Beyond the pipeline: a critique of the discourse surrounding the development of an Indigenous primary healthcare workforce in Australia
Chelsea Bond A E , Mark Brough B , Jon Willis A , Janet Stajic A , Bryan Mukandi D , Condy Canuto A , Shannon Springer C , Deborah Askew D , Lynnell Angus A and Tara Lewis A
+ Author Affiliations
- Author Affiliations
A The University of Queensland Poche Centre for Indigenous Health, Brisbane, Qld 4072, Australia.
B Queensland University of Technology, GPO Box 2434, Brisbane, Qld 4001, Australia.
C Bond University, 14 University Drive, Robina, Qld 4226, Australia.
D The University of Queensland School of Medicine, Brisbane, Qld 4072, Australia.
E Corresponding author. Email: c.bond3@uq.edu.au
Australian Journal of Primary Health 25(5) 389-394 https://doi.org/10.1071/PY19044
Submitted: 18 February 2019 Accepted: 11 July 2019 Published: 17 October 2019
Journal Compilation © La Trobe University 2019 Open Access CC BY-NC-ND
Abstract
A central strategy in addressing health disparities experienced by Indigenous people has been based on a concern with workforce improvement. In this paper, the Indigenous Australian healthcare workforce literature since 1977 is reviewed and its scope of concern, as being often limited to questions of ‘supply’, is critiqued. The pipeline metaphor, whether used explicitly or implied, regularly focuses attention on closing the gap on Indigenous representation within the health workforce. The exception though is the discourse concerning Indigenous Health Workers (IHWs), where questions concerning the legitimacy of the role continue to abound within a workforce hierarchy where community knowledge, though shown to be crucial to culturally safe health service provision, is trumped by the other health professions whose knowledges and legitimacy are not in question. This contrast exemplifies the need to examine the working of power not just ‘supply’. The pipeline metaphor is disrupted with concerns about a range of other ‘gaps’ – gaps in the recognition of Indigenous knowledges, in organisational structures, in governance and in self-awareness by the health professions of their whiteness. As the health system continues to measure workforce development in terms of pipeline capacity, our study questions what happens beyond the pipeline.
References
Abbott P, Gordon E, Davison J (2007) Expanding roles of Aboriginal health workers in the primary care setting: seeking recognition Contemporary Nurse 26, 66–73.| Expanding roles of Aboriginal health workers in the primary care setting: seeking recognitionCrossref | GoogleScholarGoogle Scholar | 18041986PubMed |
Anderson I (2011) Indigenous pathways into the professions. Department of Health, Australian Government: Canberra, ACT, Australia.
Australian Bureau of Statistics (ABS) (2016) 2016 Census - Employment, Income and Education (June 2016), TableBuilder. Findings based on use of ABS TableBuilder data. ABS: Canberra, ACT, Australia.
Australian Bureau of Statistics (ABS) (2017) 2016 Census shows growing Aboriginal and Torres Strait Islander population. (ABS: Canberra, ACT, Australia) Available at http://www.abs.gov.au/ausstats/abs@.nsf/MediaRealesesByCatalogue/02D50FAA9987D6B7CA25814800087E03 [Verified 19 August 2019]
Australian Institute for Health and Welfare (2019) National Health Workforce Datasets. (AIHW: Canberra, ACT, Australia) Available at https://www.aihw.gov.au/about-our-data/our-data-collections/national-health-workforce-dataset [Verified 19 August 2019]
Bailey J, Veitch C, Crossland L, Preston R (2006) Developing research capacity building for Aboriginal & Torres Strait Islander health workers in health service settings. Rural and Remote Health 6, 556
Best O (2014) The cultural safety journey: an Australian nursing context. In ‘Yatdjuligin: Aboriginal and Torres Strait Islander Nursing & Midwifery Care’. (Eds O Best, B Fredericks) pp. 51–79. (Cambridge University Press: London, UK)
Buzzacott C (2018) I said ‘I’m in labour’ but no one listened. IndigenousX. Available at https://indigenousx.com.au/i-said-im-in-labour-but-no-one-listened/ [Verified 19 August 2019]
Cameron L (2010) Supporting Indigenous nursing students. Australian Nursing Journal 18, 39
Cameron S, Robinson K (2014) The experiences of Indigenous Australian psychologists at university. Australian Psychologist 49, 54–62.
| The experiences of Indigenous Australian psychologists at university.Crossref | GoogleScholarGoogle Scholar |
Cannady M, Greenwald E, Harris K (2014) Problematizing the STEM pipeline metaphor: is the STEM pipeline metaphor serving our students and the STEM workforce? Science Education 98, 443–460.
