The North West Plan A Geographical Planning Approach for

The North West Plan: A Geographical Planning Approach for Health Gain for Rural and Remote Communities Kim Snowball, Rose Murray, M Seel 5th National Rural Health Conference Adelaide, South Australia, 14-17th March 1999 Proceedings 5 th NATIONAL RURAL HEALTH CONFERENCE The North West Plan: A Geographical Planning Approach for Health Gain for Rural and Remote Communities Kim Snowball, Rose Murray, M Seel INTRODUCTION People living in the North West of Western Australia experience significantly worse health status than other Western Australians. Not only is the health status the worst in the State, the health trends and known risk factors are indicating that the health status of the population will deteriorate further unless corrective action is taken. Amongst North West residents, Aboriginal people carry a significantly higher burden of ill health compared to the rest of the population. Without corrective action the health costs and social costs associated with early death and disease will escalate in coming years. The seriousness of the situation in the North West cannot be over emphasised and the resolutions will be difficult and must be sustained in the longer term to be successful. Predictions made from the current knowledge about health and risk factors in the North West is that recurrent hospital costs alone will increase by approximately $14m on current costs by 2006. This represents almost 50per cent increase in hospitalisation that is inevitable. This rate of growth in hospitalisation will continue to escalate exponentially beyond 2006. This situation is repeated across remote areas throughout Australia and this fact has been recently documented by the Australian Institute for Health and Welfare in its publication, “The health of rural and remote Australians”. Past efforts to address the health of North West residents, by both State and Commonwealth Governments, has met with limited success as the planning processes have been ad hoc, short term, uncoordinated with other agencies and lacking in resourcing and commitment. As a consequence the Western Australian Health Minister, Kevin Prince launched a strategic planning process in February 1998. This is the first time that a plan has been initiated to address the long term health trends in a systematic way across the North West as a whole with the involvement of all health agencies and community representatives in formulating a strategic plan. 5 th NATIONAL RURAL HEALTH CONFERENCE The overall objective of the plan is: “To arrest the worsening health trends and achieve, by 2020, a health status for the population that is at least equal to that enjoyed by other Western Australians.” D e a th r a te fo r s e le c te d c o n d itio n s in th e N o rth W e s t c o m p a re d to th e S ta te (1 9 9 2 -9 6 ) re n a l fa ilu r e R e s p ira to ry P r e g n a n c y a n d th e N e w b o rn In ju ry a n d P o is o n in g C a rd io v a s c u la r M e n ta l H e a lth D ia b e te s 0 1 2 3 T im e s th e S ta te ra t e 4 5 6 Sitting behind these statistics is an underlying social dismay, grief and trauma that is having a lasting impact on the community as a whole. Children losing parents at a young age, spouses without partners and communities constantly in mourning for people who have died too young. H o sp italis atio n s o f N W re s id e n ts c au se d b y th e N in e K e y H e alth Iss u e s, 199 2-1 996 , p ro je cte d to 200 6 30000 25000 20000 Cases 15000 10000 5000 0 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 ABORIGINAL HEALTH An important aspect of the planning process was that the strategic plan is designed to address the health of all residents, without separation between Aboriginal and non Aboriginal people. 5 th NATIONAL RURAL HEALTH CONFERENCE Clearly Aboriginal people carry the heaviest burden of ill health and for this reason specific Regional Aboriginal Health Plans have, and are, being developed throughout the North West under the auspices of the bilateral agreement on Aboriginal Health. This has included direct involvement and leadership by the Western Australian Aboriginal Community Controlled Health Organisations (WACCHO). This has been an important development as it has ensured that Aboriginal communities and the Aboriginal Medical Services in the North West have been able to address health issues and priorities in the context of a wider Norhealth 2020. This has effectively brought together the government funded hospitals and health services with Aboriginal organisations to more clearly understand and address the health of Aboriginal people through a co-ordinated effort. The purpose of the regional Aboriginal health plans has been to consult with Aboriginal communities and identify health priorities and service gaps that require specific attention. This is complementary to the overall Norhealth 2020 that will also seek to serve better and respond to the needs of Aboriginal people. These two planning processes were conducted together. A key message derived from the process has been the importance of Aboriginal community control over the planning and delivery of services in the North West and this cannot be ignored as an overriding principle in the implementation of any Government action. Indeed much can be learnt from the holistic and community based approach to health being practised by many of the Aboriginal Medical Services and also being demanded by the Aboriginal communities themselves. The purpose of this presentation is to provide an outline of the planning process developed by the Pilbara based Aboriginal Community Controlled Health Services as a demonstration of an effective partnership in achieving improved health services. BACKGROUND TO THE PILBARA ABORIGINAL HEALTH PLANNING PROCESS In the latter half of 1998 the Norhealth 2020 team sought the support of the Pilbara’s three Aboriginal Community Controlled Health Organisation’s (ACCHOs) and their participation in health planning for the region. A separate process to inform and enhance the main Norhealth 2020 Plan was established. This was to be managed by the regions’ three Aboriginal Community Controlled Health Organisations. This was the first ever 'joint action' of the three ACCHOs. After firmly establishing that there would be health gains for the Pilbara Aboriginal community as a result, representatives of the ACCHOs developed a consultative and research process. Pilbara Aboriginal people hold a negative view about research and consultation. The community has seen few positive results of such activities over many years. The experience was one of a non-Aboriginal expert or consultant flying into the 5 th NATIONAL RURAL HEALTH CONFERENCE area for a few brief meetings, latching onto a few key community figures and recording Aboriginal viewpoints in words that Aboriginal people don’t