultations being held.
As the leading voice in Aboriginal and Torres Strait Islander alcohol and drug policy advice, NIDAC provides advice to the government, based on its collective expertise and knowledge from those working in the field, health professionals and other relevant experts.
Please feel free to forward this invitation to other relevant people.
Please RSVP by the specified date for your location at:
The Australian Government has announced $777 million to fund its share of a renewed National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes for a further three years to 30 June 2016.
This funding will ensure indigenous Australians continue to benefit from improved health services and support our commitment to close the gap on indigenous disadvantage.
In particular, our health funding will help us achieve our commitment to close the gap in life expectancy between indigenous and non-indigenous Australians within a generation, and to halve the gap in mortality rates for indigenous children under five within a decade.
The Australian Government will ask the States and Territories to also continue their investment to renew the National Partnership Agreement.
Under the current National Partnership Agreement, due to expire on 30 June 2013, governments provided $1.58 billion over four years to improve access to health services for indigenous families and communities.
The Australian Government provided $805.5 million over four years for this initial agreement.
Our renewed funding of $777 million over three years is an increase over previous per annum expenditure.
The Australian Government will continue to work with indigenous people and health services as we implement the renewed agreement.
As a result of our investments in indigenous health, we are seeing improvements.
This year’s Closing the Gap report showed that local health services were helping to lead a comprehensive approach to chronic disease management, encouraging people to undergo health checks and follow ups.
In 2011-12, 65,501 health assessments were provided to Aboriginal and Torres Strait Islander people aged 15 and over, a 34 per cent increase from 2010-11.
There are also more primary care workers in indigenous and mainstream health services to help meet the increase the uptake of health services by indigenous people.
While this work is encouraging we know there is more to be done.
We need sustained investment and effort to continue the momentum and ensure continued progress.
The renewed NPA will complement the proposed National Aboriginal and Torres Strait Islander Health Plan which has been the subject of extensive stakeholder consultations over the last several months.
Closing the gap now in the hands of state and territory governments
See Page 5 todays April 18 The Australian for the CTG/NACCHO campaign half page ad
The National Community Controlled Health Organisation (NACCHO) today welcomed the Gillard Government’s commitment to the National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes and called on state and territory leaders to urgently do the same.
According to AAP reports this morning Prime Minister Julia Gillard will announce that the federal contribution for a renewed deal will be $777 million until June 2016.
Ms Gillard will ask the states and territory government to chip in the remainder, although the issue will not be on the agenda of the Council of Australian Governments (COAG) meeting on Friday.
“As a result of our investments in indigenous health, we are seeing improvements,” Ms Gillard said in a statement.
“We know there is more to be done.”
The original national partnership deal struck in 2008 was worth $1.58 billion over four years and the federal contribution was $805.5 million.
Ms Gillard said the renewed federal contribution would be an increase over previous per annum expenditure.
Following former prime minister Kevin Rudd’s apology to the stolen generations in 2008, federal, state and territory governments agreed on six ambitious Close the Gap targets to tackle indigenous disadvantage.
NACCHO Chair, Justin Mohamed said the National Partnership Agreement was due to expire at the end of June, putting critical Aboriginal health programs at risk.
“Improving the appalling state of Aboriginal health must be a priority for all levels of government and Aboriginal people will be relieved to finally have a commitment from the Gillard Government today.
“The pressure is now squarely on the states and territories as signatories of the 2008 Close the GapStatement of Intent in which they committed to work together to close the disgraceful seventeen year gap in life expectancy between Aboriginal and non-Aboriginal Australians by 2030.
“The states and territories need to uphold their commitment to this important goal and sign up to continue the National Partnership Agreement which is due to expire in less than two months.”
Mr Mohamed said it was imperative the Agreement was given priority at the COAG meeting tomorrow.
“Improving Aboriginal health is not a quick fix – it requires a long-term commitment above party politics.
“This is not just a matter for the Federal Government. It has been proven that only by all levels of government working together will we see improvements in Aboriginal health.
