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Aboriginal health is everybody’s business

The Croakey Conference Reporting Service’s last post from the Health Workforce Australia Conference details how the development of a culturally inclusive, interdisciplinary Aboriginal and Torres Strait Islander health curriculum framework is contributing to closing the health and life expectancy gap between Aboriginal and Torres Strait Islanders and non-Indigenous Australians. 

A Health Workforce Australia (HWA) project is making positive progress towards ensuring Aboriginal and Torres Strait Islander Australians can be confident of receiving culturally safe services, regardless of where they choose to access health care.

This project was showcased at the ‘Aboriginal health is everybody’s business’ workshop at the HWA 2013 conference and was co-presented by Pat Maher, HWA Program Manager, Marion Kickett, Associate Professor, Curtin University, Sue Jones, Associate Professor, Curtin University and Zell Dodd, HWA Project Manager.

The presenters described how a combination of workforce distribution issues and a lack of cultural competency skills across the health professions create a barrier to the provision of appropriate care to Aboriginal and Torres Strait Islanders.

“There is good evidence that Aboriginal and Torres Strait Islander Australians often avoid treatment if they are not comfortable with, or do not understand, the care that is being provided.  Studies also suggest that Aboriginal and Torres Strait Islander patients are more likely to access services where providers have an understanding of Aboriginal and Torres Strait Islander culture,” said Pat Maher.

“Even when they access services, Aboriginal and Torres Strait Islander people often do not receive best practice care.  For example, Aboriginal and Torres Strait Islander  patients self-discharge from hospital at a rate six times higher than non-Indigenous patients.  One reason for this is that health care providers often do not have the knowledge and experience of Aboriginal and Torres Strait Islander culture required to provide a culturally safe environment,” he said.

Ensuring all health care providers are equipped with the knowledge and skills – both clinical and cultural – to provide effective, accessible and culturally appropriate services to Aboriginal and Torres Strait Islanders is essential in order to reduce the current health gap that exists between our Aboriginal and Torres Strait Islander population and non-Indigenous Australians.

This requires consistency across professions in the education and training students receive in Aboriginal and Torres Strait Islander health and cultural issues.  To support this aim, HWA is developing a culturally inclusive, interdisciplinary Aboriginal and Torres Strait Islander health curriculum framework to be integrated into entry-level health profession training.

The project is being run by HWA which has established a Project Advisory Committee with a majority of Aboriginal and Torres Strait Islander people, most of whom represent peak organisations. The Committee has agreed to appoint an Aboriginal and Torres Strait Islander co-chair to lead the group, and this role will be filled at the next face-to-face meeting in March 2014.

A central aim of this project is to increase health professionals’ knowledge of the resources they can draw on to provide high quality and culturally appropriate care to Aboriginal and Torres Strait Islander Australians. This includes giving them an understanding of the role of the Aboriginal and Torres Strait Islander Health Workers and Practitioners (AHW/Ps) and how they significantly contribute to the provision of care in multi-disciplinary health teams.

In conjunction with health workforce reform, HWA hopes that the curriculum framework will result in better utilisation of AHW/Ps and, over the long term, support an increase in the numbers of Aboriginal and Torres Strait Islanders training and working as health care providers.

The first stage of the project is nearly completed and involves a literature review and environmental scan  of current entry level health profession curricula with respect to Aboriginal and Torres Strait Islander health content and competencies related to working with Aboriginal and Torres Strait Islander people.

This found that 14 health professions had some mention of Aboriginal and Torres Strait Islander health issues within their standards or competencies, such as the need to adapt provision of health care to ensure it is culturally respectful.  Most of remaining professions had a generic statement indicating need to provide culturally competent care.  The majority of professions did not specify concrete requirements for Aboriginal and Torres Strait Islander students, staff, clinical practice, or engagement with Aboriginal and Torres Strait Islander communities, the exceptions being medicine, nursing, occupational therapy, pharmacy and social work.

The information obtained via the scan, literature review and key informant interviews is now being used to develop a draft curriculum framework which will be put out to public consultation and discussed at national consultation workshops early in 2014. Once finalised, implementation guidelines will be developed to support the implementation of the curriculum framework in higher educational institutions.  This will include accreditation guidelines and an assessment tool to assist health profession accreditation authorities to assess implementation of the curriculum framework.

Leadership by universities will play an important role in the implementation of the curricula.  Currently only nine universities out of a total of 39 have graduate attributes specifically related to Aboriginal and Torres Strait Islander peoples.  In addition only 25% of universities have a reconciliation plan and only 50% have a reconciliation statement.

The presenters said that they hope to change these figures through highlighting positive examples of universities and other educational institutions which have increased the focus on Aboriginal and Torres Strait Islander culture within their curricula.

Resources to support this process were highlighted in the workshop, for example, Universities Australia has produced a National Best Practice Framework for Indigenous Cultural Competence in Australian Universities which states that universities should ensure that both students and staff have “knowledge and understanding of Indigenous Australian cultures, histories and contemporary realities and awareness of Indigenous protocols, combined with the proficiency to engage and work effectively in contexts congruent to the expectations of Indigenous Australian Peoples.” 

The Aboriginal and Torres Strait Islander health curriculum framework is an important strategy to support the achievement of this aim across the health disciplines.  When finalised, by the end of 2014, it is expected to  be applicable across 25 health professions and in 39 universities.  This will deliver a nationally consistent approach to increasing Aboriginal and Torres Strait Islander cultural capability across the health sector and play an important role in closing the health gap between the Aboriginal and Torres Strait Islander and non-Indigenous Australians.

This article is part of Croakey’s coverage of HWA 2013 – the rest of the articles can be found here.  Thanks to HWA staff for assistance in writing this article.

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