use. Because the consultants are 'fly in fly out' there is little, if any automatic feedback and accountability for the research outcomes. There is no transfer of skills and little information passed on to the community. Aboriginal members of the planning team were very clear that they wanted to participate in a process which built on the way that they lived and thought, they wanted to learn and understand more and they wanted to direct their own future. While acknowledging the importance of gathering information for planning and improvement of services, our challenge was to develop and use processes which worked in the interests of Aboriginal people. We wanted to move beyond needs analysis. We came up with an innovative approach which was determined by Aboriginal people. This process incorporated Aboriginal ways, made past research accountable back to the Aboriginal community, was efficient and rapid and became a vehicle for two way learning for Aboriginal community members and health officials. The results form the basis of the first Pilbara Aboriginal health plan and the process has built and strengthened partnerships that will allow the plan to be implemented. It was a departure from what had been done before and has lessons for the future in our region and elsewhere, both in Aboriginal and mainstream health planning. INITIAL DISCUSSIONS Representatives from the three ACCHOs met with initial focus of the discussion centred around the questions of “What Aboriginal ways are there to make this work?" “What are Aboriginal priorities” and “How can these be incorporated into the process and final document?" There was also discussion about the academic side – how would data be collected, managed, interpreted, fed back and stored? Who would do it and how would Aboriginal people be upskilled and empowered as part of the process? A framework which addressed these issues was developed and guided planning and implementation. PROCESS A steering group was then established, comprising chairpersons and representatives of the three Pilbara ACCHO’s, the general managers of the State regional health services, the (then) Commonwealth Department of Health and Family Services and the director of the regional public health unit. The group met in various locations around the region. The project’s information gathering was divided into two parts. Data of two types was sought – published research and input directly from people living in the region. The link between the two was the policy recommendations from the published reports which formed the basis of the community consultation tool. 5 th NATIONAL RURAL HEALTH CONFERENCE It was felt that a repetition of a standard needs analysis did not fit with the philosophical framework agreed upon. It was felt that sufficient data on the health issues already existed. The steering group was interested to know what had been done as a result of the reports and what the community saw as its options to address the issues raised. The process of consultation then became a tool for accountability and empowerment in its own right. A search for all reports and relevant literature both published and departmental as well as from other sources was conducted. There were social researchers locally with the expertise to summarise the reports and they were contracted by the group to produce two types of document: • • a discussion booklet, in plain English, called “Let’s talk about health”; and background notes on each of the health areas to inform and support the information gatherers in community consultations. The discussion booklet had sections on 15 priority areas. The choice of priority areas were the nine used in the broader Northwest Plan plus several additional ones which the steering group thought should be included, such as youth health, spiritual and mental health and environmental health. The second part of the process was collecting information from communities about the health issues. Each ACCHO determined how the consultations would be conducted in their part of the Pilbara region after the steering group reached agreement on how that information should be formatted for data collation. Using the background notes as a guide, people with local knowledge were able to conduct the consultations. These people were remunerated for their time and expertise. Using the booklet as a discussion tool, information on the communities’ profile and specific feedback under the various topics was sought. The specific discussion points were recommendations from the published literature and reports. There were four areas asked about on each report recommendation. These were: • • • • Has this happened in your community? What else could your community do? What could other people and services be doing and who? When should these things be done? We aimed to form consultation teams involving ACCHO and Health Department staff. Consultations we conducted in communities and lasted from two to eight hours in length. Written submissions were also sought from organisations. There was a tight time frame with the consultations conducted and data returned and collated within six weeks. This partnership at operational level 'on the ground' is highly valued and represents the basis on which the regional Aboriginal health plan can be developed and implemented. 5 th NATIONAL RURAL HEALTH CONFERENCE OUTCOMES The outcomes included 'process gains' as well as a delineation of priorities and intervention strategies for Aboriginal people’s health. The key outcomes of the planning process include: • • • • • • • partnerships between ACCHOs; partnerships between ACCHOs and the State health sector with a process based on Aboriginal priorities; a time efficient and cost effective planning process which did not re-collect data which already existed; an Aboriginal perspective informing the broader Northwest Health Plan, bringing in new information and priorities with local viability; local Aboriginal people with increased research skills; reframing of needs analysis to incorporate community’s ideas on solutions; and a framework document for regional Aboriginal health planning and priority setting CONCLUSION The partnership planning process adopted in the Pilbara region of Western Australia has shown that with goodwill a very effective blend of traditional health planning processes with Aboriginal led consultative and planning methods can be achieved. Such a process can bring a more satisfying and better targeted health planning outcome that has greater likelihood of acceptance and commitment through shared ownership of the process and the outcomes. Time will determine how enduring the partnership will be; however, there is growing confidence that through this shared process a long term relationship and better shared understandings has developed that will improve the health for Aboriginal residents in the Pilbara.