Aboriginal and Torres Strait Islander Health Workers and Health Practitioners – The A to Z of Allied Health
Improving the health and wellbeing experiences and outcomes of First Nations people and communities is critical to reducing the gap between the life expectancy of First Nations and non-First Nations Australians.
Aboriginal and Torres Strait Islander Health Workers and Health Practitioners (ATSIHWP) are fundamental healthcare workers that provide culturally safe and inclusive healthcare to First Nations people and communities, as well as education for the broader health and social care workforce to promote optimal care and service delivery for First Australians.
What do Aboriginal and Torres Strait Islander Health Workers and Health Practitioners do?
ATSIHWPs are part of a standalone profession and work within multidisciplinary teams including medical doctors, community and practice nurses, dentists, podiatrists, and other allied health professions. The ATSIHWP workforce is unique to Australia.
ATSIHWPs work with First Nations people and within communities to provide a range of clinical, supportive, and advocacy services.
The scope of practice of an ATSIHWP depends on their qualifications, clinical experience, work setting, and access to clinical supervision.
Some of the activities ATSIHWPs typically engage in during their day-to-day work include:
- Clinical assessments and screening for common physical or mental health conditions, such as high blood pressure and anxiety/depression
- Education and health promotion to reduce modifiable risk factors, such as smoking, poor nutrition, and physical activity
- Clinical services such as the administration of vaccines and the provision of diabetes education and support
- Share important health messages with First Nations people and communities, such as via flyers and brochures
- Liaise with health care team members, and where appropriate, make referrals to other health services and providers
- Administer and provide access to medications
- Develop, implement, and evaluate community or population level health programs and resources
- Interpret and translate health information for First Nations people.
Another important aspect of ATSIHWPs’ role is attending community forums to develop their understanding of issues impacting the community they work with, and to build rapport with community members. They also provide education, training and support for health workers, policy makers, and researchers which may be formal or informal.
History of Aboriginal and Torres Strait Islander Health Workers and Health Practitioners
The ATSIHWP role was referred to in the healthcare literature as early as 1977 when Kumantje Jagamara reflected on his journey to becoming a Ngangkari or “medicine man”. Rather than learning through university training, community-held knowledge of practice was handed down to Jagamara. At this time, there was an apparent lack of trust in non-First Nations health systems.
In the 1990s, the health disparities between Indigenous and non-Indigenous populations became a feature of the health research literature. It was not until approximately a decade later that the role of Aboriginal Health Workers (AHWs) in reducing these health inequalities was described in the health workforce literature.
The lack of recognition of the key role played by AHWs in the health system, as well as the need for educational support for AHWs, led to the development of the Indigenous Health Program (IHP). The development of the IHP began in 1992 in consultation with First Nations community health leaders and other stakeholders across Queensland. Following challenges securing university endorsement, the IHP was eventually supported by the University of Queensland in Brisbane.
The University of Queensland Bachelor of Applied Science (Indigenous Primary Health Care) or IHP ran from 1994 – 2005 as a 3-year program to train TAFE educated AHWs. The IHP was unique and considered successful, with more than 70 Indigenous and non-Indigenous student graduating from the program. However, amid concerns held by the University of Queensland about the sustainability of the IHP and its funding model, the program was abandoned. The last cohort graduated in 2005.
In 2009, the National Association of Aboriginal and Torres Strait Islander Health Workers and Practitioners (NAATSIHWP) was established. Among other things, the NAATSIHWP was tasked with professionalising and promoting the ATSIWHP workforce.
In 2012, there were several important milestones for the Aboriginal Health Workforce. First, the establishment of the Aboriginal and Torres Strait Islander Health Practice Board of Australia (ATSIHPBA), with its role to regulate and register the new ATSIHWP role. Second, the Australian Government produced a report with recommendations to develop and expand the ATSIHWP workforce. Among the 27 recommendations was an endorsement of the need to support the existing Aboriginal Health workforce to meet the minimum education requirements for registration as an ATSIHWP through the recognition of prior learning.
