human rights council social forum 2015 - ohchr | home · 2016-12-17 · • no aboriginal person...

Human Rights Council

Social Forum 2015

Improving Aboriginal and Torres Strait Islander Access to Medical Care – Patient Centred Approaches

18-20 February 2015

Room XII, Palais des Nations, Geneva

Associate Professor Noel Hayman

Indigenous Population Profile

State

Indigenous population

Proportion of Indigenous

population %

Proportion of total State/Territory

population %

NSW 172,624 31.5 2.5

Qld 155,825 28.4 3.6

WA 69,665 12.7 3.1

NT 56,779 10.4 26.8

Vic 37,991 6.9 0.7

SA 30,431 5.5 1.9

Tas 19,625 3.6 4.0

ACT 5,184 0.9 1.5

TOTAL 548,370 100.0 2.5

ABS - June 2011


Social Forum 2015 – Room XII, Palais des Nations, Geneva


18 – 20 February 2015

Inala Community Health Building – Indigenous Health resides in this building

Access data to Inala Health Centre General Practice




18 – 20 February 2015

Improving Indigenous access to a mainstream health service

• Intervention Location

• Inala – Urban multicultural population

• Inala – 8% Indigenous but only 12 Indigenous patients attended UGP

Services Provided at Inala Community Health Centre • Inala Health Centre General Practice (UGP-IHCGP – IPC)

• Inala Indigenous Health Service established in 1995

• Home & Community Care (HACC)

• Child Health (visiting pediatricians)

• Oral Health

• Mental Health (visiting psychiatrists)

• Alcohol, Tobacco & Other Drugs

• Breast screening Unit

• Therapies

Noel Hayman, Nola White and Geoffrey Spurling. Improving Indigenous patients’ access to mainstream health services: The Inala experience. Medical Journal of Australia (MJA), 2009; 190 (10): 604-606

Access to Primary Health Care-very important health issue

for Aboriginal and Torres Strait Islander people




18 – 20 February 2015

Improving Indigenous access to a mainstream health service

Data from focus group and phone interviews 1994.

Reasons for not attending IHCGP:

• No Aboriginal person working within the centre

• Aboriginal people perceived staff as unfriendly & uncaring

• Staff talk down to you “Make you feel shamed”

• Staff body language was interpreted by aboriginal people as unwelcoming

• Treated poorly at reception eg: “Why are you coming in at 4.30 pm, we

close at 5.00pm. Go home and come back tomorrow”.

• Staff showed low tolerance to indigenous child behaviour “keep them

quiet’.

• Long wait to see doctor

• There is “nothing” at the centre that aboriginal people can identify with.

Reasons for attending IHCGP (UGP):

• Convenience

• Satisfied with doctors & Staff

• No racism reported and patients older




18 – 20 February 2015

Five key strategies to improve indigenous access

Strategy 1

To Employ an Aboriginal or Torres Strait person in IHCGP. This person could be a nurse,

Aboriginal or Torres Strait Islander Health Worker, a receptionist , or a liaison person for the

centre.

Strategy 2

To purchase culturally appropriate health posters and artifacts for the center to help make

Aboriginal & Torres Strait Islanders people “feel more at home”. Also play Aboriginal radio “AAA

Murri Country” on occasions. This will enable Aboriginal & Torres Strait Islander people to

identify with the centre.

Strategy 3

To provide cultural awareness talks to all staff within the centre.

Strategy 4

To disseminate information into the Aboriginal and Torres Strait Islander community about what

services are available at the Inala Community Health Centre.

Strategy 5

To promote intersectoral collaboration:

Woolloongabba Aboriginal & Islander Community Health Service (AICHS) to conduct a clinic

within IHCGP.

Liaison with the Inala Aboriginal & Torres Islander Women’s Health Support Group

Attend Aboriginal & Torres Strait Islanders Inter-Agency meetings.




18 – 20 February 2015

IHCGP (UGP) 1994 IIHS 2006-2013




18 – 20 February 2015

Inala Indigenous Health Clinic

and patient waiting area 2006-2013




18 – 20 February 2015

Benefits from Access Data

Funding from Queensland Health limited: Access to section 19(2) Health Act.

Increase in staff

1995 – Staff

Doctor 1.0 Doctor

Nurse 1.0 Nurse

2012 – Staff

Doctor 2.5 VMO

3.0 SMO

1.0 GP Registrar

0.25 Ophthalmologist

0.25 Cardiologist

0.25 Endocrinologist

0.3 Paediatrician

Nurse 1.0 NUM

4.0 Child Health Nurses

3.0 Clinical Nurses

1.0 Chronic Disease Co-ordinator

0.4 Outreach Immuniser

3.0 Research Nurses (Aboriginal)

Research Director 1.0 Research Director

Research and Teaching Manager 1.0 Research and Teaching Manager

AHW 4.0 Aboriginal Health Worker

Dietician 1.0 Dietician- Clinic

Nutritionist 1.0 Nutritionist- Community

Project Officers 14.0 Research associated project officers

Administration 5.0 Administration Officers

Total FTE’s Over 50 staff in 2014




18 – 20 February 2015

Benefits from Study

• Indigenous people finding it easier to access Mainstream Health Services.

