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As special protections urged for remote communities, Aboriginal health workers call for full scope of practice

Croakey is closed for summer holidays and will resume publishing in the week of 18 January 2021. In the meantime, we are re-publishing some of our top articles from 2020.

This article was first published on March 31, 2020


Introduction by Croakey: As unprecedented measures are stepped up across Australia to slow the spread of the novel coronavirus, a group of medical professionals on Monday published an open letter to Minister for Indigenous Australians, Ken Wyatt, calling for targeted measures to protect Aboriginal and Torres Strait Islander communities.

The letter, which has been signed by more than two dozen prominent doctors and other medical professionals including Dr Kris Rallah-Baker, Australia’s first and only Aboriginal ophthalmologist and head of the Australian Indigenous Doctors’ Association, urges Wyatt to “do whatever is necessary to empower” Indigenous people and communities to protect themselves from the COVID outbreak. The letter’s lead author is Melbourne GP Dr Margaret Beavis, who has an interest in public health and nuclear issues and is secretary of the Medical Association for the Prevention of War (Australia).

Though there is no one size fits all approach, the signatories call for a number of priority areas to be addressed, including:

  • cessation of all non-essential fly-in-fly-out (FIFO) workforce contact
  • urgent release of all minor offenders from custody and those not deemed a threat to others, particularly young people, women, the elderly and those with pre-existing health conditions (read our other coverage of this issue here and here)
  • government guarantee of essential supplies to remote communities amid reports of shortages including meat and other basic foodstuffs, toilet paper and hand sanitiser, cleaning supplies and ammunition for hunting
  • provision of clear, accurate and timely information, in local languages, that also recognises the intersection of culture with public health imperatives (more on this important issue here)
  • specialist training, appropriate PPE and testing capability for health workers in Aboriginal and Torres Strait Islander and remote communities, as well as guarantee of other essential health services (dialysis, mental health and telehealth, for example) and medicines during this emergency.

A number of these issues are touched on in the Government’s Australian Health Sector Emergency Response Plan for Novel Coronavirus (COVID-19): Management Plan For Aboriginal and Torres Strait Islander Populations, which was published on Monday.

With Prime Minister Scott Morrison already announcing strict limitations on travel to and from remote Indigenous communities and areas including the Tiwi Islands banning entry for all non-residents, adequately skilling and resourcing local health staff is of paramount concern.

In this piece for Croakey, CEO of the National Aboriginal and Torres Strait Islander Health Worker Association (NATSIHWA) Karl Briscoe, writes that allowing Aboriginal Health Workers and Practitioners to work to a standardised minimum scope of practice will be vital to protecting their communities from the COVID outbreak.


Karl Briscoe writes:

As we know, Aboriginal and Torres Strait Islander people experience a burden of disease which is 2.3 times that of non-Indigenous Australians. This is especially the case with our Elders who rely on medicines in order to keep them on country and out of the acute setting.

In the midst of COVID-19 we have seen our health workforces being stretched to capacity, moreso in rural and remote Aboriginal and Torres Strait Islander communities. This will only become more evident as visiting health professionals will now need to self-isolate for 14 days before accessing rural and remote communities.

To address these unprecedented stresses, we are calling for the urgent standardisation of drugs and poisons legislation across Australia to allow Aboriginal Health Practitioners to have the same basic rights to supply and administer medications in their communities.

For more than 10 years the National Aboriginal and Torres Strait Islander Health Worker Association, NATSIHWA, has supported its vocationally-trained membership, which comprises:

  • Aboriginal and/or Torres Strait Islander Health Workers (Certificate II, III, IV, Diploma and Advanced Diploma in Aboriginal and Torres Strait Islander Primary Health Care)
  • Aboriginal and Torres Strait Islander Health Practitioners (Certificate IV and Diploma in Aboriginal and Torres Strait Islander Primary Health Care Practice)

Though AHPs are registered by the Australian Health Practitioner Regulation Agency (AHPRA) Aboriginal and Torres Strait Islander Health Practice Board, their ability to supply and administer medicines under a doctor’s order varies widely across states and territories (see below).

Vocational training pathway for Australia’s AHWs and AHPs
The status of AHW/AHPs to administer and supply medicines varies by state and territory

Urgent need for a minimum scope of practice

While AHWs are not trained to supply and administer medicines, these issues highlight a broader need to establish a minimum scope of practice that is harmonised across jurisdictions.

As it stands, some states and territories will not allow AHWs to undertake basic observations such as blood pressure, temperature, pulse and respiratory rate, despite them being trained in these skills for screening.

Over the past few weeks we have witnessed COVID-19 screening clinics being set up with the involvement of Aboriginal and Torres Strait Islander Health Workers. NATSIHWA’s concern is that such restrictions on the most basic clinical activities for our workforce could have disastrous consequences.

Our workforce is uniquely positioned to contribute, with our cultural intellect and primary health care knowledge and skills, but workforce development barriers need to be addressed to better enable us to do so.

More often than not, Aboriginal and Torres Strait Islander Health Workers and Health Practitioners have lived experience in and a deep understanding of the communities we serve, meaning we have cultural, social and linguistic knowledge and skills that set the workforce apart from other health professional groups.

These skills underpin our community reach and engagement capability and, coupled with our comprehensive foundations in primary health care, give us our unique ability and perspectives as health care professionals, cultural brokers and health system navigators.

Karl Briscoe is a Kuku Yalanji man from the Mossman-Daintree area of Far North Queensland and a trained Aboriginal and Torres Strait Islander Health Worker.

As a practitioner, and CEO of NATSIHWA, Karl has a deep appreciation of health service failures and worsening health indicators experienced by Aboriginal and Torres Strait Islander people across Australia