Academic journal article Australian Health Review

Closing the (Service) Gap: Exploring Partnerships between Aboriginal and Mainstream Health Services

Academic journal article Australian Health Review

Closing the (Service) Gap: Exploring Partnerships between Aboriginal and Mainstream Health Services

Article excerpt


The crisis (in terms of Aboriginal health in Australia) is that we as a people and service agencies don't know how to come together to find solutions to these problems and to create the synergy necessary to respond. [Attributed to Kerry Colbung, 2004A]

There are many reasons for organisations to collaborate in the delivery of human services around complex issues. Cost efficiencies in planning, research, training and other development activities such as avoiding duplication of effort are key benefits, as is making services that are more likely to meet the complexity of client needs.1 According to Mattesich et al., 'Collaboration results in easier, faster and more coherent access to services and benefits and in greater effects on systems. Working in synergy is not a substitute for adequate funding although the synergistic efforts of the collaborating partners often result in creative ways to overcome obstacles' (p. 3-4).1 It is therefore not surprising that governments at all levels have been increasingly interested in whole-of-government approaches and collaboration between services, as well as new ways of planning, funding and delivering services to deal with social and health problems.

Since the release of the Social Justice Report in 2005, the 'Close the Gap' campaign has advocated for the Australian Government to reduce the 17 year life expectancy gap between AboriginalB and non-Aboriginal Australians by 2030.2 Partnerships between mainstream and Aboriginal health services are strongly supported as a means of improving Aboriginal life expectancy3 and there has been increasing focus at the state level for strategic partnerships to improve Aboriginal health service access and outcomes.4-6 Such partnerships are seen as fundamental if services are to address the complex social determinants driving poor Aboriginal health7 while working towards a more culturally competent model of service delivery. Yet although these partnerships may have benefits, those working in Aboriginal health are aware of the tensions that exist and that can impede robust Aboriginal-mainstream relationships, while acknowledging that different approaches to health service delivery often create challenges for staff and clients. To assist such partnerships to be genuinely successful, it is important they are informed by best practice.

A seminal literature review conducted first in 1992 and updated in 2001 by Mattesich et al. sourced (in total) 414 studies and identified six key factors that characterise successful collaborations (Box 1).1 The World Health Organization (WHO) emphasises that collaboration involves joint planning, joint implementation and joint evaluation between individuals or organisations working towards a common purpose.8 However, relatively little information is available that addresses how to build effective partnerships between Aboriginal and mainstream health services.9

This literature review was initially undertaken at the request of an Aboriginal community controlled health service that had entered into a partnership with mainstream health services, to understand the issues and strategies for enhancing cross-cultural collaborative arrangements. Given that the purpose of the review was to explore the relational aspects of a partnership (as opposed to simply contractual) we adopted Mattesich et al.'s definition of collaboration as most pertinent to the joint arrangements which are the subject of our study:

A mutually beneficial and well-defined relationship entered in to by two or more organisations to achieve common goals. The relationship includes a commitment to mutual relationships and goals; a jointly developed structure and shared responsibility; mutual authority and accountability for success; and sharing of resources and rewards (p. 11).1

In this paper, the terms 'partnership' and 'collaboration' are used interchangeably to refer to a joint arrangement between Aboriginal-mainstream health services (and the staff employed by them). …

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