Valuing ACCHOs

June 2023

Generally speaking, Aboriginal and Torres Strait Islander people needing health care want to be cared for by Aboriginal and Torres Strait Islander people (Larke et al., 2021) and attend Aboriginal and Torres Strait Islander-led services (Cox Inall Ridgeway, 2020). One estimate of a decade ago found that Aboriginal community controlled health organisations (ACCHOs) provide primary care services to between a third and a half of the Aboriginal and Torres Strait Islander population (Dwyer et al., 2011).

There is growing evidence about the many successful outcomes of ACCHOs, and some data that demonstrates how they outperform mainstream services in recognising and dealing with chronic diseases (Panaretto et al, 2014; Thompson et al. cited in Mackey et al., 2014).

As well as evidence for success in providing comprehensive primary health care, ACCHOs have a vital role in:

preventing poor mental health and intervening early when it appears
understanding and addressing the risks for developing and worsening of mental health problems
supporting people to use mental health services and allied health care
supporting people through the complexity of the health system
connecting community members with the range of community-based support services
working with mainstream community health staff and hospital staff to improve understanding of health from an Aboriginal and/or Torres Strait Islander person’s perspective
working as part of multi-agency and multidisciplinary teams aimed at delivering shared care arrangements (NATSILMH, 2017).

ACCHOs are well placed to provide accessible, culturally safe care because they:

are operated by, are situated in and reflect local Aboriginal and Torres Strait Islander communities and cultures
are controlled by an Aboriginal and Torres Strait Islander community-based board, elected by community members, to lead responses to local issues
are affordable, as they largely bulk bill for medical services (Dudgeon et al, 2018).

Aboriginal and Torres Strait Islander cultures are central to health service delivery within ACCHOs. Cultures are embedded across health care delivery (see Figure 1) through:

focusing on the needs of individuals, families and communities
respecting gender-based cultural protocols and needs
creating welcoming and family-friendly environments
incorporating local cultural values, protocols, ceremonies and spirituality in programs and services
having processes for local community to be empowered to shape ACCHO services
employing Aboriginal and Torres Strait Islander staff and supporting their leadership
using local Aboriginal and Torres Strait Islander language, arts, and resources
developing health promotion and prevention resources relevant to local communities
ensuring many ways learning between Aboriginal and Torres Strait Islander and other colleagues (Bailey et al, 2020; CREATE, 2020).

Figure 1: Accho values, services and centring of culture

Source: CREATE, 2020

A systematic review of qualitative evidence by several Aboriginal and Torres Strait Islander researchers and their collaborators (Gomersall et al., 2017), with guidance from the leadership group of the National Health and Medical Research Council Centre of Research Excellence in Aboriginal Chronic Disease Knowledge Translation and Exchange (CREATE), sought to understand what Aboriginal people valued about ACCHO health care compared to mainstream primary health care services. See Table 1.

Source: Gomersall et al., 2017

That review summarised Aboriginal and Torres Strait Islander people’s perceptions of care in mainstream health services as:

lacking respect
lacking a shared understanding between service users and providers
feeling discriminated against, both in the open areas and in the clinical space
feeling a lack of reciprocal trust (Gomersall et al., 2017).

Recommended citation

Williams, M. & Ragg, M. (2023). Valuing ACCHOs. Yulang Indigenous Evaluation. https://yulang.com.au/starburst-indigenous-evaluations/valuing-acchos/

References

Bailey, J., Blignault, I., Carriage, C., Demassi, K., Joseph, T., … Williams, M. (2020). We are working for our people: Growing and strengthening the Aboriginal and Torres Strait Islander health workforce. https://www.lowitja.org.au/cotent/Image/Career_Pathways_Report_Working_for_Our_People_2020.pdf

CREATE (The Centre of Research Excellence in Aboriginal Chronic Disease Knowledge Translation and Exchange). (2020). Aboriginal Community Controlled Health Organisations in practice: Sharing ways of working from the ACCHO sector. South Australian Health and Medical Research Institute.

Dudgeon, P., Calma, T., Milroy, J., McPhee, R., Darwin, L., … Holland, C. (2018). Indigenous governance for suicide prevention in Aboriginal and Torres Strait Islander communities: A guide for primary health networks. Centre of Best Practice in Aboriginal and Torres Strait Islander Suicide Prevention and the Black Dog Institute.

Dwyer, J., Lavoie, J., O’Donnell, K., Marlina, U., & Sullivan, P. (2011). Contracting for Indigenous health care: towards mutual accountability. Australian Journal of Public Administration, 70(1),34-46.

Gomersall, J., Gibson, O., Dwyer, J., O’Donnell, K., Stephenson, M., Carter, D., Canuto, K., Munn, Z., Aromataris, E., & Brown, A. (2017). What Indigenous Australian clients value about primary health care: a systematic review of qualitative evidence. Australian and New Zealand Journal of Public Health, doi: 10.1111/1753-6405.12687.

Larke, B., Broe, G, Daylight, G., Draper, B., Cumming, R., Allan, W., Donovan, T., Costa, D., Lah, S., & Radford. K. (2021). Patterns and preferences for accessing health and aged care services in older Aboriginal and Torres Strait Islander Australians. Australasian Journal of Ageing. Volume 40, 2, pp 145-153.

Mackey, P., Boxall, A-M., Partel, K. (2014). The relative effectiveness of Aboriginal Community Controlled Health Services compared with mainstream health service. Deeble Institute Evidence Brief, 12.

National Aboriginal and Torres Strait Islander Leadership in Mental Health (NATSILMH). (2017). Health in Culture: Gayaa dhuwi (Proud Spirit) Declaration Implementation Guide. https://www.gayaadhuwi.org.au/resources/the-gayaa-dhuwi-proud-spirit-declaration/

Panaretto, K., Wenitong, M., Button, S., & Ring I. (2014) Aboriginal community controlled health services: leading the way in primary care. Medical Journal of Australia, 200(11), 649-652.