Concerns about the harmful impacts of over-regulation of Aboriginal Community Controlled Health Organisations (ACCHOs) are longstanding, and include the diversion of organisational focus from community needs to the demands of government funders.
Researchers at the University of Queensland, who have been investigating the governance of ACCHOs, argue in a recent paper that the imposed regulatory overburden can lead to “the conditions for controlled communities rather than community control”.
In a paper published earlier this year in the Australian Journal of Political Science, Dr Morgan Brigg and Dr Jodie Curth-Bibb suggest approaching governance of ACCHOs as an intercultural and a political exercise, rather than taking a technical focus.
They cite the example of the Institute for Urban Indigenous Health (IUIH) in south-east Queensland, in recalibrating governance arrangements and promoting greater community engagement and participation, and suggest such a model may have wider application.
Their article below is timely, with the ABC recently profiling the IUIH as “arguably the most innovative and responsive ACCHO in the country” in developing a model of care based on prevention and empowering patients that has “profound lessons for mainstream health”.
Morgan Brigg and Jodie Curth-Bibb write:
As the achievements of Aboriginal and Torres Strait Islander peoples are celebrated in NAIDOC Week, Indigenous approaches to organisational governance demonstrate distinct advantages over reliance upon technical and bureaucratic approaches alone.
Aboriginal Community Controlled Health Organisations (ACCHOs) have had their share of successes and governance controversies since they emerged as an Indigenous-led response to shortcomings of mainstream health services in the 1970s.
While governance challenges have been a problem for the sector from time to time, ACCHOs are broadly recognised as crucial vehicles for improving Indigenous health outcomes in Australia.
Less recognised, as our research has shown, is the potential for dealing with organisational challenges and improving service delivery by drawing upon Indigenous approaches to governance.
ACCHOs have been labouring under a remarkable bureaucratic regulatory burden that emphasises technical approaches to accountability. Such regulatory burdens have a tendency to contribute to governance failures rather than prevent them, including because the high volume of reporting required by ACCHOs can be a risk in itself.
Rather than generating compliance, increasing technical rules, reporting and bureaucratic procedures can create the conditions for governance failure through government-domination or organisational capture at the hands of a small number of individuals or single families.
When governments overburden ACCHOs with reporting requirements and ACCHOs embrace heavy government direction, they risk becoming de facto government managers and quasi-mainstream services. This compromises the key advantages of ACCHOs and is at odds with the principles informing their origins in the 1970s.
Conversely upwards accountability to government through mechanisms that are inaccessible to Aboriginal communities can create distance between communities and their ACCHOs. This can allow a small group of individuals to wield power through formal mechanisms and board membership in a manner that takes power away from communities.
The Institute for Urban Indigenous Health (IUIH), operating in south-east Queensland, has observed both government domination and mis-management through organisational capture in the ACCHO sector. Their model consciously works to avoid both.
The IUIH is weaving together the strengths of corporate technical governance and accountability with Indigenous values and forms of community governance. The latter provides the real glue and foundation for the IUIH and the basis for meaningful accountability.
The thoroughly intercultural nature of ACCHOs governance has long been recognised. What’s new about the IUIH model is the deliberate entwinement of European-derived and Aboriginal forms of governance.
The IUIH aims to avoid governance failures borne of competing governance systems coming together in contradictory ways that lead to state dominance on one hand or allow space for opportunism on the other. In this way their model is recalibrating key governance relationships.
Differences in governance systems are linked to differences in approaches to knowledge and relationships. The technocratic governance approach required by the state attempts to compartmentalise problems and create governance ‘proxies’. Board meetings are taken as representative of community, for instance, and paper trails stand in for commitments to do the right thing by others.
In contrast, Indigenous approaches tend to be more relational, with issues seen as complex and interconnected, and effective governance requiring adherence to community values along with face-to-face accountability.
Chief executive Adrian Carson says: “We have problems when we compartmentalise ourselves and our systems like white fellas. We have to realise our strength is in our holistic understandings. This is what will make us healthy.”
This is reflected in the IUIH approach involving ‘one-stop shops for health for Indigenous people’. Rather than individual services for particular diseases or problems, these clinics are for whole people and whole communities.
Formal procedure and rules have their place, but being accountable to the community and being responsive to needs is primarily achieved through a close relationship with community members and direct engagement with them and their expectations. And success appears to be flowing in terms of the growth of IUIH clinics and positive clinical outcomes.
Balancing technical and Indigenous community governance in intercultural organisations is a tricky and subtle business. It is not a matter of pitting white against black, or corporate against community governance. It is about making them come together in a productive way.
Working through these relationships requires careful delineation and diagnosis. But IUIH are doing this to improve health outcomes while staying true to the values of Indigenous autonomy that led to the original and remarkable development of ACCHOs.
• Dr Morgan Brigg is Senior Lecturer in the School of Political Science and International Studies, and affiliate of the Poche Centre for Indigenous Health, The University of Queensland.
• Dr Jodie Curth-Bibb is an affiliate of the School of Political Science and International Studies, and Manager (Pacific) at UQ International Development, The University of Queensland.
Readers who would like more information about the article, Recalibrating intercultural governance in Australian Indigenous organisations: the case of Aboriginal community controlled health, are encouraged to contact the authors. The research received funding from the Institute for Urban Indigenous Health, the Queensland Aboriginal and Islander Health Council and The University of Queensland.