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Australian Indigenous HealthBulletin
 

Workforce development

Table of Contents

    Introduction

    Aboriginal and Torres Strait Islander Health Workers have been recognised for many years as a vital component of the Indigenous health workforce, but there is no uniformity across Australia in their roles, training, conditions of employment, and the ways they interact with other members of the health workforce [1]. The roles of Indigenous Health Workers vary across Australia, but include: clinical functions (often as the first point of contact with the health workforce, particularly in remote parts of the country); liaison and cultural brokerage; health promotion; environmental health; community care; administration, management and control; and policy development and program planning [1] [2] [3] [4].

    The emergence of Aboriginal and Torres Strait Islander Health Workers as a professional group began with the employment of Aboriginal people, mainly women, in leprosy hospitals in the Northern Territory in the 1950s and then as medical assistants in these locations [2]. Thus, it is likely that the development of Aboriginal and Torres Strait Islander health workers preceded the international trend to implement primary health care models in Indigenous communities in rural areas.

    Since that time, the Indigenous Health Worker workforce has grown substantially, and is now fully acknowledged as a crucial component of strategies aimed at improving Indigenous health. Development of the Indigenous Health Worker workforce is a part of The Aboriginal and Torres Strait Islander Workforce National Strategic Framework, endorsed in 2002 by the Australian Health Minister's Advisory Committee (AHMAC). Efforts to improve the clarity of roles, regulation and recognition of Aboriginal and Torres Strait Islander Health Workers are key strategies of that framework, which is expected to be fully implemented by 2007.

    The following sections summarise information about the employment and education of Aboriginal and Torres Strait Islander Health Workers, and progress towards implementation of the Workforce Strategic Framework.

    Employment of Aboriginal and Torres Strait Islander Health Workers

    According to information collected as part of the 2006 Australian Census, there were 4,891 Indigenous people aged 15-64 years working in the health industry in 2006 (Table 1) [5] . New South Wales had the highest number workers (1,743), followed by Queensland (1,343) and Western Australia (486). (In this context, 'health worker' refers to all health-related occupations. The term ‘Aboriginal and/or Torres Strait Islander Health Worker' or 'Indigenous Health Worker' refers to people working in that specific occupation.) There were only 390 Aboriginal and Torres Strait Islander Health Workers in the Northern Territory in 2006, but they made up a much larger proportion of the total health workforce (8.8%) than they did in other jurisdictions.

    Three-quarters of the Indigenous health workforce were females in 2006 (Table 2), virtually the same proportion as for the total Australian workforce [5]. Almost three-fifths of the Indigenous health workforce was aged between 35 and 54 years, again a very similar proportion to the total Australian workforce.

    Almost 40% of the total Indigenous workforce in 2006 worked in nursing, including more than 1,160 registered nurses and midwives (24%) (Table 3) [5]. There were 965 Aboriginal and Torres Strait Islander Health Workers (20% of the Indigenous workforce), 473 health promotion officers (8.9%), 100 medical practitioners (2.0%) and 16 dentists (0.3%) [5]

    Aboriginal and Torres Strait Islander Health Workers
    Table 1: Numbers and proportions (%) of , by jurisdiction, Australia, 2006
     JurisdictionNSWVicQldWASATasACTNTAustralia
    Source: Steering Committee for the Review of Government Service Provision (2008) Report on Government Services 2008, Indigenous Compendium, Productivity Commission, Canberra.
    Notes
    1. The 2006 Australian Census of Population and Housing was the primary source for these figures
    2. Proportions of populations relate to people aged 15 years and older
    3. Figures for Australia include 'other territories'
    Indigenous health workforceNumbers 1,743 381 1,343 486 302 196 47 390 4,891
    Proportions of total health workforce 1.1 0.3 1.4 1.0 0.7 1.7 0.6 8.8 1.0
    Proportions of Indigenous population 15 years and older 2.0 2.0 1.7 1.3 1.9 1.8 1.9 1.1 1.7
    Indigenous people as proportion of total population 1.6 0.5 2.5 2.4 1.3 2.8 0.9 24.1 1.8

