Foreword. Closing the Gap in Indigenous Health Outcomes. Indigenous Early Childhood Development. Indigenous Economic Participation.

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1 National Aboriginal and Torres Strait Islander Health Workforce Strategic Framework Prepared for The Australian Health Ministers Advisory Council by the Aboriginal and Torres Strait Islander Health Workforce Working Group

2 Foreword This National Aboriginal and Torres Strait Islander Health Workforce Strategic Framework ( ) has been developed by the Aboriginal and Torres Strait Islander Health Workforce Working Group (ATSIHWWG). Input was provided by key Aboriginal and Torres Strait Islander health and education stakeholders. The membership of ATSIHWWG is provided at Appendix 3. The extensive consultations that underpinned the previous Framework are acknowledged. This Framework is an essential tool encompassing innovative elements of reform required to improve the Aboriginal and Torres Strait Islander health workforce over the period It will contribute to Aboriginal and Torres Strait Islander health workforce needs across all service delivery areas and also help address the Closing the Gap Statement of Intent goals and health equality targets. It is also informed by health workforce elements within the following National Partnership agreements: Closing the Gap in Indigenous Health Outcomes Indigenous Early Childhood Development Indigenous Economic Participation. The Framework will embrace an aspirational target of 2.6 per cent 1 of the Australian health workforce being Aboriginal or Torres Strait Islander by The aim is to ensure that Aboriginal and Torres Strait Islander peoples are strongly represented across all health disciplines and that representation of Aboriginal and Torres Strait Islander peoples in the health workforce more than matches the proportional composition of the total population. For this to occur, the expected impact of the Framework will be: 1. increased and improved recruitment and retention of Aboriginal and Torres Strait Islander peoples in the health sector 2. improved delivery of education and training of Aboriginal and Torres Strait Islander peoples to prepare them for work in the health sector and support ongoing professional development in the workplace 3. improved education and training of all health professionals to ensure they have the skills and understanding to provide health services that meet the needs and expectations of Aboriginal and Torres Strait Islander peoples and effectively equip staff with appropriate cultural knowledge. Achieving this will require effective resources and partnerships with Aboriginal and Torres Strait Islander peoples and relevant organisations. It will also require cooperative efforts at all levels of government and across the health service delivery and education sectors. This Framework provides a mechanism to assist in planning, prioritisation, target setting, monitoring, and reporting of progress in Aboriginal and Torres Strait Islander health workforce capacity building. ISBN: Online ISBN: Publications Approval Number- D0442 Internet sites Commonwealth of Australia 2011 This work is copyright. You may download, display, print and reproduce the whole or part of this work in unaltered form for your own personal use or, if you are part of an organisation, for internal use within your organisation, but only if you or your organisation do not use the reproduction for any commercial purpose and retain this copyright notice and all disclaimer notices as part of that reproduction. Apart from rights to use as permitted by the Copyright Act 1968 or allowed by this copyright notice, all other rights are reserved and you are not allowed to reproduce the whole or any part of this work in any way (electronic or otherwise) without first being given the specific written permission from the Commonwealth to do so. Requests and inquiries concerning reproduction and rights are to be sent to the Online, Services and External Relations Branch, Department of Health and Ageing, GPO Box 9848, Canberra ACT 2601, or via to 1 National Partnership Agreement on Indigenous Economic Participation. i: National Aboriginal and Torres Strait Islander Health Workforce Strategic Framework Artwork and design throughout by Dreamtime Public Relations.

3 Contents Foreword... i Review of the Aboriginal and Torres Strait Islander Health Workforce National Strategic Framework (2002)...1 Review findings Consultation with key stakeholders involved in policy and the delivery of health services and health workforce development Examination of relevant national policy and service delivery initiatives Key underpinning health policy Cross portfolio linkages Vocational education and training State and territory health workforce plans...4 National Aboriginal and Torres Strait Islander Health Workforce Strategic Framework ( ) aims and principles...5 Key priority areas: objectives and strategies...7 KPA 1 Participation of Aboriginal and Torres Strait Islander peoples in the health workforce... 7 KPA 2 Workforce capacity of the community-controlled sector including Aboriginal and Torres Strait Islander Health Workers...7 KPA 3 Competent health workforce to meet the needs of Aboriginal and Torres Strait Islander peoples...7 KPA 4 Leadership...8 KPA 5 Accountability...8 Monitoring and reporting implementation...9 Appendix 1: Policy principles on which to base improvements for Aboriginal and Torres Strait Islander environmental health...10 Appendix 2: Aboriginal and Torres Strait Islander health workforce working group terms of reference...11 Appendix 3: Membership of ATSIHWWG...11 Glossary...12

