Abstracts
Abstract
This qualitative research, the first Australian study of its kind, constitutes an in-depth analysis of kidney disease care policies and strategic plans (n=11) to identify how they recognise and affirm the healthcare rights of the Northern Territory’s (NT) Indigenous People. The Australian Charter of Healthcare Rights was used as a guiding document for the research. The study employed a thematic analysis method, specifically the framework analysis, due to its suitability for identifying and analysing patterns in qualitative data. The findings revealed that the Indigenous People’s healthcare rights are not explicitly addressed in the policies and plans, even though they constitute 89% of the kidney disease patient population in the NT. A salient aspect of every policy and strategic plan was the lack of specific affirmative actions and targets to evaluate renal care processes and progress for Indigenous Peoples.
Keywords:
- Healthcare rights,
- chronic kidney disease,
- Indigenous,
- Aboriginal and Torres Strait Islander,
- First Nations,
- renal care,
- health policies,
- framework analysis,
- kidney disease
Appendices
Bibliography
- Aboriginal Medical Services Alliance Northern Territory (AMSANT). (2025). Facing the Health Gap: The Key Challenges Undermining Progress in Aboriginal Health Outcomes in the NT.
- Anderson, I., Crengle, S., Leialoha Kamaka, M., Chen, T.-H., Palafox, N., & Jackson-Pulver, L. (2006). Indigenous health in Australia, New Zealand, and the Pacific. Lancet, 367(9524), 1775–1785. https://doi.org/10.1016/S0140-6736(06)68773-4
- Anderson, I., & Loff, B. (2004). Voices lost: Indigenous health and human rights in Australia. Lancet, 364(9441), 1281–1282. https://doi.org/10.1016/S0140-6736(04)17146-8
- Angell, B., Eades, S., & Jan, S. (2017). To close the gap, we need to identify the best (and worst) buys in Indigenous health. Australian & New Zealand Journal of Public Health, 41(3), 224–226. https://doi.org/10.1111/1753-6405.12612
- Australia and New Zealand Dialysis and Transplant Registry (ANZDATA). (2024). ANZDATA 47th annual report 2024 (data to 2023). https://anzorrg.org.au/reports/anzdata-47th-annual-report-2024-data-survey-2023
- Australian Commission on Safety and Quality in Health Care (ACSQHC). (2008). Australian Charter of Healthcare Rights.
- Australian Commission on Safety and Quality in Health Care (ACSQHC). (2019). Australian Charter of Healthcare Rights (2nd ed.). https://www.safetyandquality.gov.au/our-work/partnering-consumers/australian-charter-healthcare-rights
- Australian Government. (2013). National Aboriginal and Torres Strait Islander Health Plan 2013–2023. https://www.health.gov.au/sites/default/files/documents/2021/02/national-aboriginal-and-torres-strait-islander-health-plan-2013-2023.pdf
- Australian Health Ministers’ Advisory Council. (2016). Cultural Respect Framework 2016–2026 for Aboriginal and Torres Strait Islander Health. Australian Government.
- Australian Institute of Health and Welfare (AIHW). (2011). Health and the environment: A compilation of evidence. Cat. No. PHE 136.
- Australian Institute of Health and Welfare (AIHW). (2022). Australia’s health 2022: In brief. https://www.aihw.gov.au/reports/australias-health/australias-health-2022-in-brief/summary
- Australian Institute of Health and Welfare (AIHW). (2023). Aboriginal and Torres Strait Islander Health Performance Framework. 1.10 Kidney Disease. https://www.indigenoushpf.gov.au/measures/1-10-kidney-disease
- Beisheim, M., Asseburg, M., Ballbach, E. J., Eickhoff, K., Fischer, S., Godehardt, N., Kurtz, G., Meyer, M., Müller, M., Roll, S., Sahm, A., Wagner, C., & Zilla, C. (2025). Politics matters! Political will is a critical condition for implementing the Sustainable Development Goals. Earth System Governance, 24, 100244. https://doi.org/10.1016/j.esg.2025.100244
- Bowen, G. A. (2009). Document analysis as a qualitative research method. Qualitative Research Journal, 9(2), 27–40. https://doi.org/10.3316/QRJ0902027
- Braun, V., & Clarke, V. (2019). Reflecting on reflexive thematic analysis. Qualitative Research in Sport, Exercise and Health, 11(4), 589–597. https://doi.org/10.1080/2159676x.2019.1628806
- Braun, V., & Clarke, V. (2022). Thematic analysis: A practical guide. Sage.