    Aboriginal and Torres Strait Islander Health Workers
    Table 2: Numbers and proportions (%) of , by age group and sex, Australia, 2006
     Age group15-2425-3435-4445-5455-64All ages
    Source: Steering Committee for the Review of Government Service Provision (2008) Report on Government Services 2008, Indigenous Compendium, Productivity Commission, Canberra
    Notes
    1. The 2006 Australian Census of Population and Housing was the primary source for these figures
    2. Figures for 'all ages' include people aged 65 years or older
    NumbersMales 108 301 388 314 104 1,223
    Females 406 803 1,100 984 347 3,666
    Persons 518 1,098 1,486 1,290 453 4,891
    Proportion of total health workforceMales 0.3 0.3 0.3 0.2 0.2 0.2
    Females 1.1 0.8 0.9 0.7 0.5 0.7
    Persons 1.4 1.1 1.2 0.9 0.7 1.0

    Aboriginal and Torres Strait Islander Health Workers
    Table 3: Numbers and proportions (%) of , by selected health-related occupation, Australia , 2006
     NumbersProportion
    Source: Steering Committee for the Review of Government Service Provision (2008) Report on Government Services 2008, Indigenous Compendium, Productivity Commission, Canberra.
    Notes
    1. The 2006 Australian Census of Population and Housing was the primary source for these figures
    2. People aged 15 years or older
    3. Proportions are the percentages of Indigenous people of all workers in each health-related occupation
    4. See source for details of each heath-related occupation
    Health and welfare services managers 141 1.3
    Medical practitioners  
    General medical practitioner 60 0.2
    Other medical practitioners 40 0.2
    Nursing and midwifery professionals  
    Registered nurses 1107 0.6
    Midwives 53 0.4
    Nurse educators and researchers 17 0.5
    Nurse manager 46 0.4
    Other health professionals  
    Aboriginal and Torres Strait Islander Health Worker 965 95.5
    Environmental health officer 98 2.5
    Health promotion officer 437 11.2
    Psychologists 39 0.3
    Physiotherapist 54 0.4
    Medical imaging professionals 18 0.2
    Occupational health and safety advisor 50 0.7
    Dental practitioners 16 0.2
    Dental hygienists, technicians and therapists 22 0.4
    Dental assistant 171 1.1
    Other 103 0.2
    Other health-related occupations  
    Ambulance officers and paramedics 153 1.7
    Diversional therapist 41 1.0
    Enrolled and mothercraft nurses 215 1.1
    Massage therapist 54 0.7
    Hospital orderly 165 1.7
    Nursing support worker 442 2.0
    Personal care assistant 339 1.5
    Other nursing support and personal care workers 39 1.0
    Other 6 -
    All health-related occupations4,8911.0

    Training of Aboriginal and Torres Strait Islander Health Workers

    Nationally there is a range of accredited certificate, diploma, associate degree and degree courses available for Aboriginal and Torres Strait Islander Health Workers at tertiary and non-tertiary educational settings [2]. Courses and training programs have been designed to address specific health issues.

    There have been a number of concerns expressed, however, in regard to training. Concerns include lack of planning and coordination for training within and between states and territories [2]. Funding is a major issue and many Aboriginal and Torres Strait Islander Health Workers have highlighted difficulties in accessing and attending education and training opportunities. Funding is provided by the States and Territories, and the Commonwealth Departments of Education, Training and Youth Affairs (DEST) and Health and Ageing (through the Office for Aboriginal and Torres Strait Islander Health). In some cases, sufficient funding for meeting overall fees associated with undertaking and completing further training is not available.

    Strategies that have been identified for improving access to education and training include the provision of courses and programs that will meet the needs of Aboriginal and Torres Strait Islander Health Workers and enable them to hold positions in the public health sector [2]. As much as possible, courses need to have an agreed national focus and development of training packages should include Indigenous Health Worker participation in planning and adaptations for meeting community needs.

    The National summary of the 2001 and 2002 jurisdictional reports against the Aboriginal and Torres Strait Islander health performance indicators reports on higher education and training in key professions [6]. Bearing in mind that the data are likely to under-estimate the true numbers, in 2002:

    As a part of its 2004 analysis of the Aboriginal and Torres Strait Islander health workforce, the Australian Medical Association (AMA) recommended that an additional 2,000 Aboriginal and Torres Strait Islander Health Workers were required [7].