D’Antoine N, Paul D (2006) Pre-medicine and Pre-dentistry Program: creating opportunity for Indigenous students. Aboriginal and Islander Health Worker Journal 30, 6–8.
Dawson AP, Cargo M, Stewart H, Chong A, Daniel M (2012a) Aboriginal health workers experience multilevel barriers to quitting smoking: a qualitative study. International Journal for Equity in Health 11, 27
| Aboriginal health workers experience multilevel barriers to quitting smoking: a qualitative study.Crossref | GoogleScholarGoogle Scholar | 22621767PubMed |
Dawson AP, Cargo M, Stewart H, Chong A, Daniel M (2012b) “I know it’s bad for me and yet I do it”: exploring the factors that perpetuate smoking in Aboriginal Health Workers – a qualitative study. BMC Health Services Research 12, 102
| “I know it’s bad for me and yet I do it”: exploring the factors that perpetuate smoking in Aboriginal Health Workers – a qualitative study.Crossref | GoogleScholarGoogle Scholar | 22533609PubMed |
Deshmukh T, Abbott P, Reath J (2014) ‘It’s got to be another approach’: an Aboriginal health worker perspective on cardiovascular risk screening and education. Australian Family Physician 43, 475–478.
Ellender I, Drysdale M, Chesters J, Faulkner S, Kelly H, Turnbull L (2008) When a dream becomes a nightmare: why do Indigenous Australian medical students withdraw from their courses? The Australian Journal of Indigenous Education 37, 40–47.
| When a dream becomes a nightmare: why do Indigenous Australian medical students withdraw from their courses?Crossref | GoogleScholarGoogle Scholar |
Felton-Busch C, Maza K, Ghee M, Mills F, Mills J, Hitchins M, Park T, Chamberlain-Salaun J (2013) Using mentoring circles to support Aboriginal and Torres Strait Islander nursing students: guidelines for sharing and learning. Contemporary Nurse 46, 135–138.
| Using mentoring circles to support Aboriginal and Torres Strait Islander nursing students: guidelines for sharing and learning.Crossref | GoogleScholarGoogle Scholar | 24716771PubMed |
Fredericks B (2009) ‘Getting a job’: Aboriginal women’s issues and experiences in the health sector. International Journal of Critical Indigenous Studies 2, 24–35.
| ‘Getting a job’: Aboriginal women’s issues and experiences in the health sector.Crossref | GoogleScholarGoogle Scholar |
Garvey G, Rolfe IE, Pearson SA, Treloar C (2009) Indigenous Australian medical students’ perceptions of their medical school training. Medical Education 43, 1047–1055.
| Indigenous Australian medical students’ perceptions of their medical school training.Crossref | GoogleScholarGoogle Scholar | 19874497PubMed |
Gilroy J, Dew A, Lincoln M, Hines M (2017) Need for an Australian Indigenous disability workforce strategy: review of the literature. Disability and Rehabilitation 39, 1664–1673.
| Need for an Australian Indigenous disability workforce strategy: review of the literature.Crossref | GoogleScholarGoogle Scholar | 27384020PubMed |
Goold S (2006) ‘Getting em n keepin em’: Indigenous issues in nursing education. Australian Aboriginal Studies 2, 57–61.
Harris A, Robinson G (2007) The Aboriginal Mental Health Worker Program: the challenge of supporting Aboriginal involvement in mental health care in the remote community context Australian e-Journal for the Advancement of Mental Health 6, 15–25.
| The Aboriginal Mental Health Worker Program: the challenge of supporting Aboriginal involvement in mental health care in the remote community contextCrossref | GoogleScholarGoogle Scholar |
Hecker R (1997) Participatory action research as a strategy for empowering Aboriginal health workers. Australian and New Zealand Journal of Public Health 21, 784–788.
| Participatory action research as a strategy for empowering Aboriginal health workers.Crossref | GoogleScholarGoogle Scholar | 9489200PubMed |
Hill K, Harvey N, Felton-Busch C, Hoskins J, Rasalam R, Malouf P, Knight S (2018) The road to registration: Aboriginal and Torres Strait Islander health practitioner training in North Queensland Rural and Remote Health 18, 3899
| The road to registration: Aboriginal and Torres Strait Islander health practitioner training in North QueenslandCrossref | GoogleScholarGoogle Scholar | 29334752PubMed |
Hinton A, Chirgwin S (2010) Nursing education: reducing reality shock for graduate Indigenous nurses – it’s all about time. The Australian Journal of Advanced Nursing 28, 60–66.
Humphreys JS, Wakerman J, Wells R, Kuipers P, Jones JA, Entwistle P (2008) “Beyond workforce”: a systemic solution for health service provision in small rural and remote communities The Medical Journal of Australia 188, S77–S80.
