Tag Archives: Aboriginal Medical Service

NACCHO good news:Aboriginal health initiative proves to be one real success story

6z1yi

“Governments need to step back a bit, they do need to facilitate it, there is a role for government funding and government services but it’s about decision-making and its about the control the communities take and NACCHO (National Aboriginal Community Controlled Health Organisation) is a good example of that because it is community controlled.” Jody Broun, Co-Chair of the National Congress of Australia’s First Peoples and Co-Chair of the National Health Leadership Forum (NHLF),

One of the most successful of the Aboriginal community-controlled sectors in the country over recent decades has been the health sector and recently 30 Indigenous high school students from across the country converged on the nation’s capital to take one further step on their own paths to a career in health.

Out thanks to  National Indigenous Times reporter Geoff Bagnall for this report and picture below

SUBSCRIBE to NIT here

geoff---health-workers-Murra-Mullangari-Jilpia-with-students

Murra Mullangari, an initiative of the Australian Indigenous Doctors Association (AIDA) and their partners in the Indigenous health field, brought the year 10, 11 and 12 students together for a week in Canberra that aimed to inspire Aboriginal and Torres Strait Islander students to pursue a career in health and to support them in their transition from secondary school to the health workforce.

Jilpia Napparljari was there at the very beginning of Aboriginal community-controlled health having been involved in the founding of the very first Aboriginal Medical Service (AMS), Redfern.

“I was involved in the Aboriginal Medical Service when it first started and worked with Fred Hollows at the National Trachoma and eye Health,” Ms Nappaljari said.

She sees programs like Murra Mullangari opening options for the young participants that Indigenous people had to fight much harder for previously.

“As I told some of the young people who came up and spoke to me ‘ just remember, the world is your oyster.”

Ms Nappaljari believes this and similar programs will secure the future of Aboriginal Self-determination.

“Its good as an old person we ‘re not going to live very long and its good to see it’s been taken on, ‘ she said.

Aboriginal and Torres Strait Islander Social Justice Commissioner, Mick Gooda agrees saying events like this are “succession planning” and the inspiring thing is there were over 200 applicants for only 30 places available.

“This is part of succession planning and what we ‘re seeing now is our kids, you can see it here, leaving school and going straight into university whereas in the past a lot of our students have been mature age students, ‘ Mr gooda said.

“That’s an evolution that’s happening now and that’s an indication of the increase of achievement in the education field, so I think it’s pretty exciting. I think for this conference the thing that gets me is more than 200 kids applied for 30 places.

“How great is that to come down to talk about working as doctors working in the allied health areas, so I just think it’s so just deadly to see these kids here, and they will take over, “Mr gooda said.

Pat Anderson, one of the co-authors of the ‘Little Children are Sacred report and Chairperson of the Lowitja Institute Board, agrees with Mr Gooda the event is inspiring but said it showed the unevenness of Aboriginal Opportunity around the country.

“It’s a wonderful initiative by AIDA and they’re t be heartily congratulated on such a program and project and the fact they had more than 200 applicants is just amazing but also I think, a bit more controversially, it demonstrates very tellingly the unevenness of what’s happening in education for Aboriginal people, ‘Ms Anderson said.

“I’m from the Northern territory and its wonderful but there aren’t any kids from the Northern Territory here who are participants, I’ve checked the list.

‘In a lot of the more isolated communities we’re not doing so well but maybe some of these young people might take that on as one of their leadership tasks to try to tackle that unevenness there, she said.

Jody Broun, Co-Chair of the National Congress of Australia’s First Peoples and Co-Chair of the National Health Leadership Forum (NHLF), sees events like this as a crucial part of the Closing the Gap strategy, a strategy few non-Indigenous people realise was actually started by Aboriginal community-controlled organisations before being taken over by the Council of Australian Governments.

“The issue with the Close the Gap, the actual Close the Gap was it came from the ground, it came from the communities, it’s really about us and our communities, taking the lead and taking control, Ms Broun said.

