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Aboriginal and Torres Strait Islander Primary Health Care Systems Evaluation

Introduction

The evaluation focuses on the Australian Government’s main investment in primary health care for Aboriginal and Torres Strait Islander peoples, which occurs primarily through the Indigenous Australians’ Health Programme (IAHP).

An evaluation co-design phase from mid-2017 – mid-2018 included design and planning meetings with people recognised for their work in the health sector, and those working closely with Aboriginal and Torres Strait Islander peoples who use and do not use health services, as well as health sector workers and other key participants across all states and territories.

The co-design phase led to a Monitoring and Evaluation Design Report which was approved by the project’s Health Sector Co-design Group (HSCG), the Department of Health, and the Minister for Indigenous Health. The Minister has announced the commencement of the evaluation’s implementation phase.

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In the spirit of respect and reconciliation, the evaluation team acknowledge and pay respect to the Traditional Custodians of Australia – the Aboriginal and Torres Strait Islander people, and their continuing connection to land, waters, sea and community.

 

The original artwork was produced by Emma Walke. Emma is a Bundjalung Aboriginal woman from northern NSW and is on the evaluation team. Here is her description of the artwork:

Because I don’t speak for every country, and because we are working across many of them, the work seeks to represent Indigenous Australia. I feel that colour makes a statement so I have used colours that can be linked to many of our communities and countries, land or sea based. The colours represent our people and the land they come from – ochres/yellows represent desert and hills and the cliffs where our ochres come from. Blues for ocean and blue greens for rivers. The circles are universal in the way they represent groups or clans of people, the markings inside some of the circles represent individuals. The dots and slashes are representational of tracks and time lines. There are a few blank circles – they represent the missing, the lost peoples. I thought I would try and incorporate the colours to show respect for them.

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The evaluation design process

The evaluation design process began in late 2017. The following diagram charts the progress and timeline of the evaluation design, and the start date of the evaluation itself.

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The structure for co-designing the evaluation is shown in the figure below. It shows that the evaluation team is working collaboratively with a group of people working across the health sector – the Health Sector Co-design Group (HSCG) – and engaging with people in communities, as part of a community co-design process. It also shows engagement with a wider group of interested people across states and territories. As part of the community co-design process, we are working towards the establishment of a Community Co-design Group for the implementation phase of the evaluation. The Community Co-design Group will be in direct conversation with the HSCG as well as the evaluation team.

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The project team

The following independent team has been appointed by the Department of Health to lead the evaluation design process. Please click on their names below for more information.

If you would like to contact the team, please email Ned at [email protected], or phone him on +61 02 6188 4487

Team leader  

Qualifications

  • Bachelor of Arts (Honours), Master of Arts (Distinction).

Relevant experience

  • Over 18 years of experience in evaluation and research.

  • Team Leader on Phase 1 of this evaluation project (IAHP evaluation).

  • Lead evaluator on health sector evaluations in NZ, Australia and the Pacific.

  • Lead evaluator, Evaluation of the Child Health Check Initiative and the Expanding Health Service Delivery Initiative, NT.

  • Lead evaluator, Evaluation of the NT Continuous Quality Improvement Investment Strategy.

Senior indigenous health researcher  

Qualifications

  • Bachelor of Social Science (Honours), PhD.

Relevant experience

  • Roxanne is from the Gungarri/Kunja nations of south-west Queensland.

  • Public health equity research, specifically the social and cultural determinants of health.

  • Extensive experience and expertise in Indigenous research impact assessment and evaluation; the implementation of quality improvement approaches in and beyond primary health care settings; family-centred care; and participatory action-oriented approaches.

Senior health consultant  

Qualifications

  • Currently Master of Public Health, Diploma of Community Development, Diploma of Community Service (Aboriginal Sexual Health), Certificate IV (Training and Assessment; Frontline Management; Assessment and Workplace Training).

Relevant experience

  • Robert is a descendant of the Bundjalung Nation on his mother’s side. His family and his extended family are from the North Coast of NSW alongside the Clarence River at Baryulgil. On his father’s side a long and rich history of descendants from Ireland.
  • 18 years working within both National/State and Local Governments working within the Aboriginal community controlled sector.
  • Research projects at UNSWs Kirby Institute for the past 4 years in Aboriginal communities across Australia.
  • Diverse range of learnt and lived experiences that he attributes to working in and with communities that are passionate about Aboriginal culture that is rich in life.
Team member  

Qualifications

  • Diploma of Indigenous Health Promotion – University of Sydney, Certificate IV Health Promotion Principles and Practices – Territory Health Services, Bachelor of Applied Science (Aboriginal Community Management and Development) – Curtin University – WA

Relevant experience

  • Lyn is an Aboriginal woman who is descendent to both Yankunytjatjara (APY Lands-SA) and Warumungu peoples (Central Barkly-NT).

