NACCHO Aboriginal Prisoner Health #ClosingThe Gap #HaveYourSayCTG : What are the barriers preventing community-controlled health organisations providing care to Aboriginal and Torres Strait Islander people in prison ?

“Findings showed that while most participant ACCHOs had delivered services to people in the community upon release from prison, opportunities to deliver primary health care services to individuals in prisons were very limited.

Two key barriers to implementing holistic and culturally appropriate health care in prisons were lack of access to prisoners due to security protocols and prison staff attitudes, and lack of a sustainable funding model.

A reliable funding model underpinned by consistent access to prisoners and access to certain Medicare items could resolve this conundrum, as has been previously proposed.23

To this end, we encourage the Commonwealth of Australia to engage in appropriate discussions to resolve this matter.

Additionally, custodial and prison health providers need to engage in meaningful discussions with ACCHOs to address prisoner access issues. “

Download the Research Paper Here or READ Online

Barriers prevent ACCHOs from getting care to prisoners

Read all the Aboriginal health and Just Justice articles by NACCHO

How likely are you to go to jail? As an Aboriginal adult you are 16 times more likely to be incarcerated. Juveniles in Western Australia are 52 times more likely to be imprisoned than their white peers [15

Closing the Gap / Have your say about the prison system see Part 3 below

Deadline extended to Friday, 8 November 2019.

Part 1 PHAA Press Release

New research has revealed that Aboriginal Community Controlled Health Organisations (ACCHOs) face barriers to deliver to Aboriginal and Torres Strait Islander prisoners what they do best – holistic primary health care for Aboriginal and Torres Strait Islander people.

Researchers interviewed nineteen staff from four ACCHOs close to prisons across three Australian jurisdictions.

They found that while most ACCHOs deliver post release programs, their capacity to deliver health care to prisoners is limited by security protocols that restrict access to prisoners and funding constraints.

The study results are published today in the Public Health Association of Australia’s journal, the Australian and New Zealand Journal of Public Health.

ACCHOs are universally acknowledged as organisations that are run by Aboriginal and Torres Strait Islander people for Aboriginal and Torres Strait Islander people, delivering holistic primary health care that’s local and community owned.

The authors make several recommendations including reliable funding for ACCHOs and better and consistent access to prisoners.

State governments are encouraged to address prison access issues while the Federal Government is urged to consider changing the rules that prevent ACCHOs from using Medicare to fund work undertaken in the prison setting.

The health of Aboriginal and Torres Strait Islander people is poorer than that of other Australians. They are over-represented in Australian jails. Due to the unique cultural, social and historical factors, specific solutions to address health issues are required.

Part 2 Selected extracts

The offender population is one of the most stigmatised and socially excluded groups in society. Epidemiological studies of prisoners consistently find high levels of physical ill health, psychiatric illness and communicable diseases, and engagement in health risk behaviours such as smoking, alcohol consumption, illicit drug use and violence.12

For Aboriginal and Torres Strait Islander (hereon ‘Indigenous’) offenders, disadvantage is further compounded by poor social determinants of health.

Since colonisation more than 230 years ago, Indigenous Australians have lower levels of political representation, educational attainment and income when compared to the general Australian population, as well as higher rates of social exclusion, unemployment, trauma and ill‐health, and shorter life expectancy.3 Indigenous Australians frequently experience racism and low levels of access in mainstream health services and the legal system.45 These issues underscore the importance of community controlled primary health care for Indigenous offenders that is contextually relevant, holistic and culturally safe.

Aboriginal and Torres Strait Islander Community Controlled Health Organisations (ACCHOs) provide culturally appropriate, autonomous primary health care services that are initiated, planned and governed by local Aboriginal Australian communities through an elected board of directors.6

ACCHOs are represented nationally by the National Aboriginal Community Controlled Organisation (NACCHO), which engages directly with policy makers and funding bodies, links ACCHOs to facilitate health service delivery and research, advises on research, and provides leadership on service delivery principles such as community control.

Community control is vital for culturally appropriate and acceptable health care services in Indigenous communities and enacts articles of the United Nations Declaration on the Rights of Indigenous Peoples, ensuring self‐reliance, self‐determination, appropriate and acceptable health care.6

Since the establishment of the first ACCHO in inner Sydney in 1971, the network of ACCHOs has grown to 143 across Australia, providing more than three million episodes of care each year for approximately 350,000 people.7

Primary health care services provided by ACCHOs embody the Aboriginal definition of health, which is not just about an individual’s physical wellbeing but also the social, emotional and cultural wellbeing of the community, and takes a whole‐of‐life perspective that incorporates a cyclical concept of life–death–life.8

ACCHOs provide comprehensive primary health care that includes health education, health promotion, social and emotional wellbeing support and a range of other community development initiatives.9