“This is great because you’ve got young people who want these jobs in communities and too often you go to an Aboriginal community and all the health providers are white fellas from outside the communities.

“Whether it’s teachers or health workers, we need to take control of that ourselves and see that these jobs in these communities are for our young people”, she said.

“There are people out there who want these skills and my view, and the Congress’ view, is the communities need the opportunity to take that control back and not be disempowered.

“Governments need to step back a bit, they do need to facilitate it, there is a role for government funding and government services but it’s about decision-making and its about the control the communities take and NACCHO (National Aboriginal Community Controlled Health Organisation) is a good example of that because it is community controlled. They decide the services they deliver.

“These are young people who will be a part of that, you can see how much confidence they have got and some additional skills and having some belief in themselves is really important and the support they will get through this program and hopefully where will be development of that as well,” Ms Broun said.

NACCHO good news:Video to promote training in Aboriginal Medical Services to registrars in rural NSW

  vid

To promote the benefits of working and training in an Aboriginal Medical Service (AMS), Pius X AMS in Moree, Armajun AMS in Inverell and local general practice training provider, GP Synergy, have come together to develop a video showcasing the AMS training experience to GP registrars.

You can view the 16 minute VIDEO here

Across the country, many AMS facilities are involved in the education and training of GP registrars, who are qualified doctors undertaking specialist training in the field of general practice.

The general practice training program requires GP registrars to undertake training in a variety of hospital and community based settings, and this can include training in accredited AMS facilities.

To encourage more GP registrars to consider undertaking part of their training in a rural AMS facility, GP Synergy approached Armajun AMS and Pius X AMS to develop a promotional video showcasing the benefits of working and training in an AMS.

The video features interviews with GP registrars who have undertaken their training in the facilities, as well as interviews with GPs and AMS staff about their AMS experience.

“We wanted to be able to explain to GP registrars the benefits of training in a rural AMS and felt the best way to do this was for the registrars and staff to share their own personal AMS experiences,” said GP Synergy CEO John Oldfield.

Both AMS facilities were happy to take part in the initiative.

“Our involvement in the training program has shown that GP registrars training in AMS facilities can contribute enormously to the primary care health provision for local Aboriginal communities,” Said Armajun AMS CEO Debbie McCowen.

“We are happy to support any initiative that seeks to increase the numbers of GP registrars training in AMS facilities,” she said.

Acting CEO Ray Dennison from Pius X AMS agrees.

“We have found being involved in training GP registrars invaluable,” Ray Dennison.

“Our local community has benefited from improved access to primary health care and it has been a positive two way learning experience. We have learnt as much from the registrar as they have from working with us,” she said.

CEO John Oldfield said the video provides a positive and realistic account of what registrars could expect working in an AMS.

“We hope the video encourages more GP registrars to undertake part of their GP training in an AMS, not just in New England/Northwest NSW, but anywhere in Australia,” he said.

The video can be viewed on GP Synergy’s YouTube channel or by following the link: http://www.youtube.com/watch?v=5Oa7YgC_fV8

For all media enquiries please contact Kate Froggatt on 02 9818 4433.

About GP Synergy

GP Synergy is a leading provider of general practice education and training delivering prevocational and vocational training to doctors seeking to specialise as General Practitioners (GPs).

GP Synergy’s training footprint extends across New England/Northwest regional NSW as well as central, northern, eastern, southern and southwestern Sydney.

For more information about GP Synergy please visit our website at www.gpsynergy.com.au or contact Kate Froggatt, Marketing and Events Manager, at katef@gpsynergy.com.au or (02) 9818 4433.

GP Synergy acknowledges the traditional custodians of the land on which GP Synergy delivers training and respects all Elders past and present.

 

NACCHO health news alert:NT program will educate students on Foetal Alcohol Disorder

 sign1

NT Minister for Education, Peter Chandler, today announced the development of programs that will educate students about the problems of Foetal Alcohol Spectrum Disorder and support affected children.

