Workforce development

Introduction

Indigenous 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 Indigenous 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 Indigenous 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 Indigenous Health Workers, and progress towards implementation of the Workforce Strategic Framework.

Employment of Indigenous 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 Indigenous 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 Indigenous Health Workers (20% of the Indigenous workforce), 473 health promotion officers (8.9%), 100 medical practitioners (2.0%) and 16 dentists (0.3%) [5]

Table 1: Numbers and proportions (%) of Indigenous health workers, by jurisdiction, Australia, 2006

	Jurisdiction	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Australia
Source: Steering Committee for the Review of Government Service Provision (2008) Report on Government Services 2008, Indigenous Compendium, Productivity Commission, Canberra. Notes The 2006 Australian Census of Population and Housing was the primary source for these figures Proportions of populations relate to people aged 15 years and older Figures for Australia include 'other territories'
Indigenous health workforce	Numbers	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

Table 2: Numbers and proportions (%) of Indigenous health workers, by age group and sex, Australia, 2006

	Age group	15-24	25-34	35-44	45-54	55-64	All ages
Source: Steering Committee for the Review of Government Service Provision (2008) Report on Government Services 2008, Indigenous Compendium, Productivity Commission, Canberra Notes The 2006 Australian Census of Population and Housing was the primary source for these figures Figures for 'all ages' include people aged 65 years or older
Numbers	Males	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 workforce	Males	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

Table 3: Numbers and proportions (%) of Indigenous health workers, by selected health-related occupation, Australia , 2006

	Numbers	Proportion
Source: Steering Committee for the Review of Government Service Provision (2008) Report on Government Services 2008, Indigenous Compendium, Productivity Commission, Canberra. Notes The 2006 Australian Census of Population and Housing was the primary source for these figures People aged 15 years or older Proportions are the percentages of Indigenous people of all workers in each health-related occupation 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 occupations	4,891	1.0

 

Training of Indigenous Health Workers

Nationally there is a range of accredited certificate, diploma, associate degree and degree courses available for Indigenous 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 Indigenous 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 Indigenous 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:

• 822 people qualified in the previous academic year as Indigenous Health Workers, and 1,653 were enrolled;
• 57% of the people who qualified as Indigenous Health Workers completed the Certificate II course; and
• The highest numbers of Indigenous Health Workers were in Queensland (468 qualified and 306 enrolled), followed by New South Wales (301 qualified and 330 enrolled) [6].

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 Indigenous 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 Indigenous 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 Indigenous Health Workers as a key component of the health workforce, and improve vocational education and training sector support for training for Indigenous 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 Indigenous Health Workers. A project focusing on competencies and qualifications, which has been 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

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