Governance of Aboriginal and Torres Strait Islander Health Workers across Northern Australia – A case comparison

Who’s steering the ship? A case comparison of the governance of Aboriginal and Torres Strait Islander Health Workers.

National and state-based health policy in Australia places Aboriginal and Torres Strait Islander Health Workers (A&TSIHW) at the centre of efforts to ‘close the gap’ between Indigenous and non-Indigenous health outcomes. Yet little is known about the governance of Aboriginal and Torres Strait Islander Health Workers, or the influence that competing expectations of, or obligations to, health service employers, colleagues, communities, and culture can have on recruitment, retention and performance.

Using a qualitative design, informed by Indigenous research methodologies, this project will expand on current Queensland-based work to address this gap in knowledge by exploring the governance arrangements that shape the work practices of A&TSIHW in the Northern Territory and potentially Western Australia.

Continuing the first systematic work relating to A&TSIHW governance carried out in Queensland as part of a 2019 with Hot North support, this project aims to:

a) extend the project scope and characterize both the formal and informal rules and norms that influence A&TSIHW roles in the Top End Health Service of the NT, and
b) through cross-case analysis of QLD and NT data, develop new insights into the influence of different geographic, social and administrative structures on A&TSIHW performance.

The outcomes are expected to support efforts to strengthen Indigenous health workforce planning across Northern Australia.

Chronic disease contributes substantially to the health gap between Indigenous and non-Indigenous Australians. In the past two decades, moreover, the prevalence of chronic disease within Aboriginal and Torres Strait Islander communities across Northern Australia has increased (Zhao, Connors et al. 2008, Australian Institute of Health and Welfare 2017).

A major challenge for service planners, managers and the Aboriginal and Torres Strait communities of Northern Australia themselves, relates to adequate provision of culturally safe health services (Schmidt et al, 2016). The role of Aboriginal and Torres Strait Islander Health Workers (A&TSIHW) within such services takes on particular significance, as they are members of integrated teams of professionals responsible for facilitating active client engagement and self-management within a broader framework of holistic and culturally safe care (McDermott et al, 2015).

Notwithstanding the above consensus, the accessibility and impact of chronic disease services for Aboriginal and Torres Strait Islanders remains an enormous challenge. Part of this challenge lies in the tensions between personal, cultural and professional obligations that A&TSIHW face in their day-to-day work (Tregenza & Abbott, 1995; Genat et al, 2006; Topp et al, 2018). Substantial numbers of unfilled A&TSIHW posts across Northern Australia (Health Workforce Australia, 2014) point to ongoing and even intensifying issues of job satisfaction. Such issues have the potential to undermine the ability of already stretched health services to address or mitigate the burden of chronic disease, and the associated problems of social, cultural and geographic marginalisation.

Understanding how the current governance arrangements for A&TSIHWs influence their capacity to help ‘close the gap’, is thus of direct relevance to a key pillar of the Northern Australian health workforce, and health service delivery model, on which chronic disease services for the Aboriginal and Torres Strait Islander populations of Northern Australia depend (Topp et al, 2018).