Associate Professor Noel Hayman in the waiting room of the Inala Indigenous Health Service. Credit Carl Smith
By Carl Elliot Smith, September 11, 2012
The Inala Indigenous Health Service is a promising model for improving the future of Indigenous health in rural Australia.
As secured funding for the Indigenous Health National Partnership Agreement (NPA) on Closing the Gap in Indigenous Health Outcomes ends in mid-2013, government and health professionals are looking to successful initiatives like the Brisbane-based Inala service to broach the still-elusive health divide.
The service, under the management of Associate Professor Noel Hayman from the University of Queensland, involves Indigenous community members in every level of management.
This includes staff and board members, but also extends through to artists who sell their work for display in the waiting room.
Since 1994 the service has seen its number of Indigenous clients surge from 12 to 8000 in 2012.
With two-thirds of Indigenous Australians currently living in regional or remote parts of the country, the service may also provide a framework for bridging the health gap for Aboriginal and Torres Strait Islander populations in rural and regional areas.
Prof Hayman believes the success of the service comes from a combination of centralising diverse health services, and specialising the centre for Indigenous people.
“We found that patients were more comfortable with someone who understood Indigenous customs and who would stop to explain medical terminology,” he said.
“What’s more, once patients had made that initial contact then they were much more likely to come back to the clinic, even if it was to see a non-Indigenous doctor.”
The centre also brings in specialists in endocrinology, cardiology, paediatrics and ophthalmology to help cluster services for Indigenous people.
“One of the big problems we have had with Indigenous patients is getting them back for follow-up appointments or specialist appointments off-site,” said Prof Hayman, “but by providing these services at the clinic we have seen a higher rate of return.”
Prof Hayman, who is a member of the stolen generation and the first Indigenous person to become a doctor in the State, argues that community participation is also required for a successful Indigenous health service.
“This includes having more Indigenous faces in the clinic,” he said, “but it also means involving the community in the provision of health by giving them direct input into health service delivery and health projects.”
In 2009, the Council of Australian Governments (COAG) committed $1.6 billion over four years for the Indigenous Health NPA.
With the COAG funding only secured until June 2013, Indigenous health services are looking elsewhere for continued funding.
However, the Federal government announced in its 2012-2013 budget that only around one tenth of its $475 million Regional and Remote Healthcare Facilities fund would go to rural Indigenous health projects.
In Queensland, the Newman government has announced that more than 2500 jobs are to be lost within Queensland Health as part of its move to reduce debt in the state.
Because of financial support from COAG, the Inala service has been able to improve health outcomes of Aboriginal and Torres Strait Islander patients.
Prof Hayman says that without continued funding, Indigenous health will suffer.
“To me, Closing the Gap has been a very important program over the last three to four years,” he said, “with funding going to finish in June 2013 I really believe there should be a commitment from governments to extend that funding.
“If we don’t then the good results that we’ve actually made will be lost.”
Prof Hayman has been collecting data on Indigenous patients at the centre for 16 years.
Results from the 2006-2011 Healthy for Life program show that patients at the service are better immunised, have lower smoking rates, and are being better screened for chronic diseases such as diabetes, compared to the broader Indigenous population.
“Between 2006 and 2011, we’ve seen a significant drop in HbA1c levels in our Indigenous patients,” said Prof Hayman.
The molecule HbA1c is used as a marker for diabetes control.
“We also saw a non-significant drop in blood pressure in the same group,” he said.
With the NPA end-date looming, health professionals are encouraging governments to renew Indigenous health funding.
The Aboriginal and Torres Strait Islander Community Health Service (ATSICHS) Brisbane Limited, was established in 1973 and is the oldest and the largest community-controlled Indigenous health service in Queensland.
ATSICHS has a network of primary health clinics and 84 staff around south-east Queensland, augmented by specialist health services.
Chief Executive Officer of ATSICHS Wayne Ahboo says that the NPA funding has allowed the organisation to properly address community health in the area.
“We’ve really seen the changes start to occur, both in terms of the usage and access by the community, and then also the results of the health assessments that we’ve been running,” said Mr Ahboo.
Since 2008/2009, ATSICHS has seen patient visits double to over 20,000, and it has also seen an exponential growth in Health Assessments and GP Management Plans.
Mr Ahboo, said of the approaching 2013 NPA deadline: “you don’t close the gap in four years’ worth of funding.
“If the government’s looking at making that and sustaining that, they really need to commit for the long term,” he said.
Australian Medical Association (AMA) President Dr Steve Hambleton has echoed Mr Ahboo’s comments in a statement on the AMA’s 2012 Audit Report on Aboriginal and Torres Strait Health.
“This funding better reflects the genuine needs in Aboriginal and Torres Strait Islander health and must continue beyond 2013,” said Dr Hambleton.
With life expectancy in Indigenous Australians still estimated to be between 10 and 17 years less than other Australians, Prof Hayman is concerned that the recent impetus gained in Indigenous health may be lost under a climate of budget cuts.
He also argues that funding for rural areas needs to be prioritised.
As part of an NPA-funded outreach program that brings specialist services to remote Indigenous communities, Prof Hayman visits Cunnamulla in the State’s South West each month.
“We’ve just run a service for 98 patients in Cunnamulla, and we’ve been finding pathology out there that really needs urgent attention,” said Prof Hayman.
“We’ve shown that we can actually improve access and health outcomes [in Cunnamulla],” said Prof Hayman, “but funding needs to be continued.”
Queensland’s State Opposition Leader, and member for Inala, Annastacia Palaszczuk, is also concerned about the future of Indigenous health initiatives like the Inala service under the new LNP-Newman government.
“I hope that the new government will provide the $2 million of recurrent funding that is needed for Professor Hayman to continue his work at the centre and this invaluable health care for Indigenous Queenslanders,” said Ms Palaszczuk.
“It would be detrimental to Indigenous health care across Queensland if the new government did not continue to support this important service,” she said.
For the moment, Prof Hayman and his team are excited about providing better healthcare to a larger population of Indigenous patients.
Prof Hayman’s success at the Inala service was recognised in 2009 with funding from the NPA for the new $7 million South East Queensland Centre of Excellence in Indigenous Primary Health Care.
The new centre, due to open later this year, is based on the Inala service’s model of centralised, tailored healthcare for Indigenous people and will have an increased capacity of 15,000 to 20,000.
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