“While there are already significant resources in schools to assist with education about alcohol these programs will focus on the disorder.

“New educational programs will address the consumption of alcohol in pregnancy as a way to prevent further cases.

“The Department of Education and Children’s Services will work with non-government organisations to deliver programs to middle and senior school students on the consequences of drinking alcohol during pregnancy.

“An educational psychologist will be employed to work with schools on programs to support children affected by the disorder,” Mr Chandler said during a visit to Centralian Senior College in Alice Springs.

“The Government is taking a broad approach to addressing the effects of alcohol, which includes this week’s announcement of mandatory rehabilitation for problem drunks and education in schools.

“The Country Liberals understands we need to address the cause of alcoholism and support prevention efforts.”

Member for Stuart, Bess Price, who also visited Centralian Senior College, said Foetal Alcohol Spectrum Disorder, which has lifelong complications for children, is preventable by avoiding the consumption of alcohol during pregnancy.

“There are a range of effects on children whose mothers drink alcohol during pregnancy.

“These include physical, mental, behavioural and learning disabilities.

“School programs are unable to reverse these problems but can do a lot to support children in their social and learning development.”

NACCHO member good news alert:A new beginning for Dubbo Aboriginal Community Controlled Health

logo 

Aboriginal health services return to Aboriginal Community control with the opening of the Interim Dubbo Aboriginal Medical Service

27 March 2012 – Sydney: The Aboriginal Health and Medical Research Council of New South Wales (AH&MRC) and the Bila Muuji Aboriginal Health Service have formed a Coalition to support the re-establishment of Aboriginal health services in Dubbo following the closure of Thubbo Aboriginal Medical Co-op Ltd (Thubbo AMS) in 2012.

 Aboriginal Community Controlled Health Services (ACCHSs) in the region are concerned about the Dubbo Aboriginal Community’s ability to access culturally appropriate primary health care.

The Coalition was formed to provide interim services to Aboriginal people in Dubbo while also working with the Community towards the long-term goal of establishing a viable ACCHS in Dubbo that is dedicated to improving the health and wellbeing of the local Aboriginal Community.

 The Interim Dubbo Aboriginal Medical Service (AMS) will open at 211 Brisbane Street in coming weeks and will soon be taking bookings for GPs to start providing clinics three days per week.

 “Restoring access to high-quality, culturally appropriate primary health care in Dubbo, which is delivered by Aboriginal health services from the region, has been our first priority,” said Ms Sandra Bailey, CEO of the AH&MRC.

 “The AH&MRC is leading this Coalition to assist the Community with the eventual development of a new Community Controlled Health Service and will coordinate ongoing services in the interim. Bila Muuji has already responded quickly to restore access and primary health care services in the area,” Ms Bailey said.

 The Interim Dubbo AMS is located right in the centre of Dubbo and is close to public transport. A toll free hotline has been set up to assist with patient enquires, bookings and concerns. The hotline can be reached on 1800 999 444.

 The Interim Dubbo AMS will be open to new clients as well as people who previously attended Thubbo AMS. Thubbo AMS patients who do not wish to access the new service can choose to have their medical records transferred to a health service of their choice by contacting the hotline number listed above.

 The establishment of the Interim Dubbo AMS has been supported at Community meetings of the Dubbo Aboriginal Community and also has the endorsement of the Dubbo Aboriginal Community Working Party (DACWP).

 The Department of Health and Ageing (DoHA) also supports this strategy to re-establish culturally appropriate services in Dubbo. “The Government is committed to the concept of Aboriginal community control for the provision of health services to Aboriginal and Torres Strait Islander people wherever possible,” said a spokesperson from DoHA.

 The AH&MRC will continue to provide information about the ongoing development of the Interim Dubbo AMS as the service gets up and running and grows to meet the local Aboriginal Community’s health needs. Further consultation will take place to ensure there are opportunities for Community input.

