Examining the role of governance structures in the planning of health reform

Internationally, a meshing of top-down and bottom-up approaches to policy development has been viewed as the most effective way to address social inequalities. The governance structures underpinning such interventions are critical to their success or failure and yet are rarely studied. We use social network analysis to understand the role of committee structures in planning reform and the role of Aboriginal and Torres Strait Islander people in those processes.

Methods

Data about governance structures and their interrelationships was obtained through document review and interview. UCINET was used to graph and analyse the network data. Connectivity and in-degree centrality were analysed to identify the power of participants to enact system change in each of the networks.

Results

The results suggest that governance structures are important in shaping relationships between participating organisations. Peak bodies for Aboriginal organisations, National and State governments are all central players in planning. The shift to regional planning processes has led to an increase in the number of organisations involved in planning. This increase is exponentially greater for mainstream organisations than Aboriginal and Torres Strait Islander organisations. Differences in the governance structures used to join regional planning with higher level planning have a significant impact on the density of the network structures.

Conclusions

Australia has entered a period of unprecedented reform in Aboriginal and Torres Strait Islander health. This study highlights the challenges facing Aboriginal and Torres Strait Islander organisations in regional planning structures and the types of governance structures that support better connectedness.