Navigating a complex organizational landscape : leadership challenges and practices

This paper discusses exploratory research to identify the reported leadership challenges faced by leaders in the public sector in Australia and what specific leadership practices they engage in to deal with these challenges. Emerging is a sense that leadership in these complex work environments is not about controlling or mandating action but about engaging in conversation, building relationships and empowering staff to engage in innovative ways to solve complex problems. In addition leaders provide a strong sense of purpose and identity to guide behaviour and decisions to overcome being overwhelmed by the sheer volume of demands in a unpredictable and often unsupportive environment. Questions are raised as to the core competencies leaders need to develop to drive and underpin these leadership practices and the implications this has for the focus on future leadership development programmes. The possible direction of a future research programme will be put forward for further discussion.

Principals’ and teacher leaders’ perceptions of their role and interaction under current Chinese reform : a case study in Shandong province

This study aims to explore the perceptions of principals and teacher leaders regarding their roles and the interaction between these roles in Chinese urban primary schools at the time of unprecedented curriculum reform. This involves a complexity of factors such as the influence of globalisation, the impact of traditional Chinese cultural attitudes towards education through Confucianism, and the implementation requirements of the current education reforms. All of these wider contextual factors help to shape the leadership practices that are described in the study. A qualitative exploratory case study approach has been utilised to undertake this investigation. The conceptual framework for this study draws upon scholars‘ work from Western countries but has been adapted in order to address three research questions for the study‘s focus on the context in Shandong province, Mainland China. Three research questions were addressed: First, what are principals‘ perceptions of their leadership roles in Mainland China under current educational reform? Second, what are teacher leaders‘ perceptions of their leadership roles in Mainland China under current educational reform? And finally, what are principals‘ and teacher leaders‘ perceptions of how their roles interact? With reference to the principals in the study, the findings confirm Gurr‘s (2008) comprehensive leadership model relating to four roles, specifically, learning and teaching, symbolic and cultural awareness, future orientation, and accountability. Significantly, some sub-roles that emerge from the data are uniquely Chinese. For example, school culture construction is a very deliberate process in which principals and their staff talked openly about and were involved in creating a positive school climate comprising spiritual, material, and system dimensions. Another finding relates to school feature construction. This refers to the process that principals and staff used to make their schools distinctive and different from other schools and included such features as the school‘s philosophy and the school-based curriculum. In seeking to understand the nature of teacher leadership in Chinese primary schools, this research confirms some findings identified in Western literature. For instance, teacher leaders in Shandong province were involved in decision-making, working with parents and community members, undertaking and planning professional development for staff, and mediating between colleagues (Day & Harris, 2002; Harrison & Killion, 2007; Leithwood, Jantzi, & Steinbach, 1999; Muijs & Harris, 2006; Smylie, 1992). However, some new aspects, such as a heightened awareness of the importance of accountability, emerge from this study. The study‘s conceptual framework also draws upon some significant insights from micropolitics and, in particular, two core constructs, namely cooperation and conflict (Blase, 1991), to explore the interactions between principals and teacher leaders. In this study, principals and teacher leaders employed exchange and facilitation as two strategies in cooperative processes; and they adopted enforcement and compromise in conflictive processes. Finally, the study‘s findings indicate that principals and teacher leaders were developing new ways of interacting in response to the requirements of significant education reform. Most principals were exercising their power through (Blase, 1991) their teacher leaders who in turn, were working in alignment with their principals to achieve the desired outcomes in schools. It was significant that this form of 'parallel leadership' (Crowther, Ferguson, & Ham, 2009) characterised the teacher leadership roles at this period of change to the curriculum in Mainland China.

Leadership as dance : a consideration of the applicability of the ‘mother’ of all arts as the basis for establishing connoisseurship

This article follows the lead of several researchers who claim there is an urgent need to utilize insights from the arts, aesthetics and the humanities to expand our understanding of leadership. It endeavours to do this by exploring the metaphor of dance. It begins by critiquing current policy metaphors used in the leadership literature that present a narrow and functional view of leadership. It presents and discusses a conceptual model of leadership as dance that incorporates key dimensions such as context, dance and music and includes Polyani’s concept of connoisseurship. This article identifies some of the tensions that are inherent in both notions of dance and leadership. The final part of the article discusses the implications the model raises for broadening our understanding of leadership and school leadership preparation programmes. Three core implications raised here are (i) making space for alternative metaphors in leadership preparation programmes; (ii) providing opportunities to students of leadership to understand through alternative learning approaches and (iii) providing opportunities for engagement in alternative research agendas.

