Remote Australia Online

OBJECTIVE: To undertake an evaluation of elements of the role of the child health nurse in the development of peer support for Aboriginal families with young children in a remote setting. DESIGN: The Halls Creek Community Families Program uses expertise of peer support workers to support parents of young families. In stage one, participatory action research was used. The program facilitator, who was a child health nurse, undertook action learning sets where issues were explored relating to home visiting strategies to families. Additionally, the facilitator maintained a reflective practice diary. Outcomes contributed to stage two, where an independent researcher evaluated program changes.This report relates to stage one, which used descriptive qualitative data from interviews with peer support workers and community support agencies, and the facilitator's reflective diary. Data were analysed by thematic analysis, focusing on elements of the role of the facilitator in program development. SETTING: A remote Aboriginal community in the Kimberley region of Western Australia. PARTICIPANTS: Eight peer support workers and five health and welfare professionals from community support agencies. MAIN OUTCOME MEASURES: This study measures changes in participants' understanding of the role and scope of practice of the child health nurse facilitator, thereby supporting improved support for Aboriginal families with young children. RESULTS: Thematic analysis identified three major changes in understanding the child health nurse facilitator role: working in partnership, communication strategies and education and organisational strategies. CONCLUSION: Findings suggest empowering benefits for Aboriginal peer support workers from the facilitating role of the child health nurse.

This participatory action research study was situated within a larger research study, which investigated the development of a peer-led Aboriginal parent support program in the remote setting of Halls Creek in Western Australia. The aim of this smaller research component was to explore the self-perceived role of home visiting peer support workers in this remote area. Participatory Action Research methodology was employed, within which eleven Action Learning Sets were used to facilitate participant collaboration (n = 8). All participant data was collected in focus groups during the Action Learning Sets where culturally appropriate home visiting parent support strategies were developed and examined in partnership with a child health nurse researcher. Data were analyzed using thematic analysis with three themes relating to the peer support workers' self-perceived role being identified: Helping parents be strong for their children; Strengthening culture; and Facilitating effective communication. These elements support peer support worker activities, helping parents to enhance their children's physical and psychosocial developmental environment. This research highlights the critical emerging role of peer support workers in home visiting family support in a remote area of Australia.

Background Human T-Lymphotropic virus type 1 (HTLV-1) is endemic amongst the Aborigines of the Northern Territory of Australia. HTLV-1 associated Myelopathy/Tropical Spastic paraparesis (HAM/TSP) has been associated with this infection. In general population, isolated neurogenic bladder dysfunction in HTLV-1–infected individuals without HAM/TSP has been reported and the HTLV-1 proviral load has been found to be higher in such patients compared with asymptomatic carriers. In solid organ transplantation, few cases of HAM/TSP have been reported worldwide but not an isolated neurogenic bladder. Case A 50-year-old indigenous women from Alice Springs with end stage renal disease secondary to diabetic nephropathy with no prior history of bladder dysfunction received a cadaveric renal allograft following which she developed recurrent urinary tract infections. The recipient was seropositive for HTLV-1 infection. HTLV-1 status of donor was not checked. Urodynamic studies revealed stress incontinence and detrusor overactivity without urethral intrinsic sphincter deficiency. She had no features of myelopathy. There was elevation of the serum and cerebrospinal fluid (CSF) HTLV-1 proviral load. The MRI myelogram was normal. Pyelonephritis was diagnosed based on clinical features, positive cultures and renal allograft biopsy. Continuous suprapubic catheter drainage helped preventing further episodes of allograft pyelonephritis in spite of chronic colonisation of the urinary tract. Conclusion Isolated bladder dysfunction is a rare manifestation of HTLV-1 infection and is probably associated with high proviral loads. This may adversely affect renal allograft and patient outcomes.

