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Aboriginal and Torres Strait Islander Primary Health Care Systems Evaluation

Fully funded by the Australian Commonwealth Department of Health

Introduction

The evaluation focuses on the Australian Government’s investment in primary health care for Aboriginal and Torres Strait Islander peoples, which occurs primarily through the Indigenous Australians’ Health Programme (IAHP).

An evaluation co-design phase was undertaken over 2017–2018 and led to a Monitoring and Evaluation Design Report which was approved by the project’s Health Sector Co-design Group (HSCG), the Department of Health, and the Minister for Indigenous Health. The Minister announced the commencement of the evaluation’s implementation phase.

From November 2018-December 2023 the evaluation is in the implementation phase. The evaluation has engaged 17 geographical site partners across Australia. Over three participatory action research (PAR) cycles, the team will undertake interviews and yarns with site partners as well as national and state/territory-level stakeholders. Each cycle will include two site-based workshops to support development of shared priorities, reflection, sense making and planning for change.   Each cycle also includes 1-2 deep-dive cross-cutting collaboratives.

Last modified 05/07/2021

Artwork

The original artwork was produced by Emma Walke. Emma is a Bundjalung Aboriginal woman from northern NSW and was part of the evaluation team which designed and set-up the evaluation. Here is her description of the artwork:

Because I don’t speak for every country, and because we are working across many of them, the work seeks to represent Indigenous Australia. I feel that colour makes a statement so I have used colours that can be linked to many of our communities and countries, land or sea based. The colours represent our people and the land they come from – ochres/yellows represent desert and hills and the cliffs where our ochres come from. Blues for ocean and blue greens for rivers.

The circles are universal in the way they represent groups or clans of people, the markings inside some of the circles represent individuals.

The dots and slashes are representational of tracks and time lines. There are a few blank circles – they represent the missing, the lost peoples.

I thought I would try and incorporate the colours to show respect for them.

Last modified 01/10/2019

The evaluation design process

The evaluation design process began in late 2017. The following diagram charts the progress and timeline of the evaluation design, and the start date of the evaluation itself.

The structure for co-designing the evaluation is shown in the figure below. It shows that the evaluation team is working collaboratively with a group of people working across the health sector – the Health Sector Co-design Group (HSCG) – and engaging with people in communities, as part of a community co-design process. It also shows engagement with a wider group of interested people across states and territories. As part of the community co-design process, we are working towards the establishment of a Community Co-design Group for the implementation phase of the evaluation. The Community Co-design Group will be in direct conversation with the HSCG as well as the evaluation team.

Last modified 13/09/2019

The project team

The following independent team has been appointed by the Department of Health to lead the evaluation design process. Please click on their names below for more information.

If you would like to contact the team, please email Ned at IPHCeval@allenandclarke.com.au, or phone him on +61 02 6188 4487

Project Lead  

Qualifications

  • Bachelor of Arts (Honours), Master of Arts (Distinction).

Relevant experience

  • Over 18 years of experience in evaluation and research.

  • Team Leader on Phase 1 of this evaluation project (IAHP evaluation).

  • Lead evaluator on health sector evaluations in NZ, Australia and the Pacific.

  • Lead evaluator, Evaluation of the Child Health Check Initiative and the Expanding Health Service Delivery Initiative, NT.

  • Lead evaluator, Evaluation of the NT Continuous Quality Improvement Investment Strategy.

Principal Investigator  

Qualifications

  • Bachelor of Social Science (Honours), PhD.

Relevant experience

  • Roxanne is from the Gungarri/Kunja nations of south-west Queensland.

  • Public health equity research, specifically the social and cultural determinants of health.

  • Extensive experience and expertise in Indigenous research impact assessment and evaluation; the implementation of quality improvement approaches in and beyond primary health care settings; family-centred care; and participatory action-oriented approaches.

National Engagement Lead  

Qualifications

  • Currently Master of Public Health, Diploma of Community Development, Diploma of Community Service (Aboriginal Sexual Health), Certificate IV (Training and Assessment; Frontline Management; Assessment and Workplace Training).

