- Project background
The University of Queensland (UQ) Bachelor of Applied Health Science (Indigenous Primary Health Care) or Indigenous Health Program (IHP) was a unique three-year undergraduate program that ran from 1994 to 2005. At the time the program was first developed, there was a significant lack of recognition of the critical role of the Aboriginal Health Worker (AHW) within the health system. As a result, there were also limited career structures available to AHWs. The IHP sought to respond to this lack of recognition and lack of educational support by providing next level training for TAFE educated AHWs.
Development of the program curriculum commenced in 1992 through consultation with Indigenous community health leaders and other stakeholders across Queensland. While there were challenges in obtaining university endorsement for the program, the IHP was ultimately supported by UQ and courses were run through UQ Herston campus in Brisbane.
The IHP pioneered Problem Based Learning (PBL) which centres students’ prior knowledge in approaching an unfamiliar issue or problem. Students were asked to draw upon their prior knowledge and work collaboratively in small groups to identify gaps in knowledge. Through this network approach, students utilised prior knowledge while also developing and expanding their knowledge and understanding of an issue or problem.
The program was highly successful with a strong cohort of over 70 Indigenous and non-Indigenous students graduating from the program. Unfortunately, UQ felt that the program had an unsustainable funding model. With a national shift in emphasis on mainstreaming Indigenous programs in higher education, the IHP was seen to be increasingly at odds with such an approach. The last cohort of graduates completed the program in 2005.
The aims of the project were:
- To map the career trajectories of a multidisciplinary cohort of Indigenous graduates of the IHP
- To determine the enablers of professional success of these health leaders in various facets of the health system
- To investigate the impact of active participation in the community of Indigenous health professionals over the course of a career; and
- To theorise the confluence of community, subjectivity, self-determination and health.
- Activities undertaken
This retrospective cohort analysis took a strengths-based approach which privileges the narrative accounts of a multidisciplinary cohort of approximately 70 Indigenous health professionals which includes Chief Executive Officers of medical services, General Practitioners, clinical specialists, senior policy advisors, program managers and senior academics. Foregrounding their testimony illuminates our understanding of Aboriginal and Torres Strait Islander health workforce leadership across the health system.
Led by a predominantly Aboriginal and Torres Strait Islander investigative team (including researchers from UQ, Queensland University of Technology (QUT), and Bond University), this report elevates Indigenous knowledges, insights and experience in order to advance a more sophisticated Aboriginal and Torres Strait Islander health workforce agenda. ‘Moving beyond the frontline’ refers to the task of promulgating a health workforce agenda grounded in both the collective goal and realities of Aboriginal and Torres Strait Islander health workforce leadership across the health system, moving beyond the existing emphasis upon aspiration and capacity building within specific health professions.
- Outcomes and key achievements
Drawing upon the rich narratives shared through the data collection process, six key domains were identified that captured the Indigenous health workforce leadership experiences of the cohort analysed.
Building leaders through building confidence
Many of the graduates interviewed were the first in their family to attend university and had not followed a singular or straight path to higher education. For many, experiences in school had undermined their desire or capacity to pursue further education and many subsequently experienced a high degree of anxiety or self-doubt when applying to the IHP.
The IHP developed students’ confidence and strengthened graduates’ sense of themselves through affirming and centring Indigeneity. The IHP itself drew strength from the non-traditional pathways that students took to enter the program; and through the collective support of the cohort and staff, fostered a community of Indigenous health workforce graduates who used this to shape future careers.
Building leaders through building capabilities
Graduates brought to the IHP a wealth of knowledge, skills and experience. Many were self-motivated having already witnessed in their own lives and relationships the profound impact of health inequality. In coming to the program aware that existing approaches were failing Indigenous families and communities, many harboured a strong sense of the transformative potential of Indigenous knowledge. They sought to use the program to contest existing approaches that fail Indigenous people and as a means to implement Indigenist strategies and knowledges that would transform the health system.
The IHP was unique in its creation of a collective Indigenous learning environment through which Indigenous student’s identities were affirmed as critical sources of knowledge and power.
Transformative Learning Through Supportive Relationships
A key dimension of the IHP experience was the uniqueness of the program as an educational experience. Critically, all participants described the importance of the relationships they enjoyed with fellow classmates, professional staff and academic staff throughout the program and beyond.
The staff were critical to fostering the supportive learning environment. The staff created a safe learning environment that meant students did not need to expend energy battling rigid and inflexible learning spaces. The isolation of the Herston campus was also seen to be an advantage, giving students time to develop strong relationships with their cohorts as part of a more intimate hospital campus.
