Given the status, roles and expertise of the organisations, and the pioneering, systematic and comprehensive nature of the goals and targets, a close interactive ongoing working relationship with government was anticipated, to further refine the goals and targets as part of the process of developing the comprehensive long-term action plan which was the first commitment in the statement of intent signed by Prime Minister Kevin Rudd and other leaders. Not so. In fact government officials seem to have an astonishing and perplexing reluctance to use this valuable piece of work.

Partnership, the first group of targets, is entirely consistent with the Rudd's preamble in the statement of intent, which starts by saying, ''Our challenge for the future is to embrace a new partnership between indigenous and non-indigenous Australians.''

This emphasis on a new partnership runs right through the statement of intent and Rudd's first progress report to Parliament. But Rudd is way ahead of his public servants, who instead of a ''new partnership'' have provided the old partnership, of government hand-picked individuals on advisory committees and bodies, and have rebuffed repeated efforts by Aboriginal organisations for genuine partnership.

Does anyone really believe governments can make indigenous people healthy and that the gap can be closed without the full and active involvement of Aboriginal people and their representative bodies? Indigenous and mainstream organisations in the Close the Gap campaign certainly don't, and nor do respected commentators such as Peter Shergold, Fred Cheney or Noel Pearson. History is replete with the lack of success of initiatives, no matter how well intentioned, which don't involve genuine partnership.

It will take a generation to Close the Gap. The first commitment signed by Rudd and other leaders was to develop ''a comprehensive, long-term plan of action, that is targeted to need, evidence-based and capable of addressing the existing inequities in health services, in order to achieve equality of health status and life expectancy between Aboriginal and Torres Strait Islander peoples and non-indigenous Australians by 2030''.

It is obvious that generational change requires long-term planning and that such planning must be done in partnership with indigenous organisations. Instead we have short-term plans drawn up by officials in state and territory governments, without meaningful participation of indigenous people and their representative bodies.

A starting point for such a long-term plan with time frames for 2013, 2018 and 2028 has been developed in the Close the Gap publication, and even at this late stage governments should sit down with NACCHO and the other organisations in the Close the Gap Coalition, and develop the promised long-term action plan in partnership and before all the $1.6billion is locked up in Council of Australian Governments agreements which may limit the capacity to actually Close the Gap.

For those wishing to close the gap, a fundamental question is what mix of services is required and how they should be delivered.

Ambiguous survey questions about service usage and questionable policy analysis have given rise to much controversy as it appears that the interpretation has been that most indigenous people attend mainstream services, and accordingly Close the Gap funds should be particularly directed to mainstream services.

However, the key question is not what is happening at the moment, but what is the best mix of services to Close the Gap. Given the lack of progress, the last thing you would want to do in such an enterprise is preserve the current service model. Even if most indigenous people attend mainstream services, it would certainly not mean that pumping much of the additional funding into mainstream services is the most effective way to Close the Gap.

The broad policy directions are fairly clear. All are agreed that if not most, then many, indigenous people attend mainstream services many, no doubt, because there is no readily accessible Aboriginal Community Controlled Health Services. All are agreed that there is a capacity gap for primary health care services, and that the right kind of such services is the key if the gap is to be closed.

The Aboriginal Community Controlled Health Services sector offers advantages in terms of providing the kind of comprehensive primary health care that is not only difficult to do in a general practice, but also, and most importantly, they are much more likely to promote access to health services because they are run by and for Aboriginal people. It is of little benefit to provide even high-class mainstream services if many indigenous people are reluctant to use them.

It is critical that there is an urgent effort directed towards building up the capacity of the sector through strengthening existing services and establishing new services where they are needed, But also, recognising that many indigenous people may not have access to such services now and for some time to come, it is important that those who use mainstream services receive effective services delivered in a culturally appropriate way. In short, the need is both to strengthen existing mainstream services and introduce much needed accountability for them, and to have a major and immediate capacity building plan for the sector.

The long path to Close the Gap is at a critical point.

The appointment of Warren Snowdon as Minister for Indigenous Health provides a real opportunity to make the right turn at the crossroads, and ensure a change in public service culture and approach to meet this extraordinary challenge and achieve rapid progress through partnership with NACCHO and other indigenous and mainstream organisations, the development of a comprehensive long-term action plan, a capacity building plan for Aboriginal Community Controlled Health Services and accountability for existing mainstream health services.

Ian Ring is professorial fellow at the Centre for Health Service Development, University of Wollongong.