Social workers face unique challenges in working with families, young people and children in rural and remote communities. Simultaneously, workers juggle dual relationships, personal boundaries and high visibility. Social work practise in rural Australia also faces high staff turnover, burnout and difficulties with recruitment, retention and available professional supervision. A lack of professional supervision has been identified as directly contributing to decreased worker retention in rural and remote areas. This paper reports on emerging themes from a qualitative research study on peer supervision in virtual teams in rural and remote Australia. Data collection consisted of pre- and post-trial individual interviews, monthly group supervision sessions, online evaluations and focus groups. A key conclusion from the study is that peer group supervision worked in supporting rural and remote workers to perform their everyday professional roles. The ease and access afforded by the use of simple technology was noteworthy. Whilst the research was conducted with social workers in rural and remote areas, the use of peer group supervision could be applicable for other professionals who work with families and communities in rural and remote Australia.

Aboriginalisation or localisation of leadership in schools in remote areas of the Northern Territory is becoming more widespread in this last decade of the second millennium. Emerging models or ways in which Indigenous leadership is practised in some of these schools is the focus of this research project. Developing understandings of the history of education in its western guise and ways in which teacher education has been practised, as well as other influences which have impacted on people within remote communities are essential in order to contexualise the changes which are occurring in school governance and decision-making. Group interviews with senior Aboriginal teachers in five remote schools provide the core data for an analysis of preparation for leadership for executive teachers, decision-making structures, strengths, supports and difficulties in leadership, and areas for localised decision-making. Preparation for leadership for executive teachers in remote areas which occurs primarily through mentoring programs and accredited study courses in educational administration are detailed to provide a framework for initiatives which are being taken. Leadership theories from the western perspective provide a partial understanding of what is occurring in the localisation of educational leadership and management of some remote Aboriginal schools. A number of significant developments have occurred including ways of incorporating shared leadership into the executive of the school, greater collaboration between Aboriginal and non-Aboriginal members, and an increase in collegiality. This interplay between traditional and western leadership styles has the potential for transforming education in remote communities.

Introduction: In rural and remote regions, access to healthcare services is reliant on the availability of a competent workforce. The global challenge for the attraction and retention of health professionals in rural and remote regions is exacerbated by inconsistent management practices, as well as the disparity of distribution of health professionals between urban, rural and remote areas. This aim of this study was to examine how remote health professionals describe a sustainable remote health workforce and how they propose it could be achieved. This study contributes to the research in this field by examining how health professionals who are currently working in remote regions of Australia describe aspects of a sustainable remote health workforce. Methods: The findings from two data sources (interviews (n=24) and an online questionnaire (n=191)) were examined to identify the characteristics of a sustainable remote health workforce. A purposive sampling method was used to recruit interview participants, ensuring the sample contained managers and health professionals with longevity working in remote regions. In contrast, the online questionnaire was disseminated by eight health service providers resulting in a random sample of current health professionals. The interview and questionnaire participants were asked the same question: 'What is a sustainable remote health workforce?' A thematic analysis was conducted and the emergent themes from the interviews were used to guide the thematic data analysis for the questionnaire. Results: Examination of the characteristics of a sustainable remote health workforce, as described by health professionals currently working in remote areas, revealed that participants identified three extant themes: people, practice and place. Further analysis revealed that a sustainable remote health workforce is about an appropriate mix of health professionals with suitable personal characteristics and professional attributes to meet the remote populations' needs. Irrespective of geographical location, it seems that infrastructure, resources and community engagement together with the organisational systems influence the effectiveness of management practices. Hence, management practices influence the outcomes of many of the policy choices that can improve workforce sustainability. Conclusions: A sustainable remote health workforce is about an appropriate mix of health professionals with suitable personal characteristics and professional attributes to meet the remote populations' needs. Beyond person-fit, a sustainable remote health workforce requires an appropriate model of service delivery that provides continuity of health care through improved retention of competent health professionals. The solutions-focused approach of this study revealed opportunities for management practices that could positively influence the sustainability of future health workforces. Members of the current remote health workforce, experienced remote health professionals who know the landscape, propose that future health workforce sustainability is achievable with effective management practices focused on people, practice and place.