- Calma, T. (2009). A human rights-based approach to social and emotional well-being. Australasian Psychiatry, 17(1), S15–S19. https://doi.org/10.1080/10398560902948613
- Carroll, C., Booth, A., & Cooper, K. (2011). A worked example of “best fit” framework synthesis: A systematic review of views concerning the taking of some potential chemo preventive agents. BMC Medical Research Methodology, 11(1), Article 29. https://doi.org/10.1186/1471-2288-11-29
- Cass, A., Lowell, A., Christie, M., Snelling, P. L., Flack, M., Marrnganyin, B., & Brown, I. (2002). Sharing the true stories: Improving communication between Aboriginal patients and healthcare workers. Medical Journal of Australia, 176(10), 466–470. https://doi.org/10.5694/j.1326-5377.2002.tb04517.x
- Clifford, H., Pearson, G., F. P., Walker, R., & Zosky, G. (2015). Environmental health challenges in remote Aboriginal Australian communities: Clean air, clean water and safe housing. Australian Indigenous Health Bulletin, 15(2).
- Department of Health and Families. (2010). Northern Territory Chronic Conditions Prevention and Management Strategy 2010–2020. Northern Territory Government. http://hdl.handle.net/10137/371
- Devitt, J., Anderson, K., Cunningham, J., Preece, C., Snelling, P., & Cass, A. (2017). Difficult conversations: Australian Indigenous patients’ views on kidney transplantation. BMC Nephrology, 18, Article 310. https://doi.org/10.1186/s12882-017-0726-z
- Devitt, J., Cass, A., Cunningham, J., Preece, C., Anderson, K., & Snelling, P. (2008). Study Protocol – Improving Access to Kidney Transplants (IMPAKT): A detailed account of a qualitative study investigating barriers to transplant for Australian Indigenous people with end-stage kidney disease. BMC Health Services Research, 8(1), Article 31. https://doi.org/10.1186/1472-6963-8-31
- Dixon-Woods, M. (2011). Using framework-based synthesis for conducting reviews of qualitative studies. BMC Medicine, 9(1), Article 39. https://doi.org/10.1186/1741-7015-9-39
- Freeman, T., Baum, F., Lawless, A., Labonté, R., Sanders, D., Boffa, J., Edwards, T., Javanparast, S. (2016). Case study of an Aboriginal community-controlled health service in Australia: Universal, rights-based, publicly funded comprehensive primary health care in action. Health & Human Rights, 18(2), 93–108.
- Gale, N. K., Heath, G., Cameron, E., Rashid, S., & Redwood, S. (2013). Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Medical Research Methodology, 13, Article 117. https://doi.org/10.1186/1471-2288-13-117
- Gale, R. C., Wu, J., Erhardt, T., Bounthavong, M., Reardon, C. M., Damschroder, L. J., & Midboe, A. M. (2019). Comparison of rapid vs in-depth qualitative analytic methods from a process evaluation of academic detailing in the Veterans Health Administration. Implementation Science, 14(1), Article 11. https://doi.org/10.1186/s13012-019-0853-y
- Gorham, G., Howard. K., Cunningham, J., Barzi, F., Lawton, P., & Cass, A. (2021). Do remote dialysis services really cost more? An economic analysis of hospital and dialysis modality costs associated with dialysis services in urban, rural and remote settings. BMC Health Services Research, 21(1), Article 582. https://doi.org/10.1186/s12913-021-06612-z
- Gray, M. A., & Oprescu, F. I. (2016). Role of non-Indigenous researchers in Indigenous health research in Australia: A review of the literature. Australian Health Review, 40(4), 459–465. https://doi.org/10.1071/AH15103
- Gruskin. S, Mills. E.J., & Tarantola D. (2007). History, principles, and practice of health and human rights. Lancet, 370(9585), 449–455. https://doi.org/10.1016/S0140-6736(07)61200-8
- Hill, K., Barker, B., & Vos, T. (2007). Excess Indigenous mortality: Are Indigenous Australians more severely disadvantaged than other Indigenous populations? International Journal of Epidemiology, 36(3), 580–589. https://doi.org/10.1093/ije/dym011
- Hoy, W. E. (2014). Kidney disease in Aboriginal Australians: A perspective from the Northern Territory. Clinical Kidney Journal, 7(6), 524–530. https://doi.org/10.1093/ckj/sfu109
