The Little Children Are Sacred (LCAS) report1 provided a watershed opportunity for government and communities to tackle one of the most urgent and confronting issues facing Aboriginal communities in the Northern Territory – the safety and wellbeing of children.
As the peak body for Aboriginal community-controlled health services (ACCHSs) in the Northern Territory, AMSANT strongly supported the recommendations of the LCAS report and the need for decisive action, and expressed concern to the previous Australian Government regarding the relevance and appropriateness of a number of the measures adopted in its response to the report. AMSANT provided leadership in advocating to government the need for the views of Aboriginal communities and community-based organisations, particularly those that are community-controlled, to be sought and listened to. AMSANT provided a briefing paper to then Minister for Health (Attachment 1) and wrote an editorial to the Medical Journal of Australia2 (Attachment 2), outlining AMSANT's views on the NTER and providing suggestions for improving the initiative.
Despite concerns about the service model and implementation of the Australian Government Child Health Check (AG CHC) initiative, AMSANT has worked cooperatively with the Australian Government and key agencies and has assisted in addressing the difficulties and problems associated with the rollout of the child health checks (CHCs), particularly as it has affected our member health services. AMSANT's decision to engage with the process was in part in response to community concerns expressed to our member services regarding the proposed checks. It also reflected our sector's responsibility to ensure the best possible clinical outcomes for children and families, particularly given the deficiencies and potential negative impacts of the process. AMSANT also took the view that positive engagement with the Australian Government and its agencies was likely to result in improvements to the NTER over time, including the opportunity to address longer-term reform towards a properly resourced, sustainable Aboriginal comprehensive primary health care system.
Indeed, there have been some encouraging developments that have come about as a result of the NTER, particularly with regard to increased levels of Commonwealth and Northern Territory funding and resources around primary health care and addressing the social determinants of health. However, these still fall short of need and are not linked to a comprehensive, coordinated long-term plan to ‘close the gap' on Aboriginal disadvantage. AMSANT also remains concerned that many aspects of the NTER lack integration with existing services and do not allow or invite the level of Aboriginal partnership and participation in NTER processes that should be demanded of any significant initiative in Aboriginal affairs policy.
Following the announcement of the 12 month review of the NTER, AMSANT provided a submission to the Minister for Families and Housing, Community Services and Indigenous Affairs on the process and terms of reference for the review. This is provided as Attachment 3.
It is AMSANT's view that the experiences and difficulties encountered during first 12 months of the NTER provide a rich evidence base for reforming the NTER. Our experience suggests that the following key messages emerge from that evidence base:
- It is imperative to ensure that the CHC initiative and other NTER measures ultimately result in long-term, sustainable improvements in those areas that contribute to child safety and protection and the general health and well-being of Aboriginal children and families in the Northern Territory. Achieving sustainable improvement in these areas requires maintaining increased levels of investment by the Federal Government in services and programs in primary health care (PHC) and addressing the social determinants of health. It is essential that funding is provided commensurate with need via coordinated delivery based on comprehensive planning.
- Both in terms of achieving legitimacy among Aboriginal people and meeting Australia's human rights obligations, effective reform of the NTER cannot be achieved without removing the racially-discriminatory aspects of the NTER measures, and reinstating the protections of the Racial Discrimination Act 1975 (Cmth).
- Some NTER measures do not address the issues that provided the Australian Government's justification for its intervention; many lack an evidence-base that they are effective or appropriate responses; and, there have been considerable and unnecessary negative impacts on affected individuals and communities. These deficiencies should be rectified as a consequence of the current review.
- Addressing the health, wellbeing and protection of Aboriginal children and families requires an approach that: builds on existing services, capacities and strengths in communities; addresses immediate needs as well as long-term community development; and provides for Aboriginal engagement, participation and control in the design and implementation of solutions.
- The centralised decision making processes, poor strategic prioritisation and flawed processes of implementation adopted by the NTER have resulted in the considerable unnecessary expenditure of public money that could have been better-utilised towards achieving more effective and sustainable outcomes.
About this submission
This submission seeks to provide constructive feedback and criticism to the Review Panel based on the experience and involvement of AMSANT and our member services with the NTER. It should be noted that AMSANT's member services are community-based as well as community-controlled and therefore have been able to provide evidence and perspectives based on direct experience of the implementation of the NTER measures in prescribed communities and regional centres. Accordingly, this submission has been developed with the detailed input from member services and, by extension, the affected Aboriginal communities.
The submission first addresses broader issues concerning the foundations and background of the NTER and human rights concerns associated with the NTER legislation. It then turns to a detailed discussion of the NTER Child Health Check Initiative and longer-term primary health care needs. Sections follow on alcohol issues, child protection, income quarantining, housing and land tenure, employment and CDEP, education, Government Business Managers and finally, the viability of Aboriginal communities.
Key Messages and Recommendations are provided at the end of the submission (p37).
1. Anderson, P. & Wild, R., (2007), Ampe Akelyernemane Meke Mekarle ‘Little Children are Sacred' Report of the Northern Territory Board of Inquiry into the Protection of Aboriginal Children from Sexual Abuse.
2. John D Boffa, Andrew I Bell, Tanya E Davies, John Paterson and David E Cooper, (2007), ‘The Aboriginal Medical Services Alliance Northern Territory: engaging with the intervention to improve primary health care', MJA, Volume 187 Number 11/12, 3/17 December 2007.