Health workers


Summary of information about Aboriginal and Torres Strait Islander Health Workers


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 Aboriginal and Torres Strait Islander 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 Aboriginal and Torres Strait Islander 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 Aboriginal and Torres Strait Islander 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.

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Employment of Aboriginal and Torres Strait Islander health workers

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 of Indigenous health workers (1,743), followed by Queensland (1,343) and Western Australia (486). (In this context, ‘Indigenous health worker' refers to all health-related occupations. The term ‘Aboriginal and/or Torres Strait Islander 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 Aboriginal and/or 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]

Table 1 Numbers and proportions of Indigenous health workers, by jurisdiction, Australia , 2006

Jurisdiction

NSW

Vic

Qld

WA

SA

Tas

ACT

NT

Australia
Indigenous health workers
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
Proportion
1.6
0.5
2.5
2.4
1.3
2.8
0.9
24.1
1.8

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'

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
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

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

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

Numbers
Proportion
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

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

 

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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 Aboriginal and Torres Strait Islander 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 [10]. 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 Aboriginal or Torres Strait Islander health workers, and 1,653 were enrolled;
  • 57% of the people who qualified as Aboriginal or Torres Strait Islander health workers completed the Certificate II course; and
  • The highest numbers of Aboriginal and Torres Strait Islander health workers were in Queensland (468 qualified and 306 enrolled), followed by New South Wales (301 qualified and 330 enrolled) [10].

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 [6].

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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 [7].

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 [8]

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 [9].

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, 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 [9]. 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 Aboriginal and Torres Strait Islander 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 [9].

Overall, the ATSIHWWG is planning for full implementation of the Aboriginal and Torres Strait Islander Workforce National Strategic Framework [9].

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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 (nd) Training re-visions: a national review of Aboriginal and Torres Strait Islander health worker training. Perth: Curtin University
3 Tregenza N, Abbott K (1995) Rhetoric and reality: perceptions of the roles of Aboriginal health workers in central Australia. Paper presented at the Central Australian Aboriginal Congress Alice Springs
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 Medical Association (2004) Aboriginal and Torres Strait Islander health, healing hands: Aboriginal and Torres Strait Islander workforce requirements. Kingston, ACT: Australian Medical Association
7 House of Representatives Standing Committee on Family and Community Affairs, Wakelin B (2000) Health is life: report on the inquiry into Indigenous health. Canberra: The Parliament of the Commonwealth of Australia
8 Australian Health Ministers' Advisory Council (2002) Aboriginal and Torres Strait Islander health workforce national strategic framework. (3049) Canberra: Australian Health Ministers' Advisory Council
9 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
10 Statistical Information Management Committee 2004 (2004) National summary of the 2001 and 2002 jurisdicational reports against the Aboriginal and Torres Strait Islander health performance indicators. (AIHW cat. no. IHW12) Canberra: Australian Institute of Health and Welfare

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Last updated: 16 June 2008