 “We are committed to working together as a team to support the ultimate goal of re-establishing Aboriginal Community Controlled Health Services in Dubbo as a matter of priority,” said Ms Bailey.

 The Interim Dubbo Aboriginal Medical Service can contacted on 1800 999 444 for clinic appointments and health enquiries.

For all media enquiries please contact Adam Stuart on (02) 9212 4777.

 About the Aboriginal Health & Medical Research Council of NSW

The Aboriginal Health & Medical Research Council of New South Wales (AH&MRC) is the peak representative body and voice of Aboriginal communities on health in NSW. The AH&MRC represents its members, Aboriginal Community Controlled Health Services (ACCHSs), which deliver culturally appropriate comprehensive primary health care to their communities.

 Aboriginal Community Control has its origins in Aboriginal people’s right to self-determination. The AH&MRC is governed by a Board of Directors who are Aboriginal people elected by our members on a regional basis and represents, supports and advocates for our members and their communities on Aboriginal health issues at state and national levels.

 For more information about the AH&MRC please visit our website at www.ahmrc.org.au or contact Matthew Rodgers, Media and Communications Officer, at mrodgers@ahmrc.org.au or (02) 9212 4777.

  Acknowledging the traditional custodians of the land on which the Aboriginal Health & Medical Research Council operates and respecting all Elders past and present.

 

NACCHO scholarship alert:Aboriginal Medical Service Professional Development scholarships now open: closes 19 April 2013

ACN logo design_v1 

The Aboriginal Medical Service Professional Development scholarships opened on 4 March 2013 and will close 19 April 2013.

 The scholarships are an Australian Government initiative; distributed under the Nursing and Allied Health Scholarship and Support Scheme (NAHSSS), to facilitate continuing professional development (CPD) and to encourage the pursuit of a health career in both rural and metropolitan areas.

 The professional development scholarship is aimed to support nurses and midwives working in an Aboriginal Medical Service.

The scholarships are available for either CPD or postgraduate study and successful applicants may receive up to $15,000 for activities undertaken in the period 1 January 2013 to 31 December 2013.

 The Australian College of Nursing’s (ACN) Chief Executive Officer, Adjunct Professor Debra Thoms is committed to continuing to support the Department of Health and Ageing’s Scholarship Scheme for nurses and midwives and to promote educational opportunities to nurses across Australia.

 “It is encouraging to see the Government’s support of Australian nurse’s careers and ongoing development. These scholarships help to promote nursing as a career within Australia and particularly in Indigenous communities. Scholarships provide nurses with the security they need to further their careers,” Professor Thoms said.

 NAHSSS scholarships are open to Australian citizens whose registration with the Nursing and Midwifery Board of Australia is current as an enrolled nurse, a registered nurse or registered midwife. Applicants must be working in a clinical setting.

 For more information on this, or other NAHSSS scholarships, visit http://www.acn.edu.au/australian-government-scholarships.

– 

Inquiries:

Contact – NAHSSS Scholarships Team
Phone – 1 800 117 262

NACCHO health innovation and excellence:Mobile Aboriginal health clinic reaches out to underserviced communities

25872
 
Further to our story earlier this week:
 

Mobile Aboriginal health clinic reaches out to underserviced  communities

A GP, Registered Nurse and primary health workers will staff the clinic in conjunction with local Aboriginal Medical Service provider Carbal Medical Services
 
The University of Queensland’s new Indigenous Health Mobile Training Unit aims to service Aboriginal and Torres Strait Islander communities outside the Toowoomba area.
 
The 10m-long mobile clinic was debuted at the USQ Indigenous Connections Expo in Toowoomba (Thursday 21 February
School of Medicine Indigenous Health Director Dr Maree Toombs said the clinic would train UQ medical students in indigenous health and provide a medical outreach clinic for Aboriginal and Torres Strait Islander communities
 
“The clinic will focus on providing culturally safe, primary health care with a holistic approach to early detection and prevention.” Dr Toombs said
 
One goal is to improve chronic disease management by addressing barriers to accessing primary health care from Indigenous communities.”
 