Relevant experience

  • Robert is a descendant of the Bundjalung Nation on his mother’s side. His family and his extended family are from the North Coast of NSW alongside the Clarence River at Baryulgil. On his father’s side a long and rich history of descendants from Ireland.
  • 18 years working within both National/State and Local Governments working within the Aboriginal community controlled sector.
  • Research projects at UNSWs Kirby Institute for the past 4 years in Aboriginal communities across Australia.
  • Diverse range of learnt and lived experiences that he attributes to working in and with communities that are passionate about Aboriginal culture that is rich in life.
Evaluation Manager  

Qualifications

  • Bachelor of Social Sciences, Diploma of Social Science Research, Post-Graduate Diploma Social Sector Evaluation Research (Distinction).

Relevant experience

  • Over 30 years of experience in evaluation and research.
  • Senior evaluator on a health sector evaluation in Australia.
  • Lead or co-lead evaluator of public health, social, community, housing, youth development and employment equity projects in New Zealand.
  • Co-led development of a youth health and wellbeing outcomes measurement model.
  • Author of the New Zealand evaluator competencies and evaluation standards.
Quantitative data lead  

Qualifications

  • Graduate Australian Institute of Company Directors
  • Doctor of Philosophy (Health Economics Ph.D.) – University of Newcastle
  • Bachelor of Economics (Honours) – University of Newcastle

Relevant experience

  • Professor Chris Doran holds a Bachelor of Economics (Honours), a PhD in Health Economics and is a recent graduate of the Australian Institute of Company Directors. Chris is a Professor of Health Economics in the Centre for Indigenous Health Equity Research and is currently leading the research cluster for resilience and wellness.

  • Chris works within a multidisciplinary environment and collaborates extensively with academics, clinicians and policy makers in building capacity in the knowledge, use and translation of complex health data and systems analysis.

  • He has over 15 years’ experience in working with Aboriginal and Torres Strait Islander communities, health organisations and people. Examples include: working with the Yarrabah community in Far North Queensland to co-design and evaluate a Best Da Binge alcohol intervention; an NHMRC funded project to find solutions to Indigenous alcohol problems; an ARC funded project that embeds research into-youth services in remote Australian communities; an NHMRC funded project to reduce smoking rates among Indigenous pregnant women; and, a government funded project to evaluate the governments investment into Aboriginal and Torres Strait Islander residential rehabilitation services.

Quantitative data team member  

Qualifications

  • Bachelor of Psychology (Honours) – Griffith University
  • Graduate Certificate in Mathematical Science – Queensland University of Technology
  • Master of Philosophy (Data Science) – University of Queensland.

Relevant experience

  • Boyd has an educational background in psychology and maths, focussing on statistics and computational methods. He is particularly interested in the problem of nonlinear scaling of epidemiological metrics for small populations and developing new approaches to significance testing for rare events. These techniques have applications in the correct analysis of key population groups such as persons of Aboriginal and Torres Strait Island descent.

  • Boyd works concurrently with Menzies School of Health Research on the Better Cardiac Care Data Linkage Project, examining the continuum of care for Aboriginal and Torres Strait Islander patients in the Queensland health system.

  • He has previously worked with Griffith University’s EEG laboratory and later with the Queensland Suicide Register where he developed the automated text data extraction from police and coronial reports, provided statistical and geospatial analyses for suicide mortality and created the first predictive statistical model of suicide rate increases in Queensland, presented at the Australian Vital Statistics Interest Group (Australian Bureau of Statistics) in 2016.

Team member  

Qualifications

  • Diploma in Criminology, Bachelor of Medicine, Bachelor of Surgery, Diploma from the Royal College of Obstetricians and Gynaecologists.
  • Fellow of the Royal New Zealand College of General Practitioners, Fellowship Australian College of Rural and Remote Medicine, Fellow of the Australian Faculty of Public Health Medicine.

Relevant experience

  • Clinical medicine (general practice/primary care) and public health physician in New Zealand and Australia.
  • GP in Indigenous health services in both urban and rural settings, including for Inala Indigenous Health Service in Brisbane, and Ngati Porou Hauora on New Zealand’s East Coast.
  • Health policy development, evaluation and innovation.
  • Interface between the health, social and justice sectors and in innovation for hard to reach and marginalised populations.
  • Experience in service planning and funding.
  • Quantitative and qualitative analytical skills, as well as health systems and population health perspectives.
Site Evaluation Coordinator  

Qualifications

  • Bachelor of Health Science (Aboriginal Health and Community Development), University of Sydney

Relevant experience

  • Sarina is a proud Adnyamathanha woman from South Australia who is focused on Aboriginal and Torres Strait Islander health, education and community engagement.