  • Lyn has lived and worked in Darwin for many years and has a good understanding of services, structures and geographical contexts in the Northern Territory.  She has extensive experience in health promotion workforce training and development, continuous quality improvement, research and evaluation, and community engagement, and has a strong interest in Aboriginal health.

  • Chief Investigator, NH&MRC funded Centre for Research Excellence in Integrated Quality Improvement.

  • Associate Investigator and professional research person for a structured systems approach for improving Health Promotion Practice for Chronic Diseases Prevention in Indigenous Communities.

  • Chief Investigator, Audit and Best Practice for Chronic Disease Extension Project.

  • Indigenous Steering Group member, for the Diabetes and Related conditions in Urban Indigenous people in the Darwin Region Study.

Engagement lead  

Qualifications

  • PhD Candidate (Indigenous Wellbeing), Bachelor of Health Promotion, Master of Indigenous Health, Graduate Certificate in Indigenous Research.

Relevant experience

  • Senior Research Fellow Griffith University Indigenous Research Unit.

  • Program Lead/lecturer of Indigenous Health, University of the Sunshine Coast.

  • Lecturer and course coordinator Indigenous Health Master of Public Health Program at James Cook University.

  • Health Promotion Project Officer - Aboriginal and Torres Strait Islander Maternal Tobacco Harm Reduction.

Team member  

Qualifications

  • Bachelor of Health Sciences (Honours), Bachelor of Health Sciences
  • PhD Candidate (Submitted) (Evaluation).

Relevant experience

  • Chief investigator on the Youth Engagement Evaluation, commissioned by VicHealth Foundation.

  • Investigator on the Evaluation of the Differentiated Support for School Improvement, commissioned by the Department of Education and Training.

  • Investigator on a project to establishing the key determinants of teaching, commissioned by the Department of Education and Training [Federal Government].

  • Investigator on the Evaluation Capacity Building Program, commissioned by Local Government Professionals.

Evaluation Manager  

Qualifications

  • Bachelor of Social Sciences, Diploma of Social Science Research, Post-Graduate Diploma Social Sector Evaluation Research (Distinction).

Relevant experience

  • Over 30 years of experience in evaluation and research.
  • Senior evaluator on a health sector evaluation in Australia.
  • Lead or co-lead evaluator of public health, social, community, housing, youth development and employment equity projects in New Zealand.
  • Co-led development of a youth health and wellbeing outcomes measurement model.
  • Author of the New Zealand evaluator competencies and evaluation standards.
Senior health consultant  

Qualifications

  • Diploma in Criminology, Bachelor of Medicine, Bachelor of Surgery, Diploma from the Royal College of Obstetricians and Gynaecologists.
  • Fellow of the Royal New Zealand College of General Practitioners, Fellowship Australian College of Rural and Remote Medicine, Fellow of the Australian Faculty of Public Health Medicine.

Relevant experience

  • Clinical medicine (general practice/primary care) and public health physician in New Zealand and Australia.
  • GP in Indigenous health services in both urban and rural settings, including for Inala Indigenous Health Service in Brisbane, and Ngati Porou Hauora on New Zealand’s East Coast.
  • Health policy development, evaluation and innovation.
  • Interface between the health, social and justice sectors and in innovation for hard to reach and marginalised populations.
  • Experience in service planning and funding.
  • Quantitative and qualitative analytical skills, as well as health systems and population health perspectives.
Team member  

Qualifications

  • Post Graduate Diploma in Social Sector Evaluation, Master of Arts (Appl) Social Sciences, Bachelor of Arts.

  • PhD Candidate (Evaluation).

Relevant experience

  • Lead evaluator on social services, disability sector and employment-related evaluations in New Zealand and the Pacific.

  • Significant project management experience of multi-year, multi-agency evaluations.

  • Evaluation tutor for two Master in Evaluation subjects at the University of Melbourne.    