“While our principal aim is to assess, evaluate and provide on-going primary care for local patients, as well as educate indigenous families in healthy lifestyle choices, we have a secondary aim to collect primary health care service delivery data,” she said
 
A GP, Registered Nurse and primary health workers will staff the clinic in conjunction with local Aboriginal Medical Service provider Carbal Medical Services
 
This team will also facilitate training of UQ’s Rural third and fourth year medical students.The clinic is expected to operate four days a week, spending two days at each of two outlying areas.
 
The clinic encompasses one GP room, a RN room and a small kitchenette area, and a fully enclosed annexe will provide a weather-proof waiting area.
 
An indigenous design covers the clinic to encourage attendance and treatment access by community members.This project was awarded $331,000 from Health Workforce Australia as an Australian Government initiative to increase the number of UQ’s clinical training placements in the area of indigenous health and to expand the clinical training capacity of Australia’s health system.
 
Dr Toombs said the initiative created an opportunity to deliver beyond the grant proposal.

NACCHO affiliate news alert:Plea for Aboriginal health funds

intro1

WA’s peak Aboriginal health group says almost 100 services and more than 300 jobs are under threat because the State Government is dragging its feet to sign up to a new $150 million funding agreement.

Picture above and more info

Cathy O’Leary, Medical Editor, The West Australian

The Aboriginal Health Council of WA, which oversees the Aboriginal Medical Service, wants the Government to commit in writing to the next four-year Council of Australian Governments funding agreement for Closing the Gap in Aboriginal Health Outcomes before it goes into caretaker mode.

Chairwoman Vicki O’Donnell said the current funding ended in June, and the May Budget was too late to find out how much would be provided in the future, particularly for staff who did not know if there would be cutbacks and whether they would still have a job.

Health Minister Kim Hames said the Liberal-Nationals Government had given $117.4 million in 2009 towards closing the gap in Aboriginal health. Dr Hames said future funding for the program would be considered as part of the Budget process.

“The significant improvements we’ve made to date to the health outcomes of Aboriginal people in WA now face an uncertain future due to the lack of clarity over the program’s ongoing funding,” Mrs O’Donnell said.

“Since the four-year COAG funding agreement commenced, we have seen healthcare services delivered to both Aboriginal and non-Aboriginal people in rural, remote and metropolitan regions we’ve never been able to reach before.”

Mrs O’Donnell said the national partnership agreement had helped set up and expand 98 Statewide services, including 23 programs addressing chronic disease and specialist mental health services.

“Without the Government’s continued support and its investment in the health … of Aboriginal people in this State, 98 critical health services will cease and over 300 jobs will be lost in the workforce, 70 per cent of which are held by Aboriginal people,” she said.

“Not having made a commitment at this late stage to continuing this approach and renewing the COAG funding agreement is bordering on recklessness. The situation is critical.”

Dr Ngaire Brown:Real stories of real people who are working to deliver better health outcomes for Aboriginal people.

Ngiare Brown has always wanted to be a doctor.

Nbrown

Dr Ngiare Brown pictured above is currently a NACCHO Public Health Medical Officer

Download Ngiare’s poster

Do you know an Aboriginal person employed in an Aboriginal Community Controlled Health organisation working to deliver better health outcomes for Aboriginal people. NACCHO would like to share thier “real” story.Send details to media@naccho.org.au

This story is reproduced from  Real stories of real people

“From a very young age – seven or eight years old – I really wanted to be a doctor,” she says. “My parents said ‘we don’t mind what you do, as long as you do your best, do what you love, and love what you do.’ I have always seen myself working in health. Lucky for me, my family agreed.”