- Hoy, W. E., Mott, S. A. & McDonald, S. P. (2019). An update on chronic kidney disease in Aboriginal Australians. Clinical Nephrology, 93(1), 124–128. https://doi.org/10.5414/cnp92s122
- Hughes, J. T., Freeman, N., Beaton, B., Puruntatemeri, A.-M., Hausin, M., Tipiloura, G., Wood, P., Signal, S., Majoni, A. W., Cass, A., Maple-Brown, L. J., & Kirkham, R. (2019). My experiences with kidney care: A qualitative study of adults in the Northern Territory of Australia living with chronic kidney disease, dialysis and transplantation. PLoS ONE, 14(12), Article e0225722. https://doi.org/10.1371/journal.pone.0225722
- Josif, C., Kruske, S., Kildea, S., & Barclay, L. (2017). The quality of health services provided to remote dwelling Aboriginal infants in the top end of northern Australia following health system changes: A qualitative analysis. BMC Pediatrics, 17, Article 93. https://doi.org/10.1186/s12887-017-0849-1
- Kerrigan, V. (2022). Batji-gum dilba (good talk medicine): Improving culturally safe communication between doctors and Aboriginal patients in the Northern Territory of Australia [PhD thesis, Charles Darwin University]. ProQuest Dissertations & Theses Global. https://doi.org/10.25913/vmrv-q919
- Kerrigan, V., Lewis, N., Cass, C., Hefler, M., & Ralph, A. P. (2020a). “How can I do more?” Cultural awareness training for hospital-based healthcare providers working with high Aboriginal “caseload”. BMC Medical Education, 20(1), Article 173. https://doi.org/10.1186/s12909-020-02086-5
- Kerrigan, V., McGrath, S. Y., Lee, B., Puruntatameri, P., Herdman, R. M. (2020b). Ask the Specialist: Larrakia, Tiwi and Yolŋu stories to inspire better healthcare. Apple Podcasts. https://podcasts.apple.com/au/podcast/ask-the-specialist-stories-to-inspire-better-healthcare/id1516150200
- Kerrigan, V., McGrath, S. Y., Majoni, S. W., Walker, M., Ahmat, M., Lee, B., Cass, A., Hefler, M., & Ralph, A. P. (2021). From “stuck” to satisfied: Aboriginal people’s experience of culturally safe care with interpreters in a Northern Territory hospital. BMC Health Services Research, 21(1), Article 548. https://doi.org/10.1186/s12913-021-06564-4
- Kidney Health Australia (KHA). (2023). What is chronic kidney disease (CKD)? [Fact sheet]. https://assets.kidney.org.au/resources/KHA-First-Nations-Factsheet-What-is-CKD.pdf
- Kiernan, M., & Hill, M. (2018). Framework analysis: A whole paradigm approach. Qualitative Research Journal, 18(3), 248–261. https://doi.org/10.1108/QRJ-D-17-00008
- Kirmayer, L. J., Gone, J. P., & Moses, J. (2014). Rethinking historical trauma. Transcultural Psychiatry, 51(3), 299–319. https://doi.org/10.1177/1363461514536358
- Lawton, P. D., Cunningham, J., Hadlow, N., Zhao, Y., & Jose, M. D. (2015). Chronic kidney disease in the Top End of the Northern Territory of Australia, 2002–2011: A retrospective cohort study using existing laboratory data. BMC Nephrology, 16, Article 168. https://doi.org/10.1186/s12882-015-0166-6
- Lowell, A., Maypilama, E., Yikaniwuy, S., Rrapa, E., Williams, R., & Dunn, S. (2012). “Hiding the story”: Indigenous consumer concerns about communication related to chronic disease in one remote region of Australia. International Journal of Speech-Language Pathology, 14(3), 200–208. https://doi.org/10.3109/17549507.2012.663791
- Madden, R., Axelsson, P., Kukutai, T., Griffiths, K., Storm Mienna, C., Brown, N., Coleman, C., & Ring, I. (2016). Statistics on indigenous peoples: International effort needed. Statistical Journal of the IAOS, 32(1), 37–41. https://doi.org/10.3233/SJI-160975
- Mazel, O. (2018). Indigenous health and human rights: A reflection on law and culture. International Journal of Environmental Research and Public Health, 15(4). https://doi.org/10.3390/ijerph15040789
- Mitchell, A., Lowell, A., & Ralph, A. (2016). Report on the Patient Educator Service at Royal Darwin Hospital, 2001–2009: Insights into inter-cultural communication in healthcare. Aboriginal Resource and Development Services.
