What factor or combination of factors combine to make interventions successful is not easy to determine. Certainly, reproducing success across services, or whole jurisdictions, is not simply a matter of identifying ‘what works’ and ‘doing the same’ elsewhere: local conditions, local personnel or community members, local histories and health status, and the dynamic, continuous interaction and evolution of all these mean simply that ‘one size does not fit all’. Nevertheless, we would extract the following important principles for success from the above case studies:
- Genuine local Indigenous community engagement to maximise participation, up to and including formal structures of community control133 or (for non-community controlled health services) an ethic and practice of community involvement.
- Collaborative approaches that see primary health care services working with (a) other service sectors e.g. housing (b) other primary health care or community-based health service delivery organisations, whether government or non-government and (c) other levels of the health care system, particularly hospitals / specialists;
- Delivery of core primary health care programs vital to the long-term health of the community including but not restricted to (a) maternal and child health and (b) chronic disease detection and management;
- Evidence-based approaches that are reflective, that are based on a continuous quality improvement approach and that involve the local community in adapting what is known to work elsewhere to local conditions and priorities;
- A multidisciplinary team approach that crucially involves the employment of local Aboriginal and Torres Strait Islander community members, and which includes continuous training and support;
- Approaches which harmonise with local Aboriginal ways of life, and in particular regionally organised service delivery and outreach services to dispersed populations;
- Adequate and secure resourcing to allow focus on the management and delivery of non-acute care.
The following principles are associated with primary health care interventions which show success at a local level:
- genuine local Indigenous community engagement to maximise participation, up to and including full community control
- a collaborative approach to working with other service providers
- delivery of core primary health care programs such as maternal and child health and/or chronic disease prevention, detection and management
- evidence-based approaches adapted to local conditions
- a multidisciplinary team approach employing local community members
- service delivery that harmonises with local Aboriginal and Torres Strait Islander ways of life
- adequate and secure resourcing.
133 Extensive work has been undertaken by the community controlled health sector to define ‘community control’. Most importantly, the National Aboriginal Community Controlled Health Organisation defines it to be “…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 ... [it] has its genesis in Aboriginal peoples' right to self-determination.” See NACCHO Website http://www.naccho.org.au/definitions/communitycont.html.