And lucky for Australia, too, because Ngiare has gone on to become one of the first Aboriginal doctors in the nation – as well as a vibrant, committed and passionate advocate for quality patient care and Aboriginal and Torres Strait Islander health policy, research, workforce and education.

Two things drive Dr Ngiare Brown – pride and commitment: pride in being an Aboriginal woman which, along with the importance of education, was instilled in her by her parents; and commitment to making a difference to the lives of Aboriginal and Torres Strait Islander people through improved health.

“I am incredibly proud to be an Aboriginal woman,” she says. “I want my children – I have two daughters – to be incredibly proud to be Aboriginal women. And I want every Aboriginal and Torres Strait Island person to feel that pride in themselves and their culture.

“I want to be able to contribute to raising tens of thousands of beautiful Aboriginal and Torres Strait Islander children in an environment where they will feel safe and proud.

“There is a lot to be done and I just hope I am doing enough and doing it right.”

Ngiare graduated from the University of Newcastle, obtained a Masters of Public Health and Tropical Medicine, and has held a range of positions including Indigenous Health Advisor to the Australian Medical Association (AMA), Senior Lecturer at the University of New South Wales and the Australian National University, Manager of Preventative Indigenous Health Programs for World Vision Australia, and foundation Chief Executive Officer for the Australian Indigenous Doctors Association in 2002-2003. In 2005, she was awarded the AMA’s Woman in Medicine for her major contribution to the medical profession. She has recently commenced as Medical Officer for the Australian Indigenous Doctors’ Association.

Having followed her destiny with energy and conviction, she’s now encouraging others to get involved with Aboriginal health, either as a change in career direction, or as a brand new career. Do so, she says, and you could be making the most personally and professionally rewarding decision of your life.

Ngiare’s vision is for her people to achieve equity, justice, respect and acknowledgment – and one of the pivotal ways to do this is through better health.

This is why she is an enthusiastic advocate of the Australian Government’s campaign to attract more people into careers in Aboriginal and Torres Strait Islander health. She knows that improvement in Aboriginal and Torres Strait Islander health cannot happen without having in place an appropriately resourced and trained health workforce. It’s a two-fold challenge. Over time, the challenge is to attract more Aboriginal and Torres Strait Islander people into health careers. In the short term, the need is to increase the number of experienced professionals working with Aboriginal and Torres Strait Islander people.

“Aboriginal and Torres Strait Islander health is everybody’s business,” Ngiare says. “We need to create an environment where people are aware of the issues in attracting people, both Aboriginal and Torres Strait Islander and non-Indigenous, into health careers. We need to support and promote the aspirations of young Aboriginal people, acknowledge the role of people currently in the workforce, and provide incentives and rewards for those who choose to work in Aboriginal health.

“For experienced professionals, there are many options in Indigenous health. It might mean working as a locum with an Aboriginal Medical Service, doing a short term clinical placement, or relocating to a regional or remote area.

“To my Aboriginal and Torres Strait Islander brothers and sisters who are working in health related roles, I say: we come from a long and proud tradition of storytelling. By sharing our stories, we can encourage more of our mob to join our ranks. We can also help current and future generations of health care providers to get to know us and better understand what it is like for our families and communities.”

With her diversity of training and experience, there’s not much Ngiare doesn’t know about Aboriginal health. “I guess I’m a Jack of all trades, master of none,” she says. “There are many things that I don’t know or am yet to learn, but I think I do have a real diversity of experience. That has been really important for me in terms of developing a broad perspective and understanding of Aboriginal and Torres Strait Islander health.”

Ngiare has seen first-hand both the challenges involved in Aboriginal health, and some of the triumphs in meeting those challenges. And, she believes, things are getting better.

“In terms of Aboriginal health and our desire for participation, the fact that we have been able to establish community-controlled health organisations, establish peak bodies for doctors, dentists, physiotherapists, psychologists and other allied health professionals – we have about 150 Aboriginal doctors and the same number of students – that kind of progress has been amazing,” she says. “These sorts of achievements have been made in the last 30, 40 or 50 years – that’s not bad given the historical context in this country, but we can do so much better.

