Ideas@TheCentre
Indigenous health suffers from lack of accountability
Given the abysmal health of Aborigines and Torres Strait Islanders living in Indigenous communities, no one disputes the need for improving health services.
Crowded living conditions contribute to high rates of infectious diseases such as rheumatic fever, nephritis and trachoma, normally found only in Third World countries.
In the last 15 years, Commonwealth funding for Indigenous specific health programs has increased by nearly 400% with no appreciable improvements in health outcomes. But addressing the health problems facing Indigenous communities requires more than just increased funding.
Indigenous people in Australia have a dual health care system – along with mainstream medical services such as GPs and hospitals, there are state and territory run health clinics specifically for Indigenous patients, and Aboriginal Community Controlled Health Services (ACCHS).
Funding is provided through a range of different health programs, which are delivered in so many conflicting ways it is not surprising that there are service gaps in some areas and duplication of services in others.
By neglecting to target resources, consult with communities, or evaluate the various health programs, the government is abdicating its responsibility to provide decent health care to Aboriginal and Torres Strait Islanders.
Commonwealth attempts to improve the service delivery of primary health care to remote communities has focused on strengthening and expanding the number of ACCHS. But this has had a limited effect on Aborigines and Torres Strait Islanders living in remote communities, as most ACCHS are located in cities and towns.
Only half of the 200 or so ACCHS meet their financial reporting requirements to the Office of the Registration of Indigenous Corporations, with few consequences applied for those who don’t. This leniency has resulted in financial mismanagement, insolvency and even fraud.
Managing overall funding and coordinating the delivery of programs could be done by following the National Health and Hospitals Reform Commission’s (NHHRC) recommendation of a National Aboriginal and Torres Strait Islander Health Authority (NATSIHA) to pool disparate funding streams. But greater transparency cannot be achieved without reporting how patient outcomes are related to the cost and quality of services.
Increased and better reporting by ACCHS has been the subject of numerous reports for well over a decade. Organisations failing to adhere to reporting requirements must be held accountable otherwise the status of Aboriginal health will never improve.
Sara Hudson is a Policy Analyst with The Centre for Independent Studies. Her paper Closing the Accountability Gap: The First Step towards Better Indigenous Health was released this week.
