Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia; and Poche Centre for Indigenous Health, The University of Sydney, Sydney, NSW, Australia.
Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia; and Menzies Centre for Health Policy and Economics, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
Aust J Prim Health. 2024 Sep;30. doi: 10.1071/PY24054.
Background The factors informing decisions to fund health services for Aboriginal and Torres Strait Islander children are unclear. This study's objective aimed to describe decision-makers' perspectives on factors informing decisions to fund health services for Aboriginal and Torres Strait Islander children. Methods We conducted semi-structured interviews with 13 participants experienced in making funding decisions at organisational, state, territory and national levels. Decision-makers were from New South Wales, Northern Territory, Queensland, Victoria and Western Australia. Transcripts were analysed thematically following the principles of grounded theory. Results We identified five themes, each with subthemes. First, prioritising engagement for authentic partnerships (opportunities to build relationships and mutual understanding, co-design and co-evaluation for implementation). Second, valuing participant experiences to secure receptiveness (cultivating culturally safe environments to facilitate acceptability, empowering for self-determination and sustainability, strengthening connectedness and collaboration for holistic care, restoring confidence and generational trust through long-term commitments). Third, comprehensive approaches to promote health and wellbeing (linking impacts to developmental milestones, maintaining access to health care, broadening conceptualisations of child health). Fourth, threats to optimal service delivery (fractured and outdated technology systems amplify data access difficulties, failure to 'truly listen' fuelling redundant policy, rigid funding models undermining innovation). Fifth, navigating political and ideological hurdles to advance community priorities (negotiating politicians' willingness to support community-driven objectives, pressure to satisfy economic and policy considerations, countering entrenched hesitancy to community-controlled governance). Conclusion Decision-makers viewed participation, engagement, trust, empowerment and community acceptance as important indicators of service performance. This study highlights factors that influence decisions to fund health services for Aboriginal and Torres Strait Islander children.
为原住民和托雷斯海峡岛民儿童提供健康服务的资金决策因素尚不清楚。本研究的目的旨在描述决策者对影响为原住民和托雷斯海峡岛民儿童提供健康服务资金决策的因素的看法。
我们对 13 名在组织、州、地区和国家各级有资金决策经验的参与者进行了半结构化访谈。决策者来自新南威尔士州、北领地、昆士兰州、维多利亚州和西澳大利亚州。根据扎根理论的原则，对转录本进行了主题分析。
我们确定了五个主题，每个主题都有子主题。首先，优先考虑参与以建立真正的伙伴关系（建立关系和相互理解、共同设计和共同评估以实施的机会）。其次，重视参与者的经验以确保接受度（营造文化安全环境以促进可接受性、赋予自主权和可持续性、加强整体关怀的联系和协作、通过长期承诺恢复信心和代际信任）。第三，全面的方法促进健康和福祉（将影响与发展里程碑联系起来，维持获得医疗保健的机会，扩大儿童健康的概念化）。第四，对最佳服务提供的威胁（破碎和过时的技术系统加剧了数据访问困难，未能“真正倾听”助长了多余的政策，僵化的资金模式破坏了创新）。第五，应对政治和意识形态障碍以推进社区优先事项（协商政治家支持社区驱动目标的意愿，满足经济和政策考虑的压力，克服对社区控制治理的根深蒂固的犹豫）。
决策者认为参与、参与、信任、赋权和社区接受是服务绩效的重要指标。本研究强调了影响为原住民和托雷斯海峡岛民儿童提供健康服务资金决策的因素。
