First Nations people and the health system

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. Several aspects of health system performance for First Nations people have improved over recent years. However, barriers affecting access remain, 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 2024).

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:

However, it is important to remember that health outcomes are affected to a large degree 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

Across the health system performance domains in the HPF, most indicators show improvement. Progress is uneven though and some areas remain inconclusive, largely due to limitations in being able to interpret trends data.

In the ‘effective, appropriate and efficient’ domain, indicators related to antenatal care, immunisation, chronic disease management, access to hospital procedures and preventable hospitalisations all improved, while early detection indicators recently declined.

In the ‘responsive’ domain, indicators for discharge at own risk from hospitals and Aboriginal and Torres Strait Islander people in the health workforce improved but indicators for mental‑health‑related hospitalisations worsened.  

The domains ‘accessible’, ‘continuous’ and ‘capable’ show improvements related to First Nations specific primary health care organisations, chronic disease care planning and training respectively.

‘Sustainable’ overall improved, especially recruitment and retention, however rising expenditure remains challenging to interpret.

More specifically, some of the notable improvements in health system performance for First Nations people include:

• Antenatal care (3.01): The proportion of First Nations women who accessed antenatal care in their first trimester of pregnancy increased from 50% to 71% from 2012 to 2020.
• Immunisation (3.02): The proportion of fully immunised First Nations children at age 5 increased from 93% to 96% over the period 2013–2022.
• Access to hospital procedures (3.06): The age-standardised proportion of hospitalisations of First Nations people with a procedure recorded increased by 12% between 2016–17 and 2022–23.
• 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 3.9% to 3.7% between 2016–17 and 2022–23.
• 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 9.9 per 1,000 to 10.9 per 1,000 between 2018–19 and 2023–24.
• Access to services compared with need (3.14): The number of First Nations specific primary health care organisations increased from 203 to 213 between 2013–14 and 2023–24. 
• Expenditure on Aboriginal and Torres Strait Islander health compared to need (3.21): Australian Government expenditure on health services tailored to the needs of First Nations people between 2013–14 and 2022–23, rose from $942 million to $1,157 million. This was an average increase of 2.3% per annum in real terms. 

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. In addition, the lack of availability of culturally safe and responsive health services and lack adoption of the Social and Emotional Wellbeing Framework in service delivery continue to be critical barriers.

Culturally safe practice is the ongoing critical reflection of health practitioner knowledge, skills, attitudes, practicing behaviours and power differentials in delivering safe, accessible and responsive health care, free of racism (AHPRA, 2020). 

Moreover, Social and Emotional Wellbeing (SEWB), a holistic Aboriginal and Torres Strait Islander framework that centres connections to culture, family, community, Country, and history, is not well-established in-service design and provision, and this lack of cultural grounding creates environments that feel unsafe or irrelevant, ultimately creating further barriers to accessing health care. 

Some of 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.

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.