4 Review of the Aboriginal and Torres Strait Islander Health Workforce National Strategic Framework (2002) The final review of the National Aboriginal and Torres Strait Islander Health Workforce Strategic Framework (2002) was conducted in 2009 to examine the ongoing usability and value of the Framework and whether it still contributes to national health workforce capacity building for Aboriginal and Torres Strait Islander peoples in Australia. Review findings The review findings indicated a need to update content and structure to better fit contemporary approaches and thinking. This National Aboriginal and Torres Strait Islander Health Workforce Strategic Framework ( ) 2 reflects the following findings of the review, which included: 1. Consultation with key stakeholders involved in policy and the delivery of health services and health workforce development Stakeholder feedback indicated that the Framework was seen as vitally important to many Aboriginal and Torres Strait Islander communities, individuals, education and health service providers, the Aboriginal and Torres Strait Islander community controlled health organisations, peak bodies, and government agencies at all levels as a guiding tool in developing and sustaining a high quality health workforce serving the needs of Aboriginal and Torres Strait Islander peoples. It is intended that state and territory governments and the Aboriginal community controlled health sector will use the Framework to underpin strategic planning. 2. Examination of relevant national policy and service delivery initiatives Since the original Framework was developed there have been a number of significant policy developments affecting its currency, relevance and usability including: The Closing the Gap Statement of Intent goals and health equality targets and subsequent budget and program initiatives, including the formation of the National Aboriginal and Torres Strait Islander Health Equality Council (NATSIHEC) formerly the National Indigenous Health Equality Council (NIHEC). NATSIHEC advises the government on the development and monitoring of health related goals and targets to support the commitments to closing the gap and, as a first priority, to consider strategies to boost the participation of Aboriginal and Torres Strait Islander peoples in the health workforce. Government announcements and Council of Australian Governments (COAG) National Partnership Agreements (NPA) including: the Indigenous Chronic Disease Package to tackle chronic disease risk factors, improve chronic disease management in primary care, improve follow up care and increase the capacity of the primary care workforce to deliver effective health care to Aboriginal and Torres Strait Islander peoples establishment of Health Workforce Australia (HWA) in July 2009 to facilitate more effective and integrated clinical training for health professionals, provide effective and accurate information and advice to guide health workforce policy and planning, and promote, support and evaluate the health workforce 2 The National Aboriginal and Torres Strait Islander Health Workforce Strategic Framework ( ) can be found at 1: National Aboriginal and Torres Strait Islander Health Workforce Strategic Framework

5 the implementation of the National Registration and Accreditation Scheme for health professionals in July 2010, including the national registration and accreditation of Aboriginal and Torres Strait Islander Health Practitioners by July 2012 the establishment of the Indigenous Environmental Health Worker workforce, funded through the NPA on Remote Indigenous Housing Key underpinning health policy National Strategic Framework for Aboriginal and Torres Strait Islander Health (2003) The goal of the National Strategic Framework for Aboriginal and Torres Strait Islander Health (2003) is to ensure that Aboriginal and Torres Strait Islander peoples enjoy a healthy life equal to that of the general population that is enriched by a strong living culture, dignity and justice. 4 The National Strategic Framework for Aboriginal and Torres Strait Islander Health (2003) Framework commits governments to monitoring and implementation within their own jurisdictions, working together at the national level and working across government on joint initiatives between health departments and other portfolios. 5 The Strategic Framework (2003) is based on the following principles: cultural respect a holistic approach health sector responsibility community control of primary health care services localised decision making promoting good health building the capacity of health services and communities accountability. working together These principles are reflected in the National Aboriginal and Torres Strait Islander Health Workforce Strategic Framework ( ). Reform processes The Australian Government has established three key reform processes in health: the National Health and Hospitals Reform Commission (NHHRC) report 6 : which profiled the need to develop the Aboriginal and Torres Strait Islander health workforce by addressing the social determinants of health, ensuring investment is proportionate to need, building the Aboriginal and Torres Strait Islander workforce, providing purchasing authority, building in accreditation processes and building the workforce across all health disciplines 3 Policy principles on which to base improvements for Aboriginal and Torres Strait Islander environmental health are provided at Appendix 2. 4 National Strategic Framework for Aboriginal and Torres Strait Islander Health (2003), p Ibid, p The National Health and Hospitals Reform Commission (NHHRC) was established in 2008 to develop a long-term health reform plan for a modern Australia. The Commission presented its final report containing its reform directions in July 2009, A healthier future for all Australians. National Aboriginal and Torres Strait Islander Health Workforce Strategic Framework : 2

