Our story

Miwatj Health – The early years

On 4 November 1991, the Regional Manager of ATSIC sent a memo to community representatives across the East Arnhem region:

The Executive of Miwatj Regional Council have recently endorsed a proposal to form a Regional Aboriginal Health Association possibly involving representative from each Community/Association within the East Arnhem Region.

I understand that ATSIC field officers have discussed this issue with your organization and invite a representative from both your elected governing body/council and your Health Service to attend the above meeting.

So Miwatj Health began life. The concept of a health organization covering the whole region was the creation of Aboriginal people from all communities and associations across East Arnhem Land. Originally it was the brainchild of the elected Aboriginal members of the ATSIC Regional Council, which proposed the concept and advocated for its acceptance.

The concept of a health organization covering the whole region was the creation of Aboriginal people from all communities and associations across East Arnhem Land.

Miwatj Health’s first funds, to enable the acquisition of staff and equipment, were provided by ATSIC through the National Aboriginal Health Strategy. At the time a number of the Board members of Miwatj were also elected members of the ATSIC Board, reflecting the community-based origins of the organization, and giving complete representation/coverage of the region.

The Prospectus of the organisation at the time stated:

Miwatj Health has been established under the auspices of the Miwatj Regional Council, to promote the extension of health and related services to the residents of homeland centres in the East Arnhem Region, in line with the recommendations of the National Aboriginal Health Strategy.

The need to extend health service provision to homeland centres (also known as outstations) is apparent in the fact that Miwatj Health was initially established under the Laynhapuy Homelands Association, prior to being established as a separate body in 1992.

Over the years this has become a longer-term pattern – overall, the motivation behind the formation of Miwatj Health, and the programs pursued by Miwatj over the years, has been the need to fill gaps in primary healthcare service provision left by the NT Government.

The early Constitution of Miwatj Health emphasized, as an aim, to assist Aboriginal people in gaining control of healthcare resources – “to provide resources and support to Yolngu people to enable them to assume control over the delivery of health services to the people of the Miwatj region.” This is clearly a regional community control agenda, and it has existed since Miwatj was first established.

“to provide resources and support to Yolngu people to enable them to assume control over the delivery of health services to the people of the Miwatj region.”

In 1992 Miwatj employed its first staff, including a Medical Officer; commenced an audit of homelands residents’ health needs; installed computer terminals at Laynhapuy, Galiwin’ku and Gapuwiyak and immediately commenced loading patient data onto them (as early as 1992 patient 2,500 files had been established on the system). At the time Miwatj took the lead in computerized patient information systems with the early installation of Healthplanner in the region (adapted to carry ‘live’ data).

The orientation of Miwatj Health towards a primary health care perspective was made clear in the 1992 Prospectus:

The excessive costs inherent in the first step recourse to major institutional health care may be addressed in terms of primary health provision and preventative health education.

At that time there was almost no primary care provision by doctors in the bush in the region. If someone needed to see a doctor, they would be evacuated out to a hospital in a city, treated briefly, and then sent back to the environment which had often been the cause of their illness. There was little emphasis on prevention or education. In this situation the need for an organization such as Miwatj to represent the needs of Aboriginal people from the bush – to advocate for the right of Aboriginal people to access highly-skilled medical care close to where they live – was clear. For many years Miwatj was the driving force in the provision of doctors at bush communities across the region.

Initially, Miwatj Health did not operate a clinic of its own, but sent doctors from its office in Nhulunbuy to those communities where the need was greatest. These included all the Laynhapuy homelands, Galiwin’ku, Gapuwiyak community and homelands, Gunyangara (Gunyangara did not have its own clinic until 1996), Yirrkala and Numbulwar. For a significant time Miwatj employed the fulltime resident GPs at Numbulwar and Gapuwiyak.

Of course doctors could not be employed in remote communities without somewhere to live. The construction of the first houses for doctors throughout the region in the mid-1990s was a direct result of advocacy by Miwatj to the Commonwealth Government.

Around late 1997 Miwatj Health constructed its own small clinic in Nhulunbuy. The rationale at that time was that patients from the Laynhapuy homelands with complex problems needed a properly-equipped facility where they could be seen by doctors. At that time neither the NT Department of Health clinic in Yirrkala nor the Laynhapuy Association employed doctors, so Miwatj was the only option.

