Aboriginal Medical Services Alliance NT
PresentationtotheThirdHealthMinistersSummit
Darwin,30thJuly2015
MarionScrymgour,Chairperson,AMSANT
Iwouldliketobeginbyacknowledgingthetraditionalownersofthelandonwhich
wemeet,theLarrakiapeople,andtheirelderspastandpresent.
IwouldalsoliketoacknowledgetheAssistantMinisterforHealth,SenatortheHon
FionaNash;MinisterforHealth,theHonJohnElferink;theHonJackSnelling;theHon
HelenMorton,andotherdistinguishedattendees.
AMSANTisverypleasedtoco-hostthissummitwiththeNorthernTerritoryMinister
forHealth,theHonourableJohnElferinkMLA.
It’sparticularlysignificantforAMSANT,havinglastyearmarked40yearsof
AboriginalcommunitycontrolledhealthservicesintheNTand20yearssince
AMSANTwasestablished.
Thisisanimportantopportunityforallofusworkingtoimprovethehealthand
wellbeingofAboriginalandTorresStraitIslanderpeople,toshareandcollaborateon
thatjourneyfortheimportantyearsahead.
AMSANT’sAboriginalcommunitycontrolledmemberservicesprovidehighquality
comprehensiveprimaryhealthcaretoourcommunitiesacrosstheNorthern
Territory.Weareworkingwithgovernmenttoprogressivelytransitionfurther
servicestocommunitycontrolandtocontinuetobuildonoursharedrecordof
improvedhealthoutcomes.
Wehaveachievedasteadyandinmanywaysremarkablehealthimprovementinthe
NTthatDrChristineConnorswillbepresentingonshortly.
WhatIwouldliketodoinmypresentationistobrieflyreflectthecontextandhistory
ofthesehealthimprovementsthathavelaidstrongfoundationsfortheroadahead.
Andalsosomeimportantlessonsfromwhatdidn’twork.
AnimportantprecursorwastheNationalAboriginalHealthStrategy,ortheNAHS,
developedin1989.TheNAHSoutlinedawayforwardforAboriginalhealthbuilton
thefoundationofAboriginalcommunitycontrolledcomprehensiveprimaryhealth
care.Oursectortookaleadingroleinitsdevelopment.
Itwasagoodplanwithsomesignificantoutcomes,butultimatelyletusdowninits
implementation.
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ItresultedintheestablishmentoftheCouncilforAboriginalHealth;Stateand
TerritoryTripartiteForums;aspecialisedhealthbranch,theOfficeofAboriginal
Health;andanationalAboriginalcommunity-controlledhealthorganisation,which
becameNACCHO.
TheTripartiteForumsprovedtobeanunwieldyandunsuccessfulmodelfor
collaborativehealthplanning,butotherinitiativessuchasaspecialisedhealth
branchandtheestablishmentofNACCHOhavebeenimportantdevelopments.
Crucially,theNAHSwasneverproperlyfunded.$232millionwasallocatedoverfive
years:$171millionforhousingandinfrastructure,and$47millionnationallyfor
Aboriginalhealthservices.Thiswasfarlessthanthe$3billionestimatedasnecessary
forfullimplementationoftheNAHS,andstatesandterritoriesfailedtomatchthe
Commonwealthfunding,resultinginagrosslyunder-fundedhealthsystem.
Atthistime,in1990,theAboriginalandTorresStraitIslanderCommission,orATSIC,
wasestablishedandassumednationalresponsibilityforIndigenoushealth.
Thisprovedtobeafurthermistake.
TheresultingunderfundingofAboriginalhealthservicesmeantAboriginalhealth
continuedtolanguish.
Inthisera,ourhealthserviceshadtoapplyeveryyearfortheircorefundingfrom
ATSIC.Therewerenothree-yearfundingagreementsandmuchuncertaintyfrom
yeartoyear,makingitverydifficulttoattractandretainstaff.Veryfewnew
Aboriginalhealthservicesweresetupassuchserviceswerenotconsideredtobe
necessarytoimproveAboriginalhealth.