  • Sarina has extensive experience working within the Aboriginal and Torres Strait Islander health and education sector with over 20 years of community engagement/development experience. She is highly competent in developing positive working relationships with government and non-government organisations.

  • High level strategic planning and policy implementation experience and research skills focusing on quantitative and qualitative research. Effective management of program deliverables and expertise around leadership and partnership collaborations.

  • Sarina is passionate and dedicated to working with Aboriginal communities to build capacity, self-determination and leadership.

Site Evaluation Coordinator  

Qualifications

  • Master of Education, Charles Darwin University
  • Bachelor of Education & Diploma of Teaching, Northern Territory University
  • Graduate Certificate Accelerated Literacy, Charles Darwin University
  • Professional Certificate Indigenous Research Methodologies, Melbourne University
  • Level One: Narrative Therapy, Dulwich Centre
  • PhD candidate (current, part time): Aboriginal Teachers in remote and very remote communities: interface of digital technologies, personal and professional identities, Charles Darwin University

Relevant experience

  • Donna’s family are Murran people from the Coburg Peninsula in West Arnhem Land, and her language group is Iwaidja.

  • Donna has extensive experience in the education sector, community development and more recently in the health sector. She is an experienced socio-cultural qualitative researcher and evaluator focusing on developmental and PAR evaluation projects, community engagement and Indigenous research methodologies.

  • Managed and coordinated the development of effective and responsive professional learning to the social emotional wellbeing (SEWB), alcohol and other drugs and mental health sector in the NT.

  • Managed research, evaluation and administration of the alcohol, other drug and gambling team contributing to research and evaluation across the NT and Northern Region of Australia.

  • Highlights of projects include: research on alcohol policy changes and trends in violence against adult women the NT; co-lead of the NTPHN SEWB Evaluation; and the Beyond Blue Be You Pilbara and Kimberley pilot evaluation.

Program manager  

Qualifications

  • Masters Public Health from University of Sydney
  • Honour’s degree in Psychology from University of Leeds

Relevant experience

  • Hannah is an experienced Program Manager in the health and research fields. Her key skills are project management including development, implementation and evaluation, partnership building, stakeholder engagement and strategy development.

  • She was responsible for the scoping and implementation of innovative statewide tele-trials program with the aim of improving access and participation in clinical trials for regional and rural cancer patients.

  • She also managed the Victorian Cancer Covid-19 Network (VCCN) Telehealth Expert Working Group and project team and provided oversight of strategies to ensure high quality, equitable implementation and evaluation of telehealth across cancer services.

  • She was the Program Manager for research and education across Primary Care, Haematology, and Melanoma and Skin Cancer. In this tole she undertook strategic planning, project management practice and framework development and governance processes.

  • Hannah was also a Researcher with the Melbourne Neuropsychiatry Centre at University Melbourne.

Site Evaluation Coordinator  

Relevant experience

Michael is a Central Arrernte of the Arrernte Nation, he also acknowledges his Irish, English and Finnish heritages. Michael was raised in Alice Springs. Michael has extensive experience across community, government and the private sectors in roles including public/primary health promotion/education, research, advocacy, policy and management.

Team member  

Qualifications

  • Post Graduate Diploma in Social Sector Evaluation, Master of Arts (Appl) Social Sciences, Bachelor of Arts.

  • PhD Candidate (Evaluation).

Relevant experience

  • Lead evaluator on social services, disability sector and employment-related evaluations in New Zealand and the Pacific.

  • Significant project management experience of multi-year, multi-agency evaluations.

  • Evaluation tutor for two Master in Evaluation subjects at the University of Melbourne.    

Project Sponsor  

Qualifications

  • Master of Philosophy

Relevant experience

  • Managing Partner of Allen + Clarke’s Melbourne office.

  • Paul is an experienced public policy and business change consultant.

  • Paul has provided services to a range of clients in different sectors, including the Australian Department of Health, NSW Health, the World Health Organisation, the Fred Hollows Foundation, Solomon Islands Ministry of Health and the United Nations Population Fund.

Team member  

Qualifications

  • Master of Population Studies from Australian National University

Relevant experience

  • Erika is a demographer and social epidemiologist, she previously worked as a research focussed academic at the Centre for Indigenous Health Equity Research

  • Erika has worked on Indigenous led projects relating to health, education, community development and systems integration.  These include evaluations of government support services for Indigenous students, capacity building programs for staff and schools working with Indigenous students, the suitability of administrative data for Indigenous research, the provision of integrated team care by a primary health network.

  • Erika has been an investigator on Indigenous research projects funded by the Western Queensland Primary Health Network, the Queensland Department of Education, Lowitja Institute, National Health and Medical Research Council, the Australian Research Council, as well as institutionally funded projects by Central Queensland University and Menzies School of Health Research. These projects have examined aspects of Indigenous youth mental health, Indigenous health workforce, transition of primary healthcare to community control, service delivery models in primary health care, and community led responses to gambling harm.

  • She has published on the validity of western health measures for Indigenous youth, health screening of Indigenous youth in primary health settings, the integration of health services, and contributed to a range of systematic reviews relating to health and education.
  • As an academic, Erika embedded Indigenous data sovereignty and Indigenous research and evaluation methods in curriculum she developed and delivered for public health students, provided training and mentoring for students and community partners, and developed workshops for knowledge translation.
Team member  

Qualifications

  • Masters Public Health from Monash University
  • Bachelor Health Science from Trobe University

Relevant experience

  • Emma is a mixed methods research, evaluation and implementation science specialist who is committed to applying her public health expertise to advance health and wellbeing and the acquisition of rights.

  • She brings more than 15 years of national and international public health expertise across the United Nations, Australian Government, Academia and Aboriginal organisations in Australia.

  • She has an established a reputation as a valued and sought after public health content specialist, with expertise across the early years, child and adolescent health, sexual reproductive health, maternal child health, health rights, child protection, violence prevention and emergency response.

  • Experience on Aboriginal-led responses to Family Preservation and Reunification, having worked closely with the Victorian Aboriginal Child Care Agency to support and advise on implementation science and evaluation of the Family Preservation and Unification initiative.

  • Provided expert policy and research advice initiatives such as the First 1000 days and led a service integration evaluation for early childhood development.

Last modified 04/07/2021

Health Sector Co-design Group

The Health Sector Evaluation Co-design Group was established in late 2017 to co-design and guide the development and implementation of the Evaluation of Aboriginal and Torres Strait Islander primary health care (PHC).

The Group brings together a wide range of experiences and perspectives from people working across the health system. Members come from a range of organisations including the National Health Leadership Forum, the Implementation Plan Advisory Group, the National Aboriginal Community Controlled Health Sector, the Primary Health Networks, health service providers, state health services, the Department of the Prime Minister and the Cabinet, the Australian Institute of Health and Welfare, and the Department of Health. The group also includes research expertise in primary health care and co-design.

HSCG Terms of Reference and Membership List

Health Sector Co-design Group (HSCG) Meeting No. 1 Communiqué – 20 December 2017

Health Sector Co-design Group (HSCG) Meeting No.2 Communiqué – 12–13 April 2018

Health Sector Co-design Group (HSCG) Meeting No.3 Communiqué – 14-15 February 2019

Health Sector Co-design Group (HSCG) Meeting No.4 Communiqué – 25-26 June 2019

Health Sector Co-design Group (HSCG) Meeting No.5 Communiqué – 8-9 October 2019

Health Sector Co-design Group (HSCG) Meeting No.6 Communiqué – 5-6 May 2021

Last modified 04/07/2021

Community co-design process

All people involved in designing the evaluation so far – evaluation team members, the Department of Health, the Health Sector Co-design Group (HSCG) and others – have expressed a strong desire that the evaluation design process genuinely engages with a diverse group of Aboriginal and Torres Strait Islander peoples, particularly those whose voices are not commonly heard.

The community co-design process is evolving organically. Essentially, it is occurring in reverse to that of the co-design process with the health sector. The community co-design has started with a wider engagement process, working towards the formation of a group for the implementation of the evaluation. The health sector co-design process has started with bringing a group together – the HSCG – followed by engaging with the health sector more broadly.

In our discussions to date we have found that many people want to discuss real issues and concerns rather than the design of an evaluation. Therefore, we have identified several areas that we are discussing with people in the community to inform the evaluation design, including:

  • what ‘health’ means for people
  • where people go to see a nurse or doctor
  • who are using health services and who is missing out
  • what works well and not so well with health services
  • what is important to people about healthcare.

We are mindful there is already a lot of research and understanding about these areas, including among the project team and the HSCG, and will also be drawing on this to design the evaluation.

Last modified 19/08/2019

Ethics

Phased ethics applications

Given the multi-year and responsive nature of the evaluation, we are undertaking a phased ethics application approach to ensure the evaluation is responsive to community and organisational needs, as well as being carried out in line with the National Statement on Ethical Conduct in Human Research and other relevant ethical guidelines.

