Leading with local solutions to keep Yarrabah safe: a grounded theory study of an Aboriginal community-controlled health organisation’s response to COVID-19

Abstract

Background Pandemics such as COVID-19 are a serious public health risk for Australian Aboriginal and Torres Strait Islander communities, yet primary healthcare systems are not well resourced to respond to such urgent events. At the start of the COVID-19 pandemic, a federal government advisory group recommended a rapid, tailored Indigenous response to prevent predicted high morbidity and mortality rates. This paper examines the efforts of one ACCHO, which in the absence of dedicated funding, pivoted its operations in response to COVID-19. Gurriny Yealamucka Health Service (Gurriny) is the only primary healthcare service in the discrete Indigenous community of Yarrabah, Far North Queensland. Methods The research was conducted at the request of the Chief Executive Officer of Gurriny. Using grounded theory methods, thirteen Gurriny staff and five Yarrabah and government leaders and community members were interviewed, transcripts of these interviews and 59 documents were imported into NVIVO-12 and coded, and key concepts were compared, organised into higher order constructs, then structured into a theoretical framework. Results Gurriny responded to COVID-19 by leading with local solutions to keep Yarrabah safe. Four key strategies were implemented: managing the health service operations, realigning services, educating and supporting community, and working across agencies. These strategies were enabled or hindered by five conditions: the governance and leadership capacity of Gurriny, relying on the health taskforce, locking the door, “copping it”, and (not) having resources. A year after the first case was experienced in Australia and on the eve of vaccine rollout to Indigenous communities, there have been no COVID-19 cases in Yarrabah. Discussion The success of the locally led, holistic, comprehensive and culturally safe response of Gurriny suggests that such tailored place-based approaches to pandemics (and other health issues) are appropriate, but require dedicated resourcing. Key challenges were the fragmented and rapidly changing government processes, poorly coordinated communication and resource allocation channels, and bottlenecks in hierarchical funding approval processes. Conclusions The COVID-19 response in Yarrabah demonstrates the need for governance reform towards greater resourcing and support for local decision making by Aboriginal community-controlled health organisations.

Global Experiences of Community Responses to COVID-19: A Systematic Literature Review

“…Six studies addressed the theme of community screening for COVID-19 ( 48 , 53 , 58 , 62 , 63 , 67 ). There were two subthemes relating to this theme: biotechnology-based detection methods and non-biotechnology-based detection methods.…”

“…In an Australian indigenous community Yarrabah , community-based testing was provided by a primary healthcare center. Community-based testing, aside from other measures, successfully prevented the invasion of COVID-19 into Yarrabah community ( 58 ). It was also suggested that the nationwide intensive community screening in China was extremely effective in controlling the spread of the COVID-19 epidemic ( 63 ).…”

“…This theme examined how residential communities cut off the transmission chain of COVID-19. This theme involved nine studies ( 48 – 50 , 53 , 55 , 56 , 58 , 69 , 70 ). Two subthemes underpinned this theme, that is, preventing the invasion of the COVID-19 into the community and preventing cross-infection in the community.…”

The Intensifying Threat of COVID-19 Among First Nations People of Australia

“…The federal government's responsibility for First Nations' health care should have guaranteed its collaboration with state and regionally based Indigenous community-controlled health organizations to defend First Nations people from the health threat of COVID-19. 4 Instead, not all ACCHOs in each state have been directly given the support and resources required. 4 Personal protective equipment and vaccine rollouts were directed through state government agencies with inconsistent, and in some states, dangerously slow progress.…”

“…4 Instead, not all ACCHOs in each state have been directly given the support and resources required. 4 Personal protective equipment and vaccine rollouts were directed through state government agencies with inconsistent, and in some states, dangerously slow progress. For example, as of late September 2021, the proportions of fully vaccinated First Nations people 12 years and older were just 15.7% in Western Australia, 24.2% in South Australia, and 23.4% in Queensland.…”