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Making sense of the dollars

Providing adequate funding alone won’t improve Aboriginal healthcare in Australia if it continues to be misspent, researchers warn. Annie May reports.

Inefficient funding arrangements, mainstream programs being inappropriate for Aboriginal Australians and competing interests determining the allocation of resources.

These have been identified as the three main factors contributing to the under-resourcing of Aboriginal health by frontline health professionals involved in health policy and service provision in the Northern Territory.

Interviewed as part of a qualitative study by researchers exploring the impact that funding arrangements can have on the delivery of Aboriginal healthcare in Australia, many of the 35 participants were frustrated with the current arrangements, describing them as “inflexible, cumbersome and inefficient.

The argument surrounding funding for Aboriginal health can be understood in several ways, says Jane Lloyd and Associate Professor Marilyn Wise from the Centre for Primary Health Care and Equity.

“Firstly, there is insufficient money being invested to address the need. By need we are referring to addressing community illness and injury as well as the need for a quality and accessible primary healthcare system.

“Secondly, there may be enough money being invested, but because of complicated and inflexible funding arrangements it is not being spent efficiently.

“Thirdly, there may be enough money invested, but not in effective interventions, and not in building the healthcare system, for example the local workforce. Finally, there may be enough money invested, but decisions about its distribution at the community level are not sufficiently in the control of communities.”

Publishing their findings in the Australian Health Review, Lloyd and Wise found that inadequate resources were a “major and chronic” barrier to implementing Aboriginal health policy.
And the major reasons for having inadequate resources were linked to a fragmented healthcare system.

The first of the reported are structural barriers to long-term funding that emerge from federal and state funding divide.

In theory, writes the authors, the federal government has major responsibility for Aboriginal primary healthcare. It funds Aboriginal primary healthcare through the Office of Aboriginal and Torres Strait Islander Health as well as through mainstream funding such as Medicare and the PBS.

“Aboriginal communities, especially those in remote areas, cannot get equitable access to Medicare due to different service delivery models and workforce shortages. Many communities lack routine access to high-quality primary healthcare services.

“The Northern Territory government therefore complements Commonwealth funding with significant direct primary healthcare funding and service delivery. The dual funding of primary healthcare between the Commonwealth and the Northern Territory government complicates the whole picture and allows for ‘buck passing’ over their respective responsibilities.”

Another barrier referred to the decision-making process in mainstream policy development, which often occurs without consideration to the differential impacts on population groups.

“The processes of mainstream policy development in healthcare often occurs without the specific needs of Aboriginal Australians in mind, and therefore are often inappropriate for Aboriginal Australians,” says Lloyd and Wise.

“Although alterations to make mainstream policies more appropriate to Aboriginal Australians occur, they do so in subsequent years and even decades.”

“Monitoring government performance and ensuring the efficient allocation of funds would allow us to develop the delivery system for Aboriginal healthcare in Australia and therefore provide us with greater opportunities to capitalise on current interventions and future efforts.”

The full research is available from CSIRO Publishing.

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