The Primary Health Care Access Program PHCAP in the Northern Territory'

1
The Primary Health Care Access Program (PHCAP) in
the Northern Territory.

• John Boffa Public Health Medical Officer Central
  Australian Aboriginal Congress.

2
Introduction

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

3
Funds Pooling

• New and existing Commonwealth and existing
  Territory per capita PHC funding is being pooled
  to create funding benchmarks.
• 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.
• 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.
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

• Equality of funding
• Existing NT range across 11 zones is 347 to
  1115 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.

7
Funds pooling advantages

• Flexibility of funding.
• 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.

8
Funds pooling advantages

• Increased funding
• 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.
• Recognition of ACCHS as core to the health system
  / less duplication and competition by the State.

9
Funds pooling disadvantages.

• Complexity.
• States refusing to play ball with enough cash to
  make it worthwhile.
• Non Aboriginal funding issues in some remote
  areas.

10
What can be funded? Core functions of CPHC

• Clinical services.
• Support services.
• Social and preventative programs.
• Policy and Advocacy.

11
Clinical services 1

• Primary clinical care
• treatment of illness using standard treatment
  protocols
• 24 hour emergency care
• 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
• continuing management of chronic illness

12
Clinical services 2

• Preventative care
• immunisation
• antenatal care
• appropriate screening and early intervention
• STI and other communicable diseases control
• 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 chronic disease register and recall system
• collection of data to enhance evaluation and
  quality assurance.

14
Support services internal

• Staff training and support
• orientation of new staff in the management and
  presentation of major illnesses and in cross
  cultural and other issues
• Aboriginal Health Worker education
• continuing education opportunities for all staff

15
Support services internal

• Management systems
• 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

16
Support services internal

• Adequate infrastructure at the community level
• 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.

17
Support services external

• appropriate visiting specialists and allied
  health professionals
• medical evacuation services where needed
• access to hospital facilities
• costs of transport and accommodation to access
  specialist and ancillary care where needed
• 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.
• Community consultation.
• Lobbying.
• Submissions.
• Analysis of health policy and data.
• Publishing and dissemination.

20
How will this lead to new ACCHS?

• Contact team community development role.
• Zonal Aboriginal Steering Committees.
• Consultancies health service implementation plan
  and community control plan.
• Establishment of Health Boards.
• ACCHS or Aboriginal health boards contracting
  another provider.

21
Who will work in these new health services?

• AHWs shortage.
• Nurses shortage.
• Doctors shortage- almost exclusively from
  overseas.
• Need for local Aboriginal management.
• Governance training for health boards.

22
Conclusion

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