Aboriginal health monitoring, evaluation and research activities reflect Aboriginal identified priorities, align with good practice in Indigenous Data Governance and Sovereignty, and inform policy and program funding decisions through effective knowledge translation.
A robust evidence base of data through regular monitoring, evaluation and research is critical in enabling policymakers to drive quality policies and programs.
Monitoring, evaluation and research support continuous quality improvement, transparency, and accountability of health systems to Aboriginal people and communities.
Yet health inequities extend into evaluation and research, as non-Aboriginal people and organisations have controlled the agendas, methodologies and uses of evaluation and research132.
Consequently, Aboriginal peoples nationwide have been subjected to an enormous volume of scientific and medical research that has not matched their priorities and has rarely been conducted in a culturally safe way or benefited Aboriginal people. In contrast, research findings have for decades been used to validate and perpetuate systemic and interpersonal racism133 and the deficit-focused presumption that Aboriginal people are a problem that requires fixing134. This led to significant distrust of researchers and research institutions by Aboriginal peoples and communities135.
In recent decades, Aboriginal communities have advocated powerfully and persistently to both universities and government research institutions on the basis that research about Aboriginal health and wellbeing must be governed by Aboriginal people and practices, including where ethical review is concerned136. This has resulted in significant improvements to research ethics processes in many jurisdictions, including in
NSW, where the AH&MRC Human Research Ethics Committee (HREC) has since 1996 played a critical role in ensuring health research with Aboriginal people is conducted in line with community expectations.
The AH&MRC HREC is a vital mechanism for ensuring Aboriginal and Torres Strait Islander research ethical standards are met, but by itself cannot carry responsibility to shift an entire State’s health research sector to a strengths-based narrative and achieve culturally safe Aboriginal health monitoring, evaluation and research. Ongoing and expanded efforts are needed, where Aboriginal knowledges are centred and Aboriginal leadership is elevated to ensure the priorities of Aboriginal communities are met137, 138. Aboriginal leadership and decision-making are required at all stages of the process, from planning and data collection, through to interpretation, dissemination and knowledge translation. This establishes a clear line of accountability to Aboriginal communities so that project outputs are credible, useful and relevant to Aboriginal people.
In recent decades, more Aboriginal people have become experts and leaders in their fields of research, undertaking culturally safe monitoring, evaluation and research that reflects the priorities and needs of Aboriginal communities. NSW health system organisations can accelerate and scale up this intellectual leadership by supporting Aboriginal organisations, communities and researchers to advance their evaluation and research priorities and translate their research outputs into practice139.
This work can be complemented by strengthening the capability of non-Aboriginal evaluators and researchers to engage in ethical and culturally safe practices that benefit Aboriginal communities, by working in partnership with Aboriginal organisations and communities140.
Given NSW Health organisations are already subject to a comprehensive system of monitoring and accountability under the Ministry of Health’s oversight –which includes the NSW Health Performance Framework141 and various governance and accountability mechanisms142, 143, 144 –there are efficiencies to be gained from integrating Aboriginal knowledges and governance practices into this system, rather than duplicating those arrangements separately.
“If you want to consult with Aboriginal people about research, they need to own and inform research from the very beginning. You also need to credit the use of Aboriginal knowledge & respect their participation.” Aboriginal NSW Health staff (regional) consultation participant
“If you want to consult with Aboriginal people about research, they need to own and inform research from the very beginning. You also need to credit the use of Aboriginal knowledge & respect their participation.”
Aboriginal health monitoring, evaluation and research is led, governed and undertaken by Aboriginal people, with the involvement of non-Aboriginal people as determined by Aboriginal people, and is experienced as culturally safe.
The lack of progress against several Closing the Gap targets, despite an abundance of Aboriginal-led research and evaluation highlighting solutions, signals a substantial gap between research evidence, policymaking, and practice145. Aboriginal health and wellbeing improvements are not limited by lack of evidence or knowledge, but by failure to apply this knowledge to practice –in other words by not undertaking, or ineffective, knowledge translation146.
Knowledge translation refers to a complex and reciprocal series of interactions between knowledge holders, knowledge producers, and knowledge users, with the goal of achieving research impact –positive and sustainable long-term benefit for Aboriginal people, beyond the realm of academia147. Effective knowledge translation centres Aboriginal communities and their wisdoms, minimises power dynamics, and responds to community needs to maximise research impact.
“Let’s listen to ideas and innovative ways of learning and engaging, not just from people in senior positions but more broadly and widely.” Aboriginal NSW Health staff consultation participant
“Let’s listen to ideas and innovative ways of learning and engaging, not just from people in senior positions but more broadly and widely.”
Knowledge translation of Aboriginal health monitoring, evaluation and research outcomes occurs regularly, reflects priorities determined by Aboriginal people and contributes to improved health policy and services that involve or impact Aboriginal people.