Abstract: Introduction: Health inequality of Australia’s remote populations continues to confound primary care funders and policy architects and challenge Australia’s new primary health commissioning organisations. Post codes are a proxy for lower life expectancy and early onset of preventable disease. For First Nations people the health differential is severe and compounded through social determinants including racism and economic disempowerment. Population decline and climate extremes are impacting on economies and health, and new approaches are urgently needed in authentic collaboration with communities and health leaders that live and work in remote areas. As national aspirations fail to close the gap, a new regional cross-cultural partnership is aiming to harness strengths of local communities, respect cultural authority, improve sustainability, and extract better value from health investment in remote areas. Cross-cultural Alliancing: NSW Outback Division of General Practice, a regional mainstream provider and broker of primary care services and Maari Ma Health Aboriginal Corporation, a regional Aboriginal Community Controlled Health Organisation (ACCHO) have co-designed an Alliancing framework that aims to systematically improve health outcomes through greater regional autonomy and capacity. Place-based Approach: The Murdi Paaki Region (translates as ‘Black Man’s River’) covers a land area of western NSW that is greater than the UK. Covering 8 local government authorities with more than 20 First Nations language groups, this catchment is defined by a First Nations Assembly with traditional and contemporary linkages of communities along the Barwon-Darling River system. This region is remote and people have poor access to health services and often a poor experience of care. Collectively they are amongst the most socio-economically disadvantaged populations in New South Wales. Case for change: •Very high burden of illness; •Up to a 15 year gap in life expectancy; •High rates of Preventable hospitalisation and ED presentations; •Disinvestment in regional organisations with increasing emphasis on digital services; •Competitive tendering creating greater fragility of local organisations; •Loss of local decision-making and influence; •No coherent strategy for remote health. Enabling Commissioning performance: Alliancing shapes a fragile market and assists local leadership to influence place-based commissioning efficacy and safeguard complimentary and supportive relationships across local organisations. It secures an integrated, culturally safe foundation on which to collectively build wider primary health capacity, investment, sustainability, and engagement. The Alliance provides a pragmatic ‘ground-up’ approach to operational challenges that collectively impact on remote organisations and encourages joint advocacy and co-design in solutions. Shared Services and Capabilities: Alliancing is exploring new shared service functions to be aligned with agreed organisational and system priorities including workforce support and development, shared health intelligence, planning, model of care refinement and strengthened clinical leadership inclusive of cultural safety considerations. Multi-institutional Academic partnerships are being nurtured and are aligned with population health and system level priorities. Key considerations: Contemporary industry-led approach to primary care innovation that elevates cultural safety as a critical enabler for partnership and universal model of care adoption and evaluation. Transparency and trust are foundations for co-design and innovation. Regional scale without compromising organisational and community sovereignty.
Gordon, S, Davis, B, 2022, Exploring a cross-cultural system-wide Alliance empowering Aboriginal Community Controlled Health leadership through integrated partnerships enabling quality through primary care innovation in remote Australia, Volume:22, Journal Article, viewed 02 December 2023, https://www.nintione.com.au/?p=39564.