Indigenous people often complain that they aren’t being listened to, that researchers, institutions and policy makers aren’t taking them seriously or listening properly to their concerns (Donald, 2016). In response, researchers, politicians and interested ‘others’ make commitments to do a better job. The language of ‘better listening’ is framed in terms such as to ‘listen deeply’ (Kohn, 2016; Wallace & Lovell, 2009), or listen ‘truly’ (Snowden, 2017), and in some cases, notions of ‘listening’ as opposed to ‘hearing’ as an act of good faith in responding to Indigenous peoples’ concerns is argued (Davis, 2016). As an ‘outsider’ working in Indigenous research, it is a primary concern to respectfully engage with, interpret, and ultimately, represent the voices and concerns of Indigenous people as ethically and truthfully as possible within a broader understanding of the limitations on us to do so well, if at all. In reality, this is a precarious negotiation at the best of times and requires careful ethical/methodological consideration to better represent claims that research is ultimately beneficial to participants and the communities they represent. This paper adopts the Pitjantjatjara language term ‘kulini’ (listen to, hear) to mark out the terms of ‘ethical listening’ at the cultural interface (Nakata, 2007a) through an Aboriginal language lens. Ethical responsibilities for initiating dialogue towards action is then developed as a model based on Delpit’s (1993) framing of ethical listening and action in educating ‘other people’s children’. Working from the kulini frame provides methodological cues that can orient research towards justice and more just possibilities.

This study explored the principles of good practice that support the success of university students who come from remote Australia. The research confirms that remote students are not just a component of a larger regional cohort, but are a distinct group in themselves. Moreover, remote students often have unique knowledge, capabilities and perspectives that are a valuable part of a wider Australian culture. There is a compelling case to explore the great potential that remote Australia, its cultures and people have to offer. The research adopted a mixed-methods approach. Analysis of national datasets was undertaken to identify the unique characteristics of the ‘remote’ student cohort as a separate group, instead of it being subsumed within the broader ‘regional and remote’ equity category. Qualitative methods involved case studies of three universities, to identify ways in which the government and universities can better support remote student success. Interviews were conducted with 14 remote students and 13 staff members.

BACKGROUND: In Australia generally, smoking prevalence more than halved after 1980 and recently commenced to decline among Australia's disadvantaged Indigenous peoples. However, in some remote Indigenous Australian communities in the Northern Territory (NT), extremely high rates of up to 83% have not changed over the past 25 years. The World Health Organisation has called for public health and political leadership to address a global tobacco epidemic. For Indigenous Australians, unprecedented policies aim to overcome disadvantage and close the 'health gap' with reducing tobacco use the top priority. This study identifies challenges and opportunities to implementing these important new tobacco initiatives in remote Indigenous communities. METHODS: With little empirical evidence available, we interviewed 82 key stakeholders across the NT representing operational- and management-level service providers, local Indigenous and non-Indigenous participants to identify challenges and opportunities for translating new policies into successful tobacco interventions. Data were analysed using qualitative approaches to identify emergent themes. RESULTS: The 20 emergent themes were classified using counts of occasions each theme occurred in the transcribed data as challenge or opportunity. The 'smoke-free policies' theme occurred most frequently as opportunity but infrequently as challenge while 'health workforce capacity' occurred most frequently as challenge but less frequently as opportunity, suggesting that policy implementation is constrained by lack of a skilled workforce. 'Smoking cessation support' occurred frequently as opportunity but also frequently as challenge suggesting that support for individuals requires additional input and attention. CONCLUSIONS: These results from interviews with local and operational-level participants indicate that current tobacco policies in Australia targeting Indigenous smoking are sound and comprehensive. However, for remote Indigenous Australian communities, local and operational-level participants' views point to an 'implementation gap'. Their views should be heard because they are in a position to provide practical recommendations for effective policy implementation faithful to its design, thereby translating sound policy into meaningful action. Some recommendations may also find a place in culturally diverse low- and middle-income countries. Key words: tobacco policy implementation, challenges, opportunities, remote Indigenous Australian communities.

