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Introducing the Core Services
and Outcomes Framework

What community-controlled comprehensive primary health care offers and why it matters for advancing health and wellbeing of Aboriginal and Torres Strait Islander peoples

In Australia, Aboriginal and Torres Strait Islander Community-Controlled Health Services were the first to offer comprehensive primary health care and are acknowledged in multiple forums as the best example of community-based health infrastructure improving health and wellbeing.

History

In 2019, the Board of the National Aboriginal Community Controlled Health Organisation (NACCHO) and the sector more broadly acknowledged the importance of describing the principles, scope and functions of comprehensive primary health care when controlled by Aboriginal and Torres Strait Islander communities. National consultations and extensive feedback produced the sector’s Core Services and Outcomes Framework. The NACCHO Board will use the Core Services and Outcomes Framework to advocate for the funds the sector requires to deliver better health and wellbeing for Aboriginal and Torres Strait Islander peoples. This brief overview is an introduction to the key elements of the Core Services and Outcomes Framework. More information is readily available in the complete document.

Impact

Aboriginal community-controlled comprehensive primary health care is highly cost-effective. The transition of one remote health clinic from government management to Aboriginal community controlled comprehensive primary health care increased utilisation of primary health care by 408 per cent; accelerated immunisation rates; reduced the proportion of babies born with low birth weights to less than 10 per cent; and increased employment opportunities for local Aboriginal and Torres Strait Islander people. Prevention, early intervention and chronic disease management are tailor-made to each person with community-wide health promotion and knowledge sharing to support community empowerment. One major study concluded that: ‘... up to fifty percent more health gain or benefit can be achieved if health programs are delivered to the Aboriginal population via ACCHSs, compared to if the same programs are delivered via mainstream primary care services’. More information is readily available in the complete document.

To call yourself a comprehensive primary health care service, you need to be more than a ‘sick care service’. You also need to be public health advocates to garner action on poverty and overcrowding.

You must invest in communities, develop leaders and reclaim community empowerment. You must look to act on social determinants of health as well.

Participant at CSOF Expert Advisory Group meeting,
Sydney, December 2019

Framework Principles

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Aboriginal and Torres Strait Islander leadership and control are not negotiable as a foundation for primary health care service design, integrated client/ family-centred care and community empowerment that will achieve better health and wellbeing
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Social, cultural, historical and economic
determinants of health matter

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Comprehensive primary health care as an accessible and generalist ‘front-line’ service based on relationships is the cornerstone of a sustainable health-care system

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A model of community-controlled comprehensive primary health care will support consistently high
standards, ensure sustainability for primary health care services controlled as an act of self-
determination by Aboriginal and Torres Strait Islander peoples and achieve health equity

Operating Principles

This is an outstanding piece of work, thoroughly comprehensive, and with reference to all the key elements, funding, workforce, training and, importantly, CQI.

It is, in my view, international best practice and of textbook quality. I know of nothing that is remotely comparable for mainstream health services in Australia.

Professor Ian Ring, AO

How the 'model' works

This visualisation has been developed to convey the components of the Model of community-controlled comprehensive primary health care that is the foundation for this Core Services and Outcomes Framework.

Needs Assessment

Under Development

Outcomes

Under Development

Clinical services

ACCHSs ensure their own services are culturally appropriate, physically accessible, financially affordable and provide the necessary supports with language and health literacy. Clinical services cover diagnosis, investigation and evidence-based treatment of illnesses, injuries and diseases affecting people and inhibiting their quality of life whether acute, short-term, long-term or lifelong. In Aboriginal and Torres Strait islander community-controlled comprehensive primary health care, clinical services are holistic in approach to include all body systems including mental health, cardiovascular, renal, respiratory and others. Comprehensive primary health care must deliver clinical services that are evidence-based. This care must be person-centred. This must be more than various members of the clinical team simply accessing a shared electronic clinical record. Strategies must be in place to integrate visiting service providers,contracted clinicians and staff in a common service model, focused on the client, their lifecourse and family. The capacity of an individual or family to self-navigate a Western health system or self-care must be assessed and the appropriate supports put in place. This complexity of clinical presentations and treatment pathways (the client journey) may require novel service models and innovation to ensure clinical outcomes are achieved efficiently, effectively and equitably in a culturally safe way. Aboriginal and Torres Strait Islander peoples are disproportionately more likely to be experiencing trauma. ‘Bush medicine’ and traditional healers have always held a central place in Aboriginal and Torres Strait Islander healing systems and are now being recognised by governments and Western health systems.

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Artwork

The Core Services and Outcomes Framework artwork was created by Kamilaroi artist, Ethan French.

The diagram is a visual representation of the Core Services and Outcomes Framework foundations for community-controlled primary health care. At the centre of the diagram is a meeting place which represents members of the community being the heart of this document. Each ring and section of the diagram represents each component of the Core Services and Outcomes Framework, with culture surrounding the whole diagram and foundations, which is a representation showing that culture is involved in all aspects of the Core Services and Outcomes Framework.

... health done ‘our way’ is unique.
It is a holistic system grounded in truth, lived realities, our culture, law and country. ...You can bring these ingredients together, utilise changing structures and relationships to design the culturally informed health models and work programs our people need. It is the way that we deliver our work from the ground up that informs the best policy and legislation. We have to seize this moment.

June Oscar, speech at AMSANT conference, August 2019