NACCHO Strategic Direction
NACCHO’s Strategic Direction providing direction for the organisation over a 3 year period and is developed by the Board through a consultative process with NACCHO’s Membership, stakeholders and the Secretariat. It forms the basis for the organisation’s strategic action plan – the Service Development Reporting Framework.
NACCHO’s Strategic Directions over the next three years will focus on three central areas that are consistent with its constitutional objectives.
Each Strategic Direction has objectives and several key strategies that will be implemented to achieve the objective over the next three years.
The listed indicators will determine how well NACCHO is progressing under each Strategic Direction. They are divided into ‘process’ and ‘impact’ indicators. Process indicators are used to judge the effectiveness and appropriateness of strategies, and focus on issues of satisfaction, quality, audience and reach. Impact indicators are used to judge progress toward or achievement of objectives and focus on difference or change.
Objective 1: To increase the ACCH Sector’s involvement and authority in determining how Aboriginal health is funded, managed and monitored in the national health reform process.
Impact 1.1: The ACCH Sector is regularly involved in decision-making on how Aboriginal health is funded, managed and monitored through the national health reform process.
Impact 1.2: The authority of the ACCH Sector in how Aboriginal health is funded, managed and monitored is consistently recognised and respected by Government and other health stakeholders.
As a NACCHO guiding principle, the right to self-determination means having the authority to determine how health services and related-activities are designed, managed and monitored for Aboriginal Peoples. NACCHO is the only remaining legitimate and truly representative national organisation for Aboriginal communities serviced by ACCHSs covering remote, rural and urban areas.
This enables NACCHO to clearly articulate the health concerns of Aboriginal Australia, propose culturally appropriate and relevant models of service delivery, and determine whether reported health outcomes represent real and substantial change for Aboriginal communities.
NACCHO offers a vital resource to the national health reform process that has yet to be fully realised. It can be involved more effectively in a consistent and ongoing manner to set the public health agenda and determine how to fund, monitor and report on health activities and outcomes. The authority vested in NACCHO’s voice will be a critical factor in achieving Australia’s shared aspirations to close the gap in
The first, to ‘Shape the national reform of Aboriginal health’, makes it clear that we need to embark on a new process of reform at the national level. The last major national reform was the transfer of responsibility for Aboriginal health to the Department of Health and Ageing back in 1995. Our sector led the advocacy for this change and it was the springboard we needed to greatly increase the amount of funding now available for Aboriginal health service delivery. This included much better access to the MBS and PBS as well as grant funding.
Unfortunately, these funds have not systematically flowed into the creation of new and enhancing existing Aboriginal community controlled health services even though this is the best practice model agreed in the national strategic plan. There are systemic barriers within government to transforming of the health system in favour of Aboriginal community controlled comprehensive primary health care. Once again, national reform is needed to address these barriers so that our people can access the highest quality, culturally safe community controlled health care in a way that builds our responsibility for our own health. This requires existing health funds to be better invested.
Objective 2a: To increase the profile of the ACCH Sector’s comprehensive primary health care model and achievements.
Objective 2b: To improve the capacity of the ACCH Sector to provide best practice comprehensive primary health care, and monitor and report the outcomes of care.
Impact 2.1: The ACCH Sector comprehensive primary health care model is consistently recognised and supported by Government and other health stakeholders as the best practice model for providing culturally appropriate services for Aboriginal Peoples.
Impact 2.2: Australian Government funding decisions and allocations in Aboriginal health reflect the achievements and capacity-strengthening needs of the ACCH Sector.
Impact 2.3: The ACCH Sector has ready access to data and information on the impact and value of comprehensive primary health care for Aboriginal Peoples.
Our commitment to Aboriginal concepts of health as holistic, recognition of diverse communities and different needs and the right to have universal access to basic health care has resulted in NACCHO Members developing a culturally appropriate comprehensive primary health care model that is adaptable to a variety of locations. In fact, NACCHO Members’ ability to service areas in which few or any access to health care is available has increasingly been used as the recommended model for the delivery of services in difficult to access and often forgotten or hidden areas of Australia.
It is a critical part of achieving health equity for all Aboriginal people throughout Australia.
While there is increasing evidence for the effectiveness of the ACCH Sector’s culturally appropriate comprehensive primary health care model, the model and its achievements needs to be profiled on a broader basis so it is recognised and supported more effectively.
Opportunities to enhance the model and ensure the ACCH Sector has the capacity to deliver, monitor and report on best practice health services are also required.
This aligns with NACCHO’s guiding principle of ensuring Aboriginal people have access to high quality health care services.
This leads into our second strategic direction which is to promote the quality and effectiveness of our services and for greater recognition that Aboriginal community controlled health services are the best practice model for Aboriginal people.
This was recognised in the recent report from the National Health and Hospital Reform Commission. It is time for a more effective pathway to community controlled primary health care to enhance the quality and effectiveness of the health system for our people.
Finally, this plan is clear that the Gap cannot be closed by the health system alone – even if we achieve our goal of reforming the health system so that there is a greater focus on Aboriginal community controlled health services.