“There have been five years of good work on Closing the Gap programs and must maintain the momentum.
“We must maintain our commitment and build on the inroads the 150 Aboriginal community controlled health organisations (ACCHOs) are making in their communities.
“Aboriginal comprehensive primary health care provided by Aboriginal communities is the key to making a difference to Aboriginal health outcomes.”
Mr Mohamed said the Federal Government’s ongoing commitment to Aboriginal health in a challenging fiscal environment was a testament to many in the sector who had worked tirelessly to keep Aboriginal health on the national agenda.
Press release from the CTG campaign group
Aboriginal and Torres Strait Islander health must be placed on the agenda for this Friday’s COAG meeting if there is to be any hope of closing the life expectancy gap by 2030, the Close the Gap Campaign said today.
“Five years ago all sides of politics agreed to do something about the national disgrace that sees Aboriginal and Torres Strait Islander people die more than 10 years younger than the broader Australian community,” Campaign Co- Chair Mick Gooda said.
“While the 2008 COAG meeting saw federal, state and territory governments commit to long term funding for services and programs though the National Partnership Agreement, Aboriginal and Torres Strait Islander health is absent from this Friday’s COAG meeting agenda.
“We know that the policies and programs resulting from these 2008 COAG commitments are starting to bear fruit and make a real difference on the ground, for example, mortality rates for under five year old Aboriginal and Torres Strait Islander children are falling,” he said.
“But the life expectancy gap remains just as unacceptable today as it was back then and I know that most of those attending COAG this Friday agree with me,” Mr Gooda said.
The National Partnership Agreement which has driven efforts to close the gap in Aboriginal and Torres Strait Islander health outcomes is set to expire at the end of June 2013. Despite Federal Government indications that it will continue funding its share of the Agreement, State and Territory governments have not yet signed up to the Agreement leaving some services and programs in real doubt as to whether they can continue to provide badly needed services beyond 30 June.
Campaign Co Chair Jody Broun said governments of all persuasions owed it to the rest of the country to maintain their efforts to close the life expectancy gap by 2030.
“There’s no doubt that nothing short of ongoing funding and commitment to working with Aboriginal and Torres Strait Islander peoples from all levels of government is what’s needed to keep on track,” Ms Broun said.
“State, territory and federal governments need to continue working together to fund more services and programs that make a real difference to health outcomes for Aboriginal and Torres Strait Islander peoples.
“We have to maintain our efforts to improve access to critical chronic disease services and to deliver anti-smoking measures, more affordable medicines and healthy lifestyle programs. We need to support and build capacity in our Aboriginal Community Controlled Health Services and we need to build on the inroads already made by our child and maternal health services,” she said.
“We need more Aboriginal health workers, allied health professionals, doctors, nurses and health promotion workers.
“A recommitment from state, territory and federal governments at this Friday’s COAG meeting is needed to quite literally save lives.”
Who is the CLOSE the Gap campaign mob
Australia’s peak Aboriginal and Torres Strait Islander and non-Indigenous health bodies, health professional bodies and human rights organisations operate the Close the Gap Campaign.
The Campaign’s goal is to raise the health and life expectancy of Aboriginal and Torres Strait Islander peoples to that of the non-Indigenous population within a generation : to close the gap by 2030.
It aims to do this through the implementation of a human rights based approach set out in the Aboriginal and Torres Strait Islander Social Justice Commissioner’s Social Justice Report 2005.
The Campaign’s Steering Committee first met in March 2006. Our patrons, Catherine Freeman OAM and Ian Thorpe OAM launched the campaign in April 2007. To date 176,000 Australians have formally pledged their support. In August 2010 and 2011, the National Rugby League dedicated an annual round of matches as a Close the Gap round, reaching around 3 million Australians per round. 840 community events involving 130,000 Australians were held on National Close the Gap Day in 2011.
How can you ask your state Premier or territory Chief Minister to support Close the Gap?
All Australian governments have committed to Close the Gap through the COAG process and the National Indigenous Reform Agreement.