6 Australia s first National Primary Health Care Strategy 7 : which sets out a road map for the future to provide Australians with a primary health care system which is among the best in the world and which is equipped to meet future challenges the development of the National Preventative Health Strategy 8 : the development of which provides a blueprint for tackling the burden of chronic disease currently caused by obesity, tobacco, and excessive consumption of alcohol. In July 2008 Minister Roxon released A Blueprint for Action Pathways into the health workforce for Aboriginal and Torres Strait Islander people. This report has a focus on: boosting the Aboriginal and Torres Strait Islander health workforce by improving pathways between school, vocational education, training and higher education building the capacity of the existing health workforce by addressing ongoing support and career development needs building links across the health and education/training/employment portfolios. 4. Cross portfolio linkages Education Ministers recognised the important link between education and health in the draft Indigenous Education Action Plan which closed for public comment in February Through the Action Plan the Ministerial Council for Education, Early Childhood Development and Youth Affairs (MCEECDYA) will seek support from the Australian Health Ministers Conference and Community and Disability Services Ministers Conference to strengthen connections between schools and health, welfare and community services at local and systemic levels. 10 Higher education The Review of Australian Higher Education (2008) 11 was established to address whether the higher education sector positions Australia to compete effectively in the new globalised economy. The review concluded that, while the system has great strengths, it faces significant challenges. The review recommended major reforms to the financing and regulatory frameworks for higher education and establishment of initiatives to increase both the enrolment and success of students from disadvantaged backgrounds, including Aboriginal and Torres Strait Islander students. The review recommended that the government regularly review the effectiveness of measures to improve higher education access and outcomes for Aboriginal and Torres Strait Islander peoples, in consultation with the Indigenous Higher Education Advisory Council. 7 The National Primary Health Care Strategy (July 2009) was developed to provide a national road map to guide future primary health care policy and planning in Australia. 8 The National Preventative Health Strategy (September 2009) was developed to reduce the burden of obesity, alcohol and tobacco on Australian s health and wellbeing, providing the government with a road map of guidelines to address these significant health issues. 9 The public consultation process on the draft Indigenous Education Action Plan closed on 28 February Indigenous Education Action Plan , p In March 2008 the government initiated a Review of Higher Education to examine the future direction of the higher education sector, its fitness for purpose in meeting the needs of the Australian community and economy, and the options for ongoing reform. The review was conducted by an independent expert panel led by Emeritus Professor Denise Bradley AC. 3: National Aboriginal and Torres Strait Islander Health Workforce Strategic Framework

