_________________________________________________________

ACTIONS FOR POLICY AND IMPLEMENTATION

Policy makers need to consider appropriate funding and scale-up strategies for evidence-based strategies included in state and national plans to address Aboriginal and Torres Strait Islander health issues.

Funding and workforce training models need to be re-considered and adapted for population prevention strategies such as school-based fluoride varnish programs.

Plans and strategies require appropriate funding and a commitment to regular review, evaluation and reporting if efforts to close the gaps in Aboriginal and Torres Strait Islander Health are to be successful.

_________________________________________________________

RESEARCH CONTEXT

There have been multiple National and State oral health plans and strategies developed in Australia and all include Aboriginal and Torres Strait Islander peoples as a focus, particularly children. Nevertheless, these plans often remain plans with only limited progress and evaluation. In NSW, an Aboriginal Oral Health Plan was developed under the leadership of an Aboriginal Elder and was the first such Plan developed, released, and actively implemented in NSW. In 2021, we led a project with three Master of Public Health students to undertake a formal scoping review of progress against the Plan.

Of the 25 peer-reviewed journal articles identified by the scoping review; 16 were led by the Poche Centre for Indigenous Health at the University of Sydney in collaboration with partners including Aboriginal Community Controlled Health Services (ACCHSs). All these studies used an adapted collective impact approach to co-design which we have named the “Rambaldini Model” in recognition of Bundjalung Elder Boe Rambaldini who not only co-authored the Plan with a Senior Policy Analyst at the NSW Ministry of Health but spent almost five years implementing the Plan as the Director of the Poche Centre for Indigenous Health.

The interest generated from this engagement and research led to substantial national interest from academic, policy makers and health care professionals that further widened the impact of the Plan. The use of co-design and strong engagement with ACCHSs and Aboriginal communities and partners led to several new models of care and prevention initiatives that have endured for the life of the Plan. This led to increased funding by the NSW Ministry of Health as well as philanthropists. We found that the process of codesign and valuing Indigenous ways of knowing, being and doing enabled the development of projects that addressed a range of social and economic determinants of oral health and general health. For instance, our co-designed oral health service delivery model led to the development of a school based oral health promotion program. The oral health promotion program led to the development of a school-based fluoride varnish program which has now generated national and international interest. The Aboriginal and Torres Strait Islander Health Theme has noted these linkages in the model below that includes our work in oral health and workforce, and more recently food policy and systems.

We were able to then develop our Aboriginal Dental Assistant Scholarship Program which was influenced by all these projects. We have also built on the implementation of the water fountains in oral health promotion program with a state and national initiative to roll-out fountains nationally in rural and remote areas. These initiatives have led to further collaboration between jurisdictions, partners, and universities, often in the absence of policy leadership from the Commonwealth. With our partners in academia, government and in the related professions we have sought to identify and address implementation barriers. This work has led to greater interest in co-translation of this evidence-based strategic from policy into practice. Importantly co-produced research has been undertaken at key steps along the way with our partners which in turn has led to further scale-up where local jurisdiction resources are available.  In NSW alone our work has led to a further investment of over $5M via our programs at the Poche Centre at the University of Sydney and this has often directly supported staffing and services at ACCHSs.

Two of the main reasons we have been successful in this work is that we have two engaged Aboriginal leaders and Elders who understand where oral health fits in the wider health research and policy environment at the state and national level. It is vital to have leaders who can represent the needs of community for evidence-based initiatives against a background where there is often political, professional, and academic inertia. The second critical reason for success is the ongoing engagement, trust and feedback with communities and partners, an absolute commitment to shared decision making and the application of a Continuous Quality Improvement (CQI) practice throughout projects.

_________________________________________________________

Read more here.

Read the NSW Aboriginal Oral Health Plan 2014-2020 here.

Follow the Poche Centre for Indigenous Health on Twitter.
Follow John Skinner on Twitter.
Follow Kylie Gwynne on Twitter.
Follow Boe Rambaldini on Twitter.