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Shedding light or fanning flames?: a consideration of the challenges in exploring the relative effectiveness of Aboriginal Community Controlled Health Services

Sandra Claire Thompson, Emma Haynes`, Shaouli Shahid, John A Woods, Tiew-Hwa Katherine Teng, Patricia Mary Davidson, Patricia Mary Davidson

This paper explores some of the history and rationale for the Aboriginal Community Controlled Health Services (ACCHS) model of service delivery, and why it is difficult to compare their effectiveness directly with that of other primary health care services in Australia. ACCHS were pioneered over 40 years ago. Since then, they have been established across Australia as a model of primary health care to meet the needs of Australia’s disadvantaged Indigenous population which had been underserviced within mainstream health services. ACCHS are managed by Aboriginal boards, promote a model of holistic and comprehensive primary health care and are largely funded by government. Over recent years, additional funding has gone to ACCHS and mainstream services in an effort to close the gap in Aboriginal life expectancy. In this context, the authors were commissioned to examine the peer-reviewed literature to explore the question of the relative effectiveness of ACCHS compared with other primary health care services. In responding to the question, we were led to consider the historical experience of Aboriginal people, their social and economic disadvantage, the geographic distribution of Aboriginal people where there is market-failure of general practice, the predominant model of primary care in Australia, the complexity of Aboriginal people’s health needs, and the limitations of peer-review studies. We argue that the provision of effective health services requires that they are accessible and attentive to the needs of their client, not just that they deliver evidence-based medicine. Services exist on a performance continuum, so quality improvement approaches with appropriate measures of quality to assess performance for Aboriginal people are needed. We argue that partnerships between ACCHS and mainstream health care providers are essential to improving Aboriginal health outcomes given the complex nature of modern health care and the myriad of health and social problems experienced by Aboriginal people.