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The Overburden project

Funding and regulation of primary health care for Aboriginal and Torres Strait Islander people

The aim of this project was to improve the effectiveness of funding models and regulatory arrangements for Aboriginal primary health care.

The Aboriginal Community Controlled Health Services (ACCHSs) sector is the only sector of the Australian health system that BOTH provides an essential comprehensive primary health care service AND does so from a base of fragmented funding contracts. This project aimed to expand understanding of current problems and identify possible solutions in the way that Aboriginal-specific primary health care is funded and regulated across jurisdictions, from the point of view of primary health care provider organisations. In this project, the terms funding and regulation were used to mean the size and shape of the funding and revenue primary health care providers receive, the related conditions, reporting requirements and accountability measures, and the structure of the relationships between funders and providers. Project activities involved mapping and analysing current primary health care funding and regulatory models as applied to primary health care providers in all Australian jurisdictions, based on existing information and using a relational contracting framework adapted from the work of Associate Professor Josée Lavoie and others.

Note: the meaning of the term 'overburden'

The term 'overburden' comes from the mining industry, where it is used to refer to the soil, rock and other materials that must be removed to get to the ore. We used it in this project to mean the administrative work that has to be done by providers and funders to allocate, acquire, manage, report on, and account for funding and the services and other activities it was used for. These are overhead expenses and should be kept to a minimum.

Key findings

The findings highlighted that:

This project has provided a national overview of the arrangements across states and territories and a clear conceptual framework, informed by Indigenous specific values and priorities and the experience of stakeholders (both providers and funders). It proposes a framework of criteria against which the effectiveness of funding and accountability approaches can be judged, and improved. These outcomes will enable rigorous analysis and trialling of alternatives in future work by industry and researchers.

Summary of project implementation

The project explored two research questions:

  1. What are the major enablers and impediments to effective PHC delivery embedded in the current frameworks of funding and accountability for PHC services to Aboriginal and Torres Strait Islander people, in Australian States and Territories?
  2. How could the effectiveness of funding and accountability arrangements be improved, drawing on insights from current Australian practice and international comparisons?

This project investigated the impact of funding programs as implemented in terms of administrative complexity, the burden of conditions and reporting and accounting requirements, effect on comprehensiveness of service provision and on workforce (recruitment, retention and skillmix). It used a relational contracting framework for understanding the dimensions of the funding policy and programs (which was adapted by Lavoie for use in an Indigenous context)1, to analyse the characteristics of funding and related policy in five main dimensions: nature of funding, priority setting, monitoring, transaction costs and risk. The major activities were:

Related resources:
Project leader

Professor Judith Dwyer

Administering institution:

Flinders University

Completion date:

Main study: April 2007 to July 2009 Repeat funding and reporting study: July 2009 to June 2010