About the NSW Aboriginal Health Governance, Shared Decision Making and Accountability Framework

​​​Purpose of the framework

The NSW Aboriginal Health Governance, Shared Decision Making and Accountability Framework aims to improve outcomes for Aboriginal people in NSW through:

• embedding and amplifying Aboriginal voices and leadership within NSW Health policies, procedures, and structures as a determinant of health and wellbeing for Aboriginal people,
• implementing the concepts of shared decision making and self-determination in the NSW Health system for Aboriginal health to ensure Aboriginal voices are included in a culturally safe way using Aboriginal methods of decision making,
• embedding and including Aboriginal people in the design, delivery, monitoring and evaluation of all NSW Health programs and policies to ensure they are culturally accessible, safe and address the needs of Aboriginal people,
• strengthening the accountability between NSW Health and NSW Aboriginal Communities through increasing the transparency of policy, procedure, structural and financial decisions made across the system for Aboriginal health,
• building upon and strengthening partnerships between NSW Health and Aboriginal Community Controlled Organisations (ACCOs) to enable integrated, coordinated and continued care for Aboriginal people.

This framework focuses on transforming NSW Health systems, structures and processes to enable shared decision making with Aboriginal people. This framework:

• is grounded in the principle that the NSW Health system needs to change to embed Aboriginal governance and accountability, rather than creating additional governance and bureaucracy for Aboriginal Communities,
• is not a NSW Government wide framework. Aboriginal Affairs NSW (AANSW) leads a range of priority reforms which establish whole of government approaches to partnership, governance and accountability, including the Opportunity, Choice, Healing, Responsibility and Empowerment (OCHRE) framework, Local Decision Making (LDM) program and the National Agreement on Closing the Gap (CTG) mechanisms²,
• is designed to transform all NSW Health systems, structures, and processes, including systems that work in partnership with other government and non- government stakeholders, for example partnership agreements, funding contracts and joint programs and procedures.

How to use this framework

The goal of this framework is to outline the ‘gold standard’ for Aboriginal governance, shared decision- making and accountability within NSW Health. This framework has four principles to guide and embed these concepts in NSW Health. Each principle in the framework includes:

• the aim of the principle and why it is important
• what success looks like for each principle for the NSW Health system
• what success looks like for each principle at each level of decision-making and governance in NSW Health
• case studies of what the principle looks like in practice for NSW Health.

The framework will be accompanied by a robust ‘NSW Aboriginal Health Governance and Accountability Maturity Matrix’ and a ‘NSW Health and ACCO Partnership Matrix’. These matrices are monitoring and accountability tools for the framework. These tools will enable all NSW Health services to assess their maturity in enacting the principles of the framework and outline a maturity journey for how they can enact success.

The framework will be supported through an implementation plan which will outline the actions needed to implement what success looks like for each principle in NSW Health. Once implemented, it will be a part of business-as-usual processes in NSW Health. The framework will be reviewed and updated as needed to ensure that it is a live tool that achieves its purpose.

Development of the framework

The framework has been developed as a partnership between NSW Health and the AH&MRC. Throughout the development of the framework, emphasis was placed on ensuring that the process embodied the key concepts of shared decision-making and self-determination.

The following methods were used to develop the framework:

• a literature review of both national and international material, publications, policies and frameworks to identify best practice governance and accountability, fundamentals, mechanisms, models and frameworks, with a focus on First Nations people in Australia, Canada, Aotearoa (New Zealand) and the United States
• a review of existing Aboriginal governance mechanisms in NSW Health, across the NSW Government and other State and Territory departments
  
• extensive consultation with Aboriginal stakeholders that prioritised cultural responsiveness, safety and adaptability to local environments. This included two phases of consultation throughout the development of the framework with:
  • Aboriginal Community Controlled Health Organisations (ACCHOs) in metropolitan, regional and rural areas of NSW
  • Aboriginal NSW Health staff across metropolitan, rural, and regional Local Health Districts (LHDs) and Specialty Health Networks (SHNs), including Directors of Aboriginal health and Aboriginal staff in a range of positions. This included Aboriginal Health Workers (AHWs), Aboriginal Health Practitioners (AHPs), Aboriginal Liaison Officers (ALOs), clinicians, program and administration officers, public health staff, chronic care coordinators and social workers
  • NSW Health Aboriginal staff within the Ministry of Health, NSW Health Pillars and Statewide Health Services
  • senior Aboriginal staff in other NSW Government organisations
  • senior Executive NSW Health staff, including Chief Executives from metropolitan, rural, and regional LHDs and SHNs.
• a review of previous consultations with Aboriginal stakeholders in NSW, including consultations with Aboriginal Communities, ACCOs and NSW Health Aboriginal staff
• advice provided by NSW Health strategic forums, including the NSW Aboriginal Health Transformation Committee, NSW LHD/SHN Aboriginal Health Directors Committee, NSW Health Senior Executive Forum and Ministry Executive Meeting.

The principles for the framework were developed in response to consultations with Aboriginal stakeholders across NSW, who reported that the framework needs to:

• be adaptable to local contexts
• amplify and embed Aboriginal voices into NSW Health systems without being prescriptive
• strengthen Aboriginal voices within the system without creating additional governance processes that overburden Aboriginal people.