Introduction by Croakey: A recent Ministerial reshuffle in Queensland, which saw former Attorney-General and Minister for Justice Shannon Fentiman appointed as Minister for Health and Ambulance Services, Mental Health and Women, offers an opportunity for the Aboriginal and Torres Strait Islander Community Controlled Health Organisation (ATSICCHO) sector, according to health leader Matthew Cooke.
In the article below, Cooke urges the Queensland Government to step up its support for a sector “struggling with overburdened staff, a health workforce in shambles, and grossly insufficient funding from governments, both state and federal”.
He also highlights the burden on the sector of ‘living with COVID’, with many ATSICCHO services spending upwards of $500,000 yearly per locum GP they need to fly into their community.
Matthew Cooke writes:
My time as Chair of QAIHC, the Queensland Aboriginal and Islander Health Council, the state’s peak body representing the Aboriginal and Torres Strait Islander Community Controlled Health Organisation (ATSICCHO) sector, has coincided with momentous upheaval in our health systems.
Our sector’s preparation in the lead-up to Queensland’s border reopening on 17 December 2021 showed just how closely government and community partners can work together. Queensland Health under [former] Minister D’Ath helped with millions in funding for targeted COVID readiness, provided funding for extra workforce, and for the first time seemed to appreciate that the health system is not only hospitals.
Today, however, Queensland’s ATSICCHO sector is struggling with overburdened staff, a health workforce in shambles, and grossly insufficient funding from governments, both state and federal.
The one-off extra funding the sector received for COVID-19 preparation has dried up but we are absorbing the costs of ‘living with COVID’.
Many of our services are spending upwards of $500,000 yearly per locum GP they need to fly into their community. As a peak organisation representing primary health organisations in some of Queensland’s most disadvantaged communities, this isn’t good enough.
The ATSICCHO sector came about in Queensland because many of our mob were shut out of the mainstream health system. Whether this was due to overt exclusion, systemic racism or a fault of distance and transport, many of our mob were being hospitalised and dying (and still are) for diseases that were easily treated.
It is also clear that being treated on Country is incredibly important to a lot of our people. It was clear that matters had to be taken into our own hands to create welcoming spaces for Aboriginal and Torres Strait Islander people. And for the most part, we have been successful.
This is why we look on Minister Fentiman’s appointment as Minister for Health, Mental Health and Ambulance Services as an important time to reset QAIHC’s relationship with government, and form closer partnerships to help close the gap.
Local solutions and partnerships in support of First Nations health were mentioned as a particular goal of the Albanese Government in their Budget papers. It is heartening that a federal government is finally acknowledging that place-based community partnerships are the best model of supplying services to mob.
QAIHC has enjoyed a good working relationship with Minister Fentiman in her past portfolios including Department of Child Safety, Youth and Women and as Ministerial Champion of the Torres Strait. We look forward to continuing and building on that relationship in Health.
I had the chance to meet with the new Minister in her first week on the job, and I believe the Sector will be able to work hand-in-glove with the Minister. In saying that, it must be emphasised that Minister Fentiman’s top priority should be achieving health equity for Aboriginal and Torres Strait Islander Queenslanders.
Health equity is a concept centred on removing the barriers that our people face when seeking healthcare. As mentioned above, some are due to living remotely, some barriers come from past experiences of racism, while others are due to our people feeling unwelcome in mainstream health settings.
We want Aboriginal and Torres Strait Islander people to be able to access all methods of healthcare in a culturally safe manner.
This is why we worked very closely with Minister D’Ath’s office on the reform to the Hospital and Health Boards (Health Equity Strategies) Amendment Regulation 2021 made under the Hospital and Health Boards Act 2011. Every Hospital and Health Service (HHS) in Queensland now has at least one Indigenous person on their board, and every HHS has designed a Health Equity Strategy to ensure mob are looked after in a culturally safe way.
But health equity doesn’t just encompass HHSs, it must also be about breaking down the barriers to mob receiving care from the state’s ATSICCHOs too. That means money to hire and train staff, many of whom are locals, help with governance and finance, and assist with continuously needed upgrades to equipment and facilities.
Self-determination is important for Aboriginal and Torres Strait Islander peoples, and this is the backbone of the ATSICCHOs. It is why the majority of Queensland’s Aboriginal and Torres Strait Islander population choose to use ATSICCHOs for holistic and culturally safe health care.
The fact is, the gap isn’t closed. Many measures have regressed. Premier Palaszczuk stood there with the heads of every Australian government and signed a document signalling their commitment to Close the Gap by 2032. That’s just nine years from now.
We need new, aggressive and targeted investment into the right parts of the health system, including ATSICCHOs, if the Government is to make good on its commitment and fully realise health equity for our peoples.
The sector are proven partners; we are an integral part of the health system architecture in Australia. We are also perfectly placed to provide and implement locally tailored solutions to social issues experienced at the local level.
The Aboriginal and Torres Strait Islander concept of health is much more than doctors and nurses, hospitals and medicine. Health means the physical, the emotional, the social, the spiritual, the family and the community. What organisation is better suited to handle all these different facets of health than the state’s growing cadre of ATSICCHOs?
And when ATSICCHOs are included from the very beginning as partners in these solutions, we see the impacts in our communities and families.
But we have to be supported if we are going to change the trajectory of diseases like rheumatic heart disease, trachoma, alcohol and other drug dependence, despair and intergenerational trauma. Investments need to reflect an increasing Aboriginal and Torres Strait Islander population and the significant burden of disease that many Aboriginal and Torres Strait Islander communities experience.
We also need to ensure the rollout of new investments are informed by open partnerships with the sector, state and territories and the Federal Government. The Federal Government has gotten the picture, the Queensland Government is getting the picture.
Now we just need funding commitment to ensure our place-based health solutions can support mob now and many years into the future.
This map, from the QAIHC annual report, shows the vast areas covered by member services.
See Croakey’s archive of articles on Indigenous health matters