In 2002 a project was initiated to evaluate and restructure the Child and Youth Mental Health (CYMH) services in three health Service Districts: Cape York, the Torres Strait and Northern Peninsula Area and remote Cairns. The objective was to develop, establish and evaluate models of best practice for remote area CYMH services for Indigenous families living in far north Queensland. For the purposes of the project, an action research framework was adopted to guide the project design, methodology, implementation and evaluation. The first phase involved mapping of needs, the second phase focused on service restructure and outcomes were measured in the third phase. The planning/implementation/planning cycle was an ongoing part of the project and raised five significant themes: service equity, service quality, service sufficiency, Indigenous workforce, and service structure/ infrastructure. The principal project outcome was the establishment of a defined model of service delivery that incorporates the identified themes and sits within a community development framework. Other significant outcomes include the implementation of regular supervision and professional development activities and improvements in service data collection. This paper is a descriptive account of the process of service restructure and discusses the key project outcomes.

Introduction: Parasitic infections can adversely impact health, nutritional status and educational attainment. This study investigated hookworm and other intestinal parasites in an Aboriginal community in Australia from 1994 to 1996. Methods: Seven surveys for intestinal parasites were conducted by a quantitative formol-ether method on faecal samples. Serological testing was conducted for Strongyloides stercoralis and Toxocara canis IgG by enzyme-linked immunosorbent assays. Results: Of the 314 participants, infections were as follows: Trichuris trichiura (86%); hookworm, predominantly Ancylostoma duodenale (36%); Entamoeba spp. (E. histolytica complex [E. histolytica, E. dispar and E. moskovski], E. coli and E. hartmanni) (25%); S. stercoralis (19%); Rodentolepis nana (16%); and Giardia duodenalis (10%). Serological diagnosis for 29 individuals showed that 28% were positive for S. stercoralis and 21% for T. canis. There was a decrease in the proportion positive for hookworm over the two-year period but not for the other parasite species. The presence of hookworm, T. trichiura and Entamoeba spp. was significantly greater in 5–14 year olds (n = 87) than in 0–4 year olds (n = 41), while the presence of S. stercoralis, R. nana, G. duodenalis and Entamoeba spp. in 5–14 year olds was significantly greater than 15–69 year olds (n = 91). Discussion: Faecal testing indicated a very high prevalence of intestinal parasites, especially in schoolchildren. The decrease in percentage positive for hookworm over the two years was likely due to the albendazole deworming programme, and recent evidence indicates that the prevalence of hookworm is now low. However there was no sustained decrease in percentage positive for the other parasite species.

Newly-graduated non-Indigenous teachers who go to remote Torres Strait and Cape York Peninsula (CYP) schools may experience a range of difficulties. This paper makes some observations about one of them: the difficulty of teaching students whose first language is not English and for whom English may well be only one of several languages spoken. Moreover, none of these other languages belongs to the same Indo-European language family as English. The ramifications extend far beyond the intellectual recognition that language, normative modes of thinking and reasoning and social values are interwoven, mutually reinforcing and almost impossible to disentangle.

Slater’s focus is settler Australia’s inability to hear Aboriginal people on their own terms. The chapter explores a five-day cultural immersion and knowledge programme—run at the KALACC festival, Kimberley, Western Australia—in which government and non-government agencies were invited to ‘listen in’ to how traditional owners envision the ‘problems’ and ‘solutions’ to pressing issues in their lives, and how the grant-makers might support community-driven solutions. The festival is an untranslatable space—an anti-festival—in which the Kimberley Aboriginal world is not readily accessible and understandable to non-Indigenous people. She examines the event as an invitation for non-Indigenous Australians to recognise their crisis of hearing and listen across difference. Ethical listening, and thus transforming the foundations of settler colonialism, requires creating spaces for respectful non-comprehension.