Limited access to primary health care services for Indigenous peoples is a major barrier to addressing the overall aim of the Australian Government’s ‘Closing the Gap’ framework.10 Data show that, compared to mainstream services, ACCHOs are frequently accessed by Indigenous people.11

A 9% growth in Indigenous community members accessing their local ACCHO was observed between 2012–13 and 2014–15, with a 23% increase in the total number of episodes of care during this time.7 In a study comparing outcomes and indicators between ACCHOs and mainstream services, ACCHOs performed better in terms of best practice care, monitoring clinical performance, increasing engagement of Indigenous community members, and better leadership in training non‐Indigenous staff in Indigenous health matters.12

Barriers to accessing mainstream services extend also to Indigenous Australians in the criminal justice system. In Australia, Indigenous people comprise 28% of the prisoner population, but only 2% of the general population.13 Australian state and territory legislation states that prisoners must be able to access health care when they require it, and that they have the right to the same level of care as in the wider community14 – a right referred to in the international context as the ‘equivalence of care’ principle.15

Incarceration causes a person to be separated from their community.17 A recommendation (168) by the Royal Commission into Aboriginal Deaths in Custody (RCIADIC) requires that a person be incarcerated as close to their home community as possible.16 Incarceration can also disrupt continuity of holistic health care provided by an ACCHO,17 if that ACCHO has no means of accessing the prisoner.

Other custodial health and safety recommendations made by the RCIADIC state that Corrective Services departments should review the provision of health services to Indigenous prisoners including the level of involvement of ACCHOs (Recommendation 152c) and the exchange of relevant health information between prison medical staff and ACCHOs (Recommendation 152e).16

Australia’s National Indigenous Drug and Alcohol Committee (NIDAC) asserts that improvements in health services for Indigenous prisoners and juvenile detainees may assist in reducing the overall prisoner numbers.18 Areas noted for improvement included health screening on reception, increasing uptake of recommended treatments, and enhancing prisoner throughcare by facilitating access of Indigenous health and other services to Indigenous prisoners.18

NIDAC highlighted that “the provision of a ‘one health service fits all’ model, as in the case for many corrections systems, creates a disjointed and unsuitable approach” for addressing health needs of Indigenous prisoners.18

In response, NIDAC recommended several strategies for involving ACCHOs to improve the health care of prisoners and their ongoing care post‐release.18 However, there is a dearth of literature on external health care provision to Australia’s prisoners from which to plan coordinated actions and resource allocation. Only a small number of reports are available on health care provided by community‐based organisations in prisons.1920

Health care varies greatly in Australia’s state‐ and territory‐based prisons, with government Departments of Health providing health care services to some through agencies such as the Justice and Forensic Mental Health Network in New South Wales (NSW), and Departments of Justice or contracted private companies providing services to others.21

There is no nationally coordinated approach or body whose role it is to monitor prisoners’ health care needs, and no national strategy for assessing or meeting the specific health needs of Indigenous prisoners.22 Australia’s publicly funded universal health care system – the Medicare Benefits Scheme and Pharmaceutical Benefits Scheme, collectively known as Medicare – is suspended for prisoners during incarceration.

This is because other state‐ and territory‐level government departments become responsible for providing health care to prisoners.23 However, this arrangement has been identified as problematic, with concerns that it reduces resources or opportunities for providing comprehensive health care to prisoners that is equivalent to that available in the community.23

This project was designed by a team of Aboriginal and non‐Aboriginal researchers working at the nexus of the justice and health systems, and with specialisations in Indigenous health research, epidemiology, qualitative research and health services research and evaluation. Three of the team members identified as Indigenous Australians.

The primary aim of the research was to explore prisoner health services and programs provided by a selection of ACCHOs, including the challenges and enablers of delivering these, and implications for further research.

Part 3 Closing the Gap / Have your say about the prison system

Deadline extended to Friday, 8 November 2019.


The engagements are now in full swing across Australia and this is generating more interest than we had anticipated in our survey on Closing the Gap.

The Coalition of Peaks has had requests from a number of organisations across Australia seeking, some Coalition of Peak members and some governments for more time to promote and complete the survey.

We want to make sure everyone has the opportunity to have their say on what should be included in a new agreement on Closing the Gap so it is agreed to extend the deadline for the survey to Friday, 8 November 2019.

This will help build further understanding and support for the new agreement and will not impact our timeframes for negotiating with government as we were advised at the most recent Partnership Working Group meeting that COAG will not meet until early 2020.

There is a discussion booklet that has background information on Closing the Gap and sets out what will be talked about in the survey.

The survey will take a little bit of time to complete. It would be great if you can answer all the questions, but you can also just focus on the issues that you care about most.

To help you prepare your answers, you can look at a full copy here

The survey is open to everyone and can be accessed here:

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