Recalibrating intercultural governance in Australian Indigenous organisations: the case of Aboriginal community controlled health

ABSTRACT

Aboriginal Community Controlled Health Services (ACCHSs) have a strong track record of delivering comprehensive primary health care in Australia, but the sector also suffers from governance challenges. This article argues that a combination of settler-state dominance of governance arrangements and inadequate conceptualisation of governance in the sector have led to the risk of ‘controlled communities’ – either quasi-government control of organisations or the control of individual ACCHSs by a small cohort of members. In response, we deploy a political rather than technical approach to governance to consider the contested and intercultural nature of ACCHSs governance alongside recent governance initiatives in Southeast Queensland that signal the value of disaggregating and delineating different forms of governance in the sector. Key conceptual steps and a matrix for recalibrating intercultural governance are presented to support further research, to clarify lines of jurisdiction, and inform governance reform in and around ACCHSs.

原住民社区控制医疗服务中心（ACCHS）对于澳大利亚初级卫生保健做了认真的记录，但这个部门也有治理方面的问题。本文认为，定居者国家的治理安排与不适当的治理观念的结合导致了“控制社区”的风险——要么是准政府的组织在控制，要么是单个ACCHS被一小拨成员控制。作者对治理进行了政治而非技术的研究，考察了ACCHS治理的竞争性和跨文化性，同时也研究了近年来东南昆士兰的一些治理动议，这些动议分解、勾勒了该领域不同的治理形态。为抛砖引玉，作者提出了矫正文化间的治理观的步骤及模版，澄清管辖的线路，并讨论了ACCHS内部及周边的改革。

KEYWORDS:

• Governance
• community
• intercultural
• Indigenous health
• settler-colonialism

Acknowledgements

We thank anonymous reviewers and those working in Indigenous Health in Southeast Queensland who were generous with their time and insights during the development of this paper. We particularly thank Cindy Shannon for comments on earlier drafts of this paper. We take full responsibility for the final text. Research for this article partially draws on the related research project ‘Toward Integrated Governance for improved Indigenous Outcomes’.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes on contributors

Morgan Brigg is Senior Lecturer in the School of Political Science and International Studies, and affiliate with the Poche Centre for Indigenous Health, The University of Queensland.

Jodie Curth-Bibb is Lecturer in the School of Political Science and International Studies at The University of Queensland and Program Manager at UQ International Development.

Notes

1. Medicare is the publicly funded healthcare system in Australia and it normally subsidises only privately provided GP services.

2. Access to this exemption was not universal and has been a gradual change. By 2005, 112 organisations were eligible but many are not able to take full advantage of this for reasons to do with technicalities and lack of capacity (Urbis Keys Young 2006).

3. The IUIH Governance Group held its Inaugural Meeting on the 1 August 2012.

4. While it is too soon to fully evaluate the effects of this model, draft findings by health economists, made available to the authors by IUIH, estimate that the IUIH’s services have significantly reduced health risks. The study estimated the combined impact on health-adjusted life expectancy (HALE) ‘of the estimated reduction in prevalent cases and death in southeast Queensland due to IUIH activities’. Between 2012 and 2017, HALE was estimated to be 66.9 years without IUIH interventions and 67.4 years with IUIH.

Additional information

Funding

This work received funding from the Institute for Urban Indigenous Health, the Queensland Aboriginal and Islander Health Council and The University of Queensland.