Transformative Learning Through Innovating Indigenous Health
Participants attributed the transformative work of IHP to the innovative approach it took in regard to Indigenous health, and the skills, attributes and understandings it sought to inculcate in students. It utilised an Indigenous health pedagogy that relied upon input from Indigenous community stakeholders in the design of the degree.
The IHP was an active research centre where students acquired foundational research skills and experience in communities. The role of Problem Based Learning (PBL) impacted participants and may reflected how this learning approach became a skill for life. It allowed for a two-way learning environment where students were able to teach the educators by drawing upon their prior knowledge. For educators, they spoke of how their teaching and knowledges were enriched as a result of working with the IHP students.
A Different Kind of Health Professional in a not so different Health System
The program developed “a different kind of Aboriginal Health Worker” with participants reflecting on how they felt better equipped to effect tangible changes through a community development and social determinants approach. It empowered and nurtured students, not just as ‘health professionals’ but also as advocates and activists within a health system still failing to adequately meet the needs of Indigenous peoples. For many participants, this equipped graduates to take on further study after completing the IHP.
For some graduates, there was frustration after graduation that employers did not sufficiently recognise the degree or that career trajectories were not always clear after graduating. There was at that time a political climate opposed to the community-controlled health sector and the Aboriginal Health Worker (AHW) role. There were also critical barriers, including structural and interpersonal racism, that denied recognition of a new kind of Indigenous health professional.
A different kind of leadership
While the goal of the IHP was to develop Aboriginal and Torres Strait Islander leadership through a highly skilled AHW workforce, it also proved to be an enabler of non-Indigenous leadership for both staff and students. For non-Indigenous graduates, discussion centred on the challenges of being exposed to racist comments in the work space and the work needed to educate and challenge the assumptions held by non-Indigenous colleagues.
For Indigenous students, a new kind of leadership emerged of which their own Indigeneity was central. Many students discussed how the IHP helped them connect with and/or affirmed their cultural identity. Leadership was characterised as relational rather than hierarchical, emphasising one’s Indigeneity and accountability to community. Participants spoke of leadership and success in a collective rather than individual sense with many not only proud of their own achievements but also the collective achievements of the cohort.
- Impact of research
While Indigenous health workforce issues may often be understood in terms of numbers and statistics, the findings of this project reveal that such an approach may often overlook the underlying human stories which give depth and nuance to the complexities of Indigenous health workforce leadership. Through a strength-based approach that centred the lived experiences of graduates from the IHP, there emerged a new way of thinking about leadership; one that centres Indigenous sovereignty so that it underpins educational and career pathways. It understands Indigeneity as an asset that engenders Indigenous knowledge and strength, so providing for effective leadership in the Indigenous health workforce.
Centring Indigenous sovereignty requires a reimagining of the Indigenous health workforce agenda so that it becomes an Indigenist health workforce agenda; one that conceptualises resistance as an emancipatory imperative and seeks to demonstrate political integrity through Indigenous control and the privileging of Indigenous voices. By advocating for an Indigenist health workforce agenda we seek to unsettle and fracture dominant discourses that frame Indigenous peoples as less than and that fail to account for structures and relations of power that deny Indigeneity as a source of power, authority and knowledge. We seek to ignite a space through which a varied and diverse Indigenous health workforce can resist, reimagine and recreate the conditions that nurture the health and wellbeing of Indigenous peoples.
- Next steps
We advocate for a reformed and transformative health workforce agenda. Drawing from the intellectual work of Rigney, we suggest an Indigenist health workforce agenda that centres Indigenous sovereignty rather than a notion of equity measured by population parity. Such an approach demands a reconfiguration of existing strategies, and success measures, each of which necessitate a radical rethink of Indigeneity.
In advancing an Indigenist health workforce agenda, we make the following recommendation that such an agenda:
- Develop a strength-based approach to Indigenous student recruitment and retention in higher education;
- Reconfigure our gaze upon possibilities rather than pipelines, celebrating and enabling existing Indigenous capabilities, leadership and transformative aspirations;
- Cultivate interdisciplinary Indigenous intellectual spaces to support the collective interests of Indigenous peoples and expand Indigenous leadership;
- Measure Indigenous health workforce success beyond keeping account of how many Indigenous peoples enter mainstream services and professions;
- Imagine Indigenous health workforce in terms of the transformative change of communities/services/systems rather than only attending to occupational aspirations of individuals and building resilience to a resistant health system;
- Require that the health system interrogate its own aspirations for and expectations of Indigenous people, including its resistance to addressing the unfinished business of the AHW career structure; and
- Work with peak and advocacy bodies (both Indigenous and mainstream) so that they can support this proposed re-purposed agenda.