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Subprogram 2.1-Health

SENATOR TAMBLING -I will refer to the information on outcomes. This document refers to money spent and the organisations funded, but there is nothing to indicate whether Aboriginal health is getting better or worse. There is a promise of future data arising from work being undertaken in developing health goals and targets, but we have heard that so often in the past. What specific information is available with regard to assessing whether Aboriginal health is in fact getting better or worse in the community?

DR SHERGOLD -I understand that in the past we have heard about the importance of the development of goals and targets. However, this financial year it takes on an added importance. As the Senator will be aware, we are presently negotiating with the States and Territories on the implementation of the national Aboriginal health strategy. As part of that negotiation, we are discussing with the States and Territories the sorts of goals and targets which should be set, against which we will assess outcomes. So I fully expect that during the year considerable progress will be made whereby the Commonwealth and the State and Territory governments will reach agreement on appropriate goals and targets for Aboriginal health.

SENATOR TAMBLING -The officer refers to the national Aboriginal health strategy which I note is to provide an additional $232m over a five-year period with some level of matching funds from the States and the Northern Territory. How much of the $40m-odd referred to in subprogram 2.1 can be identified as applying towards that global figure of $232m?

DR SHERGOLD -I must preface my remarks by saying that there is no intention for the State and Territory governments to match Commonwealth Government funds in terms of the Aboriginal health strategy. Cooperative agreements are being negotiated on the basis of a commitment from both sides, but it is not meant to be a dollar for dollar matching of funds in any way. In terms of this year' s expenditure and the appropriations identified in our report on Aboriginal health strategies the situation is this: roughly, the Aboriginal health strategy has about an additional $28m attached to it for this financial year. Of that amount, just over $7m has already been appropriated to ATSIC and is therefore identified in the program performance statements in front of you.

However, as the Senator will be aware, the rest of the money is tied on the basis of other developments taking place, the most important of which is, of course, negotiating the commitment of the States and Territories to work with us on the Aboriginal health strategy. In all, something like $21m is set aside as a contingency in the Budget. In other words, it has been taken into account in estimates of budgetary outlays, but has not yet been appropriated to ATSIC and is therefore not identified in the statements in front of you.

SENATOR TAMBLING -So there is nothing in this financial year that will be apportioned against the commitment figure of $232m for the national Aboriginal health strategy?

DR SHERGOLD -Already in our appropriation there is a figure of something over $7m against an expected total this year of about $28m. In other words, $21m is not yet appropriated to our budget, but is likely to be through Additional Estimates on the basis of successful negotiations with the States and Territories.

SENATOR TAMBLING -What is the basis of anticipating that you will get the extra $20m-odd in Additional Estimates?

DR SHERGOLD -The basis of that is there are a number of developments that have to take place before the money will be appropriated. One is the establishment of the council on Aboriginal health; the other is agreement on goals and targets; the establishment of tripartite forums in States and the Territory; and, most important, progress on the negotiations between the Commonwealth and the States. On that basis the rest of the money will be appropriated to ATSIC .

SENATOR TAMBLING -Has Cabinet already given a commitment to that?

DR SHERGOLD -It gave a conditional commitment when it first made the decision on the health strategy and set aside conditionally the $232m over five years.

SENATOR TAMBLING -So Cabinet has made a decision that it will endorse the additional $20m-odd this year out of Additional Estimates?

DR SHERGOLD -The Treasurer's Budget statement actually identified that amount of money. It is set aside in the estimates of budgetary outlays. It is conditional upon progress with the States and Territories.

SENATOR TAMBLING -So none of the $44m referred to in subprogram 2.1 will be applied to this particular program?

DR SHERGOLD -Already that would include the $7m appropriated for this year under the Aboriginal health strategy.

SENATOR TAMBLING -So given that last year the appropriation was almost $41m, if you are including $7m in that program, there is really no advance in this particular program activity. In fact, you probably have a shortfall of about $ 4m in comparison with last year.

DR SHERGOLD -No. Because the decision on the Aboriginal health strategy was taken mid-year, ATSIC got almost an additional $7m to spend on the Aboriginal health strategy. That was identified on page 63 and it is the money to upgrade and establish new Aboriginal health services. So last year some of the $232m for the health strategy was used. This year we have already identified, in the appropriations, another $7m and it has been indicated that on the basis of a number of developments, including the negotiations with the States and Territories, a further $21m will be made available.

SENATOR TAMBLING -But given that both the health budget and the infrastructure budget estimates for 1991-92 are substantially less than last year-I think it is about $17m-in what sense can it be said that there has been a positive funding response to the national Aboriginal health strategy by ATSIC?

DR SHERGOLD -As I have tried to suggest, the actual resources for 1990-91 already include additional funds deriving from the national Aboriginal health strategy.

MR MYERS -I will add something to clarify that: in the 1990-91 actual expenditure reported, those figures include some $20m that reflects a cash balance brought forward from 1989-90. Once spent, that cash balance disappears . So there is an artificial inflation of the expenditure figures in 1990-91 reflecting the cash balances brought forward from 1989-90.

That situation does not apply in 1991-92, so consequently there is some $20m adjustment required if one wants a year on year comparison, 1990-91 to 1991-92 , for the programs mentioned by Senator Tambling.

SENATOR TAMBLING -I note that in Budget Related Paper No. 7 starting at page 26 and moving forward, it is acknowledged that in 1990-91, that is the year just ended, ATSIC funded approximately 150 projects under this program. This included 62 Aboriginal and Torres Strait Islander community controlled health services, 11 which provided dental services. Nine new Aboriginal and Torres Strait Islander Health Services were supported in 1991 along with nine clinics providing basic health services with funding at $42.185m. What do you anticipate will be the statistical comparisons for the financial year 1991-92, in order to measure the improvement in Aboriginal health against those particular projects?

DR SHERGOLD -Senator, I think the easiest way of answering that is to suggest that most of the $7m additional funds already made available to ATSIC under the National Aboriginal Health Strategy for this year will go into the area of improving and upgrading Aboriginal health services such as those that are identified on page 28 of the Budget Related Paper.

SENATOR TAMBLING -So I can anticipate next year, when I look at a similar report, that I will see better and more improved statistics, because I note in looking at pages 63 and 64 of the performance indicators that there are no actual targets against numbers of projects to be achieved, but would I be right in assuming that we will see, given the commitment to this health strategy, a better outcome in that regard?

DR SHERGOLD -Yes, Senator, you would.

CHAIRMAN -Anything further on 2.1?

SENATOR TAMBLING -Yes, just one other. In the question on notice No. 117 which was provided to me earlier today, I asked for information with regard to the funding of an outstation community called Intjartnama, and I note in the response that they had been allocated $18,150. I have seen an application for funding for this particular project, which is an application, and I appreciate it as such, but at a total bid for $1.1m. Can I ask why the disparity in the eyes of the applicant between the application for $1.1m and the actual allocation of $18,000?

MR BEADMAN -Senator, I do not know what was in the mind of the applicant, but I would point out to the Committee the role that regional councils play now. For the very first time this year in the Budget compilation process, such bids would have been considered by the relevant regional council in central Australia along with other bids from other organisations in that locality against the available levels of funding, and it is the elected Aboriginal regional council that now takes the hard decisions as to what projects can be fitted in and what cannot within that level of funds available. The application to my knowledge has not come through to the central office level because of that process that occurs at the local level.