- Mohatt, N. V., Thompson, A. B., Thai, N. D., & Tebes, J. K. (2014). Historical trauma as public narrative: A conceptual review of how history impacts present-day health. Social Science and Medicine, 106, 128–136. https://doi.org/10.1016/j.socscimed.2014.01.043
- National Aboriginal & Torres Strait Islander Health Council. (2004). National Strategic Framework for Aboriginal and Torres Strait Islander Health 2003–2013: Framework for action by governments.
- Northern Territory (NT) Government. (2012). Language Services Policy. https://www.aph.gov.au/parliamentary_business/committees/house_of_representatives_committees?url=atsia/languages/subs/sub138%20attach%20c.pdf
- NT Health. (2012). Renal Services Framework 2012–2017. Northern Territory Government.
- NT Health. (2015). Northern Territory Aboriginal Health Plan 2015–2018. Northern Territory Government. https://digitallibrary.health.nt.gov.au/nthealthserver/api/core/bitstreams/6dce59e2-8cbf-4ce0-92c6-811c7d1db280/content
- NT Health (2016a). Aboriginal Cultural Security Framework 2016–2026. Northern Territory Government. https://families.nt.gov.au/__data/assets/pdf_file/0007/689695/aboriginal-cultural-security-framework.pdf
- NT Health. (2016b). Aboriginal Cultural Security Policy. Northern Territory Government. https://health.nt.gov.au/media/pdf/atsiwp-awards/aboriginal-cultural-security-policy.pdf
- NT Health. (2017). Northern Territory Renal Services Strategy 2017–2022. Northern Territory Government. https://hdl.handle.net/10070/833454
- NT Health. (2021). Aboriginal Health Plan 2021–2031. Northern Territory Government. https://health.nt.gov.au/__data/assets/pdf_file/0015/1035501/nt-aboriginal-health-plan-2021-2031.pdf
- NT Health. (2024). Kidney Plan 2024–2029. Northern Territory Government. https://health.nt.gov.au/__data/assets/pdf_file/0004/1378939/nt-health-kidney-plan2024-2029.pdf
- NT Health. (2025). NT Health Service Agreement 2025-2026. Northern Territory Government. https://health.nt.gov.au/__data/assets/pdf_file/0009/1559817/service-agreement-2025-2026-original.pdf
- O’Sullivan, D. (2016). Indigenous health: Capabilities and freedom. Ethnicities, 16(5), 733–751. https://doi.org/10.1177/1468796815603756
- Panicker, L. (2023). Transparency, accountability, and dignity: An exploration of healthcare rights for Indigenous patients in renal care. Doctoral dissertation, Charles Darwin University. https://doi.org/10.25913/jnjf-fj77
- Paradies, Y. (2016). Colonisation, racism and Indigenous health. Journal of Population Research, 33(1), 83–96. https://doi.org/10.1007/s12546-016-9159-y
- Parkinson, S., Eatough, V., Holmes, J., Stapley, E., & Midgley, N. (2016). Framework analysis: A worked example of a study exploring young people’s experiences of depression. Qualitative Research in Psychology, 13(2), 109–129. https://doi.org/10.1080/14780887.2015.1119228
- Ralph, A. P., McGrath, S. Y., Armstrong, E., Herdman, R. M., Ginnivan, L., Lowell, A., Lee, B., Gorham, G., Taylor, S., Hefler, M., & Kerrigan, V. (2023). Improving outcomes for hospitalised First Nations peoples through greater cultural safety and better communication: The Communicate Study Partnership study protocol. Implementation Science, 18, Article 23. https://doi.org/10.1186/s13012-023-01276-1
- Reilly, R., Evans, K., Gomersall, J., Gorham, G., Peters, M., Warren, S., O’Shea, R., Cass, A., & Brown, A. (2016). Effectiveness, cost effectiveness, acceptability and implementation barriers/enablers of chronic kidney disease management programs for Indigenous people in Australia, New Zealand and Canada: A systematic review of mixed evidence. BMC Health Services Research, 16, Article 119. https://doi.org/10.1186/s12913-016-1363-0
- Ritchie, J., & Spencer, L. (1994). Qualitative data analysis for applied policy research. In A. Bryman & R. G. Burgess (Eds.), Analysing qualitative data (pp. 173–194). Routledge.