The development of the Closing the Gap policy platform to back up this commitment set the foundations to meet this generational target.Ask your State Premier or Chief Minister to publicly commit to renewing investment in Aboriginal and Torres Strait Islander health equality.
AMA COAG Must make ‘Closing the Gap’ a National Priority
AMA President, Dr Steve Hambleton, said today that it would be a disgrace if the long-term health needs of Aboriginal people and Torres Strait Islanders were not discussed at this Friday’s Council of Australian Governments (COAG) meeting in Canberra.
Dr Hambleton said it would be irresponsible if Australia’s political leaders came away from the meeting without an agreement to continue long-term funding for the COAG National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes.
“Closing the gap and achieving health equality between Aboriginal people and Torres Strait Islanders and other Australians must be a priority for all our governments,” Dr Hambleton said.
“It is a worthy goal that requires long-term funding and genuine political commitment.
“It requires action, not just words.
“Five years ago, our governments signed up in good faith to the National Partnership Agreement, and it has delivered some positive health outcomes.
“Now is not the time to be complacent – we must build on these good results.
“The current Agreement expires in a matter of months.
“We are calling on COAG leaders to this Friday agree to the long-term continuation of the National Partnership Agreement with at least the same level of funding for another five years initially.
“This would send a very strong message to the community that our governments are serious about closing the gap,” Dr Hambleton said.
Since 2008, the Agreement has achieved a number of successes in improving Indigenous health and wellbeing, including:
being on track to halve the mortality rates for children under five;
significantly increasing Aboriginal and Torres Strait Islander peoples’ access to health services for chronic disease – which underlies much of the gap in health outcomes;
having work underway in partnership with Aboriginal and Torres Strait Islander peoples to develop a long term health plan; and
meeting the target for early childhood education access in remote communities.
Over the past few weeks, authorities have released a number of reports about the performance and expenditure of our national health system, and some of these relate directly to efforts aimed at improving the health of Aboriginal and Torres Strait Islander people.
This might seem a good thing on face value, as we need to know whether our efforts are making any difference, and where to direct resources in future to ensure ongoing outcomes.
But if this information is used without the appropriate context, it may be used as a means of reducing expenditure on Aboriginal and Torres Strait Islander health, in the name of creating ”efficiencies”.
This presents a significant risk for Aboriginal and Torres Strait Islander communities, as we continue efforts in improving the health of our people, while remaining at the whim of Ministers and government officials who rely on this information to determine policy priorities and resource investments.
What is needed now is for governments to re-think how we analyse, interpret and use data to inform ongoing priorities, practice and future innovation.
This report clearly demonstrated that the most significant gains in access to care and improvement of outcomes is and continues to be achieved through the national network of community controlled health services.
Upward of 75% of health improvements outlined in the report were directly attributed to the community controlled sector, and clearly justifies the increased investment into community controlled services as the most appropriate provider of healthcare for Indigenous people as they are making the best health gains.
Secondly, let’s consider the most recent Indigenous Expenditure report of 2012 produced by the Productivity Commission, that averages overall Medicare expenditure on Indigenous people as 60 cents in the dollar compared to the rest of the Australian population.
As many readers would be aware, Medicare was created as a safety net to ensure that all Australians get access to required care and benefits through quality primary health care services.
With community controlled services focused on providing comprehensive primary health care to our people, efforts in increasing access to an individual’s entitlements through Medicare can and will be best achieved by our organisations.
In spite of this data, we now have more recent releases stating the overall expenditure of the National health budget is 1.5 times greater for Indigenous people than the broader population.
Additionally, we have received further datastating that mortality rates for certain illnesses are only reducing by slight amounts and chronic diseases are still high placing burden upon the public health system.
Although much of this information is already 2 years old by the time it is released, it fails to identify why much of the burden is borne by secondary and tertiary public health systems, as access to comprehensive primary health care is still limited for our people nationally.
Consequently, when you don’t have access to quality primary health care, many of our people will present at secondary and tertiary facilities when their issues have escalated to a point where hospital is the last resort, requiring treatment for not only one health condition, but generally 2 or 3 issues.
