Recent health workforce initiatives in Australia have recognised that more equitable, accessible, efficient and effective care can often be achieved through intermediate-level workers such as health assistants and health workers1. In many Indigenous settings, particularly in rural and remote areas, the intermediate-level Aboriginal and Torres Strait Islander Health Workers (AHWs) have been recognised as contributing to improving health outcomes2, as facilitating access to the health system for Aboriginal and Torres Strait Islander people3 and as the backbone of Aboriginal community-controlled health services4. Likewise in the mental health area, Aboriginal and Torres Strait Islander Mental Health Workers (AMHWs) have been recognised as key service-providers for health promotion and treatment in Aboriginal mental health services in community contexts5.
Not surprisingly, the issue of the training and credentialing of AHWs and AMHWs has increasingly been an issue of interest, even beyond the current national focus on registration and credentialing of health professions in general. While discussion about this issue has existed for decades6,7, the recognition that AHWs and AMHWs potentially play a strategically important role in ‘closing the gap’ in Indigenous health care has further fuelled interest in such credentialing.
Since July 2012, the roles of AHWs have been incorporated into the new profession of Aboriginal and Torres Strait Islander Health Practitioner (ATSIHP), which has been registered under the Health Practitioner Regulation National Law Act 2009. Replacing the varied requirements across states and territories, the Aboriginal and Torres Strait Islander Health Practice Board of Australia has now set the professional standards that practitioners must meet to be registered, and a new National Aboriginal and Torres Strait Islander Health Worker Association has been incorporated. These shifts have substantial implications for credentialing, training and capacity building, as well as considerable consequences for responsiveness to local contexts.
While there has been important discussion regarding the skills and training required for the AHW3 and AMHW8 workforce, the issue remains largely unresolved1,9. In the case of the new role of ATSIHPs, the Board has specified completion of a particular Vocational Education Training (VET) Certificate IV qualification as the eligibility requirement for registration. Currently the process of skills assessment, credentialing, recognition and up-skilling prior to registration is being formally investigated and determined. A key consideration in this process will be the precedent of established training for ATSIHPs in some settings, which is competency-based and delivered within the VET sector through a series of complementary Primary Health Care certificates10. Such competency-based learning is often associated with the performance of delegated tasks within a rule-based structure. The recently identified need for a national skills assessment initiative (currently under way, commissioned by Health Workforce Australia) suggests that for ATSIHPs, the emphasis on credentialing, the content and the method of training for such workers, particularly those working in remote communities, is a matter of considerable interest. More importantly, the response to this issue has bearing on the quality and nature of services, and on the wellbeing of people in Indigenous communities, particularly remote communities.
In this brief commentary we suggest that this emphasis on credentialing might be informed by drawing attention to the following: (a) that the model of service delivery for Indigenous and particularly remote Indigenous communities is the comprehensive primary health care (CPHC) model, (b) that the context of service delivery in Indigenous and particularly remote Indigenous communities is complex, and (c) that this model and context are well suited to a critical thinking and reflective practice approach to workforce development.