Contracting for indigenous health care: towards mutual accountability

In Australia and other industrialised countries, governments contract with the non-government sector for the provision of primary health care to indigenous peoples. Australian governments have developed policies and funding programs to support this health sector, but the current arrangements are unduly complex and fragmented. The results of our study show that the complex contractual environment for Aboriginal Community-Controlled Health Services (ACCHSs) and their funders is an unintended but inevitable result of a quasi-classical approach to contracts applied by multiple funders. The analysis in this article highlights potential policy and program changes that could improve the effectiveness of funding and accountability arrangements, based on the use of an alliance contracting model, better performance indicators and greater clarity in the relative roles of national and jurisdictional governments.