Johnston E (1991) Royal Commission into the Aboriginal Deaths in Custody: National Report. Australian Government Printing Services: Canberra, ACT, Australia.
Jakamarra K, Peile A (1977) Across Australia … from Health Worker to Health Worker. Aboriginal and Islander Health Worker Journal 1, 19–21.
Kelaher M, Sabanovic H, La Brooy C, Lock M, Lusher D, Brown L (2014) Does more equitable governance lead to more equitable health care? A case study based on the implementation of health reform in Aboriginal health Australia. Social Science & Medicine 123, 278–286.
| Does more equitable governance lead to more equitable health care? A case study based on the implementation of health reform in Aboriginal health Australia.Crossref | GoogleScholarGoogle Scholar |
Mackean T, Mokak R, Carmichael A, Phillips GL, Prideaux D, Walters TR (2007) Reform in Australian medical schools: a collaborative approach to realising Indigenous health potential. The Medical Journal of Australia 186, 544–546.
Mark A, McLeod I, Booker J, Ardler C (2005) Aboriginal health worker smoking: a barrier to lower community smoking rates? Aboriginal and Islander Health Worker Journal 29, 22–26.
Martin DE, Kipling A (2006) Factors shaping Aboriginal nursing students’ experiences. Nurse Education Today 26, 688–696.
| Factors shaping Aboriginal nursing students’ experiences.Crossref | GoogleScholarGoogle Scholar | 17011675PubMed |
McRae M, Taylor SJ, Swain L, Sheldrake C (2008) Evaluation of a pharmacist-led, medicines education program for Aboriginal health workers. Rural and Remote Health 8, 946
Mills J, Felton-Busch C, Park T, Maza K, Mills F, Ghee M, Hitchins M, Chamberlain-Salaun J, Neuendorf N (2014) Supporting Australian Torres Strait Islander and Aboriginal nursing students using mentoring circles: an action research study. Higher Education Research & Development 33, 1136–1149.
| Supporting Australian Torres Strait Islander and Aboriginal nursing students using mentoring circles: an action research study.Crossref | GoogleScholarGoogle Scholar |
Moreton-Robinson A (2015) ‘The White Possessive: property, power and Indigenous sovereignty.’ (University of Minnesota Press: Minneapolis, MS, USA)
Munungguritj N, Burray Purray J, Gemuluwuy D, Bara P, Mamarika E (1978) Our social environment: views from health workers. Aboriginal and Islander Health Worker Journal 2, 4–8.
Murray RB, Wronski I (2006) When the tide goes out: health workforce in rural, remote and Indigenous communities. The Medical Journal of Australia 185, 37–38.
National Aboriginal and Torres Strait Islander Health Workforce Working Group (2015) Annual Report to the Health Workforce Principal Committee. Australian Health Ministers’ Advisory Council: Canberra, ACT, Australia.
National Aboriginal and Torres Strait Islander Health Workforce Working Group (2017) National Aboriginal and Torres Strait Islander health workforce strategic framework 2016–2023. Australian Health Ministers’ Advisory Council: Canberra, ACT, Australia.
National Aboriginal Health Strategy Working Party (1989) A national Aboriginal health strategy. National Aboriginal Health Strategy Working Party: Canberra, ACT, Australia.
Pacza T, Steele L, Tennant M (2001) Development of oral health training for rural and remote Aboriginal health workers. The Australian Journal of Rural Health 9, 105–110.
| Development of oral health training for rural and remote Aboriginal health workers.Crossref | GoogleScholarGoogle Scholar | 11421960PubMed |
Rallah-Baker K (2018) Closing the gap from both sides. Insight: Australia’s newspaper of ophthalmic optics. (Gunnamatta Media Pty Ltd: Melbourne, Vic., Australia) Available at https://www.insightnews.com.au/Article3/1819/Closing-the-gap-from-both-sides [Verified 19 August 2019]
Stamp G, Champion S, Anderson G, Warren B, Stuart-Butler D, Doolan J, Boles C, Callaghan L, Foale A, Muyambi C (2008) Aboriginal maternal and infant care workers: partners in caring for Aboriginal mothers and babies. Rural and Remote Health 8, 883
Stuart L, Nielsen AM (2010) Two Aboriginal registered nurses show us why Black nurses caring for Black patients is good medicine. Contemporary Nurse 37, 96–101.
| Two Aboriginal registered nurses show us why Black nurses caring for Black patients is good medicine.Crossref | GoogleScholarGoogle Scholar | 21591832PubMed |
Stuart L, Nielsen AM, Horner VE (2010) Support strategies that graduate Indigenous nurses – a dreaming journey. Journal of Australian Indigenous Issues 13, 95–100.