7 5. Vocational education and training The following have been endorsed: revised national health training package (HLT07) with qualifications and competencies covering workers in Aboriginal and Torres Strait Islander health revised national community services training package 2008 with qualifications and competencies covering work in areas such as aged and community care, alcohol and other drugs and mental health, and providing training pathways for other health workforce skill development to meet community needs. The Community Services and Health Industry Skills Council also undertake an annual environmental scan of the 1.3 million health and community services workforce. These annual scans provide workforce data and education and training quality improvements. 6. State and territory health workforce plans States and territories have developed jurisdictional Aboriginal and Torres Strait Islander health workforce strategies and action plans. The Aboriginal and Torres Strait Islander Workforce Working Group (ATSIHWWG) provides a forum for states and territories to articulate jurisdictional action. The terms of reference for the ATSIHWWG are at Appendix 2. Implementation of the National Aboriginal and Torres Strait Islander Health Workforce Strategic Framework ( ) is expected to deliver the following outcomes: a competent health workforce to community-controlled and mainstream health services a health workforce distribution that optimises access to health care health work environments that attract Aboriginal and Torres Strait Islander peoples to work a health workforce that is competent and adaptable to changing service delivery environments evidence-based policy and planning of the Aboriginal and Torres Strait Islander health workforce, embedded in broader health system processes a collaborative approach to health workforce development that involves all relevant stakeholders. Agreed key priority areas and performance indicators in this Framework reflect these planned outcomes and are congruent with strategic health workforce plans of national, state and territory governments and of the Aboriginal and Torres Strait Islander community controlled health sector. National Aboriginal and Torres Strait Islander Health Workforce Strategic Framework : 4

8 National Aboriginal and Torres Strait Islander Health Workforce Strategic Framework ( ) aims and principles The National Aboriginal and Torres Strait Islander Health Workforce Strategic Framework ( ) aims to achieve equitable health outcomes for Aboriginal and Torres Strait Islander peoples through a competent health workforce that has appropriate clinical, management, community development and cultural skills. This will be achieved by ensuring an increased workforce which is effective and appropriate for the needs of Aboriginal and Torres Strait Islander peoples, which in turn will lead to better access and, as a consequence, improved health outcomes. The National Aboriginal and Torres Strait Islander Health Workforce Strategic Framework ( ) is based on a commitment to the following principles. Cultural respect: Ensuring that cultural diversity, rights, views, values and expectations of Aboriginal and Torres Strait Islander peoples are respected in the delivery of culturally appropriate health services. A holistic approach: Recognising that the improvement of Aboriginal and Torres Strait Islander health status must include attention to physical, spiritual, cultural, emotional and social well being, community capacity and governance. Health sector responsibility: Improving the health of Aboriginal and Torres Strait Islander individuals and communities is a core responsibility and a high priority for the whole of the health sector. Making all services responsive to needs of Aboriginal and Torres Strait Islander peoples will provide greater choice in the services people are able to use. Community control of primary health care services: Supporting the Aboriginal and Torres Strait Islander community controlled health sector in recognition of its demonstrated effectiveness in providing appropriate and accessible health services to communities. Supporting community decision making for self determination and control of health service delivery ensures Aboriginal and Torres Strait Islander peoples are provided with health services in a holistic and culturally appropriate manner. Working together: Combining the efforts of government, non government, the community controlled sector and private organisations within and outside the health sector and, in partnership with the Aboriginal and Torres Strait Islander health sector, providing the best opportunity to improve the broader determinants of health. Localised decision making: Ensuring decision making about health needs and priorities is driven by local Aboriginal and Torres Strait Islander communities so that health needs are met in a culturally-appropriate way and promote collaboration between Aboriginal and Torres Strait Islander and mainstream health services. State/Territory and national decision making: Requires health authorities from respective jurisdictions at all levels to be inclusive and responsive to Aboriginal and Torres Strait Islander peoples in high-level decision making. 5: National Aboriginal and Torres Strait Islander Health Workforce Strategic Framework

9 Promoting good health: Recognising that health promotion and illness prevention is fundamental to comprehensive primary health care and must be a core component of all health services for Aboriginal and Torres Strait Islander communities. Building the capacity of health services and communities: Strengthening the delivery of health services and building community expertise to respond to health needs. This includes effectively equipping staff with appropriate cultural knowledge and clinical expertise, building physical, human and intellectual infrastructure and fostering leadership, good governance and financial management. Accountability for health outcomes: Recognising that accountability is reciprocal and includes accountability for health outcomes and the effective use of funds by Aboriginal and Torres Strait Islander community-controlled and mainstream services to governments and communities. Governments are accountable for effective resource application through funding support, meaningful policy, planning and service development in genuine partnership with Aboriginal and Torres Strait Islander communities. Partnerships and coordination in policy development, planning, implementation, monitoring and evaluation: Recognising the critical importance of the coordinated effort required across all sectors of government, industry and service delivery to achieve Aboriginal and Torres Strait Islander health workforce outcomes. Mechanisms for accountability: Ensuring that planning, prioritising, target setting and reporting are systematically undertaken by all relevant bodies at local state, territory and national levels, so that progress in addressing health workforce and health priorities will be monitored and reported. National Aboriginal and Torres Strait Islander Health Workforce Strategic Framework : 6