The future of sustainable building assessment tools : a case study in Australia

Sustainability issues in built environment have attracted an increasingly level of attention from both the general public and the industry. As a result, a number of green building assessment tools have been developed such as the Leadership in Energy and Environmental Design (LEED) and the BRE Environmental Assessment Method (BREEAM), etc. This paper critically reviewed the assessment tools developed in Australian context, i.e. the Green Star rating tools developed by the Green Building Council of Australia. A particular focus is given to the recent developments of these assessment tools. The results showed that the office buildings take the biggest share of Green Star rated buildings. Similarly, sustainable building assessments seem to be more performance oriented which focuses on the operation stage of buildings. In addition, stakeholder engagement during the decision making process is encouraged. These findings provide useful references to the development of next generation of sustainable building assessment tools.

Leadership [2nd Asia-Pacific ed.]

This second edition of Leadership continues to offer a balanced approach to the study of leadership, drawing on Australasian practices and international theory. It looks at the characteristics of leaders in a wide variety of Australasian settings - organisations in the private, public, and not-for-profit sectors, as well as in politics and in our community. Traditional content such as charismatic, transformational, contingency, and situational theories of leadership are covered in detail, along with the power, influence, motivation, coaching, communication, and team building aspects of leadership. The text also introduces contemporary issues, such as entrepreneurship, knowledge management, leadership in international contexts, and the importance of ethics and social responsibility.

Narcissistic and service-oriented leadership : contrasting perspectives

Leadership writing has tended to present a positive picture about leadership practice yet, in recent times, researchers have highlighted the ‘dark side’ of leadership. In this exploratory conceptual paper, we juxtapose two contrasting forms of leadership: narcissistic leadership and service-oriented leadership (that draws heavily upon servant leadership) in order to provide a better understanding of both of these forms. In particular, we explore four core constructs of leadership: service, power, role of followers, and morality, to provide a constrast. Given that little empirical works exists on narcissistic and servant leadership in educational contexts, the paper concludes by arguing for further research in the field.

What can grassroots leadership teach us about school leadership

This paper explores grassroots leadership, an under-researched and often side-lined approach to leadership that operates outside of formal bureaucratic structures. The paper’s central purpose is the claim that an understanding of grassroots leadership and tactics used by grassroots leaders provides valuable insights for the study of school leadership. In this paper, we present and discuss an original model of grassroots leadership based on the argument that this under-researched area can further our understanding of school leadership. Drawing upon the limited literature in the field, we present a model consisting of two approaches to change (i.e. conflict and consensus) and two categories of change (i.e. reform and refinement) and then provide illustrations of how the model works in practice. We make the argument that the model has much merit for conceptualizing school leadership, and this is illustrated by applying the model to formal bureaucratic leadership within school contexts. Given the current climate in education where business and management language is pervasive within leadership-preparation programs, we argue that it is timely for university academics, who are responsible for preparing school leaders to consider broadening their approach by exposing school leaders to a variety of change-based strategies and tactics used by grassroots leaders.

Ideas to improve the selection of NHMRC Project Grants

The starting point for this presentation is that applicants provide a large surplus of information when submitting a NHMRC Project Grant proposal for funding. This is costly in their time, attracts high administration costs, makes the task appear daunting for peer reviewers and may reduce the quality of the peer review leading to less than perfect reliability in decision making. We are currently experimenting with alternate models to see whether similar reliability in funding outcomes are achieved at less cost. We will compare traditional NHMRC Grant Review Panels (GRPs) with panels that use less information and journal style panels. By way of background to this experimental work, we will show some results on current levels of reliability for GRPs, the costs incurred by all who participate in Project Grant selection, and the level of reliability acceptable to researchers. By experimenting in this way and building an evidence base for how research funding should be allocated, the NHMRC is showing international leadership in this important field.

