Aboriginal Community Controlled Comprehensive Primary Health Care: The Central Australian Aboriginal Congress

Abstract

Aboriginal community controlled PHC services have led the way in Australia in developing a model of PHC service that is able to address social issues and the underlying determinants of health alongside high quality medical care. This model is characterised by a comprehensive style rather than the selective PHC model that tends to be more common in mainstream services. Central to comprehensive PHC is community control, which is critical to the bottom up approach rather than the top down approach of selective PHC. The expansion of Aboriginal Community Controlled Health Services (ACCHSs) in Australia is a product of the colonial relationship that persists between Aboriginal and non-Aboriginal Australia. It is this relationship that explains why community control has been a feature of Aboriginal PHC services while similar attempts in the dominant society have tended to be incorporated into the mainstream. The mechanisms of control occur through community processes and should not be confused with day to day management processes, although the two are related. The Core Functions of PHC is a framework that reflects the experience of ACCHSs and allows for the development and assessment of comprehensive PHC. This framework is applied to a case study of the Central Australian Aboriginal Congress (Congress) which is the major Aboriginal health service in central Australia. The case study illustrates increasing utilisation of PHC services by Aboriginal people, and the capacity of community controlled organisations to respond to demographic and health pattern changes in their client populations.