Transitioning to Aboriginal community control of primary health care: the process and strategies of one community-controlled health organisation in Queensland

Abstract

Background Aboriginal Community Controlled Health Services (ACCHSs) play a critical role in providing culturally appropriate, accessible primary healthcare (PHC) for Aboriginal and Torres Strait Islander peoples in Australia. The success of many ACCHSs has led to increased policy support for their growth and development, including the transition of state government administered PHC services to Aboriginal community control in select communities. However, there is minimal published literature available which evaluates such transitions. This paper reports on an evaluation of one ACCHS (Gurriny Yealamucka Health Service)‘s experience of transitioning local PHC services to community control in Yarrabah, Queensland, with a focus on the processes and strategies which were implemented to achieve successful transition. Methods Data was collected from interviews with key personnel involved in the transition and organisational documents from the evaluation period. Face-to-face or telephone interviews were conducted with 14 key stakeholders, audio-recorded and transcribed with written consent. Historical organisational documents were provided by Gurriny. All interview transcripts and documents were imported into NVIVO, coded and analysed using grounded theory methods. Results Gurriny’s journey of achieving community control of PHC in Yarrabah entailed an almost 30 year process of building and demonstrating organisational capacity. The first stage (1986 to 2004) was focused on establishing and developing a community-controlled health service and the second stage (2005–14) on preparing for the transition. Formal handover occurred in June 2014. Stage one strategies included: addressing community social and emotional wellbeing; consulting the community; collaborating with researchers; and, strategically building services, organisation capacity and stakeholder trust. Stage two strategies were: communicating and engaging with stakeholders; ensuring strong governance; planning and developing the services and workforce; assuring quality; and, financial planning, management and modelling. Conclusion Achieving successful transition to community control of PHC for Gurriny entailed a lengthy process of substantial, ongoing organisational growth and development. Gurriny’s experience provides a framework for both governments and the ACCHS sector to inform future transitions of PHC services to Aboriginal community control.

The Barriers and Enablers of Primary Healthcare Service Transition From Government to Community Control in Yarrabah: A Grounded Theory Study

“…"Possession" was enabled through Gurriny ownership of the final report and co-authorship of this paper (31). Further details of the approach and methods are provided in a companion paper on the processes and strategies of transition (25).…”

“…Like other ACCHOs, Gurriny was funded through administratively complex funding arrangements through the Commonwealth government's Indigenous Australian's Health Program, primary health networks and Medical Benefits Schedule, QH program and grant funding, and other sundry funding such as research grants and philanthropic funds (36). The processes undertaken in these two stages are described more fully in Jongen et al (25).…”

“…The transition of state or territory run PHC services to First Nations community control is a complex process (25). For the past 30 years, Commonwealth and state governments in Australia have provided a funding and policy commitment to community control (26).…”

“…For example, the National Aboriginal and Torres Strait Islander Health Plan 2013-2023 promotes a "robust, strong, vibrant and effective community controlled health sector" in which "individuals and community actively engage in decision making and control" [(27), p. 7]. Since the mid-late 90's this trend has included the support of the Queensland and Northern Territory health authorities for transferring PHC services delivered in First Nations communities to community control (25,26). But despite policy commitment and significant investments in health reforms, there have been few successful transitions (28).…”

Decolonizing health in Canada: A Manitoba first nation perspective

“…Global persistence of health inequities for Indigenous peoples is evident in higher rates of illness and disease, food insecurity, living standards and mental health [1,3,4,8,13,14,16,19,33,34]. International literature on health inequities suggests the key to successful outcomes is held within communities who have taken control over their health, health services and systems [12,36]. Indigenous participation, engagement in health programming, policy development [37], structural transformation [38], and culturally appropriate healthcare, recognized as a political right [35] are specific tenets within those discourses of control.…”