Our priority areas

First Nations Health


NQPHN remains committed to First Nations health, with a clear objective to achieve health equity for First Nations people by enhancing access and outcomes.  

Our collaborative efforts with partners across the sector aim to ensure First Nations peoples gain increased access to coordinated, high-quality and culturally safe care.  

To support this goal, we have been actively involved in embedding the new Integrated Team Care (ITC) model of care within the Aboriginal Community Controlled Health Organisations (ACCHO) sector. Our focus also includes improving access to culturally appropriate ITC services.  

As part of our commitment to First Nations health, we have continued to support workforce capacity and capability within the community-controlled sector, while also assisting ACCHOs to deliver maternal and child health services, and contribute to building an appropriately skilled First Nations workforce to deliver these essential services.  

NQPHN has also been dedicated to building the capacity of mainstream services to delivery culturally appropriate care to further support First Nations health equity.

A selection of our First Nation Health projects are highlighted below.

Our Region, Our People
Mulungu team leader is devoted to helping First Nations people through ITC program

A passion for looking after people has led Kim Grainer to run the Integrated Team Care (ITC) Program at Mulungu Aboriginal Corporation Medical Centre in Mareeba.

Kim has more than 20 years’ experience in First Nations health, working as an Aboriginal health practitioner at Mulungu and previously in the Northern Territory.  

As the ITC Care Coordinator, she now cares for about 100 ITC patients across Mareeba, Atherton, Malanda, Herberton, Chillagoe, and Kuranda.

“I get satisfaction helping people and my strength is in Aboriginal health. This is why I am here,” Kim said.

Ensuring access to allied health and specialist services, and making sure people attend their appointments, are both important key areas of Kim’s key role.

Two recent success stories have been particularly satisfying for Kim and her team, with one involving a five-year-old boy from Kuranda who had a foreign object lodged in his ear.

It was difficult for the boy and his mum to get to his appointments in Cairns, so Kim dispatched a transport officer to their Kuranda home. The officer knew the family, made a connection, and then ensured the mum and boy could make it to Cairns to receive the necessary treatment.

In a separate situation, a 69-year-old man with problematic alcohol use issues had difficulty attending his appointments.  

Kim said with more regular engagement from the Mulungu team, the man was able attend his appointments more often.  

“We let him know we are here to help, and he is now engaging with the team more and attending his appointments,” Kim said.  

“We also sat down with the man to explain what each appointment was about and why they were important. It’s all about advocacy and education.”

The ITC Program is funded under NQPHN’s Indigenous Australians’ Health Program, which aims to improve the health outcomes for First Nations peoples. The program supports people to access medical and allied health services that are imperative in managing their chronic and complex health conditions and deterioration to the point of needing hospitalisation.

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Key projects

First 1,000 Days program

Six Aboriginal Community Controlled Health Organisations (ACCHOs) have started delivering the First 1,000 Days program across North Queensland, focusing on maternal and child health social and emotional wellbeing to help reduce health inequities and ensure all children in the region have a healthy start to life.  

The development of this program, which was codesigned with the ACHHOs, is an important milestone that represents targeted support for First Nations women, children, and families in their first 1,000 days, defined as the period from conception through to a child’s second birthday. During this period, parents and children may receive access to a range of care and supports, including pregnancy care, birthing, post-birth care, and child development.  

Codesigning the program with ACCHOs and other health professionals began in 2022, with phase one and two workshops facilitated by Beacon Strategies.  

More than 40 people attended the workshops that brought together a targeted and diverse cross-section of staff from the ACCHOs, Hospital and Health Services (HHSs), the Department of Education and Early Childhood, Tropical Health, Queensland Aboriginal and Islander Health Council (QAIHC), and digital health organisations from across the region. Midwives, early childhood educators, mental health directors, immunisation specialists, women’s health representatives, and Indigenous health workers were also in attendance.  

Following a successful codesign process, the six ACCHOs were contracted to implement the program from 1 July 2023.  

The First 1,000 Days program aims to improve health outcomes for First Nations families and communities by providing care coordination and improving access to primary health care, including culturally appropriate mainstream services.

Key statistics
ACCHOs delivering the program
codesign workshop participants

Integrated Team Care (ITC)

The Integrated Team Care (ITC) program aims to improve the health and wellbeing of Indigenous Australians living with chronic disease, through improved access to care coordination and support, and to culturally appropriate mainstream primary care services.  

In 2022-23, NQPHN Indigenous Health Project Coordination staff worked directly with all ACCHOs to support the development and implementation of 12 place-based models.  

Implementation support has included assisting providers to run workshops, education sessions, and stakeholder engagement meetings with mainstream services to establish referral pathways.  

There is currently a collective workforce of 50 individuals – including Care Coordinators and Indigenous Outreach Workers - supporting 4,647 Aboriginal and Torres Strait Islander clients to manage their chronic conditions.  

A Peer Support Group meets monthly, and providers are sharing information, providing advice, and discussing and exchanging resources relating to areas such as cultural competencies and safety, and service delivery goals to promote efficiency. Group members are also sharing trends and issues, which have provided opportunities to work collaboratively across ACCHO and mainstream providers.    

ITC plays a role in improving the cultural competency of mainstream primary care services as a means of reducing barriers to access. As more Aboriginal and Torres Strait Islander people source their medical care through mainstream general practice, it highlights the importance of having a health system that is responsive and culturally appropriate for First Nations health needs.  

Indigenous Allied Health Australia has developed an online Cultural Responsiveness training program for providers within the NQPHN catchment, funded by NQPHN.

Key statistics
place-based models
Care Coordinators and Indigenous Outreach Workers
First Nations clients supported to manage their chronic conditions

First Nations Continuous Quality Improvement (CQI) program

In August 2022, and in an Australian first, NQPHN created the First Nations Continuous Quality Improvement (CQI) program, an ambitious 12-month program to dramatically improve access to culturally safe health assessments for the First Nations’ people within the northern Queensland catchment.  

Over the 12-month period, the program brought together general practitioners, Aboriginal Community Controlled Health Organisations (ACCHOs) and Aboriginal Medical Services (AMSs), Royal Flying Doctor Service (RFDS), and Hospital and Health Services’ (HHSs) Primary Care Clinics.  

The aim was to enhance primary care providers’ knowledge, skills, and abilities to provide culturally sensitive and effective health care to First Nations people living in North Queensland.  

Participating practices received Cultural Safety and Awareness Training, and free resources and education to assist in providing comprehensive, culturally sensitive health assessments as well as a host of other training and access to information and data.  

Quarterly workshops were held in Cairns, Townsville, and Mackay from May 2022 to June 2023, involving expert presenters, and covering First Nations health topics such as Aboriginal and Torres Strait Islander 715 Health Assessment, best practice for managing complex and chronic conditions experienced by First Nations’ Australians, Chronic Kidney Disease (CKD) in Aboriginal and Torres Strait Islanders, and First Nations Mental Health and Alcohol and Other Drugs.

Key statistics

NQPHN 12-month First Nations CQI interim outcomes included:

participating health services
mainstream general practices
HHS Primary Care Clinics

Education activities

virtual education events participants
face-to-face and virtual education event participants

Education event topics:

  • Chronic Kidney Disease (CKD)  
  • Cultural awareness  
  • 715 Health Assessment (reports show an increase in 715 Assessment uptake of 31-35 per cent)  
  • Beyond the 715 Health Assessment  
  • Mental Health of our First Nations population

Our priority areas

GPs and other Primary
Care Professionals