Online version of the 2013-14 Department of Health Annual Report

Outcome 8: Indigenous Health

Closing the gap in life expectancy and child mortality rates for Indigenous Australians, including through primary health care, child and maternal health, and substance use services

Page last updated: 31 October 2014

Major Achievements

  • Australia is on track to halve the gap in child mortality by 2018. There has been significant improvement in Indigenous child mortality from 1998 to 2012, with the Indigenous child mortality rate declining by 32% from 252.3 per 100,000 to 164.7 per 100,000. There was also a significant decline in the gap of 38% during this period.
  • Australia is also on track to eliminate trachoma, a preventable eye disease which can cause blindness, by 2020. Trachoma prevalence has significantly decreased in 5-9 year olds in screened communities from 14% in 2009 to 4% in 2013.
  • Aboriginal and Torres Strait Islander Health Survey results indicate that 44.4% of Indigenous Australians aged 18 and over smoked in 2012-13, a decrease of 3 percentage points from 47.7% in 2008.
  • The Department significantly increased its State and Territory collaboration through the Indigenous Health Partnership Forums in each jurisdiction to improve policy and programme development and service delivery, and reduce wastage and duplication.
  • Improved focus on reducing cardiovascular disease (CVD) and increasing CVD patient treatment will result from the work done by the Commonwealth and States and Territories during 2013-14.
  • Strengthened primary health care through the provision of outreach services which delivered expanded health care services to 123,136 patients in 2013-14 (a 25% increase from 2012-13).

Challenges

  • Chronic disease remains a major cause of the life expectancy gap. Improved prevention, detection and management of chronic disease is needed. Frontline service delivery must be the priority, including multidisciplinary care following health assessments and chronic disease care planning.
  • The inequality in health outcomes between Indigenous and non-Indigenous Australians remains a challenge.
  • There has been an increase in MBS health assessment and chronic disease care planning items, however follow-up care lags behind the increase in health assessment and care planning.

Looking Ahead

In 2014-15, the Department will establish the Indigenous Australians’ Health Programme. The streamlined programme consolidates Indigenous health funding to better address basic health needs at the local level. This aims to improve health outcomes and reduce health inequality between Aboriginal and Torres Strait Islander and non-Indigenous Australians.

Programme Contributing to Outcome 8

  • Programme 8.1: Aboriginal and Torres Strait Islander health

Division Contributing to Outcome 8

In 2013-14, Outcome 8 was the responsibility of Indigenous and Rural Health Division.

Outcome Strategy

Outcome 8 aims to improve access for Aboriginal and Torres Strait Islander people to effective health care services essential to improving health and life expectancy, and reducing child mortality. In 2013-14, the Department worked to achieve this Outcome by managing the programme outlined below.

Programme 8.1: Aboriginal and Torres Strait Islander health

Programme 8.1 aims to improve access for Aboriginal and Torres Strait Islander people to effective primary health care services, maternal and child health services, and social and emotional wellbeing services, and to promote the prevention and management of chronic disease.

In 2013-14, the Department released the first National Key Performance Indicators (nKPI) Report, and the report from the Sentinel Sites Evaluation of Indigenous Chronic Disease Package. The nKPI report showed improvements in the delivery of clinically appropriate care and health outcomes for Aboriginal and Torres Strait Islander patients. These reports also provide a strong evidence base for future policy and programme design and development, focussing on improved clinical quality, efficiency and effectiveness.

Reducing chronic disease

Aboriginal and Torres Strait Islander people experience more than twice the burden of disease of other Australians. The Department continued a number of initiatives in 2013-14 to reduce rates of chronic disease and improve health outcomes for Indigenous Australians living with a chronic disease. These initiatives included prevention, detection and treatment services in the primary health care system.

Chronic disease mortality rates in both Indigenous and non-Indigenous populations continue to decrease. However, because the reduction has been in both populations, the gap between them has remained.

