Perspectives on Aboriginal community controlled health services

The first Aboriginal medical service was established in the Sydney suburb of Redfern in 1971, with the aim of improving access to health services for the local Aboriginal community by creating a culturally appropriate environment. Since then, there have been many changes to primary health care arrangements for Indigenous Australians (and even now, the Aboriginal medical service sector is only part of the story). However, the important concepts behind the establishment of the first service remain. According to the National Aboriginal Community Controlled Health Organisation, the national body representing Aboriginal community controlled health services (ACCHSs) throughout Australia (http://www.naccho.org.au), an Aboriginal medical service is “a primary health care service initiated and operated by the local Aboriginal community to deliver holistic, comprehensive and culturally appropriate health care to the community that controls it (through a locally elected board of management)”. There are currently over 130 Aboriginal medical services in Australia, varying greatly in size and staffing levels. These services are unique in their management and funding structure, and their community base. As the provision of adequate primary care for Indigenous people has been identified as one of the cornerstones of improving their health, we asked representatives of two large ACCHSs in north Queensland — general practitioners, Aboriginal health workers and managers — to tell us about their community, their service and their roles.

A tale of two cities: Townsville and Cairns

Townsville and Cairns in north Queensland are among nine Aboriginal and Torres Strait Islander (ATSIC) Regions that account for almost 48% of Australia’s Indigenous population.1 The Townsville region has a population of 325 000, with an Indigenous population of 16 875 (5.2%), while the Cairns region has a population of 196 000 and an Indigenous population of 17 049 (8.7%).

Townsville Aboriginal and Islanders Health Services (TAIHS) is a large Aboriginal community controlled health service situated in one of the inner suburbs of Townsville. Its over 150 employees provide medical and dental care, social and emotional wellbeing services, a youth shelter, a volatile substance use service, crisis accommodation and child protection services. The medical unit at TAIHS provides comprehensive primary health care, with a staff of 36, including nine general practitioners, four registered nurses (three Indigenous), six Aboriginal health workers, a dietitian and a psychotherapist. In addition, visiting specialists (general physician, endocrinologist, ophthalmologist and psychiatrist) and allied health professionals (podiatrist, child health nurse, psychologist and midwife) complete a team able to provide a range of health care and lifestyle modification programs.

WuChopperen in Cairns is another large Aboriginal community controlled health service. It has a staff of around 90, with five full-time equivalent GPs, three registered nurses, seven Aboriginal health workers and sessional allied health providers. WuChopperen has developed two other, now autonomous, Aboriginal community controlled health services in Far North Queensland, Mulungu (in Mareeba) and Mamu (in Innisfail), and currently has a satellite clinic at Atherton. The range of programs provided is very wide, including a social health and youth health service, and health services for illicit/licit drug use, family violence and prison health. Visiting specialists are called on when available.

1.  Australian Bureau of Statistics. Population distribution, Indigenous Australians, 2001. Canberra: ABS, 2002. (Catalogue No. 4705.0.)