Rhetoric to reality: How the governance of Aboriginal and Torres Strait Islander health workers impacts chronic disease prevention and care in northern Australia

National and state-based health policy in Australia places Aboriginal and Torres Strait Islander Health Workers at the centre of efforts to ‘close the gap’ between Indigenous and non-Indigenous health outcomes. Yet little is known about the governance of this cadre of 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 address this gap in knowledge by exploring the governance arrangements that shape the work practices of Aboriginal and Torres Strait Islander Health Workers in two government services in far North Queensland and the Northern Territory respectively. As the first systematic work relating to Aboriginal and Torres Strait Islander Health Workers governance the project aims to characterize both the formal and informal rules and norms that influence Aboriginal and Torres Strait Islander Health Workers roles, and develop new insights into the influence of different geographic, social and administrative structures on Aboriginal and Torres Strait Islander Health Workers 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 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 Aboriginal and Torres Strait Islander Health Workers face in their day to day work (Tregenza & Abbott, 1995; Genat et al, 2006; Topp et al, 2018). Substantial numbers of unfilled Aboriginal and Torres Strait Islander Health Workers 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 Aboriginal and Torres Strait Islander Health Workers are influencing 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).

See 2020 pilot project as a continuation of this project.