NACCHO Cultural Competency : Download report Delivery of Health Services for Indigenous people


“This issues paper examines the available evidence on cultural competence in international and local literature. It defines cultural competency; reports on available evidence; identifies approaches and strategies that are effective in improving cultural competency among health services staff, examines the relationship between cultural competency and health outcomes, and documents an evidence-informed conceptual framework.”

Issues paper no. 13 produced for the Closing the Gap Clearinghouse – Roxanne Bainbridge, Janya McCalman, Anton Clifford and Komla Tsey.


What we know

Cultural competency is a key strategy for reducing inequalities in healthcare access and improving the quality and effectiveness of care for Indigenous people.

Cultural competence is more than cultural awareness—it is the set of behaviours, attitudes, and policies that come together to enable a system, agency, or professionals to work effectively in cross-cultural situations.

Developing and embedding cultural competence in health services requires a sustained focus on knowledge, awareness, behaviour, skills and attitudes at all levels of service, including at the operational or administrative service level, health practitioner level, practitioner-patient level and student-training level.

In Australia, past efforts to increase levels of cultural competence have been largely designed for particular situations. There has been an absence of a coherent approach to its inclusion or teaching and a lack of national standards for the provision of culturally competent health services.

Research on cultural competence is overwhelmingly descriptive and there are few evaluation studies that are methodologically strong. In particular, there was a lack of Australian specific evidence about what strategies are most effective for improving culturally competent healthcare delivery to Indigenous Australians.

What works

The limitations in the evidence base meant that it was not possible to draw definitive conclusions about the effectiveness of culturally competent practices and frameworks in providing health care benefits for Indigenous people. But there was both international and Australian evidence of its potential in a number of studies.

There were some studies that found that bringing together the cultures of health care organisations with Indigenous communities can improve access to health care for Indigenous Australians. This process involves health care organisations: consulting with Indigenous Australian health services and communities, tailoring service delivery to the needs and preferences of specific communities embedding cultural competence within the health care organisational culture, governance, policies and programs.

Education for health care students that incorporates cultural perspectives and experiences can improve health students’ preparedness for working in Indigenous health and their future commitment to working for change.

It can lead to more open attitudes, increased awareness, more effective advocacy, a preparedness to engage with Indigenous people, and a better understanding of Indigenous health issues.

Field experience can also make an important and positive contribution to health students’ perspectives.

What doesn’t work

Internationally validated instruments that measure health service access and use, service quality, perceived discrimination, language barriers and trust of practitioners could be useful if tailored to Indigenous Australian health services.

Embedding cultural competency principles within legislation or policy (as has been done in the United States and New Zealand) is a strategy that could be useful across Australia’s health systems as part of an ongoing commitment to Indigenous Australians and delivering culturally competent care.

Several studies suggested that key to reducing health disparities for Indigenous populations was health care workers developing partnerships, eliminating bias through self-reflection, and building relationships with Indigenous people.

Cultural awareness training is not enough in itself. While such training might be expected to impart knowledge upon which behavioural change will develop, it has generally not been enough when it is delivered in isolation or rapidly delivered over short timeframes.

Program transfer and implementation without cultural-tailoring are ineffective. There are no homogenous approaches to developing and implementing cultural competence.

Cultural competency programs that are successful in one context cannot be assumed to work in another.

Programs need to be developed and delivered in partnership with and input from local Indigenous people.

What we don’t know

There is neither a clear definition nor consistent terminology around cultural competence.

There is inconclusive evidence on the effectiveness of culturally competent interventions and frameworks in relation to health care access and outcomes for Indigenous Australians.

More needs to be done using validated indicators to measure what works in efforts to develop culturally competent health services for Indigenous Australians.

More work is also required to determine the best combination of strategies to improve cultural competence in healthcare.



One comment on “NACCHO Cultural Competency : Download report Delivery of Health Services for Indigenous people

  1. I under took personal journey early 70’s to discover the origin of prejudice, racial discrimination and the impact on mental health of Indigenous people, the journey took me to Asia where I lived with 3 different Indigenous hill tribes, to Aotearoa Maori and Pacific Island communities within. I traveled Australia, living in town camps, visiting northern WA and NT communities.

    I found that it has taken me 40 yrs to assimilate and understand much of what I saw, I learn’t that to be able to help anyone you need to help yourself first, cleanse oneself of bias and personal issues, developing empathy for others, know what self esteem is and ensure your own is intact and strong, recognize what ego strength is and what too little or to much of it can do, personal development required before you can aid someone else with mental health issues, there is more I could add on this suffice to say you probably know much of it.

    Many Indigenous in urban areas have non-Indigenous heritage or DNA, this areas is over looked by many counselors, embracing Indigenality only, while rejecting other part of their being, immersed in their indigenous culture while rejecting other culture and it’s history, to be complete and at peace within your spirit all your cultural roots need to be given equal recognition. I came to that realization after my father died, his non-indigenous heritage was completely unknown to any member of our family, we never gave it a thought, we never asked, he never mentioned much, but without him we would never have existed, I sensed a lack of respect within myself for not embracing what he had gifted us…life, love and security, a new journey of discovery began that I know find is complete and so am I.

    We live a world with a foot in each culture, our Indigenous and non-Indigenous cultures, we may not realize that much of what we own, drive, live in, language, part of non-indigenous culture or Australian culture. It’s easy to take these advantages for granted, but more has to be done to ensure equality within, this is what we reflect to the world, our friends, children and extended family.

    Mental health has many facets and I have touched on one area basically.

    Q: Can a blind person racially vilify someone if can’t see what color, race or ethnicity they are.
    A: NO… they can only prejudice based on taste, smell, touch, sound or sense.

    Such is the nature of discrimination or prejudice, it is organic, innate to all humans and animals part of decision making process that without it we would not exist.
    Education is only way to control it’s expression. Law’s don’t work……

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