Executive Summary and Recommendations
The continuing poor health status of Aboriginal people throughout Australia is a cause for great concern. In the Kimberley region of Western Australia, Aboriginal people face the additional health burdens of a particularly harsh physical environment combined with remoteness from quality health services.
During the course of the Standing Committee on Estimates and Financial Operations (“the Committee”) inquiry into the provision of health services in the Kimberley region, the Committee was struck by the fact that many of the submissions received by the Committee expressed the view that the standard of Aboriginal health in the region was worse now than it had been 30 years ago.
One of the areas in which the Committee believes that the State Government could make a significant contribution to improving the access of Aboriginal communities in the Kimberley region to effective health services is by making better use of Aboriginal Health Workers (“AHWs”). As one witness told the Committee:
In the 32nd Report of the Committee, Environmental Health in Aboriginal Communities in the Kimberley Region, the Committee recommended that the primary focus of State Government spending in the area of Aboriginal health be on the provision of basic community-based health programs, public health education, and environmental health programs. The Committee envisages that AHWs would play a key role in such a redirection in the focus of programs providing health services to Aboriginal people in the Kimberley region.
“Health work is the area in which I could see a good investment but making sure it is coupled with good placements, supervision and an ongoing position, so that they are not there for 12 months and cut out. That would be a medium-term investment in Aboriginal health that would make quite a difference, but it has got to be done with good supervision so there is support for them, they get some training, use it, get more training and get more skilled. That certainly needs to be coupled with some sort of registration or accreditation system, otherwise they are left in limbo next time someone else comes in.”
The Committee notes, however, that before AHWs can assume a more prominent and effective role in the provision of health services to Aboriginal people, that the State Government must take action to resolve the following important issues:
The Committee recommends that the number of State Government employed or funded Aboriginal Health Workers in the Kimberley region be increased as part of a shift in the focus of the provision of State Government Aboriginal Health services in the Kimberley region to more community-based, preventative, health services.
The Committee recommends that State Government employed or funded Aboriginal Health Workers take a much greater role in preventative health education in all Aboriginal communities throughout the Kimberley region. The role should include education regarding environmental health. Aboriginal Health Workers should practice in association with the local governments’ Environmental Health Officers and Aboriginal Environmental Health Workers.
The Committee recommends that an accredited standard training program and qualification be developed for all Aboriginal Health Workers in Western Australia.
The Committee recommends that TAFE take responsibility for providing an accredited standard training program for Aboriginal Health Workers in Western Australia.
The Committee recommends that State Government employed or funded Aboriginal Health Workers working in remote Kimberley communities be given access to the benefits and inducements provided to other Kimberley-based health professionals who work in these communities.
The Committee recommends that the State Government adopt a career structure for Aboriginal Health Workers within the Health Department of Western Australia similar to those currently in place within Queensland Health and the Territory Health Services.
The Committee recommends that the Poisons Regulations 1965 be amended so as to permit senior Aboriginal Health Workers working at remote area nursing posts to administer according to protocol to patients in emergencies those medications that are listed in Schedule 4 of the Poisons Act 1964.
The Committee recommends that the qualifications and standards of conduct of Aboriginal Health Workers in Western Australia be regulated by way of a statutory registration and disciplinary scheme along the lines of that which is presently operating in the Northern Territory under the Health Practitioners and Allied Professionals Registration Act (NT) and the Dental Act (NT).
- the provision of standardised training for AHWs throughout the State;
- the introduction of a basic qualification and reasonable minimum competencies for all AHWs;
- the amendment of the Poisons Regulations 1965 so as to enable senior AHWs in remote area nursing posts to administer Schedule 4 medications to patients in emergency situations;
- the introduction of statutory regulation of AHWs, so as to define the position of “AHW”, and to maintain the basic qualifications, competencies and professional conduct standards of all AHWs;
- the introduction of clear Job Description Forms and Duty Statements for the position of AHW within the Health Department of Western Australia (“HDWA”);
- consistency between the job entitlements available to AHWs employed by the HDWA and those provided to other professional health staff within the HDWA; and
- the introduction of a career structure within the HDWA to enable appropriately qualified AHWs to advance to management positions, or alternatively to become enrolled nurses and registered nurses.