Efficient funding: a path to improving Aboriginal healthcare in Australia?Jane E. Lloyd A B and Marilyn J. Wise A
A The Centre for Health Equity Training Research and Evaluation, Research Centre for Primary Health Care and Equity, Faculty of Medicine, University of New South Wales, Locked Bag 7103, Liverpool BC, NSW 1871, Australia. Email: firstname.lastname@example.org
B Corresponding author. Email: email@example.com
Australian Health Review 34(4) 430-434 https://doi.org/10.1071/AH09760
Submitted: 16 March 2009 Accepted: 18 February 2010 Published: 25 November 2010
Objectives. To identify the factors that contribute to the under-resourcing of Aboriginal health and to explore the impact that funding arrangements have on the implementation of Aboriginal health policy.
Design, settings and participants. Qualitative study based on 35 in-depth interviews with a purposive sample of frontline health professionals involved in health policy and service provision in the Northern Territory.
Results. Participants described three factors that contributed to the under-resourcing of Aboriginal health: inefficient funding arrangements, mainstream programs being inappropriate for Aboriginal Australians, and competing interests determining the allocation of resources. Insufficient capacity within the healthcare system undermines the multilevel implementation process whereby organisations need to have the capacity to recognise new policy ideas, assess their relevance to their existing work and strategic plan and to be able to incorporate the relevant new ideas into day-to-day practice.
Conclusion. Insufficient resources for Aboriginal health were found to be a barrier to implementing Aboriginal health policy. Inadequate resources result from the cumbersome allocation of funding rather than simply the amount of funding provided to Aboriginal healthcare. Monitoring government performance and ensuring the efficient allocation of funds would allow us to develop the delivery system for Aboriginal healthcare and therefore provide greater opportunities to capitalise on current interventions and future efforts.
What is known about the topic? The extent to which Aboriginal health interventions are funded is variable, and the funding of the Aboriginal healthcare system is an important and topical issue.
What does this paper add? The argument surrounding funding for Aboriginal health can be understood in several ways. 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.
What are the implications for practitioners? To implement Aboriginal health policy, an effective delivery system is needed. Funding alone can be of limited value in achieving this aim over the long term unless it is used to build the capacity of a sustained delivery system for Aboriginal health care. Monitoring and facilitating government performance on how funds are invested, as well as the amount spent, is an important step towards the more effective implementation of Aboriginal health policy.
References Bartlett B, Legge D. Beyond the Maze: Proposals for more effective administration of Aboriginal health programs. Canberra: National Centre for Epidemiology and Population Health; 1994. Report No. 34.
 Close the Gap: National Indigenous Health Equality Targets: Outcomes from the National Indigenous Health Equality Summit Canberra. Sydney: Human Rights and Equity Opportunities Commission; 2008.
 Australian Government. Northern Territory Emergency Response: One year on. Canberra: Australian Government; 2008.
 Central Land Council. Central Land Council Submission to the NTER Review Board. 2008. Available at http://www.nterreview.gov.au/subs/nter_review_report/37_clc/37_CLC_7.htm [verified 23 February 2009].
 Hunter P. Exploding myths about Aboriginal health expenditure. The Australian Health Consumer 2000; 2 12–3.
 Anderson I, Loff B. Voices lost: indigenous health and human rights in Australia. Lancet 2004; 364 1281
| Voices lost: indigenous health and human rights in Australia.CrossRef | 15470813PubMed |
 Palmer G, Short S. The Australian health care system. Healthcare and public policy: an Australian analysis. Melbourne: Macmillan; 1989. pp. 5–20.
 Australian Government Productivity C. Australia’s Health Workforce: Productivity Commission Research Report. Canberra: Productivity Commission; 2005.
 Economics A. Indigenous Health Workforce Needs. Canberra: Australian Medical Association; 2004.
 Beaver C, Zhao Y. Investment analysis of the Aboriginal and Torres Strait Islander Primary Health Care Program in the Northern Territory. Canberra: Commonwealth Department of Health and Ageing; 2004. Report No. 2.
 Rock M. Sweet blood and social suffering: rethinking cause–effect relationships in diabetes, distress, and duress. Med Anthropol 2003; 22 131–74.
| Sweet blood and social suffering: rethinking cause–effect relationships in diabetes, distress, and duress.CrossRef | 12745637PubMed |
 Wearne B, Chesters J, Whyte S. Funding sources and consequences: the subverting of an Indigenous community outreach program. Rural Remote Health 2006; 6 542
| 16839237PubMed |
 Dodson M, Smith D. Governance for sustainable development: Strategic issues and principles for Indigenous Australian communities. Canberra: The Australian National University; 2003. Report No. 250/2003.
 Lewis JM. Power and influence: networks and health politics. In: Health Policy and Politics: Networks, Ideas and Power. Melbourne: IP Communications; 2005. pp. 56–74.
 Mooney GH, The Productivity Commission, Melbourne Institute of Applied Economics and Social Research. Access and service delivery issues. In: Health policy roundtable: conference proceedings. 7–8 March 2002; Canberra: AusInfo; 2002. pp. 161–93.
 Mooney GH, Wiseman VL, Jan S. How much should we be spending on health services for Aboriginal and Torres Strait Islander people? Med J Aust 1998; 169 508–9.
| 1:STN:280:DyaK1M%2FnvVyqtA%3D%3D&md5=6bca64a772b00acecb30b2fa1cabf241CAS | 9861903PubMed |
 Behrendt L. What lies beneath. Meanjin 2006; 65 4–12.
 Hamrosi K, Taylor SJ, Aslani P. Issues with prescribed medications in Aboriginal communities: Aboriginal Health Workers’ perspectives. Rural Remote Health 2006; 6 557
| 16683907PubMed |
 Kelaher M, Dunt D, Taylor-Thomson D, Harrison N, O’Donoghue L, Barnes T, et al Improving access to medicines among clients of remote area Aboriginal and Torres Strait Islander Health Services. Aust N Z J Public Health 2006; 30 177–83.
| Improving access to medicines among clients of remote area Aboriginal and Torres Strait Islander Health Services.CrossRef | 16681341PubMed |