Taylor KP, Thompson SC, Smith JS, Dimer L, Ali M (2009) Exploring the impact of an Aboriginal health workers on hospitalised Aboriginal experiences: lessons from cardiology. Australian Health Review 33, 549–557.
| Exploring the impact of an Aboriginal health workers on hospitalised Aboriginal experiences: lessons from cardiology.Crossref | GoogleScholarGoogle Scholar | 20166903PubMed |
Templeton DJ, Tyson BA, Meharg JP, Habgood KE, Bullen PM, Malek S, McLean R (2010) Aboriginal health worker screening for sexually transmissible infections and blood-borne viruses in a rural Australian juvenile correctional facility. Sexual Health 7, 44–48.
| Aboriginal health worker screening for sexually transmissible infections and blood-borne viruses in a rural Australian juvenile correctional facility.Crossref | GoogleScholarGoogle Scholar | 20152095PubMed |
Thompson M (2011a) A review of the barriers preventing Indigenous health workers delivering tobacco interventions to their communities. Australian and New Zealand Journal of Public Health 35, 47–53.
| A review of the barriers preventing Indigenous health workers delivering tobacco interventions to their communities.Crossref | GoogleScholarGoogle Scholar | 21299700PubMed |
Thompson M (2011b) ‘The best bang for our buck’: recommendations for the provision of training for tobacco action workers and Indigenous health workers. Contemporary Nurse 37, 90–91.
| ‘The best bang for our buck’: recommendations for the provision of training for tobacco action workers and Indigenous health workers.Crossref | GoogleScholarGoogle Scholar |
Usher K, Lindsay D, Mackay W (2005a) An innovative nurse education program in the Torres Strait Islands. Nurse Education Today 25, 437–441.
| An innovative nurse education program in the Torres Strait Islands.Crossref | GoogleScholarGoogle Scholar | 15967543PubMed |
Usher K, Lindsay D, Miller M, Miller A (2005b) Challenges faced by Indigenous nursing students and strategies that aided their progress in the course: a descriptive study. Contemporary Nurse 19, 17–31.
| Challenges faced by Indigenous nursing students and strategies that aided their progress in the course: a descriptive study.Crossref | GoogleScholarGoogle Scholar | 16167431PubMed |
Usher K, Miller M, Turale S, Goold S (2005c) Meeting the challenges of recruitment and retention of Indigenous people into nursing: outcomes of the Indigenous Nurse Education Working Group. Collegian (Royal College of Nursing, Australia) 12, 27–31.
| Meeting the challenges of recruitment and retention of Indigenous people into nursing: outcomes of the Indigenous Nurse Education Working Group.Crossref | GoogleScholarGoogle Scholar |
Wainwright J, Gridley H, Sampson E (2012) Facing a world of NO: how accessible is a career in psychology for Aboriginal and Torres Strait Islander Australians? The Australian Community Psychologist 24, 143–151.
Walter M, Taylor S, Habibis D (2011) How White is social work in Australia? Australian Social Work 64, 6–19.
| How White is social work in Australia?Crossref | GoogleScholarGoogle Scholar |
West R, Usher K, Foster K (2010) Increased numbers of Australian Indigenous nurses would make a significant contribution to ‘closing the gap’ in Indigenous health: what is getting in the way? Contemporary Nurse 36, 121–130.
| Increased numbers of Australian Indigenous nurses would make a significant contribution to ‘closing the gap’ in Indigenous health: what is getting in the way?Crossref | GoogleScholarGoogle Scholar | 21254828PubMed |
Whiteside M, Tsey K, Cadet-James Y, Wilson A (2006) Empowerment as a framework for Indigenous workforce development and organisational change. Australian Social Work 59, 422–434.
| Empowerment as a framework for Indigenous workforce development and organisational change.Crossref | GoogleScholarGoogle Scholar |
Williams S (2001) The Indigenous Australian health worker: can research enhance their development as health and community development professionals? Aboriginal and Islander Health Worker Journal 25, 9–15.
Wollin J, Cannon C, Douglas H, Fairweather C, Perrett S, Ingamells A, Purcell C (2006) Attracting and retaining Indigenous students to university for nursing education. Australian Vocational Educational Review 13, 1–5.
Wright A, Briscoe K, Lovett R (2019) A national profile of Aboriginal and Torres Strait Islander health workers, 2000–2016. Australian and New Zealand Journal of Public Health 43, 24–26.
| A national profile of Aboriginal and Torres Strait Islander health workers, 2000–2016.Crossref | GoogleScholarGoogle Scholar | 30690842PubMed |
