Improving Social Determinants of Indigenous Health Unified approach to implementing the National Partnership Mr Brian Gleeson Coordinator General for Remote Indigenous Services

The lay of the land Closing the Gap A COAG initiative Remote Service Delivery A new way of working The Office of the Coordinator General for Remote Service Delivery A watchful eye

Closing the Gap BUILDING BLOCKS Early Childhood SchoolingHealthy Homes Health Economic Participation Safe Communities Governance and Leadership

Closing the Gap TARGETS 1.Closing the life expectancy gap within a generation. 2.Halving the gap in mortality rates for Indigenous children under 5 within a decade. 3.Ensuring all Indigenous 4 year olds in remote communities have access to early childhood education within 5 years. 4.Halving the gap for Indigenous students in reading, writing and numeracy within a decade. 5.Halving the gap for Indigenous students in year 12 attainment or equivalent attainment rates by Halving the gap in employment outcomes between Indigenous and non Indigenous Australian within a decade.

Closing the Gap INDIGENOUS SPECIFIC NATIONAL PARTNERSHIPS 1.Closing the gap in Indigenous health outcomes. 2.Indigenous Early Childhood Development. 3.Indigenous Remote Service Delivery (RSD). 4.Remote Indigenous Housing. 5.Indigenous Economic Participation. 6.Remote Indigenous Public Internet Access.

What will RSD Achieve Improve services – make sure the right ones are there and that they do things properly. Help communities to be able to manage their dealings with governments and organisations better (governance and leadership). Set up offices in each community to make is easier to understand what governments can do for communities and their members. Ensure that communities are determining their own future. Help make communities better places to live in. The question should not be, why do women not accept the service that we offer? BUT Why do we not offer a service that women will accept? World Health Organization 2005

RSD Works at 3 Levels Governments working differently by themselves and together – looking at places rather than programs and levels of government. Governments and communities working differently together – a proper partnership with joint decisions about what will be done and how it is done. Communities working differently – being properly informed, making decisions, holding governments and service providers accountable. "If you talk to a man in a language he understands, that goes to his head. If you talk to him in his language, that goes to his heart." Nelson Mandela

Why is RSD Different Focuses investment in specific locations. Whole of community approach. Focused on location not policy domains. Scope for innovative approaches, trial what works. Work in partnership with communities / community development approach. Ongoing government presence – closer to communities. Governments in partnership.

RSD Priority Communities

Indigenous health The level of service delivery varies across the 29 priority communities. Many communities are over 250km away from a hospital Some only see a GP every two weeks and one has no GP service at all.

Indigenous health Distance to nearest hospital 27% of communities travel km to go to a hospital 41% of communities travel more than 249km to go to a hospital

Indigenous health GP work/ visit in community 62% of communities do not have daily access to GPs

Indigenous health Dentist work/ visit in community 96% of communities do not have weekly access to a dentist

Indigenous health Aged accommodation 68% of communities have no aged accommodation

Indigenous health The incidence of treated end stage renal disease in Indigenous Australians is eight times that of other Australians. In remote areas it is more than twice this and in the Northern Territory it is more than 28 times. PREVENTATIVE HEALTH NEEDS GREATER PRIORITY.

Case Study In early 2007 Kurra decided to support Warlpiri renal patients forced to dislocate from their communities to Alice Springs to access dialysis treatment. Using $1.6 million in Kurra royalty money, a dialysis clinic will open in Yuendumu in early The funding will also pay for patients from nearby communities to travel to Yuendumu for regular overnight visits and longer holidays at home, where they will be treated in the unit by the renal nurse. The renal service in Yuendumu will cater for patients in Yuendumu, Nyirripi, Yuelamu and Willowra. With the money from Kurra, the renal service in Yuendumu will last for around twelve months. Kurra are hoping that governments and philanthropists will agree to put some money towards the renal service to help keep it running.

Accountability breeds responsibility.

The Establishment of the Office Statutory office established under the Coordinator General for Remote Indigenous Services Act 2009

Oversee the implementation of the RSD partnership. Formally report twice a year on progress, and ensure that all government agencies are held accountable for their implementation responsibilities. Have the authority to work across agencies to cut through red tape and bureaucratic blockages and to make sure services are delivered effectively. Work with the whole of government Regional Operations Centres established to coordinate services in communities and the single government contact points located within the priority communities. Our role

Community driven solutions. Challenge the business as usual approach. Name and fame the outstanding work of many individuals and organisations. Get Governments to work together. Turn promises into results. Our approach

1. Great willingness generally from individuals to see change and support RSD. 2. Frustration with lack of results. 3. Complexity of Closing the Gap strategy. 4. Many layers of Government and reporting. 5. Governance and leadership needs attention. 6. Importance of effective communications. Key lessons learned

Questions? cgris.gov.au