NSW Health is engaged in and accountable to Aboriginal co-led and co-created formal partnership arrangements that are sustained, adequately resourced, trusted, impactful and committed to Aboriginal defined priority outcomes and strategies.
This priority reform area envisions a collaborative way of delivering health services, co-created with Aboriginal people to embed Aboriginal ways of knowing, being and doing into policy, service design and delivery throughout the life of the plan and beyond. The Aboriginal Community Controlled Health (ACCH) sector has a long history of exemplifying this approach. Through its ongoing partnerships with the ACCH sector, NSW Health can learn from and better incorporate these practices while continuing to support and invest further in work across the ACCH sector.
Aboriginal peoples have been practicing healthcare for millennia and have been tackling the devastating health effects of colonisation for well over half a century through leadership in policy, academia and the establishment of the ACCH sector.
Yet most decisions affecting Aboriginal health and wellbeing are still made and implemented by non-Aboriginal people. The lack of Aboriginal voices at decision-making tables hinders progress towards self-determination in health12.
To support self-determination and ensure the specific needs of Aboriginal people are accurately identified and addressed in health policy and service delivery, it is critical that policies and programs are developed and delivered in partnership with Aboriginal people, organisations and communities.
The National Aboriginal and Torres Strait Islander Health Plan 2021–2031 acknowledges this in priority 1, stating “Governments now recognise that meaningful change is not possible without the leadership of Aboriginal and Torres Strait Islander people”13. It is also consistent with previous learnings within NSW Health14, the NSW Health Aboriginal Health Impact Statement15, Standards 3 and 6 of the NSW Health Corporate Governance and Accountability Compendium16, and action 2.13 of the National Safety and Quality Health Service (NSQHS) Standards17, against which all NSW public health services are accredited. NSW Health and the AH&MRC are committed to a meaningful partnership, as evidenced by the NSW Aboriginal Heath Partnership Agreement 2015-2025.
“A co-design, co-owned, co-managed, co-accountability way forward is appropriate for health reform initiatives around Indigenous health”. ACCHO staff (regional) draft plan feedback
“A co-design, co-owned, co-managed, co-accountability way forward is appropriate for health reform initiatives around Indigenous health”.
Co-creation differs from co-design, as it allows all parties involved to collaboratively identify problems or priority areas. Co-creation therefore extends on co-design, where issues are already pre-defined, and on co-production, where both problems and solutions are pre-defined18. To truly enable and embed shared decision-making–which is essential to effective partnerships–Aboriginal people must be in positions to define what the priority health issues are, based on their unique experiences.
Co-creation processes are often resource-intensive, and many Aboriginal people and communities already experience consultation fatigue19. It is important these processes do not create excessive or unevenly distributed burdens upon Aboriginal organisations, or Aboriginal staff within the NSW health system.
Co-creation processes should be respected and adequately resourced as an essential element of Aboriginal people’s and organisations’ ongoing work, rather than ‘tacked’ on top of existing workloads.
Non-Aboriginal people and organisations within the health system in NSW also have a responsibility to participate effectively in co-creation processes, ensuring they make the most efficient use of the time and resources invested.
Involvement of Aboriginal people and organisations in co-creation of the commissioning, design, delivery, monitoring and evaluation of health initiatives that impact on Aboriginal people is standard practice across the health system.
For partnerships to be genuine, they must be structured around shared decision-making20, and apply to implementation, monitoring and evaluation21, 22.
This can be embedded by formalising partnerships through partnership agreements, which will support greater accountability, transparency and trust in government organisations. Formal agreements also help to distinguish partnership from ‘consultation’ or ‘participation’, which do not present any decision-making authority or control over outcomes, so is not a substitute for partnership.
A key component of partnerships and shared decision-making is Aboriginal leadership, which must be embedded across the health system. This priority focuses on embedding Aboriginal leadership at the state level, with Community Controlled sector and professional workforce peak bodies having a genuine leadership role in program and policy design, development and implementation. This includes the existing NSW Aboriginal Health Partnership Agreement with the AH&MRC, along with partnerships with CAPO, Aboriginal Affairs NSW and other government agencies.
“Our most crucial partnership is the partnership we build with communities, and that’s through community forums and meaningful engagement at a strategic level as well”. NSW Health staff (metropolitan) consultation participant
“Our most crucial partnership is the partnership we build with communities, and that’s through community forums and meaningful engagement at a strategic level as well”.
Aboriginal people and organisations involved in State-level partnership arrangements report that partnerships operate in a culturally safe and accountable manner and are effective mechanisms for shared decision-making on Aboriginal health priorities, programs and resource allocations.
This priority focuses on embedding Aboriginal leadership at the district level through local Aboriginal governance structures and/or local ACCHOs.
Aboriginal people and organisations involved in district-level partnership arrangements report that partnerships operate in a culturally safe and accountable manner and are effective mechanisms for shared decision-making on Aboriginal health priorities, programs and resource allocations.
This priority focuses on embedding Aboriginal leadership at the community level, such as through local ACCHOs, in local health service delivery organisations (for example, hospitals, Urgent Care Services, Community Health Centres, and specialist health facilities).
Aboriginal people and organisations involved in service-level partnership arrangements report that partnerships operate in a culturally safe and accountable manner and are effective mechanisms for shared decision-making on Aboriginal health priorities, programs and resource allocations.
“We’ve got a great local Aboriginal health partnership with the local AMS. Lots of great ideas coming out of that about collaboratively delivering services to the partnership region” NSW Health staff (metropolitan) consultation participant
“We’ve got a great local Aboriginal health partnership with the local AMS. Lots of great ideas coming out of that about collaboratively delivering services to the partnership region”
Supporting the wellbeing of Aboriginal communities most effectively will require breaking down the silos that exist within health systems and between policy areas23, 24, 25. This means partnerships between government health organisations and Aboriginal people and organisations need to foster broad cross-sector collaboration that responds to communities’ holistic wellbeing needs26.
At the local level particularly, place-based partnerships can drive solutions that cut across organisational, sector and government silos to address the social, cultural, economic, political and planetary determinants of health, based on community priorities and objectives.
NSW Health is recognised by Aboriginal people and organisations as taking a valuable lead role in facilitating cross-sector collaboration in the interest of better health and wellbeing outcomes.