Even though we have over 150 community controlled organisations across the country, our services do not exist in every corner of the nation, and fundamentally this would be impossible to achieve without enormous costs involved.
Alternatively, what we should be aiming to achieve is to have a strong community controlled presence providing quality care to our communities in all areas with populations greater than 900 residents focused on increasing access to comprehensive primary health care.
Why primary health care? Current and historical research by credible researchers have proven that the most effective means of delivering care and improving outcomes for Indigenous people is through community controlled services.
Health economists such as Professor Theo Vos and colleagues identified this in their work in assessing cost effectiveness of primary prevention activities across all health providers. This work clearly highlighted that compared with government-run, mainstream and private services, community controlled organisations achieve close to 50% better outcomes than other providers in delivering care to our own people.
Although this method was documented to be more expensive than other models, the focus on outcomes should not be lost, as the only variable included in his analysis that increased the overall expenditure against the model was transportation services for clients.
Due to the implementation of a comprehensive primary health care model, transport services are a core component and will always be included within the community controlled delivery of care, which does not diminish the model but does and will continue to achieve far greater outcomes.
Unfortunately, the notion of ‘If you build it he will come..’ only works for Kevin Costner in the movies, and does not work to improve health outcomes for our people.
With all this data now publicly available for all to review and analyse, we must hope that in determining future policy and funding priorities for Indigenous health care, consideration is given to understanding the context and reliablity of the information.
Importantly, there already exists some credible evidence that encapsulates comprehensive primary health care delivery into a set of core functions. This research was conducted and undertaken as a partnership between all healthcare providers, and should be the central component of any current and future policy debate about improving the health of Indigenous people, as it is widely accepted within the community controlled sector as the gold-standard in health service delivery for our people.
This work is the Core Functions of Primary Health Care in the Northern Territory, and with minimal adjustments to ensure local contexts are considered can and is applicable across all parts of the country. Utilising the Core Functions as a means to support improving outcomes goes a long way to encapsulate high quality service delivery standards with current data and information to ensure that we are all targeting the right priorities, through appropriate mechanisms.
This was not evident at start of the COAG investment to support overall Indigenous improvements, which saw over 65% of the entire $1.6B commitment channelled into mainstream and government-run service providers, as it was determined the most effective way to improve outcomes. Data was used showing that 70% of our people access care through government-run and mainstream services.
New data and information available now rebuts this myth that community controlled services have struggled with over the last 4 years.
Information now available within the community controlled sector shows that over 40% of Indigenous Queenslanders access care regularly through community controlled services, yet we are not in every part of the state.
With the end of the current Indigenous Health National Partnership Agreement set for 30 June 2013, we need to ensure that all of the relevant information and context is considered as part of ongoing discussions, policy setting and resource allocations to improve the health of our people.
Consequently, we are confident that this evidence will lead to what we have been seeking for many years – an increased investment in those services known to make a difference to the health of our people. That is community controlled organisations.
He is the former and founding editor of the National Indigenous Times, and Tracker magazine. He’s a freelance writer based in Sydney
Gillard is wrong, bans won’t stop those ‘rivers of grog’
There’s no question grog kills a lot of Aboriginal people and destroys a lot of Aboriginal lives. But for all the damage grog can do to an Aboriginal community, it’s nothing compared to the damage wrought by politics.
Earlier this week, Prime Minister Julia Gillard delivered her “closing the gap speech on indigenous disadvantage.
After the declaring that the gap was closing (it isn’t), she lined up conservative governments in Queensland and the Northern Territory over their moves against alcohol bans: “I have a real fear that the rivers of grog that wreaked such havoc among indigenous communities are starting to flow once again.”
I’m not sure where Gillard has been spending her time recently, but I do recall her visiting Alice Springs last year. So what did she see?
The rivers of grog in the Territory have never dried up. At best, you could say they’ve changed course slightly. In the first six months of 2010, the Substance Abuse Intelligence Desk (an initiative of the Northern Territory intervention) reported seizing 404 litres of alcohol from Aboriginal communities.
