In the mid-1990s, an innovative model of Aboriginal primary health care service provision began in the far west of NSW. In the light of continuing concerns about ill health and the need for better primary health care, the local community established an independent Aboriginal organisation (later to become Maari Ma) to deal with ‘health business’. Rather than set up a stand-alone Aboriginal Medical Service the community in the far west decided to develop an integrated model of primary health care delivery with the health services provided in the region by the NSW Health Department’s Area Health Service.
The collaborative approach (involving Maari Ma, the Greater Western Area Health Service, and funds from the Commonwealth for a coordinated care trial in the region) allowed Maari Ma to provide management for Health Services in the areas outside Broken Hill, while the Area Health Service provided various bureau services to Maari Ma and funding for three positions in the management team.
While generating some controversy at the time of the original agreement, the organisational interdependence provided protection against having to divert too much early effort into running a standalone organisation and allowed a continuing focus on core business.
A recent evaluation of the agreement, ten years after it was signed, found that the result had been increased funding for Aboriginal primary health care and consequent greater primary health care activity.132 A number of health indicators show some improvement – although, as in most of these local cases, it is difficult to be absolutely certain of the extent to which these were the result of improved primary health care.
- Improvements in access to antenatal care in the first 20 weeks of pregnancy
- improvements in vaccine preventable hospitalisations
- improvements in proportions of premature birth and low birth weight
- reduced rate of acute ambulatory care preventable hospitalisations
- Increased investment by State and Commonwealth in primary health care:
- Indigenous management of ‘mainstream’ health delivery
- employment of Aboriginal staff:
- innovative and appropriate training programs
- engagement of community leaders in mainstream health system development and delivery
- evidence based programs to improve health service response to key priorities:
- prevention and management of chronic disease
- coordinating with other sectors to address social determinants of health
132 Griew, R. and S. Houston (2007). Review of Management Agreement between Maari Ma Health Aboriginal Corporation and Greater Western Area Health Service. Greater Western Area Health Service, Unpublished Report