Birthing in Our Community is a program that works

Once a year in Australia a ritual plays out, in three main steps.

Those working in the Indigenous sector, including in key areas such as health, education and housing, make submissions to the Commonwealth government for funding at the annual Federal Budget.

The Budget is then handed down, as it will be tonight in Australia, with much fan fare. There will be mention of Indigenous funding, but the topic will be lost in the broader mix and alternative priorities, and in the news cycle as well.

In the next couple of weeks the Minister for Indigenous Australians will then issue a press release summarising the new funding for the Indigenous sector. It will be spun as generous and targeted, when in reality it will be entirely inadequate versus needs, and the process itself will remain in the hands of bureaucrats in Canberra.

For those working in the sector this is a dispiriting cycle.  The politics are dysfunctional, the need is great, the historical injustice is manifest and the international parallels, especially to Canada and New Zealand, are galling.

On a more positive note, and with thanks to the Together Project, here is a good news story, set within this broader context.

Credit: Wayne Quilliam

Closing the Gap requires funding

The Morrison government has pledged a women-friendly budget on May 11. It should include funding to redress the unacceptable maternal and neonatal health outcomes in our Indigenous community.

In June last year we highlighted the significance of the impending National Agreement on Closing the Gap. This was a breakthrough moment, as it involved shared decision making, rather than merely consultation, as between (then) COAG, and the Coalition of Peaks, a representative body of approximately fifty community controlled organisations.

We said that the federal budget, that was delayed until October due to COVID-19, would be the test of whether the Morrison government was ‘fair dinkum’, in terms of following through. Bear in mind that under the National Indigenous Reform Agreement of 2008, COAG committed fully $4.6bn to fund the first iteration of Closing the Gap, via Federal Financial Relations arrangements.

The Morrison government duly failed that test.

The budget papers are heavy going for anyone, but new commitments, across the entire Indigenous sector, were in the (low) hundreds of millions of dollars. The biggest ticket items were for Indigenous Business Australia, the Clontarf Foundation (a non-for-profit that supports young Indigenous men), and for remote housing in Queensland and the Northern Territory. There were also significant cuts announced, most notably to the National Indigenous Australians Agency (NIAA) and the Indigenous Land and Sea Corporation (ILSC).

New funding for Closing the Gap was derisory, around $10 million over four years. And this was to cover the administrative costs of annual reports, along with three year reviews.

On net basis the entire exercise was close to a wash.

This contrasts to Canada, where the budget last week included in excess of C$18 billion dollars in new investment over the next five years to “improve the quality of life and create new opportunities for people living in Indigenous communities.”  The centrepiece was infrastructure, inclusive of water, housing, schools and roads, and for those First Nations living on-reserve.

For reference, First Nations people in Canada represent around 5% of the population: in Australia that is closer to 3.3%. Canada’s economy is larger that Australia’s, but not by much. Our exchange rate is near enough to parity.

Overton Window

The most damning aspect of this is that the pandemic opened up what is referred to in political science circles as the Overton window.

Broadly construed, this is the range of policies that is acceptable to mainstream opinion at a given point in time. It explains why the Morrison government was able to pivot toward Jobkeeper, for example, without losing the confidence of the electorate. An idea that would have previously been considered radical, was now acceptable, even popular, independent of the political ideology of the incumbent government.

There is no doubt that the Morrison government could have and should have pivoted the funding model for the Indigenous sector over the past year. While the pandemic may have been a pretext, the National Agreement was the substance.

Instead, Canberra bogged itself down with a proposal from the Productivity Commission that envisions a new bureaucratic body known as the Office of Indigenous Policy Evaluation (OPIE). The proposal has some merits, as we discussed last time. But in the circumstances, it represented a distraction at best, and a deflection at worst.

The Productivity Commission has form here, having authored the highly influential Indigenous Expenditure Reports (IER) in 2010, 2012, 2014 and 2017.

These are the same reports that enabled Warren Mundine in 2016, then Chair of the Indigenous Advisory Council, to notoriously claim that $30 billion was being spent annually on 500,00 Indigenous people.

It is difficult to understate the damage this claim did over subsequent years in political circles.

When the Productivity Commission publishes its next IER (there is no timetable), it would be well advised to highlight that direct funding to the Indigenous community represents only around 18% of the total, and to adjust for need (and remoteness) more generally.

The most important contribution the Productivity Commission could make is to belatedly recognise that a dollar in community-controlled hands, is more productive than a dollar in the hands of bureaucrats in Canberra, and their many highly paid consultants.

Credit: Ian Waldie
Credit: Bobbi-Lee Hille

Birthing in Our Community

Even if the macro level is fundamentally broken, there are things to do at the micro level.

Providing funding for, and endorsement of, what is referred to as Birthing in Our Community (BiOC), is an excellent example.

There are six key components to this redesigned health service: 1. Partnership enabling First Nations leadership and governance; 2. Continuity of midwifery carer; 3. First Nations workforce; 4. Cultural safety framework; 5. Holistic wrap-around services and 6. Coordinated care integrating primary health network with tertiary services. The emphasis is squarely upon providing a culturally safe and supportive and holistic approach, even if within a hospital environment.

The forerunner here is the partnership between the Institute of Urban Indigenous Health (IUIH), based in South East Queensland, the Aboriginal and Torres Strait Islander Community Health Service, Brisbane and the Mater Hospital.

Importantly, in March, a paper was published in Lancet, by Professor Sue Kildea, Charles Darwin University, in collaboration with partners. The summary findings, based upon the rollout of BiOC for women having babies at Mater in Brisbane between 2013 and 2019, are startling.

They include an almost 40 per cent reduction in preterm births, a 46 per cent increase in women attending more than five antenatal visits and an almost 66 per cent increase in breastfeeding. Additional outcomes included less planned caesareans, less epidurals in labour and less admissions to neonatal wards.

There was also a six-time increase in the associated Aboriginal and Torres Strait Islander workforce.

These spectacular results need to be set against the second of the sixteen targets adopted in terms of Closing the Gap. This simply reads that children are born healthy and strong.

To be sure, as, with everything in the Indigenous sector, there is a myriad of complexities in terms of rolling out BiOC, especially on a national basis. The principal requirements pertain to infrastructure and service delivery money for the Community Controlled Sector, insurance for midwives, along with adjustments required to the Medicare Benefits Schedule.

But even a staged rollout in Queensland, where the integrated IUIH network would likely guarantee success, would be welcome at this point, enabling the model to gain further traction.

Besides this, the funding required is insignificant. Indeed, BiOC would pay for itself in time, in terms of the expenditures avoided on neonatal care for preterm births.

The only real question is whether Canberra is listening. We will find out on May 11.

Credit: LightRocket

Grant Wilson the author grew up in Alice Springs. He is Head of Asia at Exante Data, and a regular contributor to the Australian Financial Review.

He extends thanks to the Together Project for running this article.

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