Taking control : a case study of the National Aboriginal and Islander Health Organisation (NAIHO)

Social services, such as health, are often at the centre of political struggles, and are often shaped by the actions of social movements. This thesis examines the politics surrounding the development of grassroots health infrastructures in a colonialist context. In particular, this thesis sets out to examine the way in which struggle and resistance in such a context shape health infrastructures and challenge the policy process. The methodology employed is a single-unit case study analysis, focusing on the Aboriginal community-controlled health services (ACCHSs) movement in Australia. The rise of such community-controlled social services during the 1970s was one of the manifestations of the land rights movement. The ACCHSs movement developed around some similar concepts to a global Primary Health Care (PHC) movement, which focused on what is now defined as the social determinants of health. This approach argues that poor health outcomes are often derived from social and political causes. The research relies on a number of primary sources. One such source is activist literature from the time period. Fifty four issues of the AMS Newsletter, produced by the Redfern AMS, from the year 1973 to 1991 were located in the course of the data collection. These newsletters offer precious analysis from the point of view of prominent activists in the movement, and unfold some of its political history and development. Other primary sources explored are a variety of official reports, released and unreleased. This research identifies one unreleased report, the 1980 Program Effectiveness Review on Aboriginal Health, and the battle over its suppression, as a defining experience in the development of the movement. The ACCHSs movement started with the establishment of the Redfern Aboriginal Medical Service (AMS) in 1971. The movement has endured, and today there are over 150 ACCHSs across Australia. However, very little information about the movement’s history and early development is available. This case study focuses on the national aspect of the movement, and in particular, the establishment of a national umbrella organisation, the National Aboriginal and Islander Health Organisation (NAIHO). The findings of this thesis follow the development of the movement from the history of the first ACCHSs in Redfern, of NAIHO in the mid 1970s, until its mysterious demise in the late 1980s. NAIHO was eventually replaced by the National Aboriginal Community Controlled Health Organisation (NACCHO) in the early 1990s, which still exists today. The investigation of the development of the movement follows some repeating themes which emerge from the data. Some of the main themes explored include: the theory and practice of community control; the approach of the movement to the social and political determinants of health; the question of funding and its implications to community control; the relationship between the movement and different State and federal departments; and the policy process. The findings of this research trace the political history of the movement, focusing on its national organisation, through periods of development and change. The ACCHSs movement was able to survive the turn to neoliberalism, and the weakening of the wave of social movements from which it emerged. Yet the movement changed in this process. These changes are identified as a shift from a ‘movement’ to a ‘sector’ framework. Furthermore, the findings identify some of the effects such movements have on shaping the policy process. In particular, two competing types of approaches to the policy process are identified: a declaratory process, in which policy is exclusively decided on and dictated by government, and a treaty-like policy process, in which policy is jointly prepared and agreed upon by those affected by the policy

A case study of enhanced clinical care enabled by Aboriginal health research: the Hearing, EAr health and Language Services (HEALS) project

Objective: To describe and evaluate Hearing EAr health and Language Services (HEALS), a New South Wales (NSW) health initiative implemented in 2013 and 2014 as a model for enhanced clinical services arising from Aboriginal health research. Methods: A case-study involving a mixed-methods evaluation of the origins and outcomes of HEALS, a collaboration among five NSW Aboriginal Community Controlled Health Services (ACCHS), the Sydney Children's Hospitals Network, NSW Health, the Aboriginal Health and Medical Research Council, and local service providers. Service delivery data was collected fortnightly; semi-structured interviews were conducted with healthcare providers and caregivers of children who participated in HEALS. Results: To circumvent health service barriers, HEALS used relationships established through the Study of Environment on Aboriginal Resilience and Child Health (SEARCH) to form a specialist healthcare network. HEALS employed dedicated staff and provided a Memorandum of Understanding (detailing mutual goals and responsibilities) for each ACCHS. Despite very tight timeframes, HEALS provided services for 653 Aboriginal children, including 5,822 speech-language pathology sessions and 219 Ear, Nose and Throat procedures. Four themes reflecting the perceived impact of HEALS were identified: valued clinical outcomes, raising community awareness, developing relationships/networks and augmented service delivery. Conclusions: HEALS delivered rapid and effective specialist healthcare services through an existing research collaboration with five ACCHS, cooperation from local health service providers, and effective community engagement. Implications for Public Health: HEALS serves as a framework for targeted, enhanced healthcare that benefits Aboriginal communities by encapsulating the ‘no research without service’ philosoph

A case study of enhanced clinical care enabled by Aboriginal health research: the Hearing, EAr health and Language Services (HEALS) project

Abstract Objective: To describe and evaluate Hearing EAr health and Language Services (HEALS), a New South Wales (NSW) health initiative implemented in 2013 and 2014 as a model for enhanced clinical services arising from Aboriginal health research. Methods: A case‐study involving a mixed‐methods evaluation of the origins and outcomes of HEALS, a collaboration among five NSW Aboriginal Community Controlled Health Services (ACCHS), the Sydney Children's Hospitals Network, NSW Health, the Aboriginal Health and Medical Research Council, and local service providers. Service delivery data was collected fortnightly; semi‐structured interviews were conducted with healthcare providers and caregivers of children who participated in HEALS. Results: To circumvent health service barriers, HEALS used relationships established through the Study of Environment on Aboriginal Resilience and Child Health (SEARCH) to form a specialist healthcare network. HEALS employed dedicated staff and provided a Memorandum of Understanding (detailing mutual goals and responsibilities) for each ACCHS. Despite very tight timeframes, HEALS provided services for 653 Aboriginal children, including 5,822 speech‐language pathology sessions and 219 Ear, Nose and Throat procedures. Four themes reflecting the perceived impact of HEALS were identified: valued clinical outcomes, raising community awareness, developing relationships/networks and augmented service delivery. Conclusions: HEALS delivered rapid and effective specialist healthcare services through an existing research collaboration with five ACCHS, cooperation from local health service providers, and effective community engagement. Implications for Public Health: HEALS serves as a framework for targeted, enhanced healthcare that benefits Aboriginal communities by encapsulating the ‘no research without service’ philosophy