Establishing First Nations governed health commissioning agencies: Innovations from northeast Australia

OBJECTIVE: Commissioning health services for First Nations populations has evolved with the creation of independent bodies that are more responsive to community need. This paper provides a case study of the enabling environment required to establish the Cape and Torres Health Commissioning Ltd (CaTHC), an independent First Nations entity in northeast Australia. METHODS: Qualitative semi-structured interviews and workshops with reform stakeholders (n=48) were combined with program documents (n=148), to examine the organisational structure and governance, policy and funding changes, and the data systems and accountability frameworks required to operationalise CaTHC. RESULTS: Application of policy diffusion theory indicates that CaTHC was strongly influenced by health commissioning models in Australia and Aotearoa/New Zealand. Developing each component involved clear tensions between what First Nations stakeholders viewed as important and the standards that governments require. CONCLUSIONS: CaTHC aims to embed First Nations community priorities in health service planning and purchasing to improve outcomes for the regional population. Adequate resources, supportive policy and systems change, and flexibility to innovate are required for success. IMPLICATIONS FOR PUBLIC HEALTH: With access to stable funding and increased capacity CaTHC could address challenges in the service market, leading to improvements in health system performance and healthcare outcomes aligned with end-user needs.