Integrated Team Care

Chronic and complex conditions such as diabetes, renal disease and cancer are the biggest challenge to health services around the world … no more so than in the ACCHO sector where the determinants of health (poverty, nutrition, housing, education etc) intensify these problems and create an inequitable burden on Aboriginal people.

AMSANT’s ITC project officers provide comprehensive support for the 30 Care Coordinators ~ nurses, Aboriginal health workers and social workers ~ at our member services, to enable them to empower their clients in the management and control of their health conditions.

The Northern Territory has some of the highest rates of chronic health conditions in the world, across a vast geographic area, with limited GPs, specialists and health workers.  In this context, the care coordinators are passionate, dedicated and emotionally involved, and help their clients in many ways, often outside work hours.

This includes assistance with health education, transport, advocacy, housing, Centrelink, home visits, AOD support, palliative care, specialist and allied health appointments, health checks, medication delivery, family issues and provision of medical aids.

The high turnover of doctors and nurses in the NT further increases the importance of the care coordinators as they strive to maintain a continuity of care for their clients, and integrate the multiple services that are needed for the clients to prosper and survive.

AMSANT has two Indigenous health project officers who work directly with ITC services, program managers and outreach workers to ensure clients can manage their complex, chronic conditions.  They also support and contribute to advocacy, policy and research initiatives at a local, territory and national level.