Aboriginal participation in health service delivery: coordinated care trials in the Northern Territory of Australia (original) (raw)
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This paper explores some of the history and rationale for the Aboriginal Community Controlled Health Services (ACCHS) model of service delivery, and why it is difficult to compare their effectiveness directly with that of other primary health care services in Australia. ACCHS were pioneered over 40 years ago. Since then, they have been established across Australia as a model of primary health care to meet the needs of Australia's disadvantaged Indigenous population which had been underserviced within mainstream health services. ACCHS are managed by Aboriginal boards, promote a model of holistic and comprehensive primary health care and are largely funded by government. Over recent years, additional funding has gone to ACCHS and mainstream services in an effort to close the gap in Aboriginal life expectancy. In this context, the authors were commissioned to examine the peer-reviewed literature to explore the question of the relative effectiveness of ACCHS compared with other primary health care services. In responding to the question, we were led to consider the historical experience of Aboriginal people, their social and economic disadvantage, the geographic distribution of Aboriginal people where there is market-failure of general practice, the predominant model of primary care in Australia, the complexity of Aboriginal people's health needs, and the limitations of peer-review studies. We argue that the provision of effective health services requires that they are accessible and attentive to the needs of their client, not just that they deliver evidence-based medicine. Services exist on a performance continuum, so quality improvement approaches with appropriate measures of quality to assess performance for Aboriginal people are needed. We argue that partnerships between ACCHS and mainstream health care providers are essential to improving Aboriginal health outcomes given the complex nature of modern health care and the myriad of health and social problems experienced by Aboriginal people.
Case Study of an Aboriginal Community Controlled Health Service in Australia
2016
Universal health coverage provides a framework to achieve health services coverage but does not articulate the model of care desired. Comprehensive primary health care includes promotive, preventive, curative, and rehabilitative interventions and health equity and health as a human right as central goals. In Australia, Aboriginal community-controlled health services have pioneered comprehensive primary health care since their inception in the early 1970s. Our five-year project on comprehensive primary health care in Australia partnered with six services, including one Aboriginal community-controlled health service, the Central Australian Aboriginal Congress. Our findings revealed more impressive outcomes in several areas—multidisciplinary work, community participation, cultural respect and accessibility strategies, preventive and promotive work, and advocacy and intersectoral collaboration on social determinants of health—at the Aboriginal community-controlled health service compared to the other participating South Australian services (state-managed and nongovernmental ones). Because of these strengths, the Central Australian Aboriginal Congress's community-controlled model of comprehensive primary health care deserves attention as a promising form of implementation of universal health coverage by articulating a model of care based on health as a human right that pursues the goal of health equity.
Health and human rights, 2016
Universal health coverage provides a framework to achieve health services coverage but does not articulate the model of care desired. Comprehensive primary health care includes promotive, preventive, curative, and rehabilitative interventions and health equity and health as a human right as central goals. In Australia, Aboriginal community-controlled health services have pioneered comprehensive primary health care since their inception in the early 1970s. Our five-year project on comprehensive primary health care in Australia partnered with six services, including one Aboriginal community-controlled health service, the Central Australian Aboriginal Congress. Our findings revealed more impressive outcomes in several areas-multidisciplinary work, community participation, cultural respect and accessibility strategies, preventive and promotive work, and advocacy and intersectoral collaboration on social determinants of health-at the Aboriginal community-controlled health service compare...
BMC health services research, 2016
Effectively addressing health disparities between Aboriginal and non-Aboriginal Australians is long overdue. Health services engaging Aboriginal communities in designing and delivering healthcare is one way to tackle the issue. This paper presents findings from evaluating a unique strategy of community engagement between local Aboriginal people and health providers across five districts in Perth, Western Australia. Local Aboriginal community members formed District Aboriginal Health Action Groups (DAHAGs) to collaborate with health providers in designing culturally-responsive healthcare. The purpose of the strategy was to improve local health service delivery for Aboriginal Australians. The evaluation aimed to identify whether the Aboriginal community considered the community engagement strategy effective in identifying their health service needs, translating them to action by local health services and increasing their trust in these health services. Participants were recruited usin...
JMIR Research Protocols
Background: Primary, specialist, and allied health services can assist in providing equitable access in rural and remote areas, where higher proportions of Aboriginal and Torres Strait Islander people (Aboriginal Australians) reside, to overcome the high rates of chronic diseases experienced by this population group. Little is currently known about the location and frequency of services and the extent to which providers believe delivery is occurring in a sustained and coordinated manner. Objective: The objective of this study will be to determine the availability, accessibility, and level of coordination of a range of community-based health care services to Aboriginal people and identify potential barriers in accessing health care services from the perspectives of the health service providers. Methods: This mixed-methods study will take place in 3 deidentified communities in New South Wales selected for their high population of Aboriginal people and geographical representation of location type (coastal, rural, and border). The study is designed and will be conducted in collaboration with the communities, Aboriginal Community Controlled Health Services (ACCHSs), and other local health services. Data collection will involve face-to-face and telephone interviews with participants who are health and community professionals and stakeholders. Participants will be recruited through snowball sampling and will answer structured, quantitative questions about the availability and accessibility of primary health care, specialist medical and allied health services and qualitative questions about accessing services. Quantitative data analysis will determine the frequency and accessibility of specific services across each community. Thematic and content analysis will identify issues relating to availability, accessibility, and coordination arising from the qualitative data. We will then combine the quantitative and qualitative data using a health ecosystems approach.
Aboriginal and Primary Health Care in Victoria: Issues for Policy and Regional Planning
Recently in national Aboriginal and Torres Strait Islander health policy there has been an increasing focus on developing collaborative approaches to planning health services. The Framework Agreements in Aboriginal and Torres Strait Islander health were developed by the Commonwealth to provide a mechanism through which the Commonwealth and State governments, together with the Aboriginal and Torres Strait Islander Commission (ATSIC) and the Aboriginal community controlled health sector, could work collaboratively on regional planning in Aboriginal health. In addition, the national approach has placed a priority on improving the capacity of Aboriginal primary health care services. Given that it is likely that Commonwealth initiatives in Aboriginal health will be increasingly linked to the joint planning process it is critical that these barriers to the development of a collaborative regional plan in Koori health be addressed.