Skip to main content

ABORIGINAL AND TORRES STRAIT ISLANDER
HEALTH PERFORMANCE FRAMEWORK 2017 REPORT

Policies and strategies

Introduction

The Aboriginal and Torres Strait Islander Health Performance Framework is used to inform policy development and monitor progress in Indigenous health. An effective, efficient and equitable health system is an essential component for any whole-of-government effort to address the health of Aboriginal and Torres Strait Islander peoples. In addition, action is required in areas such as education, employment, safety and housing to achieve sustainable health gains.

The Council of Australian Governments (COAG) has committed to a number of Closing the Gap targets:

The Australian Government is investing $4.9 billion in the Indigenous Advancement Strategy (IAS) from 2016–17 to 2019–20. In 2014–15, the IAS replaced more than 150 individual programmes with five streamlined programmes:

The IAS will support the Government's priorities of getting children to school, adults into jobs and making communities safer. The Government will work in partnership with Aboriginal and Torres Strait Islander people in implementing the IAS. Communities will be at the centre of the design and delivery of local solutions to meet local needs.

The Australian Government Indigenous Australians' Health Programme commenced on 1 July 2014, consolidating four existing funding streams (primary health care base funding, child and maternal health programmes, Stronger Futures in the Northern Territory and the Aboriginal and Torres Strait Islander Chronic Disease Fund). In 2015, a capital works funding stream was also added to the programme. The aim of this programme is to improve the focus on local health needs, deliver the most effective outcomes, and better support efforts to achieve health equality between Indigenous and non‑Indigenous Australians.

^ Back to top

Chronic disease programmes provided through the Indigenous Australians' Health Programme include nationwide tobacco reduction and healthy lifestyle promotion activities, a care coordination and outreach workforce based in Primary Health Networks and Aboriginal Community Controlled Health Organisations and GP, specialist and allied health outreach services serving urban, rural and remote communities.

Additionally, the Australian Government provides GP health assessments for Aboriginal and Torres Strait Islander people under the MBS, along with follow-on care and incentive payments for improved chronic disease management, and cheaper medicines through the PBS. These programmes assist better chronic disease prevention and management by primary health care services.

Timeframes from program implementation to improved health outcomes vary (AIHW, 2014b). For example, the impact of antenatal care and health check initiatives can be seen fairly quickly after program implementation, while it can take up to 30 years for the decline in smoking rates at a population level to impact on population level cancer deaths rates. There is also a time lag to when data are available to measure those changes.

The National Aboriginal and Torres Strait Islander Health Plan 2013–2023 provides a long-term, evidence-based policy framework as part of the overarching COAG approach to Closing the Gap in Indigenous disadvantage. The key goal of the Health Plan is that ‘Aboriginal and Torres Strait Islander peoples have the right to live a healthy, safe and empowered life with a strong and healthy connection to culture and country’. The objectives of the Health Plan will be supported by the successful implementation of the IAS through early childhood initiatives and measures to address the underlying social determinants of poor health. The Health Plan also builds on other governments’ plans and strategies which support better health outcomes for Aboriginal and Torres Strait Islander people, including the COAG National Indigenous Reform Agreement and the previous National Strategic Framework for Aboriginal and Torres Strait Islander Health 2003–13.

The Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan 2013–2023 takes forward the overarching vision of the Health Plan by progressing strategies and actions that improve health outcomes for Aboriginal and Torres Strait Islander people. It outlines the actions to be taken by the Australian Government, the Aboriginal community controlled health sector, and other key stakeholders to give effect to the vision, principles, priorities and strategies of the Health Plan. The Implementation Plan is comprised of seven domains: health systems effectiveness; maternal health and parenting; childhood health and development; adolescent and youth health; healthy adults; healthy ageing; and the social and cultural determinants of health. The Implementation Plan identifies a set of 20 goals to support and complement the achievement of the COAG targets (see Figure 43). These goals will be used to measure progress towards achieving outcomes across governments, the health sector and community, and help to promote accountability. The goals deal broadly with improving the health of pregnant women, reducing smoking, tackling diabetes, providing more health checks and achieving better immunisation rates. These 20 goals relate to the three tiers of the Health Performance Framework and this is the first time that progress against the Implementation Plan goals have been reported on in this framework.

