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 original artwork was produced by Emma Walke. Emma is a Bundjalung Aboriginal woman from northern NSW and was part of the evaluation team which designed and set-up the evaluation. 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.
Last modified 01/10/2019
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.
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.
Last modified 13/09/2019
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.
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.
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.
Graduate Australian Institute of Company Directors
Doctor of Philosophy (Health Economics Ph.D.) – University of Newcastle
Bachelor of Economics (Honours) – University of Newcastle
Relevant experience
Professor Chris Doran holds a Bachelor of Economics (Honours), a PhD in Health Economics and is a recent graduate of the Australian Institute of Company Directors. Chris is a Professor of Health Economics in the Centre for Indigenous Health Equity Research and is currently leading the research cluster for resilience and wellness.
Chris works within a multidisciplinary environment and collaborates extensively with academics, clinicians and policy makers in building capacity in the knowledge, use and translation of complex health data and systems analysis.
He has over 15 years’ experience in working with Aboriginal and Torres Strait Islander communities, health organisations and people. Examples include: working with the Yarrabah community in Far North Queensland to co-design and evaluate a Best Da Binge alcohol intervention; an NHMRC funded project to find solutions to Indigenous alcohol problems; an ARC funded project that embeds research into-youth services in remote Australian communities; an NHMRC funded project to reduce smoking rates among Indigenous pregnant women; and, a government funded project to evaluate the governments investment into Aboriginal and Torres Strait Islander residential rehabilitation services.
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.
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.
Bachelor of Psychology (Honours) – Griffith University
Graduate Certificate in Mathematical Science – Queensland University of Technology
Master of Philosophy (Data Science) – University of Queensland.
Relevant experience
Boyd has an educational background in psychology and maths, focussing on statistics and computational methods. He is particularly interested in the problem of nonlinear scaling of epidemiological metrics for small populations and developing new approaches to significance testing for rare events. These techniques have applications in the correct analysis of key population groups such as persons of Aboriginal and Torres Strait Island descent.
Boyd works concurrently with Menzies School of Health Research on the Better Cardiac Care Data Linkage Project, examining the continuum of care for Aboriginal and Torres Strait Islander patients in the Queensland health system.
He has previously worked with Griffith University’s EEG laboratory and later with the Queensland Suicide Register where he developed the automated text data extraction from police and coronial reports, provided statistical and geospatial analyses for suicide mortality and created the first predictive statistical model of suicide rate increases in Queensland, presented at the Australian Vital Statistics Interest Group (Australian Bureau of Statistics) in 2016.
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.
Bachelor of Health Science (Aboriginal Health and Community Development).
Relevant experience
Sarina is a proud Adnyamathanha woman from South Australia who is focused on Aboriginal and Torres Strait Islander health, education and community engagement.
Sarina has extensive experience working within the Aboriginal and Torres Strait Islander health and education sector with over 20 years of community engagement/development experience. She is highly competent in developing positive working relationships with government and non-government organisations.
High level strategic planning and policy implementation experience and research skills focusing on quantitative and qualitative research. Effective management of program deliverables and expertise around leadership and partnership collaborations.
Sarina is passionate and dedicated to working with Aboriginal communities to build capacity, self-determination and leadership.
Senior Consultant and highly skilled analyst and project manager with over eight years’ experience in policy, secretariat and programme support, research and evaluation projects.
Managing Partner of Allen + Clarke’s Melbourne office.
Paul is an experienced public policy and business change consultant.
Paul has provided services to a range of clients in different sectors, including the Australian Department of Health, NSW Health, the World Health Organisation, the Fred Hollows Foundation, Solomon Islands Ministry of Health and the United Nations Population Fund.
Consultant with experience in policy and evaluation sectors.
Last modified 28/01/2020
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.
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.
Last modified 19/08/2019
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:
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.
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
Last modified 17/09/2019
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.
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]
Last modified 19/08/2019
Reports
The Monitoring and Evaluation Design Report and Appendices are available here.
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 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.