Involvement of Indigenous people and knowledge in conservation science has become a clear directive in international covenants. Currently, approximately one-third of Australia is owned and managed by Indigenous people, including 84% of the Northern Territory coastline, making Indigenous-led and cross-cultural research highly relevant. Recently, the Yolŋu Senior Knowledge Custodians of the Laynhapuy Indigenous Protected Area in northern Australia expressed concern about the dieback of culturally significant coastal Melaleuca (paperbark) stands. A partnership between Senior Knowledge Custodians and Western scientists was used to develop an ecocultural research framework to investigate the dieback. Semistructured interviews about the likely causes were conducted with Senior Knowledge Custodians of five coastal flood plain sites where dieback occurred. At these sites, comparative ecological assessments of paired dieback and healthy Melaleuca stands were conducted to explore relationships between Melaleuca stand health, salt water intrusion, acid sulfate soils and feral ungulate damage. Melaleuca dieback was observed in three species: nämbarra (M. viridiflora), raŋan (M. cajuputi) and gulun’kulun (M. acacioides). The sociocultural and ecological research approaches similarly suggested that ~70% of Melaleuca spp. dieback was attributed to combinations of salinity and feral ungulate damage. An ecocultural approach heightened understanding of Melaleuca dieback because we detected similarities and differences in likely causal factors.

At a maths workshop we were discussing measurement as a cultural concept. One of the balanda staff asked an Aboriginal colleague how he might depict the length of a crocodile. Another Aboriginal teacher laughed. ‘You balanda always think length is important. What matters to us is the girth of the belly. Can it swallow us or not!’Territory-wide the government, through its Department of Education, has the unenviably difficult task of maintaining and providing education which is both equitable and accessible to a cohort of students who represent a third of its student population. While their common qualifier is that these students are ‘Indigenous,’ their disparate worldviews often only share some common features. It seems that in recent years, rather than meet these diverse needs the department has determined that the only way around the difficulty is to apply a relatively prescriptive curriculum to its remote Indigenous schools. This is evidenced by the Intensive English, Foundation and General Studies programs now in place for secondary aged students. Many (including Indigenous) educators argue that perhaps this is the only pragmatic answer.

Oral healthcare in rural communities shares many of the dilemmas faced by medicine in providing services to large geographical areas with dispersed populations. This study examined the population data and service provision data relevant to the geographical distribution of oral health care in Western Australia (WA). Of the 1.7 million people resident in WA, 72% were resident in the five major urban centres with only 13% in rural and remote regions. Of the 320 postcode regions, 186 had a population of less than 2500, 31 had a population from 2500 to 5000, 42 from 5000 to 10 000, 37 from 10 000 to 20 000, and 24 had a population greater that 20 000. Almost 80% of postcode regions with a population less than 2500 are in non-urban regions. Of the total of 690 dentists who were analysed in this study, it was found that the vast majority (greater than 85%) worked in practices in postcode regions within metropolitan Perth or the major urban centres. A total of 43 postcode regions did not have a dental practice within their bounds. In order to address this disparity in service availability, strategies including the development of training for medical practitioners and auxiliaries, the use of modern technology, school-based programs and the development of interdisciplinary links should be implemented. These strategies would also facilitate the development of closer links between medical and dental practitioners and the development of skills within the medical fraternity that would facilitate improved oral health in rural and remote communities.

The number of Indigenous people enrolling in and completing higher education courses in the Northern Territory slowly continues to climb. Since the first policies supporting the Australian Government's self-determination policy that encompassed training of Indigenous teachers in the Northern Territory, Charles Darwin University and Batchelor Institute of Indigenous Tertiary Education have played vital roles in increasing opportunities for Indigenous people to participate and succeed in higher education across all industries. From a policy perspective, these institutions are responsible for implementing Indigenous higher education policies at the local level in order to ensure that practice is guided by policy. Yet, there are other factors at play when considering policy implementation. This paper will provide a historical narrative around the institutional responses to national Indigenous higher education policies and summarise how implementation has often been constrained by parallel economic and socio-political forces.