Quantitative KPI
Chronic disease related mortality rate per 100,00043
2012 Target44
Aboriginal and Torres Strait Islander: 817-903
Non-Aboriginal and Torres Strait Islander: 456-462
Rate difference: 358-444
2012 Actual
Aboriginal and Torres Strait Islander: 898
Non-Aboriginal and Torres Strait Islander: 451
Rate difference: 447
Result
Met
The 2012 Indigenous chronic disease mortality rate (898 per 100,000) was within the target range (817-903 per 100,000). The gap between the Indigenous and non-Indigenous chronic disease mortality rates for 2012 (447 per 100,000) was just outside the target range (358-444 per 100,000). Although there has been a statistically significant decline in Indigenous rates over the period 1998-2012, there has been no statistically significant change in the gap between the two populations. This is because the non-Indigenous rates in chronic disease related mortality have declined faster than Indigenous rates.
National Action to Reduce Indigenous Smoking Rates

Tobacco smoking is a major cause of chronic disease among Aboriginal and Torres Strait Islander people. The Tackling Indigenous Smoking Programme delivers community education activities and interventions intended to reduce the prevalence of smoking, and also to improve nutrition and increase physical activity to reduce risks of preventable chronic diseases. Activities delivered in 2013-14 included a network of Regional Tackling Smoking and Healthy Lifestyle teams across the nation, training in brief interventions to encourage and support smoking cessation and prevention, and enhancement of existing Quitline services to be more culturally appropriate for Indigenous clients.

The programme will be reviewed in 2014-15.

Quantitative Deliverable
Workers funded through the ATSICDF45 working on prevention and management of chronic disease including Aboriginal and Torres Strait Islander outreach workers, practice managers and other health professionals
2013-14 Target
242
2013-14 Actual
250
Result
Met
The number of workers funded through the Aboriginal and Torres Strait Islander Chronic Disease Fund working on prevention and management of chronic disease, including Aboriginal and Torres Strait Islander outreach workers, practice managers and other health professionals: 2010-11 160 workers, 2011-12 204 workers, 2012-13 246 workers.In 2013-14, the Department funded 250.05 full time equivalent (FTE) additional workforce positions for the prevention and management of chronic disease (174.95 FTE Aboriginal and Torres Strait Islander Outreach Workers, 42.90 FTE Practice Managers and 32.20 FTE additional health professionals).
Coordinated primary health care

The Aboriginal and Torres Strait Islander Chronic Disease Fund has improved access to well-coordinated, multidisciplinary primary health care services by funding Aboriginal and Torres Strait Islander Outreach Workers, additional primary health care staff and a Care Coordination and Supplementary Services Programme. This workforce has continued to help Aboriginal and Torres Strait Islander people access culturally sensitive mainstream primary care.

More than 200 FTE Care Coordinators are now employed and have assisted Aboriginal and Torres Strait Islander patients with chronic disease to access specialist and allied health services. The number of care coordination and supplementary services provided has increased from 135,722 in 2012-13 to 183,984 in the first nine months of 2013-14 (to 31 March 2014). In addition, funding for outreach services through the Medical Outreach – Indigenous Chronic Disease Programme has resulted in 1,819 services, involving 123,136 patient contacts in 383 locations being delivered nationally in 2013-14.

Improve child and maternal health

A healthy start to life, beginning in pregnancy, gives children the best opportunity to achieve their full potential, and may also provide protection from the development of chronic diseases later in life. The most recent Australian Early Development Census (AEDC) data shows that Aboriginal and Torres Strait Islander children are more than twice as likely to be developmentally vulnerable than non-Indigenous children when commencing school.46 The Aboriginal and Torres Strait Islander child and maternal health programmes managed by the Department in 2013-14 aimed to improve health outcomes for mothers and babies and contribute to improving health, education and employment outcomes across the lifespan.

