1. The Primary Health Care Access Program (PHCAP) in the Northern Territory. John Boffa Public Health Medical Officer Central Australian Aboriginal Congress.

2. Introduction 1. Funds pooling: what is it and how does it work in the NT? 2. What can be funded: the NT core functions of Aboriginal Primary Health Care? 3. How will this deliver new and expanded Aboriginal community controlled health services? 4. Where will we find the workforce?

3. Funds Pooling 1. New and existing Commonwealth and existing Territory per capita PHC funding is being pooled to create funding benchmarks. 2. Only happening in 10 out of 21 NT health zones as only 57 million nationally in the PHCAP – rationing of allocation to 2000 people per zone. 3. The integrated Commonwealth / Northern Territory funding Model.

4. Integrated funding model in the NT 1. Average national MBS usage 2000/2001 = $380 per person. 2. PHCAP remote benchmark = 4 x $380 = $1520 per person. = $1520 per person. 3. PHCAP urban benchmark = 2 x $380 = $760 per person (Darwin only). 4. PHCAP grant cap = $1520 less $215 = $1305 per person (mixed mode only: add MBS and section 100 ). 5. Integrated PHCAP grant cap = $1305 + $684 (NT per capita av.) = $1989 per person.

5. Funding model continued 5. 2 x PHCAP benchmark = $760 + $684 = $1444 per person. (Darwin) 6. Commonwealth regional grant cap in Central Australia = 19 116 (pop) x $1305 – Cwlth exisiting inscope ($11,035,961) = $13,910,419. 7. Total new funding for all 11 zones. 8. Currently only 7 new zones funded plus the conversion of the CCTs to the PHCAP.

6. Funds pooling advantages 1. Equality of funding: Existing NT range across 11 zones is $347 to $1115 per capita; Existing NT range across 11 zones is $347 to $1115 per capita; Existing Cwlth range across 11 zones is $0 to $1038 per capita; Existing Cwlth range across 11 zones is $0 to $1038 per capita; The integrated funding model achieves equal funding in all zones but not necessarily equity. The integrated funding model achieves equal funding in all zones but not necessarily equity.

7. Funds pooling advantages 2. Flexibility of funding. The NT is contributing “cash” in order to fund new and expanded ACCHS. The NT is contributing “cash” in order to fund new and expanded ACCHS. States who are not pooling will attempt to improve their outcomes in Aboriginal health by reorienting their own services. States who are not pooling will attempt to improve their outcomes in Aboriginal health by reorienting their own services.

8. Funds pooling advantages 3. Increased funding: The average PHC per capita contribution in the NT is almost twice the MBS national average; The average PHC per capita contribution in the NT is almost twice the MBS national average; Other states do not have this level of PHC expenditure in Aboriginal health. They would need to find new money to contribute significantly to a funds pool. Other states do not have this level of PHC expenditure in Aboriginal health. They would need to find new money to contribute significantly to a funds pool. 4. Recognition of ACCHS as core to the health system / less duplication and competition by the State.

9. Funds pooling disadvantages. 1. Complexity. 2. States refusing to play ball with enough cash to make it worthwhile. 3. Non Aboriginal funding issues in some remote areas.

10. What can be funded? Core functions of CPHC 1. Clinical services. 2. Support services. 3. Social and preventative programs. 4. Policy and Advocacy.

11. Clinical services 1 Primary clinical care treatment of illness using standard treatment protocols treatment of illness using standard treatment protocols 24 hour emergency care 24 hour emergency care 24 hour access to the advice of a doctor either on site or via telecommunications 24 hour access to the advice of a doctor either on site or via telecommunications provision of essential drugs including provision of medicine kits to designated holders provision of essential drugs including provision of medicine kits to designated holders continuing management of chronic illness continuing management of chronic illness

12. Clinical services 2 Preventative care immunisation immunisation antenatal care antenatal care appropriate screening and early intervention appropriate screening and early intervention STI and other communicable diseases control STI and other communicable diseases control secondary prevention of complications of chronic diseases secondary prevention of complications of chronic diseases

13. Clinical services 3 Clinical support systems such as a pharmaceutical supply system and a comprehensive health information system which will include: a population register and recall system a population register and recall system a chronic disease register and recall system a chronic disease register and recall system collection of data to enhance evaluation and quality assurance. collection of data to enhance evaluation and quality assurance.

14. Support services: internal 1. Staff training and support orientation of new staff in the management and presentation of major illnesses and in cross cultural and other issues orientation of new staff in the management and presentation of major illnesses and in cross cultural and other issues Aboriginal Health Worker education Aboriginal Health Worker education continuing education opportunities for all staff continuing education opportunities for all staff

15. Support services: internal 2. Management systems Financially accountable and include effective recruitment and termination practices. Financially accountable and include effective recruitment and termination practices. Where PHC is managed by a community controlled health service the organisation must be adequately resourced to implement and maintain good management systems Where PHC is managed by a community controlled health service the organisation must be adequately resourced to implement and maintain good management systems

16. Support services: internal 3. Adequate infrastructure at the community level staff housing and clinic facilities staff housing and clinic facilities functional transport facilities to allow access to appropriate health care when needed. This includes the availability of roads and airstrips as well as the use of road and air transport where needed. functional transport facilities to allow access to appropriate health care when needed. This includes the availability of roads and airstrips as well as the use of road and air transport where needed.

17. Support services: external appropriate visiting specialists and allied health professionals appropriate visiting specialists and allied health professionals medical evacuation services where needed medical evacuation services where needed access to hospital facilities access to hospital facilities costs of transport and accommodation to access specialist and ancillary care where needed costs of transport and accommodation to access specialist and ancillary care where needed education and training i.e. TAFE, university level etc. education and training i.e. TAFE, university level etc.

18. Social and preventative programs Resources to enable community initiated activities to address the underlying determinants of ill health. eg. Substance misuse Early childhood Nutrition

19. Policy and Advocacy Resource participation in joint planning and policy development. Resource participation in joint planning and policy development. Community consultation. Community consultation. Lobbying. Lobbying. Submissions. Submissions. Analysis of health policy and data. Analysis of health policy and data. Publishing and dissemination. Publishing and dissemination.

20. How will this lead to new ACCHS? 1. Contact team community development role. 2. Zonal Aboriginal Steering Committees. 3. Consultancies: health service implementation plan and community control plan. 4. Establishment of Health Boards. 5. ACCHS or Aboriginal health boards contracting another provider.

21. Who will work in these new health services? 1. AHWs: shortage. 2. Nurses: shortage. 3. Doctors: shortage- almost exclusively from overseas. 4. Need for local Aboriginal management. 5. Governance training for health boards.

22. Conclusion 1. Funds pooling has more advantages than disadvantages in the NT. 2. Need the PHCAP to be fully funded to avoid the “drip feed” problem. 3. Can deliver the NAHS vision that all Aboriginal communities should have an ACCHS.