By July 2011 that figure increased 1233 litres, climbing to 1445 by the end of the year. This is four years AFTER government intervention and grog bans. At the same time, alcohol infractions went through the roof.
The bi-annual intervention monitoring report concedes that in 2007, there were 1784 “alcohol related incidents”; by 2011 it was 4101. Alcohol-related domestic violence incidents also rose, from 387 in 2007 to 1109 in 2011.
The federal government likes to claim the increase in crime statistics is a result of more police. So, more coppers, more reporting. Yet while assault rates have more than doubled since 2007, the number of lodgements (charges that flow from an incident) is virtually the same in 2011 as in 2008 (548 in 2011 versus 537 in 2008).
The federal government also likes to claim the policies of the Northern Territory intervention need time to bite. After all, it’s only been five years.
Fortuitously, we have more than a decade of grog bans in Cape York on which to judge (the statistics I’ve used are assault rates, because proponents of grog bans routinely use them to justify banning alcohol). During 2000/01, the assault rate in Cape York communities was almost three times the state average (at a rate of 1419 assaults per 100,000 people). In 2001/02, the rate dropped to 1382. The following year, it dropped to 1216.
Enter the Beattie government, and a new policy of alcohol management plans, or AMPs. Over the next two years, the drop in assault rates slowed dramatically, then plateaued. Within two years, it jumped substantially, and then slowly climbed its way back down.
The net result was that after a decade of grog bans, assault rates in Cape York reduced by 15% — the same drop that occurred in the two years prior to grog bans. Why? Beyond the fact that grog bans don’t work, no one really knows. But know assault rates in Cape York — while certainly much higher than the state average — mirrored almost precisely the rise and falls of assault rates across Queensland. And you could hardly suggest that’s a dry community.
Government-imposed grog bans don’t work. Indeed, they’ve never worked. Not for Aboriginal people, not for non-Aboriginal people. All grog bans do is frame a behaviour that should be treated as a health problem as a law and order issue. Which of course helps fill our jails.
In Cape York in 2000/01, prior to the grog bans, “liquor offence rates” — which include illegal possession of alcohol — were at 142 per 100,000 people. By 2009/10 they’d increased more than seven fold to 1087, and “good order” offences also increased markedly over the same period.
“Aboriginal communities have the governance and the capacity to make their own decisions … The days of grand pronouncements from the ivory towers of Canberra must end.”
So grog bans had no real impact on assault rates on Cape York, but they were a raging success in the criminalisation of Aboriginal drinkers.
So there’s the facts, now back to the politics. The CLP’s motivation to drop the grog bans in the NT is one part “they don’t work” and nine parts “voters in Alice Springs — home to four CLP seats — are sick and tired of Aboriginal drinkers pouring into town to escape grog bans on their communities”.
Whatever their motivation, the CLP’s opposition to broad-brush grog bans across whole swathes of the Territory is the right policy. With one caveat. The CLP has abolished the banned drinkers register, drawing the ire of the Prime Minister. ”Since it was pulled down by the Country Liberal Party… we’re hearing worrying reports about the rise in admissions in the emergency department at Alice Springs Hospital due to alcohol-related accidents and abuse,” she said.
I don’t consider “we’re hearing worrying reports” to be an evidence-based discussion. If our Prime Minister is going to defend a policy, she should work in some hard stats. Even so, there is strong support for the banned drinkers register in Alice Springs.
Unlike blanket grog bans across communities, the BDR is a small, manageable policy. It targets individuals who are repeat offenders and have significant drinking problems, as opposed to targeting a whole race of people based on the colour of their skin.
Dr John Boffa, an Alice Springs doctor who has worked in Aboriginal health for 20 years, defends the BDR: “This is one strategy that’s working. And we’ve got the highest alcohol-related harm in Australia. It’s not acceptable to not implement all possible measures that we know are having an effect.”