The1994evaluationoftheNAHSshowedthat,effectively,itwasnever
implemented.
ItwasinthisclimatethatAMSANTwasformedin1994aftera3-daymeetingof
communitycontrolledhealthservicesinAliceSprings.Itskeyobjectiveswere:
expandingcommunitycontrol;increasingresources;andimprovingtraining,salaries,
andconditionsforAboriginalHealthWorkers.
AMSANT’sfirstmajorcampaign,alongsideotherstakeholders,wastohave
administrativeresponsibilityforAboriginalprimaryhealthcaretransferredfrom
ATSICtotheCommonwealthHealthDepartment.
Thiswasaverycontroversialmovebutwasbasedonthecarefullyreasoned
assessmentthatAboriginalhealthfundingwouldbeforeverconstrainedunlessfunds
couldbeaccessedfrommainstreamhealthfunding,especiallyMBSandPBS.There
wasalsoaneedforaspecialistdepartmentwithinthehealthdepartmentthat
understoodandhadspecialexpertiseinAboriginalprimaryhealthcare.TheOffice
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forAboriginalandTorresStraitIslanderHealthServices,orOATSIH,wasformedin
1995.
Theimpactofthetransferonaccesstoincreasedfundshasbeenverydramatic.In
theyearofthetransfer,in1995,therewasonly$70millionavailabletofund
Aboriginalprimaryhealthcare,howevertherehasbeenacontinuingincreaseinthis
fundingsincethentomorethan$1billionperyearforAboriginalhealth.
Securingincreasedfundingwascomplementedwithacampaigntoimprove
administrativearrangementsforAboriginalprimaryhealthcare.Settingupa
transparentandaccountableplanningstructurewasakeyobjective.
ThesigningoftheFrameworkAgreementbetweenAMSANTandtheNTand
CommonwealthgovernmentsinApril1998sawtheplanningstructurecomeinto
being—theNorthernTerritoryAboriginalHealthForum.
ItisthroughtheForumthatcollaborativeneedsbasedplanninghasoccurred
enablingcrucialimprovementstothehealthsystemthroughouttheNT.
AndforthefirsttimetheAboriginalcommunitycontrolledhealthsectorwasatthe
tableasanequalwithgovernment.AMSANTisthepermanentchairoftheForum.
However,inadequateandinequitablefundingremainedakeyproblem.
Therewasaneedforacompletelynewfundingmodelthatcombinedpooledgrant
fundingwithaccesstoMedicareandthePBS.AMSANTsuccessfullycampaignedfor
theCommonwealthGovernmenttoadoptanewIntegratedFundingmodelaspartof
thenewPrimaryHealthCareAccessProgramorPHCAP.Thisrequiredthepoolingof
allCommonwealthandTerritorygrantfundsaswellasaccesstoMBSandPBS,and
thismixedmodefundingmodelremainsthecurrentwayAboriginalhealthservicesin
theNTarefunded.
AMSANTandForumsecuredincreasedandmoreequitableprogramfundingfor
AboriginalprimaryhealthcarethroughPHCAP,whichdividedtheNTupinto21
healthzonesbasedongeographic,culturalandsocialaffiliations.
Twosuccessfulregionalhealthservicesweresubsequentlyestablished throughthe
AboriginalCoordinatedCareTrials:KatherineWestHealthBoardin1999andthe
SunriseHealthServicein2005.DuetotheseverelimitationsoftheMedicare“cash
out”approach,theseservicestransitedtoPHCAPfundingagreementsinorderto
helpsecuretheirsustainability.
Theseservicesdemonstratedthatregionalisedcommunitycontrolcanproduce
betterservicesandimprovedhealthoutcomes.Rollingoutthismodelacrossthe
TerritoryremainsamajorobjectiveofthejointplanningprocessunderForum.
Effectivelyrollingoutthisagendarequiredafurthercriticaldevelopmentthatneeds
mention.Becauseinordertoallocateincreasedfundseffectivelyandequitablythere
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neededtobeaclearerideaofwhatcoreservicesandprogramsshouldbefundedin
eachhealthzone.