^ Back to top

State and Territory Governments have developed Aboriginal and Torres Strait Islander health plans and strategies:


Figure 43
How goals of the Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan 2013–2023 are being monitored through the Health Performance Framework
Implementation Plan Goals Health Performance
Framework measures
Antenatal
Increase the rate of Aboriginal and Torres Strait Islander women attending at least one antenatal visit in the first trimester from 51% to 60% by 2023 3.01 Antenatal care
Increase the rate of Aboriginal and Torres Strait Islander women attending at least five antenatal care visits from 84% to 90% by 2023.
Decrease the rate of Aboriginal and Torres Strait Islander women who smoke during pregnancy from 47% to 37% by 2023. 2.21 Health behaviours
during pregnancy
Health checks
Increase the rate of Aboriginal and Torres Strait Islander children 0–4 years who have at least one health check in a year from 23% to 69% by 2023. 3.04 Early detection
and early treatment
Increase the rate of Aboriginal and Torres Strait Islander children 5–14 years who have at least one health check in a year from 18% to 46% by 2023.
Increase the rate of Aboriginal and Torres Strait Islander youth aged 15–24 years who have at least one health check in a year from 17% to 42% by 2023.
Increase the rate of Aboriginal and Torres Strait Islander adults aged 25–54 years who have had at least one health check in a year from 23% to 63% by 2023.
Increase the rate of Aboriginal and Torres Strait Islander adults aged 55 plus who have had at least one health check in a year from 33% to 74% by 2023.
Immunisation
Increase the rate of Aboriginal and Torres Strait Islander children at age 1 who are fully immunised from 85% to 88% by 2023. 3.02 Immunisation
Increase the rate of Aboriginal and Torres Strait Islander children at age 2 who are fully immunised from 91% to 96% by 2023.
Increase the rate of Aboriginal and Torres Strait Islander children at age 5 who are fully immunised from 92% to 96% by 2023.
Increase the rate of Aboriginal and Torres Strait Islander adults aged 50 plus who are immunised against influenza from 57% to 64% by 2023.
Increase the rate of Aboriginal and Torres Strait Islander adults aged 50 plus who are immunised against pneumonia from 29% to 33% by 2023.
Smoking
Reduce the rate of Aboriginal and Torres Strait Islander youth aged 15–17 years who smoke from 19% to 9% by 2023. 2.15 Tobacco use
Increase the rate of Aboriginal and Torres Strait Islander youth aged 15–17 years who have never smoked from 77% to 91% by 2023.
Increase the rate of Aboriginal and Torres Strait Islander youth aged 18–24 years who have never smoked from 42% to 52% by 2023.
Reduce the smoking rate among Aboriginal and Torres Strait Islander peoples aged 18 plus from 44% to 40% by 2023.
Diabetes
Increase the rate of Aboriginal and Torres Strait Islander people with type 2 diabetes who have regular HbA1c checks from 65% to 69% by 2023. 3.05 Chronic disease management
Increase the rate of Aboriginal and Torres Strait Islander people with type 2 diabetes who have regular blood pressure tests from 65% to 70% by 2023.
Increase the rate of Aboriginal and Torres Strait Islander people with type 2 diabetes who have renal function tests from 65% to 69% by 2023.

^ Back to top

Child and maternal health

Australian governments are investing in a range of initiatives aimed at improving child and maternal health.

The 2014–15 Budget provides funding of $94 million over three years from July 2015, for the Better Start to Life approach to expand efforts in child and maternal health. This includes:

As part of the Women’s Safety Package, The Australian Government committed $1.1 million to enhance the ability of the ANFPP to support families who might be experiencing domestic and family violence.

The Indigenous Australians’ Health Programme has allocated $12 million over two years (from July 2016) to support the implementation of integrated early childhood services: Connected Beginnings, as recommended by the Forrest Review. The Department of Education has also allocated $30 million over three years to support the programme. The funding will support integrated health and education services for children (perinatal to school age), improving family and community engagement for both service streams. A small number of sites in rural and remote areas of Australia are being identified to trial the model.

The National Framework for Health Services for Aboriginal and Torres Strait Islander Children and Families is a guide for policy and programme development, implementation and review of evidence-based maternal, child and family health services (from pre-conception, antenatal, postnatal and early childhood health and development).

^ Back to top

National Evidence-Based Antenatal Care Guidelines (the Guidelines) have been developed to help ensure women are provided consistent, quality, evidence-based maternity care. The Guidelines were developed with input from the Working Group for Aboriginal and Torres Strait Islander Women's Antenatal Care to provide culturally appropriate guidance and information for the health needs of Aboriginal and Torres Strait Islander pregnant women and their families. The Guidelines are intended for midwives, obstetricians, general practitioners, practice nurses, maternal and child health nurses, Aboriginal and Torres Strait Islander health workers and allied health professionals. One of the topics being reviewed/updated is the Antenatal Care of Aboriginal and Torres Strait Islander Women, focusing on how holistic care can be provided to meet spiritual, emotional, social and cultural needs as well as physical and healthcare needs. Other topics being reviewed include fetal growth and wellbeing, risk of preterm birth, and weight gain. A new topic on illicit substance use during pregnancy is also being considered.