“Some of the most significant barriers remain in the system itself. We need to get that long-term and sustainable commitment to changing the political, electoral and funding cycles.”

For all her own accomplishments, Ngiare doesn’t really see herself as a role model. But if others choose to, that’s not a problem. “I don’t stand up and say I am a role model,” she says. But I do know that it is important to lead by example, to be positive – and I do know that my actions should reflect what I am trying to achieve. If that encourages someone else to be involved in Aboriginal health, that would be wonderful.”

So what sort of people should we be looking to attract into Aboriginal health? “There will be a lot of people who will self-select,” Ngiare says. “There are a great many students and qualified practitioners in a range of disciplines who would be really interested in engaging – some may just not know how to make that first contact.

“To engage other people who may be less interested is more of a challenge – I think they need to have the right attributes and attitude: have an open mind with no pre-conceived notions. Be respectful in any role or relationship. Be able to acknowledge the contribution of others. Have an understanding of the cultural and social aspects that exist through Aboriginal and Torres Strait Islander communities. And have clinical confidence, because often you are it 24/7.

“I can tell you – the experience you have in Aboriginal and Torres Strait Islander health will certainly be among the most rewarding and enriching that you could possible envisage, both in a professional sense and in your personal growth and cultural understanding.

“There are plenty of opportunities in Aboriginal and Torres Strait Islander health. You just need to start the conversation.”

Download Ngiare’s poster

Building better systems of care for Aboriginal and Torres Strait Islander people:findings from the kanyini health systems assessment

thumbs_waynequilliamphotographywannik913

“Consistent with our theoretical understandings of kanyini, staff frequently commented on the obligations they felt to reach people and act in their best interests.

This need to hold and nurture people was most profoundly felt by Aboriginal Health Workers (AHWs).”

You can download the full report here

Background

Australian federal and jurisdictional governments are implementing ambitious policy initiatives intended to improve health care access and outcomes for Aboriginal and Torres Strait Islander people. In this qualitative study we explored Aboriginal Medical Service (AMS) staff views on factors needed to improve chronic care systems and assessed their relevance to the new policy environment.

Methods

Two theories informed the study: (1) „candidacy‟, which explores “the ways in which people‟s eligibility for care is jointly negotiated between individuals and health services”; and (2) kanyini or holding‟, a Central Australian philosophy which describes the principle andobligations of nurturing and protecting others. A structured health systems assessment, locally adapted from Chronic Care Model domains, was administered via group interviews with 37 health staff in six AMSs and one government Indigenous-led health service. Data were thematically analysed.

Results

Staff emphasised AMS health care was different to private general practices. Consistent with kanyini, community governance and leadership, community representation among staff, andcommitment to community development were important organisational features to retain and nurture both staff and patients. This was undermined, however, by constant fear of government funding for AMSs being withheld.

Staff resourcing, information systems and high-level leadership were perceived to be key drivers of health care quality. On-site specialist services, managed by AMS staff, were considered an enabling strategy to increase specialist access. Candidacy theory suggests the above factors influence whether a service is„tractable‟ and „navigable‟ to its users. Staff also described entrenched patient discriminationin hospitals and the need to expend considerable effort to reinstate care.

Conclusions

Some new policy initiatives (workforce capacity strengthening, improving chronic care delivery systems and increasing specialist access) have potential to address barriers highlighted in this study. Few of these initiatives, however, capitalise on the unique mechanisms by which AMSs „hold‟ their users and enhance their candidacy to health care.

Kanyini and candidacy are promising and complementary theories for conceptualising health care access and provide a potential framework for improving systems of care.