During 2013-14, the Department continued to implement the Australian Nurse Family Partnership Programme (ANFPP), an evidence-based programme that helps parents to understand how factors such as environment, parental style and behaviours influence their own health as well as their child’s health and development. It enables them to change their lives in ways that help themselves and their children’s health, wellbeing and development. As part of the 2014-15 Budget, the Better Start to Life investment includes $40 million to expand the ANFPP from 3 to 13 sites, from July 2015, to increase support for high needs families.

The Department also worked closely with Aboriginal Community Controlled Health Organisations (ACCHOs) and primary health care organisations to implement 85 New Directions: Mothers and Babies Services. The Better Start to Life investment also includes $54 million from July 2015 to increase the number of sites providing New Directions: Mothers and Babies Services from 85 to 136.

In collaboration with State and Territory Governments and the Department of the Prime Minister and Cabinet, the Department implemented the final year of the National Partnership Agreement on Indigenous Early Childhood Development (NPA IECD) and released the inaugural NPA IECD indicator report.47 The NPA IECD aimed to improve developmental outcomes for Indigenous children and achieve sustained improvements in pregnancy, birth and child health outcomes.

Quantitative Deliverable
Number of organisations funded to provide New Directions: Mothers and Babies Services
2013-14 Target
85
2013-14 Actual
85
Result
Met
The number of organisations funded to provide New Directions: Mothers and Babies Services: 2010-11 76 organisations, 2011-12 85 organisations, 2012-13 85 organisations.The number of organisations funded to deliver New Directions: Mothers and Babies Services remained constant in 2013-14, consistent with the funding allocation. Several quality improvement activities were undertaken during 2013-14 including: changes to reporting requirements to align with programme objectives; several services participated in the development of a national framework to inform service delivery into future years; and some organisations informed a small project examining clinician’s responses to, and management of, women presenting with perinatal mental health concerns.

In relation to child mortality rates, there has also been a significant decline in both Indigenous and non-Indigenous populations. The Indigenous child mortality rates have, however, dropped more quickly than the non-Indigenous rate, leading to a statistically significant narrowing of the gap.

Quantitative KPI
Child 0-4 mortality rate per 100,00048
2012 Target49
Aboriginal and Torres Strait Islander: 154-221
Non-Aboriginal and Torres Strait Islander: 79-90
Rate difference: 69-136
2012 Actual
Aboriginal and Torres Strait Islander: 165
Non-Aboriginal and Torres Strait Islander: 77
Rate difference: 87
Result
Met
The 2012 Indigenous child mortality rate (165 per 100,000) was within the target range for 2012 (154-221 per 100,000). The difference between the Indigenous and non-Indigenous child mortality rates for 2012 (87 per 100,000) was also within the target range for 2012 (69-136 per 100,000). Indigenous child mortality rates have significantly declined from 1998 to 2012, and the gap with non-Indigenous rates has also narrowed significantly.

Improve access to effective health services including in remote areas

In 2013-14 the Department, through the Stronger Futures in the Northern Territory Initiative, continued to improve the health and wellbeing of Aboriginal and Torres Strait Islander people in the Northern Territory, working in partnership with the Northern Territory Government and the ACCHOs. This was achieved through a range of programmes including integrated hearing and oral health programmes for Aboriginal children under 16 years.

The oral health programme delivered increased clinical and preventive oral health services to children, with a focus on those living in remote communities. From July to December 2013, 2,523 occasions of service, 26 occasions of surgery under general anaesthetic, 4,076 fissure sealants and at least 2,322 fluoride varnish applications were provided.

The hearing health programme includes an expanded Child Hearing Health Coordinator (CHHC) initiative. The coordinators provide a range of clinical services including ear health education, discussion of hearing loss strategies, and regular follow up and care planning. They also facilitate contact with other service providers. From July to December 2013, 347 children have received complex case management services from a CHHC and 958 occasions of audiology service were provided.