The Australian Health Ministers' Advisory Council (AHMAC) is in the process of developing Guiding Principles for ‘Birthing on Country’ Service Model and Evaluation Framework to build upon the National Maternity Plan.

The Pregnancy, Birth and Baby helpline and website, provides information, support and counselling for women, partners and their families in relation to pregnancy and parenting.

The 2014–15 Federal Budget provides $9.2 million for the National Foetal Alcohol Spectrum Disorders (FASD) Action Plan to address the harmful impact of FASD on children and families. As part of the National FASD Action Plan, $4 million has been provided to enhance the capacity of maternal and child health services in Indigenous communities to prevent and manage FASD. Funding of $2.34 million has been committed for the development of a FASD resource package and training of New Directions: Mothers and Babies Services staff in this material.

In WA, the FASD prevention program is an alcohol in pregnancy project in the Kimberly region, run by the Ord Valley Aboriginal Health Service. The program provides education and support of antenatal clients and their families, as well as education sessions to students in the region. The success of the program can be attributed to both community investment and ownership and the willingness of the Aboriginal community to embrace change.

The National Tobacco Campaign—More Targeted Approach is aimed at reducing smoking prevalence among high-risk and hard-to-reach groups. Materials featuring Indigenous women have been included in the Quit for You, Quit for Two component, targeting pregnant women, their partners and women contemplating pregnancy.

^ Back to top

Under the Tackling Indigenous Smoking (TIS) programme, regional grants allow for focused work on priority groups such as pregnant women and relationships with other programs for mothers and babies. Grants for three projects specifically targeting pregnant women have been awarded under the TIS innovation grant scheme.

In Tasmania, the Smoke Free Pregnancies Working Group has implemented A Smoke Free Start for Every Tasmanian Baby: A Plan for Action—2014 to 2017. The Aboriginal and Torres Strait Islander Smoking Cessation Program supports a number of smoking cessation activities in the ACT, with an emphasis on pregnant smokers and their cohabitants.

In SA, the Aboriginal Family Birthing Program (a partnership model between Aboriginal Maternal Infant Care Workers and midwives) supports Indigenous women and their families through pregnancy, childbirth and up to 6 weeks postnatally. For women in the programme, there has been a decrease in low birthweight rates, infant mortality and the proportion of Aboriginal mothers smoking during pregnancy.

In WA, the Aboriginal Maternity Group Practice programs provide outreach services for pregnant Aboriginal women. The programs are underpinned by steering groups in each district, which consist of community members and key local maternal and child health service providers. At the steering group meetings, the planning, implementation and evaluation of each of these programs is discussed and decisions are made about service delivery. The cultural governance is defined by the community participants through every aspect of the programmes’ delivery. The programmes have led to positive sustainable cultural change in practices in hospital as well as community settings.

The Collaborative Child Health, is a Birth to School Entry project in the Pilbara region, WA. Wirraka Maya allocated funding to primary prevention in Aboriginal communities; this includes conducting child health checks, hygiene sessions, ear health education, an alcohol in pregnancy intervention and the development of an outreach service to surrounding communities which results in almost 400 child health checks and 1000 immunisations per annum. Wirraka Maya also implemented the 0–5 High Risk Program across the Pilbara region which targeted children 0–5 years of age living within high risk environments.

The Koori Maternity Services programs, operating at 14 sites across Victoria, continue to increase the participation of Aboriginal women in antenatal and postnatal care services.

Community based pregnancy support and hospital antenatal services for young Aboriginal women and their families have continued in Tasmania. In particular, the state-wide Aboriginal Midwifery Outreach Project, with midwives based in Aboriginal health services, provides holistic antenatal and postnatal care and support, including home visits to Aboriginal women and women having Aboriginal babies.

^ Back to top

Chronic disease

All Australian governments are providing a range of programmes to support chronic disease prevention and management for Aboriginal and Torres Strait Islander peoples–see health plans and strategies above.

A National Strategic Framework for Chronic Conditions is being developed to provide guidance to all levels of government and health professionals to work towards the delivery of a more effective and coordinated national response to chronic conditions. The Framework moves away from a disease-specific approach recognising that there are often similar underlying principles for the prevention and management of many chronic conditions. It will better cater for shared health determinants, risk factors and multi-morbidities across a broad range of chronic conditions.