This is necessary but not sufficient by itself. We must also address the social determinants of health, beyond access to health services. This is possibly our biggest challenge and it is taken head on in this plan. This includes the need to ensure that we have strong research to build an evidence base to guide our policy development.
Impact 3.1: The quantity of available research and evaluation that reflects ACCH Sector priorities increases over the next three years.
Impact 3.2: There is increasing evidence that ACCH Sector conducted, commissioned or initiated research and evaluation is used to shape decisions about the funding, management and monitoring of Aboriginal health.
Research and evaluation in Aboriginal health that is conducted, commissioned or initiated by the ACCH Sector will fulfill important functions defined in the NACCHO Constitution. Specifically, these are to: increase NACCHO’s influence over the collection and analysis of Aboriginal health information and research, and undertake both collaborative and stand-alone research.
Research and evaluation projects must have a clear purpose that respond to ACCH Sector priorities and help identify improvements in health experiences and outcomes for Aboriginal Peoples. The learning gained must have the capacity to shape decisions about service delivery needs and models, funding, management and monitoring in Aboriginal health. NACCHO would work with relevant organisations to source funds to undertake collaborative, independent and commissioned research and evaluation; as well as recommend how research institutes allocate existing funds
Strategic direction three is to “Promote research that will build evidence-informed best practice in Aboriginal health policy and service delivery’.
We must get better educational outcomes for our people. This needs to be seen as central to our struggle for health improvement, but how best do we achieve this? One key part of this is to focus on the early childhood environment of our kids so that they grow up well nurtured and stimulated and free from adverse events such as violence in the home. But how can this be best achieved? We know that better education
NACCHO’s four Strategic Challenges
The Aboriginal Community Controlled Health Sector faced four major strategic challenges during 2014-2015.
1. The Australian Government and some State Governments accelerated and extended their related policies of ‘commissioning’ and creating ‘markets’ of contracted service providers.
At the Commonwealth Government level, this challenge was most evident in three major nation- wide changes to funding for Aboriginal Health Programmes, namely:
- The decision was taken to abolish the unsatisfactory Medicare Locals and replace them on 1 July 2015 with geographically much larger Primary Health Networks, responsible for “commissioning” wide-ranging primary health care service delivery from “service providers”. Primary Health Networks (PHNs) are designed to be led by private, for-profit General Practitioners (GPs) and a key objective is to reduce avoidable hospital admissions and thereby drive down the overall costs to the Budget bottom-line of medical care. In calling for consortia to submit tenders for approval as PHNs, the then Minister for Health, Hon Peter Dutton MP, did not make any provision for Aboriginal or ACCHO Sector representation on PHN Boards, their Clinical Councils or their Community Advisory Committees. A serious concern which NACCHO vigorously advocated against was the automatic transfer of scores of millions of dollars in Aboriginal and Torres Strait Islander “health programme grant funds” from Medicare Locals to Primary Health Networks for PHNs to distribute without any public guidelines to protect probity, ensure fairness, and encourage value for money or consultation with the ACCHO Sector.
- The decision was taken to use a nation-wide, open, competitive “commissioning” process to allocate grants under the five Programmes of the Indigenous Advancement Strategy (IAS), which includes the “Safety and Wellbeing Programme”, Social and Emotional Wellbeing, mental health and substance misuse (AOD). This process was authorised by the Minister for Indigenous Affairs, Senator Nigel Scullion. The resulting round of applications was widely condemned and was the subject of an Inquiry by the Senate Standing Committees on Finance and Public Administration. The Minister committed in August 2014 that the IAS “will look to channel funds through the organisations that can best work closely with Indigenous people, families and communities, particularly those organisations that employ Indigenous people and understand what needs to be done to improve outcomes for Indigenous people.” But in announcing the “winners” of the IAS commissioning round, in May 2015, Minister Scullion advised that in total only “46 per cent of funded organisations are Indigenous and 55 per cent of funds under the IAS round is going to Indigenous organisations.”
ACCHOs fared especially unfavorably. From the NACCHO member survey, ACCHOs applied for 186 programmes. Of these 186 programmes, 83 were for new funding and 103 were for continuity of existing funding. 67 funding applications for new programmes were unsuccessful, that is, 80% of the 83 new programme funding applications were rejected. Of the remaining 103 programmes that had previously been funded, 68 programmes had their funding continued and 16 other programmes were continued but with funding cuts, which is a success rate of 81.5%. 19 existing programmes were defunded – 18.5%. With 80% of new programme applications being rejected and 81.5% of existing programmes receiving either full or partial refunding, it seems fair to suggest that innovation was not a high priority.
NACCHO made representations to the Senate Standing Committees against the policy dictate from the IAS that Aboriginal organisations receiving grants in excess of $0.5M had to be incorporated under the Commonwealth Aboriginal and Torres Strait Islander Act 2006 to be regulated by the O ce of the Registrar of Indigenous Corporations – which is in no way comparable to the independent statutory regulator ASIC (Australian Securities and Investments Commission) under the superior mainstream legislation, the Corporations Act (Cth) 2001.