- Rix, E. F., Barclay, L., Stirling, J., Tong, A., & Wilson, S. (2014). “Beats the alternative but it messes up your life”: Aboriginal people’s experience of haemodialysis in rural Australia. BMJ Open, 4(9). https://doi.org/10.1136/bmjopen-2014-005945
- Rix, E. F., Barclay, L., Stirling, J., Tong, A., & Wilson, S. (2015). The perspectives of Aboriginal patients and their health care providers on improving the quality of hemodialysis services: A qualitative study. Hemodialysis International, 19(1), 80–89. https://doi.org/10.1111/hdi.12201
- Rix, E. F., Barclay, L., Wilson, S., Stirling, J., & Tong, A. (2013). Service providers’ perspectives, attitudes and beliefs on health services delivery for Aboriginal people receiving haemodialysis in rural Australia: A qualitative study. BMJ Open, 3(10). https://doi.org/10.1136/bmjopen-2013-003581
- Sabanayagam, D., Makris, A., Sciberras, F., Scholes-Robertson, N. J., & Wong, G. (2025). Dialysis care in Australia: A call for reform and innovation. Medical Journal of Australia, 223(2), 58–60. https://doi.org/10.5694/mja2.52672
- Srivastava, A., & Thomson, S. (2009). Framework analysis: A qualitative methodology for applied policy research. Journal of Administration and Governance, 4(2), 72–79.
- Taylor, J., & Kukutai, T. (2015, October 22–23). Indigenous data sovereignty and indicators: Reflections from Australia and Aotearoa New Zealand [Paper presentation]. UNPFII Expert Group Meeting “The Way Forward: Indigenous Peoples and the 2030 Agenda for Sustainable Development”, New York.
- United Nations High Commissioner for Human Rights. (2011). National report submitted in accordance with paragraph 5 of the annex to Human Rights Council resolution 16/21 – Australia: First cycle. https://www.ohchr.org/en/hr-bodies/upr/au-index
- United Nations High Commissioner for Human Rights. (2015). National report submitted in accordance with paragraph 5 of the annex to Human Rights Council resolution 16/21 – Australia: Second cycle. https://www.ohchr.org/en/hr-bodies/upr/au-index
- United Nations High Commissioner for Human Rights. (2021a). National report submitted in accordance with paragraph 5 of the annex to Human Rights Council resolution 16/21 – Australia: Third cycle. https://www.ohchr.org/en/hr-bodies/upr/au-index
- United Nations High Commissioner for Human Rights. (2021b). Universal Periodic Review – Australia, Letter from the High Commissioner to the Foreign Minister. https://www.ohchr.org/sites/default/files/2021-11/HC_letter_to_Australia.pdf
- Vermunt, N., Elwyn, G., Westert, G., Harmsen, M., Rikkert, M. O., & Meinders, M. (2019). Goal setting is insufficiently recognised as an essential part of shared decision-making in the complex care of older patients: A framework analysis. BMC Family Practice, 20, Article 76. https://doi.org/10.1186/s12875-019-0966-z
- Walt, G., & Gilson, L. (1994). Reforming the health sector in developing countries: the central role of policy analysis. Health Policy and Planning, 9(4), 353–370. https://doi.org/10.1093/heapol/9.4.353
- Waugh, E. B., Hefler, M., Pascoe, S., Mayo, M., Hare, M. J., Story, D. A., Wilkshire, N., Henwood, P., Croker, D., & Ross, J. (2025). What do Aboriginal people in the Northern Territory value during the operation journey? A qualitative study. Medical Journal of Australia, 223(1), 30-37. https://doi.org/10.5694/mja2.52695
- World Health Organisation (WHO). (2022). A toolkit on how to implement social prescribing, https://www.who.int/publications/i/item/9789290619765
- Zolnoori, M., Williams, M. D., Leasure, W. B., Angstman, K. B., & Ngufor, C. (2020). A systematic framework for analysing observation data in patient-centred registries: Case study for patients with depression. JMIR Research Protocols, 9(10), Article e18366. https://doi.org/10.2196/18366

