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Close the Gap: Aboriginal community controlled health services

Mick Adams
Med J Aust 2009; 190 (10): 593.
Published online: 18 May 2009

Aboriginal and Torres Strait Islander peoples have a right to full participation in decisions affecting their health


During 2008, the Council of Australian Governments (COAG) made several large-scale funding commitments to close the gap in life expectancy between Aboriginal and non-Aboriginal peoples, and to improve Indigenous child health. These commitments represent a significant first step, but the funding package was devised without the full and active involvement of Aboriginal and Torres Strait Islander peoples — the process failed to comply with the Close the gap statement of intent, which commits all partners to ensuring “the full participation of Aboriginal and Torres Strait Islander peoples and their representative bodies in all aspects of addressing their health needs”.

The challenge now is to turn the COAG proposals into programs that will work for the Aboriginal community, particularly for those who are most disadvantaged. To this end, committing to the partnership forums established over the past 10 years between Aboriginal community controlled health services (ACCHSs) and state, territory and Australian Government health departments will be critical. At the national level, ensuring the effectiveness and appropriateness of federal programs is difficult, given there has never been a formal partnership between the Australian Government and the Aboriginal community on health matters.

A national framework agreement between the Department of Health and Ageing and the National Aboriginal Community Controlled Health Organisation (NACCHO) will ensure Aboriginal and Torres Strait Islander peoples are in control of their health. NACCHO represents over 145 ACCHSs across Australia, which provide the vast bulk of comprehensive primary health care to Aboriginal peoples. Making sure the programs that result from the COAG commitments are in large part realised through the ACCHSs is critical to closing the gap in Aboriginal disadvantage.

A national framework agreement between NACCHO and government will ensure Aboriginal and Torres Strait Islander peoples have the right to full participation in health service design, delivery, monitoring and evaluation. Such an agreement will set the stage for improvements in four key areas:

  • joint planning processes to allow for full participation in decision making and priority setting;

  • transparent and regular reporting;

  • improved service delivery through greater cooperation among key players, and more efficient coordination; and

  • better understanding among key players of one another’s roles and responsibilities.

Every inquiry over the past 30 years has confirmed that ACCHSs are the most effective means to close the gap.

  • Mick Adams

  • National Aboriginal Community Controlled Health Organisation, Canberra, ACT

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