10 Key priority areas: objectives and strategies KPA 1 Participation of Aboriginal and Torres Strait Islander peoples in the health workforce Strategies Increased numbers and proportions of Aboriginal and Torres Strait Islander peoples working across all the health professions achieved through appropriate education, training, recruitment and retention strategies. 1.1 Implement initiatives to create sustainable long-term employment and optimise retention of Aboriginal and Torres Strait Islander peoples in the health workforce. KPA 2 Workforce capacity of the community-controlled sector including Aboriginal and Torres Strait Islander health workers Strategies Effective training, recruitment and retention of Aboriginal and Torres Strait Islander and non- Aboriginal and Torres Strait Islander health staff in Aboriginal and Torres Strait Islander communitycontrolled health services. 2.1 Expand support for the primary health care workforce in Aboriginal and Torres Strait Islander health services. 2.2 Implement career structures, pathways to a range of disciplines and employment conditions covering Aboriginal and Torres Strait Islander community controlled health services. 2.3 Support national registration and accreditation of Aboriginal and Torres Strait Islander health practitioners in Australia and support the development of a national Aboriginal health worker scope of practice. KPA 3 Competent health workforce to meet the needs of Aboriginal and Torres Strait Islander peoples Strategies The roles, skills and cultural knowledge of other health workforce groups are appropriate to health service delivery needs of Aboriginal and Torres Strait Islander peoples. 3.1 Provide education and training to the potential and current health workforce that reflects current, accepted approaches to health service delivery for Aboriginal and Torres Strait Islander peoples. 3.2 Establish a mechanism for national recognition of quality education and training delivery in relation to Aboriginal and Torres Strait Islander health. 3.3 Develop a high quality workforce to address specific health needs of Aboriginal and Torres Strait Islander peoples. 7: National Aboriginal and Torres Strait Islander Health Workforce Strategic Framework

11 KPA 4 Leadership Strategies Structures and resources support implementation of the Aboriginal and Torres Strait Islander Health Workforce Strategic Framework ( ). 4.1 Implement a nationally-coordinated approach to Aboriginal and Torres Strait Islander health workforce development. 4.2 Build leadership capacity in the Aboriginal and Torres Strait Islander health workforce. KPA 5 Accountability Strategies Embedded national accountability measures, processes and support for Aboriginal and Torres Strait Islander peoples to drive the process. 5.1 Implement a national Framework for joint planning, target setting and progress monitoring and reporting. 5.2 Monitor and evaluate the effectiveness and impact of Framework strategies against health outcomes. National Aboriginal and Torres Strait Islander Health Workforce Strategic Framework : 8

12 Monitoring and reporting implementation ATSIHWWG will oversee implementation of the Framework through an annual work plan that is consistent with the Framework and the health workforce reform agenda. It will include timeframes, targets and milestones for agreed priorities and actions. ATSIHWWG will monitor and report progress at each ATSIHWWG meeting and to the Australian Health Ministers Advisory Council (AHMAC), through the Health Workforce Principal Committee (HWPC). Annual reporting will encompass reporting against agreed performance indicators by Commonwealth, state and territory governments, Aboriginal and Torres Strait Islander health workforce professional bodies and the Aboriginal and Torres Strait Islander community-controlled health sector. Contributing to closing the gap in life expectancy between Aboriginal and Torres Strait Islander peoples and the broader population within a generation is a key aim of health workforce development and reform activities that are embedded in the Framework. It is therefore assumed that progress in implementing the Framework will also be guided by, and influence, key bodies such as the Council of Australian Governments (COAG), relevant national ministerial education and training bodies, Health Workforce Australia (HWA), the National Indigenous Health Equality Council (NIHEC) and the National Health and Hospitals Reform Commission (NHHRC). 9: National Aboriginal and Torres Strait Islander Health Workforce Strategic Framework

