MESH: the answer to Abbott’s paternalism

Federal Health Minister Tony Abbott has advocated the use of administrators to improve life in some remote settlements. He talks of a vacuum of authority in many Indigenous communities. "Paternalism based on competence rather than race is really unavoidable if these places are to be well run," he is quoted as saying.

One has to wonder when this government, aided and abetted by compliant media, will drop this neo-colonialist, arrogant, finger-pointing and recognise that Aboriginal people are not stupid, they know better than any white government what their problems are and they know what the solutions are. What they need is not another lecture from a latter day A.O. Neville (the former chief protector of Aborigines). They need support to rebuild their communities in the way that they want according to their cultural values. They do not need administrators to be sent into their communities to ensure that “these places are … well run”.

A different approach is needed. This is to allow Aboriginal people to have a real say in how to improve the life of their communities. At the same time it does accept that for some communities things are not going well. The idea that some white fella might be drafted in to solve these problems is however very firmly rejected.

This alternative approach (which I have developed with an Aboriginal colleague Shane Houston) is based on what we have called MESH (Management, Economic, Social and Human) infrastructure.

Some communities manage their affairs well, others struggle. So the idea behind MESH is to accept this diversity as the starting point. Thus some communities have good “infrastructure” that provides considerable “capacity to benefit” from any program resources they receive. Other communities are not so well placed to use program resources efficiently.

Communities, which currently have a low capacity to benefit from program monies because of deficiencies in MESH, would under a MESH intervention over time have their capacity to benefit improved. This “infrastructure” can be built in all sorts of ways but is likely to involve management skills, economic resources, strong social institutions and human capital. Building up such infrastructure where it is deficient is a way to improve the capacity to benefit of those communities which are struggling.

More of the effort in Aboriginal health in Australia needs to include a strong and appropriate emphasis on involving the communities themselves and, in many policy areas, but especially primary health care (defined broadly), actual community control of services. There is a need to recognise that in many Aboriginal communities the management, economic, social and human (MESH) infrastructure on which success might be built is not there and when designing, delivering and funding Aboriginal services this needs to be taken into account.

The adoption of MESH is important not only in economic terms but also politically. The idea that Aboriginal people are getting more than a fair share of public funding and then wasting most of the money is a common myth. Nonetheless there are cases where monies have not been well used. Most often this has been because of poor management or lack of leadership, essentially lack of MESH.

The explicit recognition of this, through labeling this as lack of MESH, invests this construct of MESH with political importance. It then means that funding and resource allocation formulae need to be couched in terms of two strands: one for explicitly building up MESH and the other for program funding (with acknowledgement that the MESH stream will decrease in size over time).

The approach thus argues for investing in interventions that will first strengthen the formal and informal institutions and knowledge-skills base in Aboriginal communities and which will in turn foster the “capacity to benefit” of those specific communities which are struggling.

It has become clear from discussions with Aboriginal leaders in Western Australia that to them the concept of MESH is very real. They accepted however that its precise contents could vary from community to community.

MESH factors of leadership, community cohesion, community skill levels and strength of culture clearly involve subjective assessments. Previously, using components not dissimilar to those mentioned above, ATSIC regularly assessed the capacity of organisations and communities to manage grants provided to them for a variety of services. Other government agencies currently undertake (to differing degrees of completeness) an assessment of risk of host communities when granting funds for community based initiatives.

In most jurisdictions such assessments are considered obligatory components of the financial accountability responsibilities of agencies. Examples such as these demonstrate that MESH-type assessments are possible and can be made credible.

There is a need to decide what proportion of any overall spending that is to go to Aboriginal communities should go to MESH and what residual proportion should go to actual programs. The initial work done in Western Australia using the judgment of key Aboriginal figures suggests that in the immediate future MESH on average might account for about 40 per cent of any new spending.

Second there is a need to determine in different communities what approaches to the development of MESH are likely to prove most useful and sustainable.

The overall spend also needs to be radically increased. In primary health care alone the increase needed, just to allow Aboriginal people given their needs and access problems, to have a just share of the primary health care budget is about five times the current level. That could be paid for by reducing the 30 per cent tax rebate on private health insurance to about 15 per cent. Surely in boom time Australia we can afford to exercise such minimal caring towards and about Aboriginal people.

Whatever is spent on Aboriginal health and their well-being more generally, the key however remains to build Aboriginal community autonomy. Abbott’s paternalism will just destroy that. Sadly, that is precisely what it is aimed to do.