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How is Aboriginal Health Policy Implemented?

Lloyd, J. 2008, How is Aboriginal Health Policy Implemented?, PhD thesis, Menzies School of Health Research & University of Sydney.

The development of Aboriginal-led, evidence-based policy is vital to the future of Aboriginal health, and there is now a considerable body of evidence identifying the steps in developing effective public policy. However, there is much less evidence to guide policy implementation. There is a perception in the public health literature and among practitioners, that Aboriginal health policies are either partly, or not well implemented.Qualitative research was conducted to explore the extent to which Aboriginal health policy is implemented. The research was based on a case study of the implementation of the Northern Territory Preventable Chronic Disease Strategy and involved 35 in-depth interviews with service providers and administrators across urban and remote areas of the Northern Territory.This research found Aboriginal health policies are not implemented seamlessly across all components of the health care system at the same time. Policies evolve as they are implemented. The ways in which these ideas evolve are influenced by the context in which they are received. Health professionals migrate to implementing aspects of policy that are most familiar to them rather than according to evidence or population needs. Pre-existing limitations in the structure of the health care system generate further inequities as policies evolve. If there is diminished capacity within Aboriginal health services, these services will have less ability to respond to, and therefore benefit from, policy ideas. This undermines the effectiveness of policy and the capacity of the health care system to do things differently.The implications of this research are relevant at two levels. This research has shown that, prior and during implementation, certain steps are required to enhance the effectiveness and equity with which policy ideas are implemented. When implementing policy it will be important to discern proactively who needs to be involved in the policy decision-making process and at what point; identify the deal breakers in negotiations about which aspects of policy are implemented; find ways to build the capacity of health services during implementation; and monitor the evolution of policy ideas.In addition, the research found the implementation of policy depends upon there being a robust health care system. In a region such as the Northern Territory of Australia, in which many communities are very small and very remote, and even then they are not, when there has been long-standing under-investment in developing culturally-effective health services, it is common to find health services that are inadequate to meet the demands of the communities they serve. Developing and implementing stand alone policies is not the solution to improving Aboriginal health. A comprehensive health care system is required so that all policies have a greater chance of being implemented comprehensively and equitably. This research has generated a number of lessons for building a robust health care system. There is a need to build the learning capacity of organisations; create a more equitable health care system; connect and integrate different parts of the health care system; and monitor performance.