Leadership for creating a thinking school at Buranda State School

This article explores the role of principal leadership in creating a thinking school. It contributes to the school leadership literature by exploring the intersection of two important areas of study in education - school leadership and education for thinking - which is a particularly apt area of study, because effective school leadership is crucial if students are to learn to be critical and creative thinkers, yet this connection has not be widely investigated. We describe how one principal, Hinton, turned around an underperforming school by using critical and creative philosophical thinking as the focus for students, staff and parents. Then, drawing on the school leadership literature, the article describes seven attributes of school leadership beginning with four articulated by Leithwood and colleagues (2006) (building vision and setting direction; redesigning the organisation; understanding and developing people; managing the teaching and learning program), and adding three others (influence; self-development; and responding to context). This framework is then used in a case study format in a collaboration between practitioner and researchers to first explore evidence from empirical studies and personal reflection about Hinton's leadership of Buranda State School, and second to illuminate how these general features of school leadership apply to creating a thinking school. Based on the case study and using the general characteristics of school leadership, a framework for leading a thinking school is described. Because the framework is based on a turnaround school, this framework has wide applicability: to schools that are doing well as an indication of how to implement a contemporary approach to curriculum and pedagogy; and to schools that are underperforming and want a rigorous, high expectation and contemporary way to improve student learning.

Community Partnerships for Fostering Student Interest and Engagement in STEM

The foundations of Science, Technology, Engineering and Mathematics (STEM) education begins in the early years of schooling when students encounter formal learning experiences primarily in mathematics and science. Politicians, economists and industrialists recognise the importance of STEM in society, and therefore a number of strategies have been implemented to foster interest. Similarly, most students see the importance of science and mathematics in their lives, but school science and mathematics is usually seen as irrelevant, particularly by students in developed countries. This paper reports on the establishment and implementation of partnerships with industry experts from one jurisdiction which have, over a decade, attempted to reconcile the interests of youth and the contemporary world of science. Four case studies are presented and qualitative findings analyzed in terms of program outcomes and student engagement. The key finding is that the formation of relationships and partnerships, in which students have high degree of autonomy and sense of responsibility, is paramount to positive dispositions towards STEM. Those features of successful partnerships are also discussed. The findings raise some hope that innovative schools and partnerships can foster innovation and connect youth with the real world.

The role for police in addressing alcohol-related harm inside and outside licensed premises