In 1999-2000 Miwatj established itself as a registered training organization and set about training Aboriginal Health Workers, in response to the need expressed by community elders for a local training facility. The first graduates of that still hold prominent positions in their respective organisations.

Miwatj Health – Today

The pace of change in healthcare provision has quickened even more in recent times. Input from community members, developments in government policy and changes in the region’s health profile have all meant Miwatj Health has had to change and adapt.

The major change to which Miwatj has had to adapt in the past 6 or 7 years is rapid exponential growth. As the population serviced by Miwatj has increased, and as new Commonwealth programs are announced, so staff numbers and budgets have increased dramatically. Managing this rapid change has been a challenge for both Board and staff members, but Miwatj has risen to the task and currently enjoys the minimum risk rating possible for a Commonwealth-funded organization.

Today Miwatj continues to answer the calls of communities in need.

Since 2008, when the local councils were abolished,Miwatj has taken on full management of the health centres at Gunyangara and Galiwin’ku.  The newly formed Shire councils changed the model of service for local government to the exclusion of primary health care and NT Government did not want to take on service delivery due to insufficient resourcing. Specifically, NT Government had been providing a grant in aid to the Galiwin’ku Council for $900,000 per annum for a clinic that now looks after around 3,000 people. Concerned for the health of the community, Miwatj agreed to take over responsibility and liability for Ngalkanbuy Health Centre and successfully took control with just 4 weeks’ notice. Miwatj then lobbied for increased funding and has raised the budget for Galiwin’ku to over $5million in the intervening years, and transformed the way that service operates.

Developments in government policy in the past decade have also had a big impact on the current operations of Miwatj. The rights-based perspective on Indigenous social development, built up through the work of successive Social Justice Commissioners , was challenged by the Commonwealth as it unrolled the NT Emergency Response (the NTER, or Intervention). In Arnhem Land, the initial exclusion of the NTER measures from the Racial Discrimination Act brought about widespread anger among Aboriginal people, and the community planning undertaken by the Commonwealth as part of the NTER has been problematic in many places, particularly in regard to health.

However, one important aspect of the NTER was increased funding by the Commonwealth for Aboriginal primary healthcare services. Funds from the Commonwealth’s Expanded Health Service Delivery Initiative (which later became known as ‘Strengthening Primary Healthcare Services’ funding) have been made available to all primary health care services in the NT, and Miwatj has been able to use that money well, particularly to extend its chronic disease focus.

The national attention which the NTER brought to the problems of remote NT Aboriginal communities extended to a subsequent commitment by all governments to ‘Close the Gap’ in Indigenous advantage. The National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes was signed by the Comnmonwealth, State and Territory governments in 2009. Health outcome targets in this are:

(i) eliminate the gap between the life expectancies of Indigenous and non Indigenous people by 2030; and
(ii) halve the rate of infant mortality within a decade.

Closing the Gap funds have been significant and a number of Miwatj’s most important programs would not exist without those policy developments. One important aspect of Close the Gap funds is that they encompass preventive programs such education about tobacco use and encouraging physical exercise, in addition to clinical programs.

Further details of Miwatj’s programs can be seen in the ‘what we do’ section of this site.

Miwatj Health – the Future

Miwatj anticipates that the next decade will see great progress. Of course we will continue to provide acute care services at all our health centres. This will be balanced by an increased emphasis on educational/preventive programs tackling the most important risk factors for Aboriginal health in this region.

Since 2008 Miwatj, and later through AMSANT, has been advocating for the ‘regionalisation’ of Aboriginal health services in the NT. Initial support from the Commonwealth  created a number of regions in the NT for health planning purposes, and with an aim to move towards a single service provider in each region. Miwatj sees this as implementing the original vision of the founders of Miwatj: one health board to represent all Aboriginal people in the region. In 2012 members of the NT Aboriginal Health Forum initiated Pathways to Community Control, but this has not been embedded in policy. In July 2012 Miwatj assumed management of the health centre at Yirrkala, and in July 2016 the clinic at Yurrwi transitioned to community control. Despite slow progress, Miwatj continues to realise the Board’s vision, and is the only Aboriginal health organisation in Australia that has taken control of their region without official government policy.

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