1995, 12 patients: 2014 over 10,000 on data base with approximately 3,000 regular patients

• Culture exchange with other Doctor’s

• Screening and early detection of Chronic diseases

• High immunisation rates (children)

• Employment of more staff (Under Section 19 (2) of the Health Act)




18 – 20 February 2015

Lessons Learnt Over Past 20 years

• Local Aboriginal & Torres Strait Islander people attend because staff is Indigenous

• Importance of Aboriginal Doctors and Nurses:

– Easy to talk to

– Knowledge of culture

– Explain medical terminology

• Importance of working with community




18 – 20 February 2015

Healthy for Life 2006 - 2011

• Commonwealth funding commencing 2006

• Healthy for Life $102.4 M over four years, continued funding

• Improve health outcomes for mums and babies

• Reduce incidence of chronic disease

• Enhance the life of patients with chronic disease

• Extensive evaluation framework

• CQI, collect data, analyse, act




18-20 February 2015

Chronic Disease - NIDDM Clients Average HbA1c 06/07 - 9.6%, 07/08 - 8.2%,

08/09 - 7.9%, 10/11 - 7.9%, 12/13 - 8.0%

2006-

2007

2007-

2008

2008-

2009

2010-

2011

2012-

2013

•9.6% •8.2% •7.9% •7.9% •8.0%

My Vision

Over the past 5-6 years

Centre of Excellence in Indigenous Primary Health Care (Indigenous Health: Everyone’s responsibility)

• Link with Universities for Teaching (medical students, nursing, Allied Health) and Research

• Link with Colleges: Teaching and training of Advanced Trainees (ie Paeds, Endocrine, Psychiatry, GP registrar) in Indigenous Health

• Improve local community capacity

• Teaching of PGY1 (Interns) eg Chronic Disease management

• Outreach to areas of need where access is poor. Cunnamulla MSOAP-IDC.

• Staff from DG’s office at one of my conference presentations: invited to meet Health Minister.

Equity to Infrastructure




18 – 20 February 2015

Vision Becomes Reality

• Queensland Government provided funding for the development of a Southern Queensland Centre of Excellence in Indigenous Primary Health Care. $7M for building + $2M recurrent for staff.

• Official Name: Southern Queensland Centre of Excellence for Aboriginal and Torres Strait Islander Primary Health Care.

• Aim is to increase the quality, quantity and appropriateness of Indigenous primary health care through teaching and research.

• The development falls under the “Closing the Gap on Indigenous Health Outcomes National Partnership Agreement” (the Indigenous Health NPA), agreed to by Council of Australian Governments (COAG), 2009-2010.

• Sod Turning Ceremony 22/05/12.




18 – 20 February 2015

Inala Aboriginal and Torres Strait Islander Community Jury for

Health Research

• Provides cultural oversight to IIHS research

• All research done at or through IIHS needs approval from the

Jury

• Researchers have to present their research to the Jury, in plain

English, focusing on the benefit for the community

• 14 members, range of ages, males & females, Aborigines and

Torres Strait Islanders

• Currently research project evaluating the experiences of the

jury members and the researchers who have presented to the

jury




18 – 20 February 2015

Campaign for Indigenous Health Equality

• Mr Mick Gooda, Co-chair, Aboriginal

and Torres Strait Islander Social

Justice Commissioner, Australian

Human Rights Commission

• Dr Tom Calma, Co-chair, National

Coordinator – Tackling Indigenous

Smoking (Campaign founder)

http://www.hreoc.gov.au/social_justice/health/index.html

Close the Gap Campaign

Steering Committee

Closing the Gap Chronic Disease Programs 2010

Closing the Gap $1.6B over four years

• MSOAP-ICD (Medical Specialist Outreach Assistance Program-

Indigenous Chronic Disease) new money (Cunnamulla-rural town)

• MSOAP-existing money

• USOAP (Urban access to specialist) new money

• PIP incentives (Practice accreditation)

• CTG Pharmaceutical Benefits Scheme (PBS) co-payment. Indigenous patients with chronic disease. If they pay full price, now they pay $5.80 per script. If they pay $5.80 per script, now medication is free. To compliment S100 in rural/remote.




18 – 20 February 2015




18 – 20 February 2015

Close the Gap Chronic Disease Program Evaluation 2010

By Menzies School of Health

Notable achievements

1. Improved access to primary care services and to affordable

medication for many Aboriginal and Torres Strait Islander people

2. Improved orientation of the General Practice sector to the

needs of Aboriginal and Torres Strait Islander people

3. Significant steps towards the early establishment of a new

workforce that is focused on health promotion and in the

development of local health promotion initiatives

4. Increased attention to enhancing access to specialist, allied

health and team-based approaches to chronic illness care




18 – 20 February 2015

For the CTG Programs to remain successful in 2015

1. Need commitment from Governments (National and State level)

Current Government has not committed to continuing the funding

for these Programs after June 2015

2. Current budget problems Nationally – need to find savings.

Significant cuts to Indigenous Health

3. Concerns that access to affordable medication may also be

cut

4. Bipartisan support. Current government and opposition need

to support Indigenous Health initiatives to be successful

?

Any Questions Thankyou.

human rights council social forum 2015 - ohchr | home · 2016-12-17 · • no aboriginal person...

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