Project manager  

Qualifications

  • BA (1st Class Hons)

  • MAdLitNumEd (Distinction)

  • GradDip Tch (Sec)

Relevant experience

  • Senior Consultant and highly skilled analyst and project manager with over eight years’ experience in policy, secretariat and programme support, research and evaluation projects.

Project coordinator  

Qualifications

  • LLB/BA (Human Geography)

Relevant experience

  • Consultant with experience in policy and evaluation sectors.

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Health Sector Co-design Group

The Health Sector Evaluation Co-design Group was established in late 2017 to co-design and guide the development and implementation of the Evaluation of Aboriginal and Torres Strait Islander primary health care (PHC).

The Group brings together a wide range of experiences and perspectives from people working across the health system. Members come from a range of organisations including the National Health Leadership Forum, the Implementation Plan Advisory Group, the National Aboriginal Community Controlled Health Sector, the Primary Health Networks, health service providers, state health services, the Department of the Prime Minister and the Cabinet, the Australian Institute of Health and Welfare, and the Department of Health. The group also includes research expertise in primary health care and co-design.

HSCG Terms of Reference and Membership List

Health Sector Co-design Group (HSCG) Meeting No. 1 Communiqué – 20 December 2017

Health Sector Co-design Group (HSCG) Meeting No.2 Communiqué – 12–13 April 2018

Health Sector Co-design Group (HSCG) Meeting No.3 Communiqué – 14-15 February 2019

Health Sector Co-design Group (HSCG) Meeting No.4 Communiqué – 25-26 June 2019

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Community co-design process

All people involved in designing the evaluation so far – evaluation team members, the Department of Health, the Health Sector Co-design Group (HSCG) and others – have expressed a strong desire that the evaluation design process genuinely engages with a diverse group of Aboriginal and Torres Strait Islander peoples, particularly those whose voices are not commonly heard.

The community co-design process is evolving organically. Essentially, it is occurring in reverse to that of the co-design process with the health sector. The community co-design has started with a wider engagement process, working towards the formation of a group for the implementation of the evaluation. The health sector co-design process has started with bringing a group together – the HSCG – followed by engaging with the health sector more broadly.

In our discussions to date we have found that many people want to discuss real issues and concerns rather than the design of an evaluation. Therefore, we have identified several areas that we are discussing with people in the community to inform the evaluation design, including:

  • what ‘health’ means for people
  • where people go to see a nurse or doctor
  • who are using health services and who is missing out
  • what works well and not so well with health services
  • what is important to people about healthcare.

We are mindful there is already a lot of research and understanding about these areas, including among the project team and the HSCG, and will also be drawing on this to design the evaluation.

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Ethics

Phased ethics applications

Given the multi-year and responsive nature of the evaluation, we are undertaking a phased ethics application approach to ensure the evaluation is responsive to community and organisational needs, as well as being carried out in line with the National Statement on Ethical Conduct in Human Research and other relevant ethical guidelines.

Phase one ethics approval:

Phase one ethics applications seeks ethics approval for:

  1. Establishment of up to 20 evaluation sites through intensive engagement with Aboriginal and Torres Strait Islander communities, health service providers and relevant organisations Australia-wide. Evaluation forums will also be established for each state/territory and at the national level.
  2. A data feasibility assessment to identify relevant data sources that can be used to monitor the appropriateness and effectiveness of the IAHP.

The application is supported by the Commonwealth Department of Health, the National Aboriginal Community-Controlled Health Organisation and the Health Sector Co-design Group.

We currently have ethics approval from the following HRECs for Phase 1:

State/Territory HREC Outcome of application for approval for Phase 1
WA Western Australian Aboriginal Health Ethics Committee Approval received
NT NT Department of Health and Menzies School of Health Research Human Research Ethics Committee Approval received
NT Central Australian Human Research Ethics Committee Approval received
National AIATSIS Research Ethics Committee Approval received
ACT ACT Health Human Research Ethics Committee Approval received
NSW Aboriginal Health and Medical Research Council Ethics Committee Approval received
QLD Darling Downs Health Human Research Ethics Committee Approval received
QLD Prince Charles Hospital Human Research Ethics Committee Approval received
QLD Far North Queensland Human Research Ethics Committee Approval received
TAS UTAS Health and Medical Research Ethics Committee Approval received
VIC St Vincent’s Hospital Human Research Ethics Committee Awaiting letter of support
SA Aboriginal Health Research Ethics Committee Approval waived for phase 1

Phase two ethics approval:

The phase two ethics application (the next set of applications) are a full ethics application seeking approval for all evaluative activities that are to occur over the three years of the evaluation 2020-2022

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The IAHP

The Indigenous Australians’ Health Programme (IAHP) is delivering $3.6 billion over four years from 2017/18 to 2020/21 to improve:

  • access to culturally appropriate comprehensive primary health care for Indigenous Australians, and
  • areas of critical need through targeted investment that are expected to accelerate progress in reaching targets.