Phase two ethics approval:

Phase two ethical applications have been approved for all 17 sites. The phase two ethics applications sought approval for all evaluative activities that are to occur over the three years of the evaluation 2020-2023.

Last modified 04/07/2021

The IAHP

The Indigenous Australians’ Health Programme (IAHP) is delivering $4.1 billion over four years from 2019-20 to 2022-23 to improve:

  • access to culturally appropriate comprehensive primary health care for Indigenous Australians, and
  • areas of critical need through targeted investment that are expected to accelerate progress in reaching targets.

The IAHP:

  • Funds organisations to deliver PHC to Aboriginal and Torres Strait Islander peoples
  • Funds Aboriginal and Torres Strait Islander-specific initiatives to address issues such as maternal and child health, smoking, mental health, and drug use
  • Seeks to strengthen the health system so that it works better for Aboriginal and Torres Strait Islander peoples.

Please see the Department of Health’s website for more information on the IAHP.

Last modified 04/07/2021

Latest news

Last modified 13/07/2021

What’s happening now

The team has commenced data gathering for Cycle 1 of the evaluation. This involves:

  • Undertaking engagement through interviews and yarns with ACCHSs, PHNs, members of the community and other organisations or people key to improving PHC systems in the evaluation sites across Australia
  • Extracting data from existing national level quantitative data sets
  • Developing coding frameworks and analysing data collected through interviews and yarns
  • Identifying preliminary findings from this analysis to inform workshops to establish shared priorities and an agenda for change in each site
  • Completing the first cross-cutting collaborative that examines how well the health system for Aboriginal and Torres Strait Islander people responded to the COVID-19 pandemic

Please contact IPHCeval@allenandclarke.com.au for more information.

Last modified 04/07/2021

Have your say

From time to time we will be inviting people to provide views on specific questions we have. These will be found under the ‘Have your say’ button below.

To ask us a question, or to provide us with any comments you have on the evaluation at any time, please click on the ‘Ask us a question’ button or email us at IPHCeval@allenandclarke.com.au

Last modified 19/08/2019

Reports

The IAHP Yarnes Year One Report Summary is available here.

002-pdf Year One Report Summary: Site Engagement – July 2020 [PDF]

The IAHP Yarnes Quantitative Data Feasibility Assessment Report is available here.

002-pdf Quantitative Data Feasibility Assessment – 18 June 2020 [PDF]

Last modified 08/08/2020

FAQs

Click on a question below to view the answer

The evaluation will focus on the Australian Government’s main investment in primary health care for Aboriginal and Torres Strait Islander peoples, which occurs primarily through the Indigenous Australians’ Health Programme (IAHP). The IAHP:
  • Funds organisations to deliver primary health care to Aboriginal and Torres Strait Islander peoples.
  • Funds Aboriginal and Torres Strait Islander-specific initiatives to address issues such as maternal and child health, smoking, mental health, and drug use.
  • Seeks to strengthen the health system so that it works better for Aboriginal and Torres Strait Islander peoples.
The Department of Health wants to know whether the IAHP is delivering the desired results. More broadly, it wants to:
  • Learn how well the primary health care system is working for Aboriginal and Torres Strait Islander peoples.
  • Demonstrate the difference that the IAHP makes.
  • Inform efforts to accelerate improvement in health and wellbeing for Aboriginal and Torres Strait Islander peoples.
  • Inform revisions to the Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan 2013-2023.
  • Support adaptive management and continuous improvement in primary health care service delivery.
  • Gain a better understanding of Aboriginal and Torres Strait Islander community needs and aspirations.
The evaluation was designed by an independent team of evaluators and researchers. As well as reviewing documents and literature and mapping existing data to evaluation questions, the design process included:
  • Co-design processes with a group of health sector and evaluation specialists and with Aboriginal and Torres Strait Islander communities.
  • Seeking input from a wider group of people working in primary health care across Australia.
An evaluation co-design phase occurred from November 2017 to April 2018. The implementation phase began in November 2018 and will end in December 2023.
The evaluation is being undertaken as collaboration between: The project team is working closely with a Health Sector Codesign Group.  A list of members of this group can be found here.
Ned Hardie-Boys, Telephone: 02 6188 4487, Email: IPHCeval@allenandclarke.com.au
Last modified 19/08/2019