NACCHO also advocated that the components of the “Safety and Wellbeing Programme” should not have been included in the IAS and NACCHO consistently advocated for these components to be returned to the Commonwealth Department of Health.
- In the 2014-2015 Budget introduced in May 2014, the Government announced the establishment of a new “Indigenous Australians’ Health Programme” (IAHP). The IAHP continued to evolve, slowly, during 2014/2015 – eventually new Programme Guidelines were promulgated in July 2015. The original IAHP Programme Guidelines and their July 2015 update both announced that the Department of Health would introduce a “new funding allocation methodology”. By 30 June 2015, no approach had been made to NACCHO to work on this new funding allocation methodology. There are serious questions about the criteria for allocating new grant monies under the IAHP between regions and the weightings given to each of the criteria, and the proportions of the $3.1 billion allocated from 2014-2015 to 2017-2018. [Source: Original Programme Guidelines]
A satisfactory outcome to the ‘‘commissioning’’ and the apparent free-for-all ‘‘service provider’’ challenges is necessary for the sustainability of the ACCHO Sector and its expansion to contribute further to Closing the Gap.
2. Applying data analysis to support the competitive positioning of ACCHOs.
NACCHO realised that one of the effective ways to deal with new and often inexperienced, ‘entrants into the new regional and local ‘service provider markets’ – and with existing competitors in the private sector and mainstream public sector – was to make much better use of data analysis.
Reports, publications, ‘’dashboard’’ graphics and geo-coded maps could be developed and produced using both publicly available information as well as de-identified service performance information from ACCHOs on a local and a regional scale.
The NACCHO Board commissioned the development of a comprehensive Health Information Strategic Plan to provide a programme of action that NACCHO could implement to support Member ACCHOs to apply data analytics to strengthen their positioning for capturing resources in their own ‘‘markets’’. A complementary review of NACCHO’s own ICT infrastructure and capability was set up by the Chief Executive O cer. In early May 2015, a national “ICT/IM Workshop” was convened by NACCHO in Canberra of representatives from jurisdictional A liates and selected ACCHOs, which was helpful in building a broad understanding of optional positioning strategies and tactics.
The NACCHO Board of Directors met on 13 May 2015 and endorsed the directions recommended for the NACCHO Health Information Strategic Plan.
3. Improving the patient journey and therefore health outcomes by applying CQI practices to practical partnerships between the public sector and the ACCHO sector.
The decision of the Commonwealth Department of Health to invest specifically in “CQI” – continuous quality improvement –opened up new possibilities to address the challenges of inter-sectoral patient journey coordination.
The Department’s injection of additional new grant funds into ACCHOs to enable them to develop their own, “local CQI Action Plans” by 31 December 2015 was a welcome initiative. So, too, was the decision to fund capacity building in state-based Affiliates to provide guidance, support and assistance to ACCHOs for their CQI Action Plans.
NACCHO contributed to the development of a “National CQI Primary Health Care Framework” which addressed the three sectors – ACCHOs, private General Practices, and public hospitals and community health facilities. One of NACCHO’s value-add contributions was in the area of inter-sectoral patient coordination.
In 2014 the Australian Health Ministers’ Advisory Council (AHMAC) “Aboriginal and Torres Strait Islander Health Performance Framework” provided compelling evidence of breakdowns in referral pathways, coordinated care arrangements, and patient handovers between the public hospital sector and the ACCHO Sector.
NACCHO’s solutions to rectify these breakdowns continued into 2015/2016, building on shared patient electronic health records and the potential to leverage o Aboriginal and Torres Strait Islander “Partnership Forums” established under jurisdictional multi-party Framework Agreements.
4. Protecting the integrity of the ACCHO “Brand” through Governance support.
Through its national level advocacy programme, NACCHO became aware early in the 2015 calendar year that successive public revelations of governance inadequacies in a number of ACCHOs and other Aboriginal corporations in areas of substance misuse, training and child protection had begun to impact negatively on the ‘‘brand’’ of Aboriginal Community Controlled Health Organisations.
Significant political figures made it clear that the Sector had a window of opportunity to reform its own governance or reforms would be imposed externally. Some of the statements emanating from the Minister for Aboriginal Affairs confirmed this understanding.
Accordingly, the NACCHO Chairperson and Board began a review and reform program of NACCHO itself, starting with its own Constitution, Governance Charter, and governance and meeting practices.
Concurrently, they addressed the strategic challenge of ‘’self-regulation”, that is, of NACCHO and state-based Affiliates taking the lead in pro-actively sorting out governance and financial management problems in ACCHOs to reduce the risk of the Department of Health imposing often non-Indigenous and always expensive consultant administrators to take over from elected Boards.
NACCHO also developed a template model ACCHO Constitution that addressed the principal causes of governance failure; and a complementary template Charter of Corporate Governance.
Confidence in the integrity of the governance systems of ACCHOs is a logical determining consideration for funding decisions by agencies entrusted with a ‘commissioning’ responsibility by the Australian and State Governments.