Alcohol consumption is enmeshed with Australian culture (Palk, 2008) and the use and misuse of alcohol contributes to considerable health and social harms (Barbor et al., 2010; English et al., 1995; Gutjahr, Gmel, & Rehm, 2001; Palk, 2008; Steenkamp, Harrison, & Allsop, 2002). Despite shifts in the way that alcohol is consumed and how it is used, it has been reported that one-third of all alcohol consumed is done so within licensed premises (Lang, Stockwell, Rydon, & Gamble, 1992). Consequently, licensed premises are over-represented as settings in which alcohol-related harms occur. These harms, particularly those related to violence, are associated with particular licensed premises operating in the night-time economy (Briscoe & Donnelly, 2001b; Chikritzhs, Stockwell, & Masters, 1997; Homel, Tomsen, & Thommeny, 1991; Stockwell, 1997). Police have a role in not only responding to the manifestation of harms, such as crime, injuries, assaults, domestic violence, stealing and sexual offences, but they also have a role in preventing problems, and thereby reducing alcohol and other drug-related harms (Doherty & Roche, 2003). Given the extent of alcohol consumption within licensed premises and the nature and extent of the harms, as well as the lack of opportunity to influence outcomes in other settings (e.g. the home), licensed premises offer police and other stakeholders a significant opportunity to influence positively the reduction of alcoholrelated harm. This research focuses specifically on the police role in policing licensed premises. Primarily, this research aims to investigate the factors which are relevant to why and how police officers respond to alcohol-related incidents inside and outside licensed premises. It examines the attitudes and beliefs of police and assesses their knowledge, capacity and ability to effectively police licensed premises. The research methodology uses three distinct surveys. Each contributes to understanding the motivations and practice of police officers in this important area of harm reduction. Study One involved a survey of police officers within a police district (Brisbane Central District) in Queensland, Australia and used a comprehensive questionnaire involving both quantitative and qualitative techniques. A key research outcome of Study One was the finding that officers had low levels of knowledge of the strategies that are effective in addressing alcohol-related harm both inside and outside licensed premises. Paradoxically, these officers also reported extensive recent experience in dealing with alcohol issues in these locations. In addition, these officers reported that alcohol was a significant contextual factor in the majority of matters to which they responded. Officers surveyed reported that alcohol increased the difficulty of responding to situations and that licensed premises (e.g. nightclubs, licensed clubs and hotels) were the most difficult contexts to police. Those surveyed were asked to self-assess their knowledge of the Liquor Act (Qld), which is the primary legislative authority in Queensland for regulating licensed premises. Surprisingly, well over half of the officers (65%) reported ‘no’ to ‘fair’ knowledge of the Act, despite officers believing that their skill level to police such premises was in the ‘good to very good range’. In an important finding, officers reported greater skill level to police outside licensed premises than inside such premises, indicating that officers felt less capable, from a skill perspective, to operate within the confines of a licensed premise than in the environment immediately outside such premises. Another key finding was that officers reported greater levels of training in responding to situations outside and around licensed premises than to situations inside licensed premises. Officers were also asked to identify the frequency with which they employed specified regulatory enforcement and community-based strategies. Irrespective of the type of response, ‘taking no action’ or passive policing interventions were not favoured by officers. The findings identified that officers favoured taking a range of strategies (sending home, releasing into the custody of friends, etc.) in preference to arrest. In another key finding, officers generally reported their support for operational stakeholder partnership approaches to policing licensed premises. This was evidenced by the high number of officers (over 90%) reporting that there should be shared responsibility for enforcing the provisions of the Liquor Act. Importantly, those surveyed also identified the factors which constrain or prevent them from policing licensed premises. Study Two involved interviewing a small but comprehensive group (n=11) of senior managers from within the Queensland Police Service (QPS) who have responsibility for setting operational and strategic policy. The aim of this study was to examine the attitudes, perceptions and influence that senior officers (at the strategy and policy-setting level) had on the officers at the operational level. This qualitative study was carried out using a purposive sampling (Denzin & Lincoln, 2005; Guba & Lincoln, 1989), focused interview and thematic analytic approach. The interview participants were drawn from three tiers of management at district, regional as well as the whole-of-organisational level. The first key theme emerging from the study related to role, in terms of both the QPS broader organisational role, and the individual officer role with respect to the policing of licensed premises. For the QPS organisational role, participants at all three strategic levels had a high degree of congruity as to the organisations service role; that is, to enhance public safety. With respect to participants’ beliefs as to whether police officers have knowledge and understanding of their individual roles concerning licensed premises (as opposed to the QPS role), participants reported most commonly that officers had a reasonable to clear understanding of their role. Participant comments also were supportive of the view that officers operating in the research area, Brisbane Central District (BCD), had a clearer understanding of their role than police operating in other locations. The second key theme to emerge identified a disparity between the knowledge and capability of specialist police, compared with general duties police, to police licensed premises. In fact, a number of the responses to a variety of questions differentiated specialist and general police in a range of domains. One such example related to the clarity of understanding of officer role. Participants agreed that specialist police (Liquor Enforcement & Proactive Strategies [LEAPS] officers) had more clarity of understanding in terms of their role than generalist police. Participants also were strongly of the opinion that specialist police had higher skill levels to deal with issues both inside and outside licensed premises. Some participants expressed the view that general duty police undertook purely response-related activities, or alternatively, dealt with lower order matters. Conversely, it was viewed that specialist police undertook more complex tasks because of their higher levels of knowledge and skill. The third key theme to emerge concerned the identification of barriers that serve to restrict or prevent police officers from policing licensed premises. Participant responses strongly indicated that there was a diversity of resourcing barriers that restrict police from undertaking their roles in licensed premises. Examples of such barriers were the lack of police and the low ratio of police to patrons, available officer time, and lack of organisational investment in skills and knowledge acquisition. However, some participants indicated that police resourcing in the BCD was appropriate and officers were equipped with sufficient powers (policy and legislation). Again, the issue of specialist police was raised by one participant who argued that increasing the numbers of specialist police would ameliorate the difficulties for police officers policing licensed