Theme 1: AMSs are different from private general practice

At all sites staff emphasised the unique aspects of AMS service delivery when compared with private general practice. In particular, engagement with local Aboriginal and Torres Strait Islander communities was repeatedly affirmed as the main difference. Staff viewed the typeof care they provided to be comprehensive, responsive to community expectations and patient rather than business oriented. By contrast, private general practice was viewed as focussing on maximising business revenue and providing reactive rather than preventive health care. It was also felt to inadequately acknowledge the particular needs of Aboriginal and Torres Strait Islander people.

I suppose, as an Indigenous doctor, you often get (patients saying) “I‟m happy to talk to you about this, but I wouldn‟t really want to talk to the GP down the road about it…..If it’s something to do with emotional, cultural, spiritual stuff, then that really does need to be addressed. But, you know, mainstream practices might not see it as „true‟ medicine. (GP1, regional AMS2)

Although community linkages are known to be an important component to chronic care, the depth of community connection in AMSs goes beyond this. Even for the only noncommunity governed health service, staff stressed the importance of ensuring community input and that this is usually not appreciated in mainstream services.

Even though we’re a mainstream health service we do work really strongly with the community. There‟s nothing more important than having local people (on staff)…that liaise between the community and us…We still have that strong contact, especially with the elders… Normally mainstream health services never venture out in Indigenous health to actually work with thecommunity and not many (patients) come to them. (Clinical director, urban AMS1)

Consistent with our theoretical understandings of kanyini, staff frequently commented on the obligations they felt to reach people and act in their best interests. This need to hold and nurture people was most profoundly felt by Aboriginal Health Workers (AHWs). One AHW stated that her work „doesn‟t just stop when we finish work‟. These obligations constitute a powerful mechanism for enhancing the candidacy of Aboriginal and Torres Strait Islander communities to health care. For AHWs there was an unconditional quality to the care provided, subtly blending the more demarcated work responsibilities with diffuse personal obligations in the community. Whilst these obligations may manifest quite differently for non-Indigenous staff a similar dedication beyond the ordinary was apparent. This duty to reach people also helps explain why health promotion constitutes a key part of service activity. Bridging clinical services with activities that develop community capacity wereviewed as central to health service function.

Daniel (pseudonym), an Aboriginal project officer, works on a shared responsibility agreement with the football club.…I think that is a really good example of delivering health in a very different way and engaging thecommunity‟s strengths. Rugby league is a huge factor for a man and it shows in figures that men attending the clinic are still under represented….So this work has seen an investment of infrastructure in the community sector as well as furthering this clinic. (AHW project officer 1, urban AMS1

In order for an AMS t o „hold‟ and nurture its community, this engagement is needed at all levels of the organisation, not just with the governing board. The employment of local Aboriginal and Torres Strait Islander staff across a variety of positions allows this holding to be adequately enacted. It affirms community linkages and the consequent legitimacy of the organisation.

Being a community controlled service you not only have it (community control) at the board level but it should be reflected in the organisational structure right through to even the groundsmen…it gives the staff themselves a sense of belonging and knowing that it is owned by the community. We all live in this community so we’re a part of the organisation and we‟re working for it, showing to the wider community that we are able to work at all these different levels..(AHW1, regional AMS3)

A key component to enhancing candidacy to health care is that services are easily navigated by their users. Staff from all professional backgrounds particularly commented on the availability of transport services as a key component to a navigable health service. Rather than merely an ancillary support, transport was viewed as an integral part of health care itself.

Staff commented that health care standards were heavily influenced by the availability of transport and that its absence „ defeats the purpose of us being here‟. For the two remote services, transport was critically important. One service provided daily visits to homelands and transport to the major referral centre for acute or specialist care. This consumedsubstantial monetary and human resources. For the other remote site airplane transportservices were especially dire with long wait times and patients having to travel alone toattend appointments. This left many fe eling vulnerable when „stuck‟ without family in the referral centre. For some people this impacted greatly on future decisions to seek specialistcare.

Thus transport is a key mechanism by which people are supported to navigate the system

Download full report here