In 2013, Health Workforce Australia contracted James Cook University and its partners to implement a two-year ATSIHWP workforce accredited skills recognition and upskilling project in north Queensland. There were only 10 ATSIHWPs employed in Queensland at the time, most of these working in the south part of the large state. The history of uncertainty about the ATSIHWP role, its scope of practice, and appropriate delegation to, and utilisation of the role added to the significant challenge of developing an educational and registration pathway for the ATSIHWP workforce. Despite this, it was thought that the region-wide collaborative project involving the health and higher education sector contributed to a strengthened ATSIHWP workforce in the area.
Wright and colleagues’ study of the national ATSIHWP workforce between 2000 and 2016 uncovered a concerning trend: that the overall growth of the workforce was not aligned with population growth, and in some regions was in fact declining. They also noted higher enrolments in training programs, but lower than expected completion rates for aspiring Aboriginal and Torres Strait Islander Health Workers.
The current National Aboriginal and Torres Strait Islander Health Workforce Strategic Framework and Implementation Plan (2021-2031) highlights critical role of a suitably qualified health workforce in addressing the health inequality experienced by Aboriginal and Torres Strait Islander people. However, the ATSIHWP role remains poorly defined and inadequately supported at the national level. As part of the strategic framework and implementation plan, the NAATSIHWP and ATSIHPBA will lead the revision of the scope of practice and education pathways for ATSIHWPs. This is expected to result in more ATSIHWPs working to the top of their scope and their skills being fully utilised within their health services and communities.
Where do Aboriginal and Torres Strait Islander Health Workers and Health Practitioners work?
ATSIHWPs work in a range of geographic settings typically in regional, rural and remote areas, however they may also work in metropolitan settings. They work in hospitals, community-based health services, mental health services, rehabilitation services, and general practice clinics. They may also work for Aboriginal Community-Controlled Health Organisations (ACCHO), and in health policy.
Few currently work within research institutions; however, this is expected to change with greater emphasis on promoting active participation of Aboriginal and Torres Strait Islander people in research, and on Aboriginal-led research.
Important character traits of Aboriginal and Torres Strait Islander Health Workers and Health Practitioners
It is important that ATSIHWPs have a deep understanding of the many factors that influence First Nations peoples’ experiences of health, high levels of culture awareness and sensitively. For these reasons, an ATSIHWP must be of Aboriginal or Torres Strait Islander descent.
ATSIHWPs need excellent communication skills and the ability to negotiate with members of the community that may have had negative experiences of healthcare and other government services throughout their lives.
ATSIHWPs may spend a great deal of time travelling between communities, so they need to be organised and able to plan their time and activities to maximise efficiency and impact. They must also be able to work autonomously but also as part of a broader health and social care team.
Finally, creativity and the drive to improve the lives and wellbeing of individuals and communities, are also important character traits for ATSIHWPs.
What are the professional education and regulatory frameworks for Aboriginal and Torres Strait Islander Health Workers and Health Practitioners?
Aboriginal and Torres Strait Islander Health Practitioners must attain a Certificate IV in Aboriginal and/or Torres Strait Islander Primary Health Care Practice. Moreover, they must be registered with the Aboriginal and/or Torres Strait Islander Health Practice Board of Australia, a national regulation body.
Aboriginal and Torres Strait Islander Health Workers complete at minimum, a Certificate II in Aboriginal and/or Torres Strait Islander Primary Health Care. In some jurisdictions, for example in South Australia, the minimum requirement for these allied health professionals is a Certificate III in Aboriginal and/or Torres Strait Islander Primary Health Care.
Workforce considerations for Aboriginal and Torres Strait Islander Health Workers and Health Practitioners
ATSIHWPs are central to initiatives designed to reduce health inequities impacting Aboriginal and Torres Strait Islander People, and the Australian Government is working to expand the Aboriginal and Torres Strait Islander Health workforce more generally. The Aboriginal and Torres Strait Islander Health Practitioner workforce is slowly increasing, with 900 currently registered with the Australian Health Practitioner Regulation Authority. More than three quarters of these registered health practitioners are female. The comparatively small male Aboriginal and Torres Strait Islander Health Practitioner workforce may present additional barriers to some First Nations men accessing culturally appropriate health services.