Which brings me back to the politics. If all politics are local, then why is all policy created in Canberra? The solution to these problems lie in the communities where the drinking occurs. Many communities later targeted by the intervention were already dry, courtesy of local decision-making.
With support, Aboriginal communities have the governance and the capacity to make their own decisions. In Queensland, that’s where the Newman government is heading, to their enormous credit. And it’s what Gillard rails against. What Campbell Newman has apparently realised is that control of Aboriginal lives needs to be put into the hands of Aboriginal people. The days of grand pronouncements from the ivory towers of Canberra must end.
Gillard said: “The government will take action in response to any irresponsible policy changes that threaten to forfeit our hard-won gains.” Great news. And does the same government have the courage to take action in response to its own irresponsible policies which have been shown time and again to fail?
*Chris Graham is the former and founding editor of the National Indigenous Times, and Tracker magazine. He’s a freelance writer based in Sydney
Pictured above Selwyn Button, CEO of the Queensland Aboriginal and Islander Health Council (QAIHC),one of the key speakers at the NACCHO AGM members meeting 2012 in Brisbane where the theme was “Our business,Our way- Governance”
In the article below, Selwyn argues that the focus of government reporting requirements should shift to looking at outcomes rather than inputs He also argues that real health service improvement will be driven by communities themselves, rather than by government contracts.
The priority should be to build and develop “the capacity of our communities to ask the hard questions of their local organisations,” he says.
Our communities will drive health service reform better than input-focused government contracts
Selwyn Button writes:
Over the past 12 months, community controlled services across the country have entered into new contractual relationships with major funding bodies, predominantly the Federal Health Department, to support the improvement of health outcomes for Aboriginal and Torres Strait Islander people across the country.
Through this process we have seen significant new investment in community controlled service delivery, which is a welcome move, whilst also ensuring that organisations remain accountable to government for the resources they received through a range of new reporting measures, streamlined into a single agreement.
This was a major recommendation from the Overburden Report, compiled by Professor Judith Dwyer and her colleagues in 2009, that sought to make sense of complexities in funding arrangements for community controlled organisations, to support greater focus on service delivery as opposed to administration and compliance.
Finally, governments had started to listen to what their funded research was telling them.
What this new contract relationship should have created was an environment where community controlled health services could focus on doing what they do best – providing quality health care to our people. It would have been an ideal opportunity to also right the service-provider relationship – where Governments purchased quality health care outcomes not administrative outcomes.
Only months before the commencement of the 2011/2012 financial year, representatives from the Office of Aboriginal and Torres Strait Islander Health (OATSIH), which happens to be the major funder of primary health services across the country for our people, undertook a road show across the country to highlight and discuss impending changes to the contractual relationship between governments and community controlled services.
Workshops were held in every State and Territory capital city, with a view to ensuring that all stakeholders were aware of impending changes and outline how new contracts and explanatory handbooks would support improved understanding of demands on services and expectations from government. When establishing solid relationships between purchasers of services and providers of health care, it is important for both parties to understand each other’s needs and how to address concerns throughout the contract period.
Many of these workshops left participants more confused than before commencing, although left some glimmer of hope that there would be some joint work around the ongoing development and updating of the Funding Agreement Handbook, which would be used as a guide for both OATSIH and community controlled service staff.
Unfortunately, at this point and still today, there is no clear indication from OATSIH what they are seeking to purchase from community controlled services.
The contracts outline priority areas for program delivery, with a focus on inputs such as primary health care, social and emotional well-being, child and maternal health etc, without providing clear indication of what OATSIH want to achieve across all areas, other than to say it all contributes to the six Close the Gap National targets.
They don’t however provide solid links between health service outcomes and their known impact on clients’ health outcomes.
Consequently, we can only draw one conclusion from this confused contractual state: that governments do not yet truly understand what it is they want to purchase in terms of Indigenous health outcomes.
A focus on inputs rather than outputs
Community controlled services have and will continue to preach that comprehensive primary health care is needed for the health of our people.
