Who Governs Australia’s Health Workforce?

HWF EXPLAINER SERIES – No. 2 How is the health workforce governed? / V.1 / 19.05.25

Governance sets the conditions within which planning, funding, regulation, and employment take place. It defines who is responsible for what, and how power and resources are distributed across the system.

Australia’s health workforce is governed through a complex mix of national, state, and local institutions. Unlike countries with a single national health system, responsibility in Australia is shared between the Commonwealth and eight states and territories. These responsibilities are further divided between agencies that oversee professional standards and training, those that manage workforce supply and distribution, and those that employ health workers directly.

This multi-level governance structure creates both strengths and challenges. On the one hand, it allows for flexibility and responsiveness to local needs. On the other, it makes national coordination and long-term planning difficult. In many areas, responsibilities are not clearly divided but instead overlap. Understanding who governs what is essential to understanding how workforce issues—like shortages, training gaps, or inequities—can be addressed.

The Commonwealth Government plays a leading role in setting workforce policy directions, funding university and vocational education training (VET) places, providing incentives for rural and remote workforce distribution, and funding general practice and other primary care through the Medicare system. Through the Department of Health and Aged Care, it funds and commissions national data collection, modelling, and workforce planning tools—though it no longer houses a dedicated workforce agency since the closure of Health Workforce Australia in 2014.

The Australian Health Practitioner Regulation Agency (AHPRA), co-funded by the Commonwealth and states and territories, administers the National Registration and Accreditation Scheme. This scheme governs registration for 16 health professions, including doctors, nurses, midwives, pharmacists, and various allied health professions. AHPRA ensures that only qualified professionals can practise, and that they meet continuing professional development requirements.

In addition to the Department of Health and Aged Care and AHPRA, a range of national-level institutions contribute to health workforce governance through data, funding, training, industrial relations, and policy coordination.

These national actors do not hold direct governance authority over all aspects of the workforce, but they provide critical data, policy framing, funding levers, or delegated training functions that shape system-wide outcomes.

Beyond formal government agencies, several other institutions and sectors play influential governance roles over the Australian health workforce—by shaping its structure, conditions, values, and priorities.

Together, these actors influence who joins the health workforce, how work is organised and valued, and what models of care are supported. While they may not all hold formal regulatory power, they contribute to the institutional logic and power dynamics that underpin Australia’s health workforce system. Health workforce governance also intersects with broader governance in aged care, disability services, and mental health—where providers and funding streams may be quite distinct.

An important distinction exists between clinical governance and corporate or organisational governance. Clinical governance refers to the systems that ensure safe, high-quality care and uphold profession-specific standards. AHPRA and the professional boards play the central role here, by regulating who can practise and by enforcing standards of conduct and competence.

Corporate or organisational governance refers to how health services (such as the QLD Hospital and Health Services, the NSW Local Health Districts, or an Aboriginal Medical Service) manage their workforce as employees. This includes hiring, industrial relations, workload planning, and workplace health and safety. These functions sit with employers—whether they are state government entities, private providers, not-for-profits, or Aboriginal Community Controlled Health Organisations.

While generally acknowledged to be necessary, in practice, this dual system can lead to confusion or fragmentation. For example, a clinician may be cleared to practise by their professional board, but suspended by their employer pending an investigation. Or a health service might seek to expand the scope of practice of certain workers (e.g. nurse practitioners), but be constrained by regulatory rules or funding structures.

Coordination and fragmentation

In Australia a recurring concern in workforce governance is the lack of a national framework. Since the disbanding of Health Workforce Australia in 2014, no central agency has had authority or resourcing to lead national conversations or strategic workforce planning. The result is fragmentation—across jurisdictions, professions, and sectors—and a reliance on often poorly harmonized policies.

Shared governance, unclear responsibility

Australia’s federated structure means that no single actor is accountable for workforce outcomes. States may be responsible for hiring, but rely on Commonwealth-funded training pipelines. The Commonwealth funds primary care, but has no direct control over where GPs work. These blurred lines make it difficult to ident strategic levers to address issues like rural maldistribution or workforce shortages in aged care.

Workforce as a system or a silo?

Workforce issues are soon treated as the concern of HR departments at the sub-state level; or as a training system issue, rather than core to health system design and reform. This limits innovation—such as embedding financing and planning that embeds team-based models, task-shifting, or better integration across health and social care.

Balancing regulation with flexibility

Strong clinical governance protects the public and ensures quality. But rigid regulatory systems can limit flexibility—particularly for under-served communities that might benefit from broader roles for non-registered workers or advanced scope of practice for nurses or allied health staff.

Equity in employment and opportunity

Governance structures can entrench inequities. Some professions have strong representation in policy processes and greater institutional power. Others, including lower-paid and non-registered workers, have less voice despite being central to care delivery—especially in community, aged, and disability care. Governance structures and processes that make representation central to decision mechanisms are likely essential if inequities are to be addressed long term.

Attribution: Topp SM, Nguyen T, Elliott LE. Health Workforce Explainer Series: No. 2 – How is the Health Workforce Governed. 2025.