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Purro Birik - 13

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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;

  • 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

  • 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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