Future-Proofing Indigenous Self-Determination in Health: Goals, Tactics, and Achievements of Aboriginal Community Controlled Health Organisations in New South Wales, Australia

Abstract

AbstractIn this chapter I examine some of the ways that Aboriginal Community Controlled Health Organisations (ACCHOs) have responded to recent federal policy turmoil in Australia. I highlight ACCHOs as contemporary examples of Indigenous self-determination in health; these grassroots organisations are persisting in their work, designing community-owned responses to complex financial and political challenges. Drawing on data generated through a series of semi-structured interviews with CEOs and managers from ACCHOs in New South Wales, I explore these First Nations organisations’ innovative and pragmatic responses to top-down policy changes. The interview data was generated with interviewees in urban, regional, and remote contexts. A thematic analysis of the data highlighted some of the on-the-ground effects of recent changes to Indigenous affairs funding and policy at the federal level. The policies in focus here, all of which were developed by the Liberal-National Coalition after its 2013 election win, are the Indigenous Advancement Strategy (IAS), the Indigenous Australians’ Health Programme (IAHP) and the Primary Health Network (PHN). The federal government developed and implemented all three policies without substantial input from First Nations leaders or ACCHOs. The academic and grey literature demonstrates how these policy developments have threatened ACCHOs’ access to primary health funding and imposed additional administrative and accountability requirements. In interviews, ACCHO leaders explained how their organisations have developed and implemented adaptive strategies to mitigate the impact on health services and outcomes. These strategies include diversifying income streams to reduce reliance on Commonwealth grant funding; partnering with health institutions at the state-government level to overcome Commonwealth funding austerity; and engaging in entrepreneurial activity. The chapter concludes that in the face of sustained fiscal pressure and regulatory constriction from Commonwealth policymakers, ACCHOs in NSW are resisting domination through innovation and pragmatism. However, in the process, some of these organisations are tending towards a more neoliberal mode of operation. This case study from the health sector illustrates how Indigenous peoples continue to exert their agency and slip through the cracks in the settler colonial edifice (Ford 2011; Simpson, A. 2014). It also shows how Indigenous organisations channel their policy and business acumen to survive in an increasingly competitive Indigenous health ‘market’.KeywordsACCHOsAboriginal healthSelf-determinationAboriginal community controlIndigenous health policyNew South WalesMedicare