premises. The fourth and last key theme to emerge from Study Two related to the perception of senior officers regarding the opportunity and capability of officers to leverage off external partnerships to reduce harms inside and outside licensed premises. Police working in partnership in BCD was seen as an effective harm reduction strategy and strongly supported by the participants. All participants demonstrated a high degree of knowledge as to who these partners were and could identify those government, non-government and community groups precisely. Furthermore, the majority of participants also held strong views that the partnerships were reasonably effective and worked to varying degrees depending on the nature of the partnership and issues such as resourcing. These senior officers identified better communication and coordination as factors that could potentially strengthen these partnerships. This research finding is particularly important for senior officers who have the capacity to shape the policy and strategic direction of the police service, not only in Queensland but throughout Australasia. Study Three examined the perceptions of those with links to the broader liquor industry (government, non-government and community but exclusive of police) concerning their understanding of the police role and the capacity of police to reduce alcohol-related harm inside and outside licensed premises, and their attitudes towards police. Participants (n=26) surveyed represented a range of areas including the liquor industry, business represenatives and government representatives from Queensland Fire and Rescue Service, Queensland Ambulance Service, Brisbane City Council and Queensland Health. The first key theme to emerge from Study Three related to participant understanding of the QPS organisational role, and importantly, individual officer role in policing licensed premises. In terms of participant understanding of the QPS role there was a clear understanding by the majority of participants that the police role was to act in ways consistent with the law and to otherwise engage in a range of enforcement-related activities. Participants saw such activities falling into two categories. The first category related to reactive policing, which included actions around responding to trouble in licensed premises, monitoring crowd controllers and removing trouble-makers. In the second category, proactive approaches, participants identified the following activities as consistent with that approach: early intervention with offenders, support of licensed premises operators and high visibility policing. When participants were asked about their understanding of individual officer roles in the policing of licensed premises, a range of responses were received but the consistent message that emerged was that there is a different role to be played by general duty (uniformed) police compared to specialist (LEAPS Unit) police, which reflects differences in knowledge, skill and capability. The second key theme that emerged from the data related to the external participants’ views of the knowledge and capability of specialist police, compared with general duty police, to police licensed premises. As noted in the first key theme, participants were universally of the view that the knowledge, skill and capability of police in specialist units (LEAPS Unit) was at a higher level than that of general duty police. Participants observed that these specialist officers were better trained than their colleagues in generalist areas and were therefore better able to intervene knowledgeably and authoritatively to deal with problems and issues as they emerged. Participants also reported that officers working within BCD generally had a positive attitude to their duties and had important local knowledge that they could use in the resolution of alcohol-related issues. Participants also commented on the importance of sound and effective QPS leadership, as well as the quality of the leadership in BCD. On both these measures, there was general consensus from participants, who reported positively on the importance and effectiveness of such leadership in BCD. The third key theme to emerge from Study Three concerned the identification of barriers that serve to restrict or prevent police officers from policing licensed premises. Overwhelmingly, external participants reported the lack of human resources (i.e. police officers) as the key barrier. Other resourcing limitations, such as available officer time, police computer systems, and the time taken to charge offenders, were identified as barriers. Some participants identified barriers in the liquor industry such as ‘dodgy operators’ and negative media attention as limitations. Other constraints to emerge related to government and policy barriers. These were reflected in comments about the collection by government of fees from licensees and better ‘powers’ for police to deal with offenders. The fourth and final key theme that emerged from Study Three related to the opportunities for and capability of police to leverage off external partnerships to reduce harms inside and outside licensed premises. Not surprisingly, participants had a comprehensive knowledge of a broad range of stakeholders, from a diversity of contexts, influential in addressing issues in licensed premises. Many participants reported their relationships with the police and other stakeholders as effective, productive and consistent with the objectives of partnering to reduce alcohol-related harm. On the other hand, there were those who were concerned with their relationship with other stakeholders, particularly those with a compliance function (e.g. Office of Liquor & Gaming Regulation [OLGR]). The resourcing limitations of partners and stakeholders were also raised as an important constraining factor in fulfilling the optimum relationship. Again, political issues were mentioned in terms of the impact on partnerships, with participants stating that there is at times political interference and that politicians complicate the relationships of stakeholders. There are some significant strengths with respect to the methodology of this research. The research is distinguished from previous work in that it examines these critical issues from three distinct perspectives (i.e. police officer, senior manager and external stakeholder). Other strengths relate to the strong theoretical framework that guides and informs the research. There are also some identified limitations, including the subjective nature of self-report data as well as the potential for bias by the author, which was controlled for using a range of initiatives. A further limitation concerns the potential for transferability and generalisability of the findings to other locations given the distinctive nature of the BCD. These limitations and issues of transferability are dealt with at length in the thesis. Despite a growing body of literature about contextual harms associated with alcohol, and specific research concerning police intervention in such contextual harms, there is still much to learn. While research on the subject of police engaging in alcohol-related incidents has focused on police behaviours and strategies in response to such issues, there is a paucity of research that focuses on the knowledge and understanding of officers engaged in such behaviours and practices. Given the scarcity of research dealing with the knowledge, skills and attitudes of police officers responding to harms inside and outside licensed premises, this research contributes significantly to what is a recent and growing body of research and literature in the field. The research makes a practical contribution to police agencies’ understanding of officer knowledge and police practice in ways that have the potential to shape education and training agendas, policy approaches around generalist versus specialist policing, strategic and operational strategy, as well as partnership engagements. The research also makes a theoretical contribution given that the research design is informed by the Three Circle

