A recent Croakey post raising questions about plans for a mass treatment program for scabies in Aboriginal and Torres Strait Islander communities has generated some interesting comments on the post, including from James Cook University paediatrician Dr Andrew White and the University of Sydney’s Professor Glenn Salkeld.

Now Selwyn Button, chief executive officer of the Queensland Aboriginal and Islander Health Council (QAIHC), offers another perspective, arguing that the capacity and infrastructure of local communities is a critical consideration for any such programs, and that local communities need to be involved in the development of these programs from the earliest stages.

Tackling scabies requires a broad-based approach tailored to local needs and capacity

Selwyn Button writes:

In order to address an issue as significant as scabies in remote Aboriginal and Torres Strait Islander communities, one cannot look at this problem in absolute isolation of all other social issues presently occurring in these communities.

What is required is a response that is tailored to the needs of each individual community with input from leaders and elders to support the ongoing sustainability, and improving the likelihood of creating some change.

Like many others in the audience last Monday at the National Rural Health Conference, I was impressed with Dr Prince’s ambitions to undertake such a bold project in eradicating scabies amongst remote communities, and throughout the project period hope to work with him and his team to support achieving the desired outcomes.

Many will argue that we require a medical model, a public health model and a social determinants approach to this situation, to all of which I agree.

But we need to do all of this in alignment with each other element of our response that suits the uniqueness of each community that we are supporting.  

The One Disease at a Time team are only just beginning their journey, and they will discover a range of variable and impacts along the way, many of which will require them to adjust their response in differing circumstances.

However, in order to create long-lasting sustainable impacts on such issues in remote communities, we often dismiss some of the most fundamental problems being faced that many would expect to be addressed in other settings, which is the social infrastructure support from local governments.

In Queensland, many of the communities that will be a part of this worthwhile project are governed by local community councils who have barely had enough time to establish themselves as strong and effective councils since the shift from the old Department of Aboriginal Affairs regime in the late 1980’s, and then being responsible for all social services up until 2007. At that time, the Qld Government reformed local shire councils and included Aboriginal and Torres Strait Island councils, thus alleviating them from the pressures of social service delivery and informing broader social policy reform in remote communities.

What is required now is fundamentally good public policy implementation to support the achievement of such ambitious projects.

Government departments are now trying to achieve this through the COAG reform process and the focus on building blocks across a range of social services supporting Aboriginal and Torres Strait Islander communities. However, up until this point, the community is absent from the conversation to design, develop and implement good public policy – they generally are involved only when government have finished their work and present what is coming in the near future.

We now have a unique opportunity to build the capacity of the most consistent piece in the puzzle of social reform for Aboriginal and Torres Strait Island communities via their locally elected representatives on local council, who ultimately will still be there post any new and flash project being undertaken.

Many will argue that local councils are not responsible for addressing such issues and lack the depth of understanding to tackle the problem. But I would question whether anyone has attempted to work with them over long periods in developing their knowledge base and understanding to inform what should be best practice public policy implementation that is sustainable for each community affected.

Local councils and communities are ‘consulted’ on a regular basis for a range of issues, without taking on board any of the identified needs of local people to support developing local solutions.

Many of these communities suffer on a regular basis from revolving doors syndrome, with multiple service providers going in and out, and many government bureaucrats and researchers following the same pattern.  Much of this activity is about investment in capacity elsewhere, and not in the communities that need it the most.

So before we start having the conversation and debate about appropriate models of service delivery to address such an issue like scabies, and who should lead such models, let’s first consider the needs and current infrastructure in each community, to determine where the sustainable efforts for such a project will come from to ensure long-term results.

Once this has been achieved, we are then well-positioned to commence, knowing that local people are included in the design, development and implementation to ensure some real results, whilst building capacity of the local community to undertake similar work in other fields on an on-going basis.