Post-implementation review of Country Health SA’s Aboriginal Community & Consumer Engagement Strategy
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Country Health SA released its Aboriginal Community & Consumer Engagement Strategy in May 2015. Our review examined the initial implementation of the Strategy to report on how well it has been achieving its intended outcomes and give advice on what we have found ought to be done to improve the chances of achieving its intended outcomes over the longer term. With the imminent devolution of functions from Country Health to a set of six new local health networks for country South Australia, our report is also a timely evidence base to help the new health networks meet their statutory obligations to develop consumer and community engagement strategies.
The various state-run health services in South Australia are charged with implementing ‘an effective consumer engagement system’. In 2015, one of the state's several local health networks published a strategy for engagement with its Aboriginal consumers and community members. As part of the South Australian Health Performance Council’s remit to review the effectiveness of the state's community engagement methods, the Council decided to evaluate how well that engagement strategy had been implemented.
As the strategy being evaluated was about Aboriginal health consumers and community members, it was necessary that they themselves would best have the experience and legitimacy necessary to guide our review. The Council therefore set up a governing advisory group made up of people with a strong mix of Aboriginal health perspectives, including – crucially – members of the very same grass roots Aboriginal community register that was itself the flagship creation of the strategy being evaluated.
This paper introduces the project governance and the co-creation of an Aboriginal advisory group and explains the lengthy but critical collaborative process the advisory group then used to develop an agreed evaluation logic model to inform the design of the evaluation. The paper then explains how the advisory group provided governance for the substantive components of the evaluation, including advice on protecting Aboriginal cultural property by procuring external expert assistance from an Aboriginal-led social research firm to undertake primary data collection. Finally, the paper presents the iterative validation process used to prove and refine the draft findings and results to ensure that they resonated with the community.
On Friday 05 October 2018, we held a community validation event to share draft findings of our review with stakeholders and provide an opportunity for feedback and discussion. We are grateful to all those who were able to attend and are pleased to make the materials available to everyone who could not join us on the day.
This video segment, shown at slide 61 in the presentation, is a personal point of view from Klynton Wanganeen, who was involved in the review. Watch the clip here via YouTube (3min, 33sec).
Transcript of video (click to open/close)
[0:00] Good morning, or good afternoon. My name is Klynton Wanganeen – Kandi to those who know me really well, and I’m Kandi to those who don't know me so well.
[0:08] I just want to say a few words about the review of the Country Health SA’s Community & Consumer Enagement Strategy and the importance of it.
[0:19] I was one of the co-facilitators of the focus groups with PriceWaterhouseCoopers (PIC) Indigenous Consulting firm, and I can say from all of the engagement we’ve had that the review was very well received, it was important and it really builds on the uniqueness of the Experts by Experience programme that is the centrepiece of the consumer engagement strategy.
[0:49] For me, I was rapt by the amount of people that were willing to give their personal experiences, because it’s those experiences that they’ve had with the system that lead to the improvement.
[1:04] Over a considerable amount of time, we went around to various locations and we had the various cohorts, whether we’re talking about Aboriginal youth, Aboriginal Elders, Aboriginal staff, staff who've been Experts by Experience as well as working with Aboriginal Experts by Experience, and in a number of locations the Experts by Experience programme works quite well; in other areas it doesn’t work so well.
[1:38] And the review is looking at how it’s working well, why it’s working well, and then what should be done to improve it so that we have consistency and overall beneficial outcomes for the Aboriginal community.
[1:52] In some areas where it’s not working so well, it could be because there is an Aboriginal commmunity-controlled system working with the non-Aboriginal system in partnerships. In other areas they don’t really have partnerships.
[2:09] We've had administrators join us in various aspects of the review at a number of sites.
[2:15] We had multiple video links for some of the focus groups and I can say that everyone who participated was very patient and willing to come forward and have their say to contribute to the review.
[2:30] The recommendations of the review, however, are only as important as the implementation. To learn from what works well, to use that information to help others to improve their services and then, over all, improve the outcome for Aboriginal peoples.
[2:48] For me, as an Aboriginal person, I see the applicability of the Experts by Experience programme being able to be rolled out to other government programmes that serve Aboriginal people becuase there’s – besides health – quite a number of government services that do not deliver the service appropriately for our people, and it needs our people to co-design and co-deliver.
[3:11] So for all those Aboriginal people and non-Aboriginal people involved in the review, and to PriceWaterhouseCoopers Indigenous Consulting and the Health performance Council – who I named last but not least – the collaborative approach for this is important to improve the wellbeing for Aboriginal people.
Thank you very much.
Questions and discussion
A summary of the question and discussion session with participants at the webinar.
Most of the discussion among participants was around the devolution, from July 2019, of functions of Country Health onto the six new Local Health Networks that are being set up for country South Australia. Management and operation of the Experts by Experience register will be spread amongst the regions as part of this decentralisation process.
It was suggested that there should be expressly identified positions on the boards for Aboriginal expertise to be properly incorporated into the Boards’ decision-making processes, although it was noted on this matter that the legislation does require at least one member of each Board to ‘be a person who has expertise, knowledge or experience in relation to Aboriginal health’#.
Participants suggested that the findings from our review would be of interest to the new Local Health Networks in fulfilling their duties. We understand that staff in Country Health are looking to inform the new Boards about the Strategy and this review, and we expect that our final report for the review will include recommendations strongly encouraging and highlighting the need for this Strategy to continue to be applied after the devolution.
We also heard that the use of the term ‘cultural competency’ is deprecated, especially when used in a context where it might be taken as implying a measure of someone’s competency in their own culture. More modern terminology therefore differs, for instance, the staff training programme in Country Health is referred to as a ‘cultural learning framework’.
There was also some discussion on the fact, as was highlighted in the webinar, that less than 1% of all Country Health staff responded to the survey for the data collection for this review, although it is fair to note that response rates were rather higher than that for the separate surveys for executives and Aboriginal staff. It cannot be known exactly why so few staff overall chose to complete the survey, but there was consensus amongst webinar participants that it at least partly indicated and underlined an institutional cultural issue around Aboriginal affairs.
Reports from our data contractor
We appointed PwC’s Indigenous Consulting†, a majority Aboriginal-owned and operated firm, as the review’s data collection contractor, with a remit to undertake a desktop review and to run a set of stakeholder surveys and face-to-face focus group sessions.
We incorporated findings from the contractor into our final report but, for completeness, the contractor’s preliminary and post-collection reports are available for download: