National Health Policies and Strategies

In July 2003, all Australian governments endorsed the National Strategic Framework for Aboriginal and Torres Strait Islander Health 2003–2013 (NSFATSIH). The key goal of the NSFATSIH is:

'To ensure that Aboriginal and Torres Strait Islander peoples enjoy a healthy life equal to that of the general population that is enriched by a strong living culture, dignity and justice.' (NATSIHC 2003)

The new National Aboriginal and Torres Strait Islander Health Plan is currently being developed and is due to be finalised in 2013. The evidence in the HPF has informed the development of the new Health Plan and also the COAG initiatives outlined below.

In December 2007, COAG agreed to a partnership between all levels of government to work with Aboriginal and Torres Strait Islander peoples to close the gap in Indigenous disadvantage. In recognition that outcomes for Indigenous Australians remain well below those of non-Indigenous Australians, COAG agreed to six targets:

1. closing the life expectancy gap within a generation (see measure 1.19)
2. halving the gap in mortality rates for Indigenous children under five within a decade (see measure 1.20)
3. ensuring all Indigenous four year olds in remote communities have access to early childhood education within five years
4. halving the gap for Indigenous students in reading, writing and numeracy within a decade (see measure 2.04)
5. halving the gap for Indigenous people in Year 12 attainment or equivalent attainment rates by 2020 (see measure 2.05)
6. halving the gap in employment outcomes between Indigenous and non-Indigenous Australians within a decade (see measure 2.07)

COAG has also identified seven building blocks that need to be addressed in a coordinated fashion if the targets above are to be achieved. These building blocks reflect the need for a whole of government approach, and emphasise the influence that social, economic and environmental factors have on overall health outcomes.

The building blocks are:

• early childhood
• education and supporting school attendance
• access to primary health care
• economic participation and active welfare
• healthy home environments
• safety and freedom from violence, and
• leadership and governance.

In November 2008, COAG agreed to sustained engagement and effort by all governments over the next decade and beyond to achieve the Close the Gap targets for Indigenous Australians. The National Indigenous Reform Agreement (NIRA) sets out the policy framework for Closing the Gap in Indigenous disadvantage. The COAG commitment also included targeted initiatives for Indigenous Australians of $4.6 billion across early childhood development, health, housing, economic participation and remote service delivery through a number of associated National Partnership Agreements (COAG 2008b). Health-related Agreements include:Top of page

• The National Partnership Agreement on Indigenous Early Childhood Development—with joint funding of $564 million over six years to June 2014, to address the needs of Indigenous children in their early years.
• The National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes—with funding of $1.6 billion over four years to June 2013, centred on five priority areas:
  
  
  1. tackling smoking
  2. providing a healthy transition to adulthood
  3. making Indigenous health everyone's business
  4. delivering effective primary health care services, and
  5. better coordinating the patient journey through the health system.

This Agreement acknowledges that to overcome Aboriginal and Torres Strait Islander health disadvantage, a holistic life stage approach is required that builds sustainable social change and embeds system reform. As part of this Agreement, the Australian Government committed to an Indigenous Chronic Disease Package that aims to reduce chronic disease risk factors; encourage earlier detection and better management of chronic disease in primary health care services; improve follow-up care; and increase the capacity of the primary care workforce to deliver effective health care to Aboriginal and Torres Strait Islander peoples across Australia.

The objectives of this agreement will be supported by the successful implementation of other Aboriginal and Torres Strait Islander initiatives including early childhood reforms, broader health system changes and measures to address the underlying social determinants of poor health.

• The National Partnership Agreement on Remote Service Delivery—which commits governments to work together with Indigenous communities to improve Aboriginal and Torres Strait Islander peoples' access to government services, including early childhood, health, housing and welfare services in selected remote communities.
• Since July 2012, the Stronger Futures in the Northern Territory National Partnership Agreement has replaced the National Partnership Agreement on Closing the Gap in the Northern Territory. This 10-year agreement includes $713.5 million investment to continue with successful initiatives to improve the health and wellbeing of Aboriginal and Torres Strait Islander peoples in the NT.

In November 2008, COAG also signed the National Healthcare Agreement committing $60.5 billion over five years. This affirmed the agreement of all governments that Australia's health system should:Top of page

• be shaped around the health needs of individual patients, their families and communities
• focus on the prevention of disease and injury and the maintenance of health, not simply the treatment of illness
• support an integrated approach to the promotion of healthy lifestyles, prevention of illness and injury, and diagnosis and treatment of illness across the continuum of care, and
• provide all Australians with timely access to quality health services based on their needs, not ability to pay, regardless of where they live in the country.

In August 2011, COAG endorsed the National Health Reform Agreement and the National Partnership Agreement on Improving Public Hospital Services. As a result of these agreements, the Commonwealth will contribute to the efficient growth funding for hospitals commencing at 45% from 1 July 2014, and increasing to 50% from 1 July 2017. A guaranteed additional $16.4 billion will be provided by the Commonwealth for public hospital services up until 2019–20. This funding is additional to that which the Commonwealth would have otherwise provided.

Since 1 July 2012, hospitals' funding is based on the services they provide. This 'Activity Based Funding' is underpinned by a set of nationally efficient prices determined by the Independent Hospital Pricing Authority. New agreed targets have begun to reduce elective surgery waiting lists and improve treatment times in emergency departments.

The Australian governments developed these reforms to ensure that the health system is put on a more financially sustainable footing, with an increasing share of public hospital costs being met by the Commonwealth into the future, more locally responsive planning and management of health services, an increased focus on safety and quality, and better publicly available information on the performance of health services. In combination, these reforms will improve timely access for people to high quality care, both in and out of hospital.

Under the National Health Reform Agreement, the Commonwealth is working collaboratively with states and territories to achieve a better integrated primary health care system through the development of a National Primary Health Care Strategic Framework. The Framework will be completed by December 2012 and will complement state-specific plans for primary health care services (to be negotiated between the Commonwealth and individual states/territories), due by July 2013.

The Aboriginal and Torres Strait Islander Health Performance Framework (HPF) is being used to inform the development of these policies and also in monitoring progress in closing the gap in Aboriginal and Torres Strait Islander disadvantage. The HPF recognises that an effective, efficient and equitable health system is an essential component for any whole of government effort that seeks to address Aboriginal and Torres Strait Islander health. In addition, action is required in areas such as education, employment, transport and housing to achieve sustainable health gains.

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