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Purro Birik - (Healthy Spirit)
5.7 Accountability
Accountability issues were
raised on a number of levels throughout the consultations. The most critical
levels of accountability for improving mental health services to Koori
people were identified as the accountability of Koori health services to
their communities, and the local level accountability of Koori health
services and mental health services to fulfil partnership commitments (where
they exist).
Where local partnership
commitments between Koori health services and mental health services do not
exist, or have broken down, the consultations identified that the response
to community need by mainstream mental health services was patchy at best
and non-responsive at worst.
The accountability between
Koori health services and Koori communities was described as generally
relying on annual general meetings and community consultations, which occur
regularly in some communities and rarely in others. A small number of Koori
health services reported community concerns regarding adequate staff
training and appropriate management of confidential information.
Two other important levels
of accountability were also identified through the consultation process:
first, the accountability between funding bodies and Koori health services;
and second, the accountability between signatories of high-level agreements
that affect the delivery of Koori Health Services.
The accountability
arrangements between funding bodies and Koori health services are often
considered to be restrict how Koori services can meet community need. These
arrangements often insist on particular types of activity being undertaken
in a particular way which may not be consistent with the individual Koori
health services' analysis of their community needs. This can be a factor in
fragmenting and limiting the development of effective and appropriate
service delivery to the community.
Accountability between
signatories of high-level agreements was raised in the context of a
perceived failure to follow through on agreements relating to community
control. This issue was highlighted by a reference to the continued
government allocation of Koori-specific funding to mainstream organisations
despite the 1996 agreement between the Commonwealth and State Health
Ministers, VACCHO and ATSIC which recognises community controlled
organisations as the culturally valid system for delivering
Aboriginal-specific health services. This issue is seen to undermine the
development of Koori Health Services.
5.8 Community Control
Issues
Both Commonwealth and State
Governments have endorsed Koori community control of Koori-specific health
services which is considered fundamental to effectively recognising and
addressing Koori health needs (particularly social, emotional and cultural
wellbeing issues).
There is a growing
frustration due to the continual failure of funding bodies to recognise that
Koori health care is provided to the Victorian Koori community through 26
community controlled health services, all of which are focussed on their own
community. The services do not compete with each other, they are not set up
according to Department of Human Services regional boundaries, and they all
seek to provide a holistic health service to their communities.
The consultations raised a
number of community control issues. The main issues were that:
restrictive funding
requirements continue to result in fragmented, poorly targeted initiatives;
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Koori specific positions
that are not managed by Koori organisations add to the fragmentation,
presenting risks that resources can be redirected to non Koori business;
-
training and service
developments that are imposed as a result of non-Koori planning processes
often result in poor targeting and poor outcomes (these processes should be
planned by community controlled planning processes);
-
Koori health services need
to be able to individually determine where and when they will employ
non-Koori people to access specific skills;
-
Koori health data should
be recognised as the property of Koori health services and their
communities, and with the exception of basic resource distribution, data
requirements should not be required as a condition of funding; and
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the competitive tendering
policy of the Department of Human Services is seen as problematic for
community controlled health services because of the potential to result in
communities competing with each other.
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