The Indigenous Australians' Health Program (IAHP), focuses on the prevention, early detection and management of chronic disease through expanded access to and coordination of comprehensive primary health care. Activities funded under the IAHP include nationwide tobacco reduction and healthy lifestyle promotion activities; a care coordination and outreach workforce based in Primary Health Networks and Aboriginal Medical Services; and GP, specialist and allied health outreach services that support urban, rural and remote communities.

Additionally, the Australian Government provides GP health assessments for Aboriginal and Torres Strait Islander people under the MBS, along with follow-on care and incentive payments for improved chronic disease management, and cheaper medicines through the PBS. These programmes assist better chronic disease prevention and management by primary health care services.

The Practice Incentives Program—Indigenous Health Incentive (PIP–IHI) supports general practices and Indigenous health services to provide better health care for Indigenous patients, including best practice management of chronic disease. GPs receive payments for registering with the program, for registering Indigenous patients with chronic disease and for providing best practice management of chronic disease.

The Medical Outreach Indigenous Chronic Disease Program aims to improve access to medical specialist, GP, allied and other health services for Aboriginal and Torres Strait Islander peoples. A total of $121.17 million from 2013–14 to 2016–17 has been committed for this measure.

The Quality Assurance for Aboriginal and Torres Strait Islander Medical Services program supports culturally appropriate and clinically effective management of diabetes patients in Indigenous communities. This occurs through training, technical support and quality assurance for ‘point of care’ pathology testing (e.g. HbA1c).

^ Back to top

Education

All governments have committed to increase the education achievement of Indigenous Australians. While the delivery of school education is constitutionally a state responsibility, the Australian Government provides leadership and fosters collective action to support achievement. Through COAG, governments have agreed to strategies relating to improving the quality of schools and education standards. Governments are also working to increase progress against the Closing the Gap targets for early childhood education, school attendance, literacy and numeracy achievement and Year 12 attainment.

In 2015, Commonwealth, State and Territory Education Ministers endorsed the National Aboriginal and Torres Strait Islander Education Strategy. The Strategy sets the principles and priorities to guide jurisdictions in developing and implementing localised policies to improve Aboriginal and Torres Strait Islander outcomes. It provides a series of national collaborative actions which Education ministers have agreed to, with a focus on:

^ Back to top

Early learning

The Australian Government has committed to work with state and territory governments to prioritise investment to support the integration of early childhood, maternal and child health, and family support services, with schools from July 2016 through the Connected Beginnings Programme. The aim of this programme is to ensure that Indigenous children in identified areas of high need achieve the learning and development outcomes necessary for a positive transition to school. Over time this will contribute to a reduction in the disparity in school readiness and educational outcomes between Indigenous and non-Indigenous children.

While state and territory governments are responsible for the provision of preschool education in their jurisdiction, the Australian Government provides funding to support jurisdictions in achieving universal access to quality early childhood education programs through a series of National Partnership Agreements on Universal Access to Early Childhood Education. This funding supports participation by all children in a preschool program for 600 hours per year, in the year before full-time school, delivered by an early childhood teacher who meets National Quality Framework requirements. The current National Partnership provides $840 million to states and territories to support the delivery of preschool programmes in 2016 and 2017. National Partnership arrangements include a focus on lifting the participation rates of Indigenous and vulnerable and disadvantaged children in preschool.
In December 2015, COAG agreed to a renewed Early Childhood Education Closing the Gap target (ECE CtG) for 95% of Indigenous four-year-olds to be enrolled in a quality early childhood education programme by 2025.

^ Back to top

Schooling

COAG has committed to improving educational standards and the quality of schools and has recently agreed a Closing the Gap target on school attendance (to be met by 2018) (COAG, 2014). Under constitutional arrangements, state and territory governments are responsible for ensuring all school-age children have the opportunity to enrol in a safe and supportive school that provides high quality education (SCRGSP, 2014). State and territory governments are responsible for the administration of government schools and provide the majority of the government funding for these schools. Non-government schools operate under conditions determined by state and territory government registration authorities.

The introduction of the Indigenous Advancement Strategy (IAS) in 2014 has improved the delivery of funding into Indigenous communities to support a range of children and schooling activities designed to improve children and young people’s education engagement and outcomes. Funding is largely used to support activities ‘outside the school gate’ which aim to further build children and young people’s learning capabilities. In remote Australia, the Australian Government’s Remote School Attendance Strategy (RSAS) operates in 77 schools, supporting around 14,000 students to get to school every day.