Redefining and leading the academic discipline in Australian universities

Disciplines have emerged as an alternative administrative structure to departments or schools in Australian universities. We presently investigate the pattern of discipline use and by way of case study examine a role for distributed leadership in discipline management. Over forty per cent of Australian universities currently employ disciplines, especially within faculties of sciences, engineering and medicine. No trend is observed according to institutional age, state, or historical origins. Effective planning, retention of corporate knowledge and good communication are important during the transition period. Moreover, it is vital that professional staff continue to work closely alongside academics as extended members of the discipline. Distributed leadership encourages this interaction. The duties of a discipline leader can be similar to those faced by a head of department. Universities should therefore establish clear policies, position descriptions and appropriate remuneration packages in order to recruit, train and retain staff within this emerging academic management role.

Consumers persepctive on pharmacists integration into private primary healthcare clinics in Malaysia

Background: Pharmacists are considered medication experts but are underutilised mainly at the periphery of the primary healthcare team. General medical practitioners (GPs) in Malaysian private healthcare clinics are granted rights to prescribe and dispense medications, thus furhter limiting pharmacists involvement in ensuring safe use of medicines. The integration of pharmacist into private primary healthcare clinics has the potential to reduce medication-relation problems. Objective: To explore the views of consumers on the integration of pharmacists within private primary healthcare clinics in Malaysia. Method: A purposive sample of healthcare consumers in Selangor and Kuala Lumpur, Malaysia were invited to participate in focus groups and semi-structured interviews. Sessions were audio recorded and transcribed verbatim and thematically analysed using NVivo 10. Results: A total of 24 healthcare consumers particpated in two focus groups and six semi-structured interviews. Four major themes were identified: (1) Pharmacists role viewed mainly as supplying medications, (2) Readiness to accept pharmacists in private healthcare clinics, (3) Willingness to pay for pharmacy services, and (4) Concerns about GPs resistance to pharmacist integration. Consumers felt that a pharmacist integrated into private prumary healthcare clinics could offer potential benefits such as counter-checking prescriptions to ensure correct medication is supplied and counselling consumers on their medications and the potential side effects. The potential to increase in costs to consumers and GPs reluctance were perceived as barriers to integration. Conclusion: This study provides insights into consumers perspectives on the roles of pharmacists within private primary healthcare clinics in Malaysia. Consumers generally supported pharmacist integration into private primary healthcare clinics. However, for pharmacists to expand their capacity in providing integrated and collaborative primary care services to consumers, barriers to pharmacist integration need to be addressed.

Enterprise Business Technology Governance: Three Competencies to Build Board Digital Leadership Capability.

The competent leadership of digital transformation needs to involve the board of directors. The reported lack of such capability in boards is becoming a pressing issue. A part of leadership in such transformation is the board of director’s competence to lead Enterprise Business Technology Governance (EBTG). In this paper we take the position that EBTG competencies are essential in boards, because competent EBTG has been shown to contribute to increased revenue, profit, and returns. We update and expand on the results of a multi-method approach to the development of a set of three board of director competencies needed for effective EBTG.

An economic case for providing free access to antiretroviral therapy for HIV-positive people in South Australia

Background As financial constraints can be a barrier to accessing HIV antiretroviral therapy (ART), we argue for the removal of copayment requirements from HIV medications in South Australia. Methods Using a simple mathematical model informed by available behavioural and biological data and reflecting the HIV epidemiology in South Australia, we calculated the expected number of new HIV transmissions caused by persons who are not currently on ART compared with transmissions for people on ART. The extra financial investment required to cover the copayments to prevent an HIV infection was compared with the treatment costs saved due to averting HIV infections. Results It was estimated that one HIV infection is prevented per year for every 31.4 persons (median, 24.0–42.7 interquartile range (IQR)) who receive treatment. By considering the incremental change in costs and outcomes of a change in program from the current status quo, it would cost the health sector $17 860 per infection averted (median, $13 651–24 287 IQR) if ART is provided as a three-dose, three-drug combination without requirements for user-pay copayments. Conclusions The costs of removing copayment fees for ART are less than the costs of treating extra HIV infections that would result under current conditions. Removing the copayment requirement for HIV medication would be cost-effective from a governmental perspective.