First Nations people and the health system
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AIHW (Australian Institute of Health and Welfare) (2024) First Nations people and the health system, AIHW, Australian Government, accessed 4 June 2026.
First Nations people and the health system
is an Australia's health
topic
Access to appropriate, high-quality and timely health care throughout life is essential for improving health outcomes for Aboriginal and Torres Strait Islander (First Nations) people (see glossary). Some aspects of health system performance for First Nations people have improved over the last decade. Barriers affecting access remain, however, as observed in the disparity in First Nations people’s level of access compared with non-Indigenous Australians.
This page presents measures of health system performance for First Nations people drawn from the Aboriginal and Torres Strait Islander Health Performance Framework (HPF) (AIHW 2024a).
For general information about the First Nations population, see Profile of First Nations people.
Measures of health system performance
The Aboriginal and Torres Strait Islander HPF monitors progress against 68 measures organised under 3 tiers: health status and outcomes; determinants of health; and health system performance.
Tier 3 of the Aboriginal and Torres Strait Islander HPF includes 22 measures organised into 6 domains relating to health system effectiveness, responsiveness, accessibility, continuity, capability, and sustainability:
Effective – the care, intervention or action achieves the desired outcome.
Appropriate – the care, intervention or action is relevant to the client’s needs and is based on established standards.
Efficient – the desired results are achieved with the most cost effective use of resources.
Measures include:
The service provides respect for persons and is client oriented, including respect for dignity, confidentiality, participation in choices, promptness, quality of amenities, access to social support networks, and choice of provider.
Measures include:
Ability of people to obtain health care at the right place and right time irrespective of income, cultural background or physical location.
Measures include:
The ability to provide uninterrupted, coordinated care or service across programs, practitioners, organisations and levels over time.
Measures include:
An individual or service’s capacity to provide a health service based on skills and knowledge.
Measures include:
System’s or organisations’ capacity to provide infrastructure such as workforce, facilities and equipment, and be innovative and respond to emerging needs (research, monitoring).
Measures include:
It is important, however, to remember that health outcomes are very much affected by factors outside the health system. For more information, see Determinants of health for First Nations people and Health and wellbeing of First Nations people.
Health system performance over time
The performance of the health system for First Nations people, as described by the measures drawn from the Aboriginal and Torres Strait Islander HPF, shows mixed results over the most recent decade. Among measures based on regularly reported data, some measures show improvement, but not all.
Improvements in health system performance for First Nations people include:
- Antenatal care (3.01): The proportion of First Nations women who accessed antenatal care (see glossary) in their first trimester of pregnancy increased from 50% to 71% between 2012 and 2020.
- Access to hospital procedures (3.06): The age-standardised proportion of hospitalisations (see glossary) of First Nations people with a procedure (see glossary) recorded increased by 19% between 2011–12 and 2020–21.
- Self-discharge from hospital (3.09): The age-standardised proportion of hospitalisations of First Nations people that ended in discharge at own risk decreased from 4.6% to 3.8% between 2011–12 and 2020–21.
- Aboriginal and Torres Strait Islander people in the health workforce (3.12): The rate of First Nations people employed in health-related occupations increased from 255 per 10,000 to 309 per 10,000 between 2011 and 2021.
- Access to services compared with need (3.14): The number of First Nation specific primary health care organisations increased from 147 to 211 between 2006–07 and 2021–22 (AIHW 2024b).
- Expenditure on Aboriginal and Torres Strait Islander health compared to need (3.21): There was a 38% increase in Australian Government expenditure on health services tailored to the needs of First Nations people between 2010–11 and 2019–20, from $703 million to $972 million.
Barriers to accessing health services
Barriers to accessing health services for First Nations people include services not being available in their area (especially for those living in remote areas), services being too far away, lack of transport, cost, waiting times, and the availability of culturally safe and responsive health services. The nuances surrounding these barriers are addressed in the measure Access to services compared with need (3.14) of the Aboriginal and Torres Strait Islander HPF.
A culturally safe and responsive health system
Improving the cultural safety and cultural responsiveness of the health system can improve access to, and the quality of, health care for First Nations people. A culturally safe health system is one that respects the cultural values, strengths and differences of First Nations people, and addresses racism and inequity. It also requires health professionals and health services to be culturally responsive, to take action to overcome racism and power imbalances and to have active engagement with First Nations clients/patients to ensure that the system meets their needs (PM&C 2020; Dudgeon et al. 2010; IAHA 2019).
To measure progress in achieving cultural safety in the Australian health system, the AIHW has developed the Cultural safety in health care for Indigenous Australians: monitoring framework (AIHW 2023). For the purposes of this framework, cultural safety is defined with reference to the experiences of First Nations health care users, the care they are given, and their ability to access services and to raise concerns.
Where do I go for more information?
For detailed information on the performance of the health system for First Nations people, see the AIHW’s and the National Indigenous Australians Agency’s (NIAA’s) Aboriginal and Torres Strait Islander Health Performance Framework and linked reports.
For more information on First Nations people’s use of health services, see also:
- Health checks and follow-ups for Aboriginal and Torres Strait Islander people
- Aboriginal and Torres Strait Islander specific primary health care: results from the OSR and nKPI collections
- Cultural safety in health care for Indigenous Australians: monitoring framework.
For broader information on this population group, visit First Nations people.
AIHW (Australian Institute of Health and Welfare) (2023) Cultural safety in health care for Indigenous Australians: monitoring framework, AIHW website, accessed 6 November 2023.
AIHW (2024a) Aboriginal and Torres Strait Islander Health Performance Framework [website], accessed 11 April 2024.
AIHW (2024b) Access to primary health care, Aboriginal and Torres Strait Islander Health Performance Framework website, accessed 10 April 2024.
Dudgeon P, Wright M and Coffin J (2010) ‘Talking it and walking it: cultural competence’, Journal of Australian Indigenous Issues, 13:29–44.
IAHA (Indigenous Allied Health Australia) (2019) Cultural responsiveness in action: an IAHA framework, IAHA, accessed 13 March 2024.
PM&C (Department of the Prime Minister and Cabinet) (2020) National Agreement on Closing the Gap [website], accessed 18 March 2024.