Wellness through prevention and management of chronic disease

For an overview of the services we fund for chronic disease, after hours and other services, please download the Summary of Commissioned Services.

Integrated Team Care – Marrabinya

In Western NSW many Aboriginal People present with complex and multiple chronic conditions, which need coordinated care. Maari Ma Health is funded by WNSW PHN to implement the Commonwealth’s Integrated Team Care (ITC) program. This program is called Marrabinya and aims to improve outcomes for Aboriginal People through better access to coordinated and multidisciplinary care and improve access to culturally appropriate mainstream primary care services. ‘Marrabinya’ comes from the Wiradjuri language and means ‘hand outstretch thee’

To find out more about the Marrabinya program and eligibility please visit the Maari Ma Health Website

Marrabinya referral form for general practice

Chronic Disease Management and Prevention Program

The Western NSW Primary Health Network (WNSW PHN) has commissioned the NSW Outback Division of General Practice (ODGP), as the service provider to deliver the Chronic Disease Management and Prevention Program (CDMPP) Model of Care in Western NSW. The ODGP are operating in a consortium with Maari Ma Health Aboriginal Corporation to deliver the CDMPP which is an evidence based Model of Care supporting better management of lifestyle related chronic diseases such as Diabetes, Cardiovascular Disease, Respiratory Disease, Renal Disease and some Cancers in the general practice setting. The program identifies key components that are necessary to ensure general practices and patients experience more comprehensive care in the management and prevention of chronic conditions. 

The program model directly supports team based care and chronic disease prevention and management services in identified communities will be enhanced by the following strategies;
• Allied Health Services Strategy
• Aboriginal Health Worker Strategy
• Practice Enrolment and Nurse Support Strategy

For more information, download a copy of the Fact Sheet.

Outback Eye Service

The Outback Eye Service (OES) is an outreach eye service for patients located in regional NSW. The service is provided in Bourke, Lightening Ridge, Walgett, Brewarrina and Cobar.

The OES provides comprehensive ophthalmic services (ie. primary, secondary and tertiary eye care services) to patients, including:

  • Optometry;
  • Ophthalmology;
  • Eye surgery; and
  • Patient referrals to the Prince of Wales Hospital for complex clinical cases.

Patient clinical services and case management is co-ordinated by the staff of the OES.

The OES is delivered by the Department of Ophthalmology at the Prince of Wales Hospital (as part of the South Eastern Sydney Local Health District) and has a longstanding history in regional NSW, which commenced with the pioneering work of Professor Fred Hollows in Bourke in the 1970s.

For more information please visit their website