In the Aboriginal Community Controlled Health sector a number of terms sometimes cause confusion. For clarity and to assist communication these terms are defined here.
The definition proposed in the Constitutional Section of the Department of Aboriginal Affairs’ Report on a review of the administration of the working definition of Aboriginal and Torres Strait Islanders (Canberra, 1981) and since used by the Federal Government as their working definition, in state legislation and by the High Court, should be the only acceptable definition of Aboriginality.
This definition is a three-part definition requiring all 3 parts to be established for Aboriginality to be recognised:
- descent (the individual can prove that a parent is of Aboriginal or Torres Strait Islander descent);
- self-identification (the individual identifies as an Aboriginal or Torres Strait Islander); and
- community recognition (the individual is accepted as such by the Aboriginal or Torres Strait Islander community in which he/she lives).
- Approved by NACCHO Board November 2007.
Aboriginal (use of the word)
At a members meeting in November 2009 it was resolved that the NACCHO refer to the term Aboriginal in all correspondence, speeches and cease use of the word Indigenous except in an International context.
The word Aboriginal is used instead of Indigenous and that the word Aboriginal is inclusive of Aboriginal and Torres Strait Islander Peoples
Aboriginal health” means not just the physical well-being of an individual but refers to the social, emotional and cultural well-being of the whole Community in which each individual is able to achieve their full potential as a human being thereby bringing about the total well-being of their Community.
It is a whole of life view and includes the cyclical concept of life-death-life.
Aboriginal Community Control in Health Services as defined in its Constitution as amended 9 March 2006
Community Control is a process which allows the local Aboriginal community to be involved in its affairs in accordance with whatever protocols or procedures are determined by the Community.
The term Aboriginal Community Control has its genesis in Aboriginal peoples’ right to self-determination.
- An Aboriginal Community Controlled Health Service is:
- An incorporated Aboriginal organisation
- Initiated by a local Aboriginal community
- Based in a local Aboriginal community
- Governed by an Aboriginal body which is elected by the local Aboriginal community
- Delivering a holistic and culturally appropriate health service to the Community which controls it.
By definition, organisations controlled by Government to any extent are excluded.
By definition, organisations which adopt a vertical approach to health, inconsistent with the Aboriginal holistic definition of health as defined by the National Aboriginal Health Strategy are excluded.
NACCHO – Broome Conference – December 1995.
Aboriginal Community Controlled Health Services (ACCHSs)
NACCHO asserts that all Aboriginal Community Controlled Health Services should be funded and supported to provide integrated comprehensive primary health care and that at this time the services listed below should constitute integrated comprehensive primary health care. NACCHO will review this list and update the services that it defines as essential at regular intervals as experience and capacity increases.
Aboriginal communities operate over 140 ACCHSs/AMSs across Australia. They range from large multi-functional services employing several medical practitioners and providing a wide range of services, to small services without medical practitioners, which rely on Aboriginal health workers and/or nurses to provide the bulk of primary care services, often with a preventive, health education focus.
The services form a network, but each is autonomous and independent both of one another and of government. The integrated primary health care model adopted by ACCHs/AMSs is in keeping with the philosophy of Aboriginal community control and the holistic view of health that this entails.
A. Clinical Services
Primary clinical care such as:
- treatment of illness using standard treatment protocols;
- 24 hour emergency care;
- provision of essential drugs;
- management of chronic illness;
Population health/preventive care such as:
- antenatal care;
- appropriate screening and early intervention (including adult and child health checks and secondary prevention of complications of chronic disease);
- communicable disease control;
Clinical support systems such as:
- pharmaceutical supply system;
- a comprehensive health information system (population registers, patient information recall systems, and systems for quality assurance)
B. Support Services
Internal to the health service
Staff training and support such as Aboriginal health worker training, cross cultural orientation, continuing education;
- Management systems that are adequately resourced, financially accountable and include effective recruitment and termination practices
- Adequate infrastructure at the community level such as staff housing and clinical facilities, and functional transport facilities.
External to the health service
- Systems for supporting visiting specialists and allied health professionals (including dental, mental health etc), medical evacuation or ambulance services; access to hospital facilities;
- Training role for tertiary and other students.
C. Special Programs
Based on locally relevant priorities and the availability of funds for programs directed at rheumatic fever, substance misuse, nutrition, environmental health, particular target groups such as youth, aged and disabled people, young mothers, school children etc..
D. Advocacy and Policy Development
Support for the community on local, state and federal issues
Primary Health Care
“Primary Health Care” has always been a continuing integral aspect of our Aboriginal life, and is the collective effort of the local Aboriginal community to achieve and maintain its cultural well being. Primary health care is a holistic approach which incorporates body, mind, spirit, land, environment, custom and socio-economic status.
Primary health care is an Aboriginal cultural construct that includes essential, integrated care based upon practical, scientifically sound and socially acceptable procedures and technology made accessible to Communities as close as possible to where they live through their full participation in the spirit of self-reliance and self-determination. The provision of this calibre of health care requires an intimate knowledge of the community and its health problems, with the community itself providing the most effective and appropriate way to address its main health problems, including promotive, preventative, curative and rehabilitative services. (Adapted from the W.H.O. Alma-Ata Declaration 1978)
Primary health care is the first level of contact of individuals, families and the community with the health care system and in Aboriginal communities this is usually through an ACCHS or satellite Aboriginal community health clinic that it services.
Primary health care, within the holistic health provision of an ACCHS, provides the sound structure to address all aspects of health care arising from social, emotional and physical factors. It incorporates numerous health related disciplines and services, subject to its level of operation, available resources and funding.
In addition to the provision of medical care, with its clinical services treating diseases and its management of chronic illness, it includes such services as environmental health, pharmaceuticals, counselling, preventive medicine, health education and promotion, rehabilitative services, antenatal and postnatal care, maternal and child care, programs and necessary support services to address the effects of socio-somatic illness and other services provided in a holistic context mentioned in Schedule 5 of these Articles and included in the NACCHO definition for “Aboriginal Health Related Services”.
Primary Health Care is all inclusive, integrated health care and refers to the quality of health services. It is a comprehensive approach to health in accordance with the Aboriginal holistic definition of health and arises out of the practical experience within the Aboriginal community itself having to provide effective and culturally appropriate health services to its communities.
As defined in the NACCHO Constitution as amended 9 March 2006.
Primary Health Care within the Australian health care system
Within the Australian context there are a variety of types of services that are called primary (health) care services. The principle providers of such services are:
- General Practices where the General Practitioner is the principle service provider with a varying number of other services provided through the practice;
- Community health services; and
- Aboriginal Medical Services including Community Controlled Aboriginal Health Services.
What is the difference between and Aboriginal Medical Service (AMS) and Aboriginal Community Controlled Health Service (ACCHS)?
There are important differences between these two terms though they are often used interchangeably and sometimes incorrectly so!
All ACCHSs are AMSs but the reverse is not the case.
An Aboriginal Medical Service (AMS) is a health service funded principally to provide services to Aboriginal and Torres Strait Islander individuals. An AMS is not necessarily community controlled. Therefore not all AMSs are eligible to be members of NACCHO and its affiliates. If an AMS is not community controlled it will be a government health service run by a State or Territory government.
These non-community controlled AMSs mainly exist in the Northern Territory and the northern part of Queensland.
An Aboriginal Community Controlled Health Service (ACCHS) is a primary health care service initiated and operated by the local Aboriginal community to deliver holistic, comprehensive, and culturally appropriate health care to the community which controls it (through a locally elected Board of Management).