    Recent developments

    Reflecting the crucial roles that they can play in improving the health of Indigenous people, there have been a number of policy efforts to improve the training, status and conditions of employment of Aboriginal and Torres Strait Islander health workers [1]. However, some efforts, such as the attempt in 1997 to develop ‘national competencies', have been criticised as ignoring the fact that there are established primary health care practice roles for Aboriginal and Torres Strait Islander health workers in many areas, particularly in northern and central parts of Australia.

    In 2000, the Health is life report recommended that the Commonwealth, in conjunction with the States, Territories and community-controlled sector, develop within two years a national system of training for Aboriginal and Torres Strait Islander Health Workers based on agreed national standards and competencies and taking account of the varied nature of their roles [8].

    More recently, one of the key objectives of The Aboriginal and Torres Strait Islander Workforce National Strategic Framework, which was developed by the Standing Committee on Aboriginal and Torres Strait Islander Health (SCATSIH) and endorsed by the Australian Health Minister's Advisory Committee (AHMAC), was to:
    Improve the clarity of roles, regulation and recognition of Aboriginal and Torres Strait Islander Health Workers as a key component of the health workforce, and improve vocational education and training sector support for training for Aboriginal and Torres Strait Islander Health Workers [9]
    Eleven strategies were aimed at achievement of this objective.

    An Aboriginal and Torres Strait Islander Health Workforce Working Group (ATSIHWWG) was established to oversight work on the Workforce Strategic Framework [10]

    Substantial progress has been achieved on a number of aspects relating to Aboriginal and Torres Strait Islander Health Workers. A project focusing on competencies and qualifications, was funded by the Australian National Training Authority and OATSIH and managed by Community Health Services Training Australia, established working groups of key stakeholders in each State and Territory [10]. Draft national Aboriginal and Torres Strait Islander Health Worker Competencies and Qualifications were released in October 2003 and are expected to be endorsed by the end 2004.

    The ATSIHWWG has contributed also to the establishment of Indigenous Health Worker Associations at State and Territory level - the Professional Aboriginal Health Worker Association of South Australia (PAHWA) became operational in August 2003 and similar groups are expected to follow on other states [10].

    Overall, the ATSIHWWG is planning for full implementation of the Aboriginal and Torres Strait Islander Workforce National Strategic Framework [10].

    References

    1. Murray RB, Bell K, Couzos S, Grant M, Wronski I (2003) Aboriginal health and the policy process. In: Couzos S, Murray R, eds. Aboriginal primary health care: an evidence-based approach. 2nd ed. South Melbourne: Oxford University Press: 1-37
    2. Curtin Indigenous Research Centre, Centre for Educational Research and Evaluation Consortium, Jojara & Associates (2000) Training re-visions: a national review of Aboriginal and Torres Strait Islander health worker training. Perth: Curtin Indigenous Research Centre with Centre for Educational Research and Evaluation Consortium
    3. Tregenza J, Abbott K (1995) Rhetoric and reality: perceptions of the roles of Aboriginal health workers in central Australia. Alice Springs: Central Australian Aboriginal Congress
    4. Adams K, Spratling M (1999) Future directions for Aboriginal health worker training in Victoria: a report to VACCHO members about issues and considerations relating to the development of Aboriginal health worker training. Melbourne: VACCHO
    5. Steering Committee for the Review of Government Service Provision (2008) Report on Government Services 2008. Canberra: Productivity Commission
    6. Australian Institute of Health and Welfare (2004) National summary of the 2001 and 2002 jurisdictional reports against the Aboriginal and Torres Strait Islander health performance indicators. Canberra: Australian Institute of Health and Welfare
    7. Australian Medical Association (2004) AMA Indigenous health report card 2004 – healing hands: Aboriginal and Torres Strait Islander workforce requirements. Kingston, ACT: Australian Medical Association
    8. House of Representatives Standing Committee on Family and Community Affairs (2000) Health is life: report on the inquiry into Indigenous health. Canberra: The Parliament of the Commonwealth of Australia
    9. Australian Health Ministers' Advisory Council (2002) Aboriginal and Torres Strait Islander health workforce national strategic framework. Canberra: Australian Health Ministers' Advisory Council
    10. Aboriginal and Torres Strait Islander Health Workforce Working Group (2004) Aboriginal and Torres Strait Islander Health Workforce Working Group, Annual Report 2002-2003: a report on the implementation of the Aboriginal and Torres Strait Islander Health Workforce National Strategic Framework. Canberra: Australian Government Department of Health and Ageing
     
    Last updated: 29 October 2013
     
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