18 Month Funding Agreements for NACCHO & Affiliates

Assistant Minister Fiona Nash commissioned a Review of NACCHO and Affiliates in the context of NACCHO’s advocacy for three year funding Contracts for all Member ACCHOs. While NACCHO was successful in securing three-year funding for Member ACCHOs as well as continuity of the existing terms and conditions of the Standard Funding Agreements (subject to further joint discussions), funding for NACCHO itself and for the eight jurisdictional Affiliates was provided for only 18 months – until 31 December 2016 – with funding after that end-date subject to the report arising from the Review. This report is due to be provided in July 2016; so the duration of the Review is nine months.

The rationale for this Review is said to be that:

“Despite significant changes in the policy and programme environment for Aboriginal and Torres Strait Islander health service delivery, the role and function of these organisations have not been reviewed since funding commenced.”

Assistant Minister Nash did insist that the Review be undertaken jointly with NACCHO and the jurisdictional Affiliates, which are separately incorporated legal entities and are not Members of NACCHO. Hence, NACCHO refers to this as the “Joint Review”.
Assistant Minister Nash delegated accountability for implementation of her Joint Review to the Indigenous Health Division (IHD) in the Department of Health (DoH), with operational accountability given to the Health Programmes and Sector Development Branch.

The Purpose

The current version of the Terms of Reference make it clear that this Joint Review is an ‘investment review’.
“This review will examine how the investment that the Commonwealth makes in these peak bodies contributes to strengthening the health system’s delivery of quality, culturally appropriate primary health care services to the Aboriginal and Torres Strait Islander population.”
This is consistent with allocating only 18 months’ funding to NACCHO and to Jurisdictional Affiliates.

The Scope

DoH makes it clear that it accepts the World Health Organization (WHO) definition of a health system consisting of “all organizations, people and actions whose primary intent is to promote, restore or maintain health” (WHO, 2007, Everybody’s Business: Strengthening Health Systems to Improve Health Outcomes).

Accordingly, when DoH talks in the Joint Review about Australia’s health system, DoH means that this encompasses both Aboriginal community controlled and mainstream health sectors and includes the organisations and activities supported by all levels of government, private sector providers, non- government and community organisations.

The Focus

The current version of the Terms of Reference make it clear that this Joint Review will:

“… entail a comprehensive analysis of current sector support arrangements and their appropriateness in meeting the Commonwealth’s objectives and the support requirements of Aboriginal Community Controlled Health Services (ACCHSs) now and into the future.”

The outcomes and recommendations from the Review will be used to inform:

  • an agreed national work programme utilising Commonwealth funding with an associated monitoring framework that will contribute to and strengthen capacity to achieve the Closing the Gap (CTG) targets; and
  • how and where the Commonwealth could direct investment so NACCHO and the state/territory peak bodies can contribute most effectively to the Commonwealth’s objectives including supporting the ability of the health system to deliver high quality, accessible and culturally safe care to Aboriginal and Torres Strait Islander people.”

Objectives of the Review

There are six (6) objectives for the Joint Review.

  • Objective 1 is to understand how NACCHO and Jurisdictional Affiliates contribute to strengthening the organizational capacity of ACCHOs in five dimensions: performance; issues management; government; viability; and financial.
  • Objective 2 is to understand how current activities of NACCHO and the state/territory peak bodies align with the needs of the Commonwealth government, ACCHSs and the broader health system, and consider the capabilities required to deliver these activities. Since there is nothing said about the needs of the Commonwealth government and the broader health system, it is difficult to see how this objective will be operationalised.
  • Objective 3 is really two completely separate objectives which logically bear no practical relationship to each other: (a) consider how NACCHO and the state/territory peak bodies function as a national network and (b) the principal issues regarding health system integration with which NACCHO and the state/territory peak bodies could engage. Item (b) is the red flag about making our Sector accountable for failures of ‘integration’ by the mainstream providers.
  • Objective 4 requires the consultant to make recommendations to inform the ongoing delivery of required support to ACCHSs. The example that the Terms of Reference o er seem to address the NACCHO Board’s policy of ‘‘self-regulation’’ for sustainable governance.
  • Objective 5 is to understand how Commonwealth and State/Territory Government investment interacts to address jurisdictional need. There is no requirement on the consultant to come forward with recommendations but the fact that this is a speci c objective would imply that DoH will make use of what ‘understandings’ the consultant produces.
  • Objective 6 in fact picks up on this point. Consider the range of Commonwealth investment that could be made in NACCHO and the state/territory peak bodies, what that range of investment could purchase and where it could be best targeted to achieve best value for money, having regard to factors such as geographical size, Aboriginal and Torres Strait Islander population, and number of ACCHSs in each jurisdiction.

Advisory Forum

There are Terms of Reference for an Advisory Forum.

NACCHO wants a representative from the supervisory body oversighting Primary Health Networks (the Australian Healthcare and Hospitals Association) to be a member of the Advisory Forum to secure input from the ‘mainstream’ providers.