Planning, implementation and effectiveness in Indigenous health reform

The Planning, Implementation and Effectiveness in Indigenous Health Reform (PIE) project, funded by the Lowitja Institute and the Australian Research Council, carried out by the University of Melbourne, arose from concerns by Aboriginal and Torres Strait Islander people that despite the importance of participation and investment in collaborative governance, little research focused on capturing current practice and identifying best practice is being done. The advent of the National Indigenous Reform Agreement (NIRA) and the Indigenous Health National Partnership Agreements (IHNPAs) has led to further development/application of collaborative approaches to governance through committees and forums at national, State and regional levels. The activities associated with these committees and forums are referred to throughout this report as collaborative governance. This report focuses on building the evidence base around best practice based on case studies of collaborative governance in relation to the NIRA. A policy brief highlighting the policy recommendations of this report is also available

Does more equitable governance lead to more equitable health care?: a case study based on the implementation of health reform in Aboriginal health Australia

There is growing evidence that providing increased voice to vulnerable or disenfranchised populations is important to improving health equity. In this paper we will examine the engagement of Aboriginal community members and community controlled organisations in local governance reforms associated with the Aboriginal Health National Partnership Agreements (AHNPA) in Australia and its impact on the uptake of health assessments. The sample included qualitative and quantitative responses from 188 people involved in regional governance in Aboriginal health. The study included data on the uptake of Aboriginal health assessments from July 2008 to December 2012. The study population was 83190 in 2008/9, 856986 in 2009/10, 88256 in 2010/11 and 90903 in 2011/12. Logistic regression was used to examine the relationships between organisations within forums and the regional uptake of Aboriginal health assessments. The independent variables included before and after the AHNPA, state, remoteness, level of representation from Aboriginal organisations and links between Aboriginal and mainstream organisations. The introduction of the AHNPA was associated with a shift in power from central government to regional forums. This shift has enabled Aboriginal people a much greater voice in governance. The results of the analyses show that improvements in the uptake of health assessments were associated with stronger links between Aboriginal organisations and between mainstream organisations working with Aboriginal organisations. Higher levels of community representation were also associated with improved uptake of health assessments in the AHNPA. The findings suggest that the incorporation of Aboriginal community and community controlled organisations in regional planning plays an important role in improving health equity. This study makes an important contribution to understanding the processes through which the incorporation of disadvantaged groups into governance might contribute to health equity