Improving the responsiveness of primary health care to ear health issues and hearing loss is the key to the improved hearing health outcomes. This is being achieved through early intervention, referral to allied health and specialist care and follow up support. Substantial effort has been focused on developing and supporting primary health practitioners including GPs, nurses and Aboriginal Health Workers. Interventions to improve the early detection and management of otitis media and hearing loss in Indigenous children and youth need to be accompanied by broader preventive public health strategies.

Trachoma is a preventable eye disease that can cause blindness and is more prevalent in Indigenous communities in rural and remote parts of Australia. In its continued efforts to eliminate trachoma by 2020, the Department has negotiated a new multilateral agreement with the Governments of New South Wales, Northern Territory, South Australia and Western Australia for $16.5 million between 2013-17. The agreement provides for trachoma screening and treatment activities for both children and adults, in line with the new 2013 national trachoma guidelines.

Quantitative Deliverable
Number of organisations funded to provide Aboriginal and Torres Strait Islander specific primary health care
2013-14 Target
248
2013-14 Actual
248
Result
Met
In 2013-14, the Department funded 248 organisations, including Aboriginal community controlled health organisations, Medicare Locals, State and Territory Governments and non-government organisations, to provide a range of primary health care services including comprehensive primary health care, chronic disease prevention, detection and management, care coordination, and child and maternal health.
Quantitative KPI
Percentage of eligible50 Aboriginal and Torres Strait Islander Primary Health Care Services that provide GP services which have achieved clinical accreditation
2013-14 Target
85%
2013-14 Actual
92%
Result
Met
The Department continued to work with the Indigenous health sector to achieve and maintain health service clinical accreditation, with 92% of services accredited in 2013-14. The Department worked in partnership with Aboriginal and Torres Strait Islander health sector peak bodies and other relevant stakeholder groups to achieve these outcomes.

Improve social and emotional wellbeing

Responsibility for Indigenous social and emotional wellbeing transferred to the Department of the Prime Minister and Cabinet with the Administrative Arrangements Order announced by the Prime Minister on 18 September 2013.

Qualitative Deliverable
Provide high quality social and emotional wellbeing services to Aboriginal and Torres Strait Islander people
2013-14 Reference Point
Biennial Social and Emotional Wellbeing Program conference to encourage good practice and networking to be held by June 2014
Result
Not applicable
The result of this qualitative deliverable is reported in the Department of the Prime Minister and Cabinet 2013-14 Annual Report.

Outcome 8 – Financial Resource Summary

(A) Budget Estimate 1
2013-14
$’000
(B) Actual 2013-14
$’000
Variation (Column B minus Column A)
$’000
Programme 8.1: Aboriginal and Torres Strait Islander Health 2
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)
759,524
724,850
( 34,674)
Departmental Expenses
Departmental Appropriation 3
50,163
50,121
( 42)
Expenses not requiring appropriation in the current year 4
2,476
2,408
( 68)
Total for Programme 8.1
812,163
777,379
( 34,784)
Outcome 8 Totals by appropriation type
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)
759,524
724,850
( 34,674)
Departmental Expenses
Departmental Appropriation 3
50,163
50,121
( 42)
Expenses not requiring appropriation in the current year 4
2,476
2,408
( 68)
Total Expenses for Outcome 8
812,163
777,379
( 34,784)
Average Staffing Level (Number)
321
312
( 9)

1 Budgeted appropriations taken from the 2014-15 Health Portfolio Budget Statements and re-aligned to the 2013-14 programme group structure.

2 This programme includes National Partnerships paid to State and Territory Governments by the Treasury as part of the Federal Financial Relations (FFR) Framework. National Partnerships are listed in this chapter under each programme.

3 Departmental appropriation combines ‘Ordinary annual services (Appropriation Bill 1)’ and ‘Revenue from independent sources (s31)’.

4 ‘Expenses not requiring appropriation in the budget year’ is made up of depreciation expense, amortisation, make good expense and audit fees. This estimate also includes approved operating losses – please refer to the departmental financial statements for further information. Some reclassifications have been made to the Budget estimates to more accurately reflect the allocation of departmental depreciation by outcome.