INTRODUCTION: Rural-remote communities report higher smoking rates and poorer health outcomes than that of metropolitan areas. While anti-smoking programs are an important measure for addressing smoking and improving health, little is known of the challenges faced by primary healthcare staff implementing those programs in the rural-remote setting. The aim of this study was to explore the challenges and strategies of implementing an anti-smoking program by primary healthcare staff in rural-remote Australia. METHODS: Guided by a phenomenological approach, semi-structured interviews and focus groups were conducted with health service managers, case managers and general practitioners involved in program implementation in Australian rural-remote communities between 2008 and 2010. RESULTS: Program implementation was reported to be challenged by limited primary and mental healthcare resources and client access to services; limited collaboration between health services; the difficulty of accessing staff training; high levels of community distress and disadvantage; the normalisation of smoking and its deleterious impact on smoking abstinence among program clients; and low morale among health staff. Strategies identified to overcome challenges included appointing tobacco-dedicated staff; improving health service collaboration, access and flexibility; providing subsidised pharmacotherapies and boosting staff morale. CONCLUSIONS: Findings may assist health services to better tailor anti-smoking programs for the rural-remote setting, where smoking rates are particularly high. Catering for the unique challenges of the rural-remote setting is necessary if anti-smoking programs are to be efficacious, cost-effective and capable of improving rural-remote health outcomes.

‘Talking About Smoking in East Arnhem Land: Denormalisation, Stigmatisation and Leadership’ was a research project that began in 2014 in East Arnhem Land, amongst the Yolŋu peoples. The study revealed a wealth of deeper meanings and beliefs about ŋarali’ or tobacco within the context of Yolŋu tradition, history and culture. In this reflective piece, the primary author describes a personal journey of learning through observations and discussions with Yolŋu informants who shared their values, expectations and obligations associated with ŋarali’, which over time, have become interwoven with Yolŋu ceremony.

The vexed and ongoing issue of poor educational outcomes for Indigenous students in the Northern Territory continues despite years of successive programs and policies. Much of the debate has been on funding and pedagogy, in particular the merits or otherwise of bi-lingual teaching. Largely omitted from discussions, although well known by teachers and schools in remote areas to be an issue, are high rates of in-term student mobility. Such “unexpected” moves are thought to affect the capacity for students to achieve benchmark outcomes, for teachers to deliver these and for schools to administer their students within the allocated systems and budgets. Up to now teachers and schools have relied on anecdotes to engage in dialogue around the impacts of mobility. This is because adequate conceptualisations for aggregating, depicting and reporting on the size and nature of in-term mobility were not available. This paper documents several years of work into producing these outcomes. Three measures are conceptualised and outlined in this paper which will be of interest to teachers, schools and educational administrators in all jurisdictions where services are delivered in a remote setting. The results clearly demonstrate the high churn of Indigenous students within terms, especially in remote areas of the Northern Territory. The findings from this study can be applied to inform funding and policy making and as a basis for further research to document the impacts for teachers and schools.

Objective The aim of this study was to establish the nature of health practitioner (HP) motivations that are associated with the practitioner who chooses and stays in work in a very remote Indigenous (VRI) community for more than 3 years. The maldistribution of HPs across Australia and the high costs associated with their low retention rates in VRI communities underpinned the study. Little work had been conducted on the HP's intrinsic motivations relating to this workplace. The power of job-based incentives to attract and hold practitioners in remote and very remote areas has received some attention. It was hypothesised that the practitioner who chooses VRI community work will provide some motivation ratings very specific to that decision, which will be useful in predicting substantial total length of stay. Method A total of 547 HPs from four levels of remoteness in Australia responded to a HP's motivation survey. Using principal component analysis, motivation components were identified. Using binary logistic regression, likelihoods were estimated, linking motivations with VRI community work retention. Results Eight of 14 subscales developed were sensitive to VRI work experience. These formed the Very Remote Health Practitioner Motivation subscale set. Four of these motivation subscale scores together provided a significant estimate of likelihood of a practitioner having a total of more than 3 years' VRI community work experience, compared with no such experience. Conclusions The aims of the study were achieved by identifying the eight subscale set and the retention predictive model. Their potential value, limitations of the study, and future research possibilities are discussed.

