Funding Aboriginal primary health care

Abstract

This paper provides an estimate of what should be spent on Aboriginal primary health care (PHC). Beyond that, it examines how such funding might best be allocated between on the one hand, programs, and on the other what might be broadly called ?investment in infrastructure?. The addressing of needs arising from a holistic Aboriginal construct of health is discussed. The paper adopts a definition of equity as equal access for equal need, but with three departures from how this is normally expressed (1) the use of ?capacity to benefit? as the basis of need - as opposed to the more conventional ?sickness-based? need (2) the weighting of capacity to benefit to reflect relative disadvantage and (3) the incorporation of the concept of MESH (Management Economic Social and Human) infrastructure to recognise that not all communities are equally well placed to use funds to allow them to realise their capacity to benefit. To arrive at a composite figure for the ratios of funding for Aboriginal versus non-Aboriginal PHC, three ratios (2.9 for relative need as capacity to benefit, 1.2 for vertical equity, and 1.5 for cultural security) are multiplied together. This gives an overall factor of over 5 as the minimum ratio of funding per capita for Aboriginal PHC compared to non-Aboriginal PHC. The paper also discusses certain aspects of how to use the funds and what research is needed to allow estimates of funding requirements to be improved.