ForumsetaboutdevelopingthefirstversionoftheCoreFunctionsofPrimaryHealth
Carein2001,andthiswasusedtodirecttheinitialinvestmentunderthePHCAP.$30
millionnewinvestmentover5yearsfrom2001to2006tooktheaverageinvestment
from$600percapitaonaveragetoabout$1800.Therewasalsoamarked
improvementinequitythroughtheneedsbasedplanningprocessoftheForum
comparedwiththepriorheavilypoliticisedfundingallocations.
Anupdatedversionin2007wasusedinnegotiatingnewinvestmentprovidedunder
theExpandedHealthServicesDeliveryInitiative,orEHSDI,thataccompaniedtheNT
EmergencyResponseinJuly2007.$50millioninnewinvestmentwasprovidedin
returnforidentifiedcoreservicesandcorrespondingcoreindicators.Thistookthe
systemuptothecurrentaverageofabout$2500percapita.
Athirdversion,developedin2011,isstilltobeimplemented.Inthisversionthere
arefivedomainareasofcomprehensiveprimaryhealthcareunderwhichthereare
moredetaileddescriptorsofkeyservicesandprograms.
Thekeygapareasthathavebeenaddressedinthethirdversionareinearly
childhood,familysupport,alcohol,tobaccoandotherdrugs,andagedanddisability
services.NewfundingcomingintotheNTintheseareasisnotcurrentlybeing
allocatedunderacoreservicesapproachorwithintheplanningmechanismofthe
Forum.
ThesignificanceofhavingtheNTAboriginalHealthForumasaneffective,high-level
healthplanningbodywiththeAboriginalsectoratthetablecannotbeunderstated.
IthasdelivereddemonstrablybetteroutcomesintheNT.
In2009anagreementwassignedbytheForumpartners,committingbothlevelsof
GovernmenttotransitionallremoteAboriginalprimaryhealthcareservicesinthe
NTtoAboriginalcommunitycontrol.
Thiswasalandmarkachievement.
AndthisyeartheForumhasestablishedthePathwaystoCommunityControl
WorkingGrouptoprogresstheregionalisationprocess.
AndinwhatisakindofreturntothefutureforAMSANT,wearerevisitingoneofour
foundingobjectivesindevelopingtheAboriginalHealthWorkerworkforce,now,of
course,referredtoasAboriginalHealthPractitioners.However,thistimeitisin
partnershipwiththeNTGovernmentthroughtheBackonTrackprogramandwith
thesupportofForum.
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AMSANTisgreatlyheartenedbythecontinuingcontributionsandcommitmentof
theNTandCommonwealthgovernmentstoAboriginalprimaryhealthcareandto
theForum.
AndweareespeciallypleasedbythelaunchingofanewFrameworkAgreementfor
theNTthatiscoincidingwiththisSummit.
ThefinalmessageIwanttoleaveyouwithrelatestoourconcernsregardingthenew
NationalAboriginalandTorresStraitIslanderHealthPlan.Itisagoodplan,aswas
theNationalAboriginalHealthStrategyallthoseyearsago.Historyhasshownthat
suchplansfailattheimplementationstageforthreemainreasons.Firstly,alackof
long-termcommitmentoffunding.Secondly,alackofcommitmentfromstatesand
territoriestotheconceptofanationalplan.Andlastly,alackofaccountability.
Wemustlearnfromhistoryandgetthisright.Weneedaten-yearfunding
commitment.WeneedthedraftimplementationplantobeendorsedbyAHMAC.
Andweneedkeyperformanceindicatorsthatmakeeveryoneaccountable.Annual
reportsontheprogressagainsttheseindicatorsshouldbetabledintheFederal
ParliamentaspartoftheClosingtheGapcommitment.
Anythinglesswouldbe,inouropinion,invitingfailure.
Andwesimplycan’taffordthat.
Thankyou.
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