Governed by Contracts: The Development of Indigenous Primary Health Services in Canada, Australia and New Zealand

Abstract

This paper is concerned with the emergence of Indigenous primary health care organizations in Canada, Australia and New Zealand. In Canada, the adoption of the 1989 Health Transfer Policy promoted the transfer of on-reserve health services from the federal government to First Nations. In Australia, Aboriginal Community-Controlled Health Services first appeared in the 1970s because of community mobilization. It aims to provide some access to free health care to Aboriginal People. A more recent model, the Primary Health Care Access Program, aims at guaranteeing Aboriginal access to comprehensive primary health care services under the authority of Regional Aboriginal Health Boards. In New Zealand, Maori providers emerged because of the market-like conditions implemented in the 1990s. This study compares the policy and contractual environment put in place to support Indigenous health providers in Canada, Australia and New Zealand, using a case study approach. Results show that the contractual environment does not necessarily match declared policy objectives, especially where competitive models for accessing funding have been implemented.

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