The IAHP:

  • Funds organisations to deliver PHC to Aboriginal and Torres Strait Islander peoples
  • Funds Aboriginal and Torres Strait Islander-specific initiatives to address issues such as maternal and child health, smoking, mental health, and drug use
  • Seeks to strengthen the health system so that it works better for Aboriginal and Torres Strait Islander peoples.

Please see the Department of Health’s website for more information on the IAHP.

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Latest news

11 December 2018 – Hon Ken Wyatt Minister for Indigenous Health media release

11 December 2018 – Monitoring and Evaluation Design Report available to the public

20 March 2018 – Newsletter

20 November 2017 – About the evaluation

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What’s happening now

The evaluation is currently in its planning phase, which includes:

  • Establishing the evaluation project team
  • Developing a project plan with details of the workplan through to July 2019
  • Developing a site selection process and engaging with stakeholders around the selection
  • Designing a quantitative data feasibility analysis
  • Preliminary engagement with possible sites for the evaluation to take place across Australian states and territories, and stakeholders at a national level
  • Developing applications for ethical approval for the evaluation
  • Meeting with the Health Sector Co-design Group (HSCG).

Please contact [email protected] for more information.

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Have your say

From time to time we will be inviting people to provide views on specific questions we have. These will be found under the ‘Have your say’ button below.

To ask us a question, or to provide us with any comments you have on the evaluation at any time, please click on the ‘Ask us a question’ button or email us at [email protected]

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FAQs

Click on a question below to view the answer

The evaluation will focus on the Australian Government’s main investment in primary health care for Aboriginal and Torres Strait Islander peoples, which occurs primarily through the Indigenous Australians’ Health Programme (IAHP). The IAHP:
  • Funds organisations to deliver primary health care to Aboriginal and Torres Strait Islander peoples.
  • Funds Aboriginal and Torres Strait Islander-specific initiatives to address issues such as maternal and child health, smoking, mental health, and drug use.
  • Seeks to strengthen the health system so that it works better for Aboriginal and Torres Strait Islander peoples.
The Department of Health wants to know whether the IAHP is delivering the desired results. More broadly, it wants to:
  • Learn how well the primary health care system is working for Aboriginal and Torres Strait Islander peoples.
  • Demonstrate the difference that the IAHP makes.
  • Inform efforts to accelerate improvement in health and wellbeing for Aboriginal and Torres Strait Islander peoples.
  • Inform revisions to the Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan 2013-2023.
  • Support adaptive management and continuous improvement in primary health care service delivery.
  • Gain a better understanding of Aboriginal and Torres Strait Islander community needs and aspirations.
The evaluation is being designed by an independent team of evaluators and researchers. As well as reviewing documents and literature and mapping existing data to evaluation questions, the design process includes:
  • Co-design processes with a group of health sector and evaluation specialists and with Aboriginal and Torres Strait Islander communities.
  • Seeking input from a wider group of people working in primary health care across Australia.
The co-design process took place from November 2017 to April 2018. Stakeholder engagement occurred from March to April 2018. The evaluation design is being finalised. Once the evaluation design has been approved, the evaluation will be implemented over four years. Those involved in the co-design processes will continue to be part of the evaluation.
During the design phase, the evaluation team met with people in states and territories to seek views and ideas to inform the evaluation design.
The independent team of evaluators and researchers is a collaboration between:
  • Evaluation consultants Allen + Clarke (Ned Hardie-Boys, Robyn Bailey and Matt Allen).
  • Robert Monaghan, from the Bundjalung Nation and Monaghan Consulting.
  • Associate Professor Roxanne Bainbridge, a Gungarri Aboriginal woman from Central Queensland University.
  • Dr Julia Carr, a public health physician and GP from Brisbane.
The project team is working closely with a Health Sector Codesign Group.  A list of members of this group can be found here.
Ned Hardie-Boys, Telephone: 02 6188 4487, Email: [email protected]
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