Community controlled health service delivery commenced on the premise that to achieve the best health outcomes for our people, we need to provide comprehensive services, not just your average primary care services, and consequently there has been much attention across the sector to build and strengthen this approach over time, with great outcomes.
Furthermore, we can assume that the fundamental notion of a formidable purchaser/provider relationship is not a priority, as governments want to continue the notion of providing grant monies to community controlled organisations tied to a range of preventative measures that are not necessarily related to performance in health service provision.
Perhaps Governments are simply not ready to move to purchaser provider relationships where outcomes and not inputs are the contractual foundations.
How do we draw these conclusions?
Firstly, I am yet to hear complaints from any community controlled service across the country that is ever questioned by OATSIH in relation to a lack of health assessments completed over a quarterly reporting period.
Rather, much of these contractual discussions centre around questions concerning governance models, constitutional changes, budget expenditure against unreported items, employee fractions on projects and other related things. Is it that Government believes such matters are a better indication of performance by each service?
Again Government remain focussed on inputs and monitoring administrative functions of service providers rather than focussing on health outcomes delivered.
Don’t get me wrong, all of the aforementioned items are important in the broader scheme of running successful businesses, although these fundamental questions should be resolved at the time of developing and endorsing relevant annual Action Plans and related project budgets.
Building capacity of community controlled organisations to do this consistently will enable and inform successful new business models to support health outcomes, and we are already starting to see this happen in many areas.
This process is being developed and led by the sector itself, which is a clear demonstration of organisational maturity and growth to support outcomes for our people. The sector must and should continue to be responsible for internal reform and improvements, whilst also setting higher expectations for itself, rather than be dictated to by governments.
What I am advocating, though, is that quarterly discussions are better spent on performance outputs and outcomes that can lead to improved health benefits for clients.
This process is not what a purchaser/provider relationship should look like when governments are attempting to purchase quality health services to support outcomes for Aboriginal and Torres Strait Islander people.
Government push for control
The current contractual relationship enables and supports ongoing government manipulation of community controlled organisations in a manner they believe will benefit communities the most. Admittedly, there are circumstances across the country where this is required, although experiences tell us that community controlled services are already delivering the best health outcomes for their own people and this is not being supported to continue and strengthen.
More concerning with the current contractual arrangement is Government seeking to ensure they can run community controlled organisations from within their departments, again evidenced in the contractual focus on day-to-day operations and inputs.
What we need at this point is not for governments to assume and attempt to maintain total control over community organisations, nor do we wish for community controlled organisations to think that they can do as they please with no accountabilities to anyone, as this is not community controlled either.
Given the growth in organisational maturity and experience in health service delivery, community controlled services are seeking to assume responsibility as the major provider of health care to our own people.
Although with this responsibility comes greater accountability, but not just to government but our accountability must be to the communities we serve, through robust reporting and monitoring mechanisms that are designed to provide clients and community with relevant information and data to meet their needs.
Governments will continue to seek improved accountability through contractual relationships, although this needs to improve and give recognition to existing processes, like those already compulsory for organisations through clinical and organisational accreditation processes.
The development of relevant Action Plans and budgets for government and community are and still should be essential, although ongoing monitoring of performance can be better achieved through focussing upon health outputs and outcomes that will lead to fundamental change.
Reporting to communities
Additionally ensuring that all organisations are regularly reporting to their local communities will further drive transparency in organisations, consequently leading to improved outcomes that can be measured competently by both community and government.
This is the relationship we need to start building and developing: the capacity of our communities to ask the hard questions of their local organisations, which demands far greater weight and attention than that of governments.
In Queensland, these reforms have commenced and we are starting to see a dramatic shift in community interactions with their local community controlled service because of it.
We now need to see this spread across the country so that the people who need high quality health services the most, Aboriginal and Torres Strait Islander people, are demanding it from their local service and seeking to ensure it continues to improve and grow.
The challenge for governments in all of this is to determine what role they are seeking to play in supporting this reform process.
Are they still wanting to remain in an old grant provision mentality of providing resources to our services that are restricted by a range of reporting and compliance requirements?