Although fire is a widespread phenomenon and major ecosystem disturbance at the global scale, fire is a relatively rare event in much of the arid lands as rainfall and productivity are generally too low to support the dense vegetation and continuous fuel needed to sustain fires (Pausas and Bradstock 2007; Pausas and Ribeiro 2013). There are exceptions to this, such as landscapes dominated by xerophytic perennial grasses, where infrequent periods with above-average rainfall can result in exceptional grass and herb growth or where invasive species, particularly alien grasses, enhance fuel loads (Greenville et al. 2009; Keeley et al. 2012; Balch et al. 2013). Changes in land management (e.g. reduction in grazing, land abandonment), climate change and increased atmospheric CO2 concentrations have also been linked to increased fire activity in arid zones across the globe (Bond and Midgley 2012; Pausas and Fernández-Muñoz 2012; Bachelet et al. 2016).

The Sharing Health Care Initiative (SHCI) demonstration project, which aimed to improve management of chronic diseases, was implemented in four small remote communities in the Katherine region which are serviced by the Katherine West Health Board, a remote Aboriginal-community-controlled health organisation in the Northern Territory. We reviewed the project proposal, final report, evaluation reports and transitional funding proposal, and supplemented these with in-depth interviews with key individuals. We determined factors critical to the sustainability of the SHCI project in relation to context, community engagement, systems flexibility and adaptability, the availability and effect of information systems, and the human nature of health care and policy. The project had a significant impact on community awareness of chronic disease and an improvement in clinic processes. We found that a number of interrelated factors promoted sustainability, including: An implementation strategy sufficiently flexible to take account of local conditions; A high level of community engagement; Appropriate timeframes, timing and congruence between national policy and local readiness to implement a chronic disease project; Effective communication between participating organisations; Project champions (key individuals) in participating organisations; Effective use of monitoring and evaluation data; and Adequate and ongoing funding. The absence of a number of these factors, such as poor communication, inhibited sustainability. Other factors could both promote and inhibit. For example, the impact of key individuals was important, but could be idiosyncratic and have negative effects.

Improved Primary Health Care (PHC) utilisation is central to reducing the unacceptable morbidity and mortality rates characterising populations living in remote communities. Despite poorer health, significant inequity characterises the funding of PHC services in Australia’s most remote areas. This pilot study sought to ascertain what funding is required to ensure equitable access to sustainable, high quality primary health care irrespective of geographical remoteness of communities.

Due to the high turnover of teaching staff in remote schools, the long-term sustainability of educational initiatives that enhance Indigenous student's learning is a major concern. This article presents a study of a remote Indigenous school (Ischool) situated in Queensland. Ischool has changed its approach to leadership, particularly the distribution of power and authority within the school context, to address this concern. The focus is on building the capacity of Indigenous staff. It is a holistic and communal approach that is culturally inclusive of Indigenous ways of being and operating. The approach actively ensures that power and authority, and roles and responsibilities, are shared between Indigenous and non-Indigenous staff. Data were collected in one-on-one interviews with Indigenous and non-Indigenous participants involved in the change process. A grounded methodological approach was utilised using open coding to break down data into distinct units of meaning. The results reveal that the Indigenous community of Ischool were more committed to promoting and sustaining education initiatives that improve student learning when: (a) school leadership structures were inclusive of Indigenous voices and Indigenous ways of relating; (b) power and authority within the school context was shared, and (c) Indigenous staff were included in professional development opportunities that foster collaborative classroom partnerships and legitimise their own knowledge of their culture and community.