13 Appendix 1: Policy principles on which to base improvements for Aboriginal and Torres Strait Islander environmental health Endorsed by the Australian Health Ministers Conference on 6 April Good environmental health conditions are an essential requirement for maintaining and improving the health of Aboriginal and Torres Strait Islander communities. 2. Policy and services development and implementation for Aboriginal and Torres Strait Islander environmental health must involve cross portfolio consultation and engagement, where appropriate, acknowledging that environmental health outcomes require coordinated input and support from many areas. 3. Each Aboriginal and Torres Strait Islander community should benefit from the services of an Aboriginal and Torres Strait Islander environmental health program. 4. The employment of trained Indigenous environmental health practitioners, or access to an equivalent appropriate and skilled environmental health program, is the minimum essential prerequisite for communities to effectively manage their own environmental health conditions and to comply with their public health responsibilities. 5. Indigenous environmental health practitioners should be adequately resourced and supported, and recompensed commensurate with their skills and experience. 6. Training for Indigenous environmental health practitioners should be provided at a level consistent with the national population health qualifications and competency standards including Indigenous environmental health qualifications and competencies. 7. The term community is used in these principles to largely apply to geographically discrete communities of Aboriginal and Torres Strait Islander peoples. National Aboriginal and Torres Strait Islander Health Workforce Strategic Framework : 10

14 Appendix 2: Aboriginal and Torres Strait Islander Health Workforce Working Group terms of reference The Aboriginal and Torres Strait Islander Health Workforce Working Group will: participate in consultation on national registration and accreditation for Aboriginal and Torres Strait Islander Health Practitioners review and provide recommendations on registration and accreditation consultation for Aboriginal and Torres Strait Islander Health Practitioners in the ATSIHWWG Annual Report to HWPC work with Health Workforce Australia on the Aboriginal Health Worker and other projects provide an annual report against the National Aboriginal and Torres Strait Islander Health Workforce Strategic Framework ( ) to the HWPC. Appendix 3: Membership of ATSIHWWG ATSIHWWG is made up of the following organisations: National Aboriginal Community Controlled Health Organisation (NACCHO) Co-Chair Commonwealth Department of Health and Ageing (DoHA) Co-Chair Commonwealth Department of Education, Employment and Workplace Relations (DEEWR) ACT Health NSW Health Department NT Health Queensland Health Department of Health, SA Department of Health and Human Services, Tasmania Department of Health, Victoria Department of Health, WA National Aboriginal & Torres Strait Islander Health Worker Association (NATSIHWA) Australian Indigenous Doctors Association (AIDA) Indigenous Allied Health Australia (IAHA) Congress of Aboriginal & Torres Strait Islander Nurses (CATSIN) 11: National Aboriginal and Torres Strait Islander Health Workforce Strategic Framework

15 Glossary ACCHS AHMAC AHW AIDA AMS ATSIHRTONN ATSIHWWG CATSIN COAG CSHISC DEEWR DoHA HWA HWPC MCEECDYA NACCHO NATSIHWA NHHRC NIHEC OATSIH WIPO Aboriginal Community Controlled Health Service Australian Health Ministers Advisory Council Aboriginal Health Worker Australian Indigenous Doctors Association Ltd Aboriginal Medical Service Aboriginal and Torres Strait Islander Health Registered Training Organisation National Network Aboriginal and Torres Strait Islander Health Workforce Working Group Congress of Aboriginal and Torres Strait Islander Nurses Council of Australian Governments Community Services and Health Industry Skills Council Department of Education Employment and Work Place Relations Department of Health and Ageing Health Workforce Australia Health Workforce Principal Committee Ministerial Council for Education, Early Childhood Development and Youth Affairs National Aboriginal and Torres Strait Islander Community Controlled Health Organisation National Aboriginal and Torres Strait Islander Health Worker Association National Health and Hospitals Reform Commission National Indigenous Health Equality Council Office of Aboriginal and Torres Strait Islander Health Workforce Information Policy Officer National Aboriginal and Torres Strait Islander Health Workforce Strategic Framework : 12

16 D0442 November 2011 All information in this publication is correct as of November 2011

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