Health services

Workforce

Aboriginal and Torres Strait Islander people are significantly under-represented in the health workforce, which could contribute to reduced access to health services for the broader Indigenous Australian population. The accessibility of a health service goes beyond its physical availability and encompasses other aspects like cultural safety (Scrimgeour & Scrimgeour 2008).

The availability of culturally safe care is essential to meet the health care needs of Indigenous Australians and:

• requires health professionals to consider power relations, cultural differences and patients’ rights (AHMAC 2016)
• should ensure the provision of services is underpinned by Indigenous Australians’ beliefs and values (AH&MRC 2015)
• should include the recognition and understanding of the diversity of Indigenous cultures as well as regional variations (Scrimgeour & Scrimgeour 2008).

A key feature of Aboriginal Community Controlled Health Services (ACCHSs) is the provision of culturally safe care, and research has found the ACCHS sector to be a leading employer of Indigenous Australians (Campbell et al. 2018).

The Indigenous workforce is integral to ensuring the health system can address the needs of Indigenous Australians. Indigenous health professionals can:

• align their unique technical and sociocultural skills to improve patient care and access to services
• support the provision of culturally appropriate care delivered (Anderson et al. 2009; West et al. 2010).

While the Indigenous workforce plays an important role in the provision of culturally appropriate services, it is the responsibility of the health-care system to ensure that mainstream health services are culturally competent through high quality professional development and training, appropriate management where cultural respect is lacking, and staff developing awareness of their own unconscious bias (AHMAC 2016).

International studies show people prefer to see a health professional from the same ethnic background, and that doing so can improve health outcomes (LaVeist et al. 2003; Powe & Cooper 2004). Australian research has found:

• Indigenous Australians want their health care to include Indigenous staff and clinicians (Lai et al. 2018).
• a preference among Indigenous Australians for care by Indigenous health professionals (de Witt et al. 2018)
• Indigenous health staff appeared to sustain better connection, rapport, trust and communication with Indigenous patients, and helped to reduce anxiety (Freeman et al. 2014, Hayman N.E. et al. 2009).
• Indigenous health workers may help to improve attendance at appointments, acceptance of treatment and assessment recommendations, reduce discharge against medical advice, increase patient contact time, enhance referrals and improve follow up (Jongen et al. 2019).

In 2020, there were 7,049 Indigenous Australians registered and working as health workers (accounting for 1.1% of the registered health workforce) (Department of Health 2022). The number has increased over time.

Between 2013 and 2020:

• The number of Indigenous Australians working as Aboriginal and Torres Strait Islander Health Practitioners rose from 270 to 620 (or from 36 per 100,000 Indigenous population to 72 per 100,000)
• The number of Indigenous Australians working as medical practitioners rose from 234 to 494 (or from 31 per 100,000 to 57 per 100,000)
• The number of Indigenous Australians working as nurses and/or midwives rose from 2,434 to 4,610 (or from 324 per 100,000 to 535 per 100,000).

Across 2013 to 2020, the number of Indigenous females registered as Aboriginal and Torres Strait Islander Health Practitioners, nurses and midwives exceeded the number of Indigenous males. From 2016, the number of Indigenous female medical practitioners exceeded the number of Indigenous males (Figure HS 5).

Between 2013 and 2020, across all remoteness areas, the number and rate of Indigenous Australians in the health workforce increased:

• The number of Indigenous Australians working as Aboriginal and Torres Strait Islander Health Practitioners in Remote and Very remote areas combined, rose from 156 to 218 (112 per 100,000 Indigenous population to 142 per 100,000). The rate of Indigenous Australians registered as Aboriginal and Torres Strait Islander Health Practitioners was highest in Remote and Very remote areas combined.
• The number of Indigenous Australians working as medical practitioners in Remote and Very remote areas combined, rose from 12 to 35 (9 per 100,000 to 23 per 100,000)
• The number of Indigenous Australians working as nurses and midwives in Remote and Very remote combined, rose from 172 to 262 (124 per 100,000 to 171 per 100,000) (Figure HS 6).

Indigenous-specific health services

The Online Services Report (OSR) collection contains 2 measures of the workforce of organisations—full-time equivalent (FTE) staff and FTE vacancies. As at 30 June 2021, organisations reporting to the OSR employed around 8,300 full-time equivalent (FTE) staff. They also had around 247 visiting FTE staff not paid for by the organisations themselves.

Of the employed FTE staff around:

• 58% (or 4,800) were health staff, with 14% being nurses and midwives, 11% being Aboriginal and Torres Strait Islander health workers and practitioners, and 7% being general practitioners (GPs)
• 52% (or 4,300) were Indigenous
• 27% (or 2,200) were in Queensland
• 22% (or around 1,800) were in Major cities
• 91% (or 7,600) were at Aboriginal Community Controlled Health Organisations (ACCHOs).

At 30 June 2021, organisations had around 657 vacant full-time equivalent (FTE) positions. Of these around:

• 76% (or 500) were for health positions
• 37% (or 245) were in the Northern Territory
• 26% (or 170) were in Very remote areas
• 18% (or 115) were for nurses and midwives, 14% (or 90) were for Aboriginal and Torres Strait Islander health workers and practitioners
• 88% (or 580) were at Aboriginal Community Controlled Health Organisations (ACCHOs).

For more information see OSR – workforce.