Policy partnerships in First Nations health reform: Establishing an independent health commissioning entity in regional Australia

Policy partnerships are an important mechanism for First Nations peoples to enact rights to self‐determine health programs. In Australia, policy partnerships between First Nations representatives and governments aim for shared decision‐making and underpin national reforms focussed on ‘Closing the Gap’ in health outcomes. This paper synthesises a framework to evaluate the quality of partnerships and the strategies required to successfully co‐design multi‐constituency health reforms. The framework is applied to the establishment phase of a new First Nations‐governed health commissioning body in regional Australia, and draws on interviews and focus groups with stakeholders engaged in the reform. Strengths of the partnership included dedicated funding, particularly for stakeholder co‐design and new information to guide the process. Commitment and flexibility displayed by First Nations representatives and governments was key to maintaining viable cross‐organisation relationships and delivering combined outputs. The creation of independent First Nations decision‐making forums provided crucial capacity for community representatives to co‐design policy. However, significant challenges arose when government partners pursued strategic objectives across multiple elements of the reform. First Nations representatives viewed that governments needed to devolve authority to community leaders to self‐determine the structure and governance of the new entity. Points for practitioners The partnership framework can be adapted to multiple health and social policy reforms involving First Nations constituencies and governments. It specifies four domains and accompanying strategies for effective First Nations policy partnerships. Establishing a new First Nations health commissioning agency through a partnership model required sustained funding, particularly for engagement and co‐design with regional stakeholders to secure broad endorsement for the reform. Creation of independent decision‐making forums enabled First Nations representatives to self‐determine priorities in the policy process. Government intervention across multiple elements of the reform destabilised the partnership. Providing a more facilitative role can deliver policy outcomes more aligned to community interests.