The Australian Government works collaboratively with states and territories to develop national priorities for schooling based on the best evidence of what works to improve student outcomes and close gaps.

The Government calculates funding for schools in accordance with the Australian Education Act 2013. Commonwealth recurrent funding is passed directly to states and territories and which combined with their own funding before the overall funding is distributed to each school according to each jurisdiction’s own needs-based allocation model. Commonwealth recurrent funding for non‑government schools is passed by the state and territory governments to the approved authorities for each school according to the Commonwealth’s funding calculation. Non‑government education systems (such as Catholic systems and Independent school systems) are also able to redistribute the Commonwealth recurrent funding they receive to their member schools, based on their own needs-based distribution method.

Under the Indigenous Boarding Initiative, non-government schools are eligible for funding to provide additional support to Aboriginal and Torres Strait Islander boarding students from remote or very remote areas. Over $11 million is provided to support 26 schools over 2014–2016.

^ Back to top

Higher education

In line with recommendations of the 2012 Review of Higher Education Access and Outcomes for Aboriginal and Torres Strait Islander People, all universities have strategies in place for improving Aboriginal and Torres Strait Islander access to and outcomes from higher education.

The former Aboriginal and Torres Strait Islander Higher Education Advisory Council (ATSIHEAC) provided recommendations to the Australian Government in 2015 to accelerate outcomes from higher education for Indigenous people. The ATSIHEAC recommendations address action in: whole-of-university approaches to improving Indigenous higher education access and outcomes; increasing the Indigenous academic workforce; and increasing Indigenous participation across the disciplines, including science, technology, engineering, mathematics and business.

Two projects were funded under the Higher Education Participation and Partnerships Programme (HEPPP) to improve Indigenous participation in professional education and careers in the STEM and business discipline areas. One project, being led by the University of South Australia and the National Aboriginal and Torres Strait Islander Higher Education Consortium, will develop implementation strategies for the ATSIHEAC recommendations. This project is expected to report in 2017. The other project, being led by the University of Newcastle, will develop best practice strategies, resources and a community of practice to increase the participation of Indigenous Australians in business higher education and related professions.

The HEPPP commenced in 2010. The aim of the HEPPP is to increase the number of people from low socio-economic status (SES) backgrounds who access, participate and succeed in higher education. HEPPP provides funding to universities to improve access to undergraduate courses for people from low SES backgrounds, including those who are also Aboriginal and Torres Strait Islander people, as well as improving the retention and completion rates of those students.

The Commonwealth Government and universities have worked together to develop the Indigenous Student Success (Higher Education) Programme (ISSP) which was announced in the 2016–17 Budget. From 1 January 2017, the ISSP will combine the Indigenous Support Programme, Commonwealth Scholarships Programme and tutorial assistance offered under the Indigenous Advancement Strategy into a single flexible programme.

Universities will continue to offer the types of services they always have, such as scholarships, tutorial support and safe cultural spaces for Aboriginal and Torres Strait Islander students to learn. However, ISSP provides greater flexibility to tailor these services and the support offered to meet the individual needs of each eligible student. The new arrangements will encourage universities to draw on the knowledge and expertise of Aboriginal and Torres Strait Islander people and support more Indigenous students to access higher education, successfully progress through university and complete their award to a high standard.

^ Back to top

Employment

Mainstream employment services operating in urban and regional locations provide support and assistance to around 88,000 Aboriginal and Torres Strait Islander job seekers.

The Community Development Programme (CDP) is the employment service operating in 60 regions across remote Australia, covering 75% of the Australian landmass. CDP replaced the former Remote Jobs and Communities Program on 1 July 2015 and assists around 35,000 job seekers of whom almost 83% are Aboriginal and Torres Strait Islander people. The program supports job seekers to build their employability skills and contribute to their communities through participation in work-like activities and training. Job seekers also have the opportunity to gain work experience in hosted placements with local employers to prepare them for the transition to real employment.

Indigenous specific employment assistance and support is also provided under the Jobs, Land and Economy Program (JLEP), which is one of five flexible broad-based programmes under the Australian Government’s Indigenous Advancement Strategy. JLEP elements help connect working age Aboriginal and Torres Strait Islander people with real and ongoing jobs, foster Indigenous business and assist Indigenous Australians to generate economic and social benefits from economic assets, including Indigenous-owned land. The programme complements mainstream employment services and programmes and supported approximately 13,700 employment placements under its various elements, including CDP, during 2015–16. During this period, JLEP achieved almost 6,800 employment outcomes for job seekers of 26 weeks or longer. Increased employment, business and economic development is achieved through a range of JLEP elements including:

^ Back to top