Researchers at Flinders University say that Indigenous community health services can be significantly improved by governments adopting a simpler model of funding.
The Overburden Report, which was launched in Canberra on August 17, argues that the ability of Australia’s 150 Aboriginal Community Controlled Health Services (ACCHSs) to provide primary health care is detrimentally affected by a fragmented and complex system of funding contracts.
Professor Judith Dwyer, Ms Kim O’Donnell and Dr Uning Marlina of the Department of Health Management at Flinders are three of the report’s authors.
The project, which was funded by the Cooperative Research Centre for Aboriginal Health (CRCAH), found that multiple funding sources and complex contracts work against the delivery of an effective, integrated health service and also inflict a burden of reporting that is inconsistent and out of proportion to the funding.
Separate funding grants received by the ACCHSs sampled in the research survey ranged from five up to 51, with an average of 22 per ACHHS: the result, according to Professor Dwyer, is “a bureaucratic mish-mash”.
Professor Dwyer said the provision of funding in separate parcels for different aspects of primary health services, such as eye care, hearing or diabetes treatment, also risks compromising health care workers in providing a holistic service to individual patients on a needs basis.
Ms O’Donnell cited one Aboriginal health service operating in a remote area that was funded from 42 different “buckets” of money, all requiring separate applications and reporting.
“Some of them were as low as $1000. It’s not hard to imagine how accounting and reporting on this multitude of grants is a waste of precious health resources,” Ms O’Donnell said.
“The trouble with all these targeted government funding contracts is that they are for specific purposes, and it makes hard work for the agencies to pull them all together to provide comprehensive care. They also have to meet quarterly or six-monthly reporting for each of the contracts.”
As well as simplifying funding to support core primary health care, the report recommends the introduction of so-called relational or alliance contracting in place of the current system of “classical” contracts, in order to reduce red tape.
Professor Dwyer said that ACCHSs should receive their core primary health care funding from single, long-term contracts that would also permit the flexibility needed to respond to local priorities.
“Currently we have too much accounting rather than meaningful accountability,” Professor Dwyer said.
“The true indicator of success of funding programs should be an improvement in health outcomes for Indigenous people.”
A full text of The Overburden Report: contracting for Indigenous Health Services is available online at the Department of Health Care Management and CRCAH websites.