“Aboriginal self-determination must be front and centre in any decision making processes if we are to truly see major gains to Close the Gap in Indigenous health and social and economic wellbeing.
The importance of the ACCHO sector is widely and formally acknowledged across the Australian health and social sectors – from GPs to hospital emergency facilities. ACCHOs are Australia’s largest, single national and preferred primary health care system for Aboriginal people.
In 2015 all major political parties supported the 10 year Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan (2013 – 2023).
NACCHO will persevere in its efforts to turn positive talk into positive action “
This year’s theme:
Strengthening Our Future through Self Determination
NACCHO Interim 3 day Program has been released
” The third factor is the effectiveness of Indigenous organisations, including local government. These are the local institutions that endure between successive policy rounds.
These organisations are the only structures of Indigenous self-governance in Australia to which powers, functions and resources can be devolved.
By providing political counterpoints to government, they contribute to a better-balanced system. New interventions should build, not corrode, their capability.”
Mark Moran is the author of Serious Whitefella Stuff: When solutions became the problem in Indigenous affairs, which is out now. Mark Moran, Chair of Development Effectiveness, The University of Queensland writing in the Conversation
There is a strong bipartisan consensus that Australia needs to close the gap in Indigenous disadvantage. It is a credit to the federal government that it has remained consistent in monitoring progress. But while maintaining these targets is important, Australia clearly has an implementation problem.
Consistent with his widespread call for innovation, Prime Minister Malcolm Turnbull remarked in this year’s Closing the Gap address to parliament that:
The Closing the Gap challenge is often described as a problem to be solved – but more than anything it is an opportunity. If our greatest assets are our people, if our richest capital is our human capital, then the opportunity to empower the imagination, the enterprise, the wisdom and the full potential of our First Australians is an exciting one.
Across remote Australia, such innovation is occurring locally in practice, under the radar of government policies and support. Central to this innovation are relationships between community leaders and trusted outsiders, and the shared understanding and new knowledge they derive.
If these relationships stay stable for long enough, innovation does emerge. Given enough time, trusted outsiders can learn about the context of a community and the richness of culture, history, family and place. And community leaders can learn about the system of Indigenous affairs and its many layers of conditionality and gatekeepers.
There is an untold story of reconciliation here, born from hard days of working through problems. We can look to this innovation and stop fixating on finding the elusive policy solution.
Too many programs, not enough impact
Remote Indigenous communities of fewer than 1000 people are supported by more than 80 programs and services. Each has public finance rules to ensure none of the money is misappropriated and that it performs against KPIs. Most are success stories with a support base in community and government.
Yet, with so many programs operating, how does the relative disadvantage of Indigenous people remain so acute?
We need only look to the sheer ratio of programs and services to so few people to see part of the problem. As these programs typically don’t take into account the effects of each other, their measurements are highly questionable.
Operating in unison, these programs combine into complex policy hybrids, the effects of which are unknown. If there is a parallel here it is pharmacology, when chronically ill patients take a cocktail of drugs for multiple health problems – a situation that also sadly besets many Indigenous people. While each drug may have been rigorously tested using randomised control trials, the effect when five or ten of these combine is largely unknown.
We need to look at other things than policy solution.
I have spent the past 12 months looking for a standard of evidence that might sort through this complexity, to find the best performers and team players. I have looked closely at randomised control trials, reverse cross-over (quasi-experimental) design, comparative case study analysis, process tracing, Bayesian analysis and fiscal ethnography. I have spoken to some of the leading experts in these methods.
The problem is that there are just too many programs for too few people. It is too causally dense, with too many conjunctions and too few who are not “treated” who might form a control.
If we can’t measure the effects of individual programs, we must remain sceptical about which programs are working. We need to look at other things than policy solutions.
Let local innovation lead
We know some things about the conditions under which this innovation occurs, through case studies such as those in my book, Serious Whitefella Stuff. There are few universal policy solutions, but there are processes, capabilities and support factors involved that do indeed travel. Here are four such factors to emerge from our research.
The first is just simply stability. When government stabilises the policy environment, those on the ground have the opportunity to adapt.
New policies tend to dismiss everything before them, sweeping away organisations, jobs, people and long-term relationships. In the Northern Territory, the aftermath of The Intervention and the creation of the super shires led to the departure of long-term employees and community organisations.
New policies should build on – not undermine – the achievements of their predecessors. For as long as progress remains elusive we can’t afford to ignore earlier gains.
The second factor is the capability of frontline workers. Much effort is targeted at building the capability of local Indigenous people and organisations, but what about the capability of visiting outsiders?
Half of the universities in Australia offer tertiary education to prepare students to work in international development, but there is no equivalent for remote Indigenous communities. Why is this so, when the contexts are only more complex and confronting? So you arrive in a community from scratch, work it out through the school of hard knocks. Few go the distance, and few Indigenous leaders have the endurance to cope with the revolving door of recruits.
Outcomes are determined on the rocks of implementation and on the actions of community leaders and outside workers. This is the real engine room of Indigenous affairs, not the boardrooms or broadsheets of capital cities.
The third factor is the effectiveness of Indigenous organisations, including local government. These are the local institutions that endure between successive policy rounds.
These organisations are the only structures of Indigenous self-governance in Australia to which powers, functions and resources can be devolved. By providing political counterpoints to government, they contribute to a better-balanced system. New interventions should build, not corrode, their capability.
Finally, frontline workers need to find new ways to collaborate with each other. In such a crowded institutional space, collective efforts between programs will enhance effectiveness, beyond the ingenuity of any one program.
Regardless of the policy solution and measurement system, outcomes are determined on the rocks of implementation and on the actions of community leaders and outside workers. This is the real engine room of Indigenous affairs, not the boardrooms or broadsheets of capital cities.
An innovation-driven system in Indigenous affairs is a future that already exists, if politicians would only shift their gaze.