Or do they seek to see fundamental change in health outcomes through new relationships that pay tribute to services that are providing high quality health care for our people and achieving relevant outcomes?
This shift requires significant attitudinal change by governments, reflected in the language they use, and demonstrated in contractual relationships that support and enable services to do their jobs, rather than restrict them into long-winded reporting regimes.
Then we will see real improvements and communities openly demanding further improvements from their local service.
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.
NACCHO will be represented by Associate Professor Mark Wenitong, Senior Aboriginal Public Health Medical Officer at NACCHO
This year’s Royal Australian College of General Practitioners (RACGP) national conference, GP12, will host a range of activities addressing how general practitioners (GPs) from around Australia can play an important role in ‘Closing the Gap’, regardless of whether they practice in urban, rural or remote communities
Associate Professor Brad Murphy, Chair of the RACGP’s National Faculty of Aboriginal and Torres Strait Islander Health, said GP12 presents a timely reminder that closing the gap on health outcomes and life expectancy between Aboriginal and Torres Strait Islander people and non-Indigenous Australians remains one of Australia’s highest health priorities.
“Providing clinically and culturally appropriate healthcare to Aboriginal and Torres Strait Islander people should be a priority for all GPs.
“Ensuring proper identification of the Aboriginal and Torres Strait Islander status of patients is needed in order for all GPs to assess specific healthcare needs, whilst also providing an opportunity to outline available services these patients can access,” A/Prof Murphy said.
A highlight of GP12 will be the National Faculty of Aboriginal and Torres Strait Islander Health plenary session, held Thursday 25 October 4.45 pm – 5.45 pm (EST). The session aims to review recent developments and promote greater understanding of issues affecting Aboriginal and Torres Strait Islander health.
“We are honoured to have an esteemed line-up of guests on the panel, including
Mr Mick Gooda, Aboriginal and Torres Strait Islander Social Justice Commissioner,
Ms Mary Martin AM, General Practice Education and Training Coordinator of the Queensland Aboriginal and Islander Health Council (QAIHC) and Honorary Faculty Provost, and
Associate Professor Mark Wenitong, Senior Aboriginal Public Health Medical Officer for the National Aboriginal Community Controlled Health Organisation (NACCHO),” A/Prof Murphy stated.
Facilitated by Melissa Sweet, moderator of the online health blog, Croakey, this year’s interactive plenary session will focus on topics such as the impact of racism on Aboriginal and Torres Strait Islander health.
“Racism is a major issue preventing Aboriginal and Torres Strait Islander people proactively accessing health services because of the lack of cultural safety,” said A/Prof Murphy.
In addition, the following topics will also be addressed:
An overview of ‘Closing the Gap’ campaign highlighting the important aspects, challenges and issues that the campaign is facing now and into the future;
What the wider health sector, particularly private general practice, can learn from the success and failures of Aboriginal Community Controlled Health Services;
What the wider health sector can do to better support Aboriginal and Torres Strait Islander health professionals with the high expectations placed on them within their community; and
The joys and rewards of working in Aboriginal and Torres Strait Islander health.
Associate Professor Murphy encourages all GP12 delegates to attend sessions relating to Aboriginal and Torres Strait Islander health.
“Within the seven key streams outlined in this year’s program, there are a number of excellent presentations that will take place during the conference, including ‘Working with Aboriginal and Torres Strait Islander patients: what every doctor needs to know’, ‘Supporting Aboriginal and Torres Strait Islander doctors to gain FRACGP’ and many others.
“Some GPs believe that they don’t have any Aboriginal and/or Torres Strait Islander people amongst their patient group, but they may be surprised. It is only when a general practice starts identifying the Indigenous status of all their patients that they can be sure.
“GPs have significant potential to make a difference in improving health outcomes for Indigenous Australians – it is important to be aware of the issues and developments affecting Aboriginal and Torres Strait Islander health.” concluded Associate Professor Murphy.
For more information on the National Faculty of Aboriginal and Torres Strait Islander Health plenary session or any other sessions held at GP12, visit