Socially inclusive nursing roles in Aboriginal Community Controlled Health Services

This case study explores the importance of socially inclusive nursing roles in Aboriginal Community Controlled Health Services (ACCHS) and their impact on the indigenous community. It discusses the background for the formation of ACCHS, the promotion of evidence-based healthcare interventions, and the effects of ACCHS on risk management and health management. The study also highlights the challenges faced in providing healthcare services to the indigenous community and offers potential solutions. Overall, it emphasizes the need for active participation of the aboriginal community in improving local health services.

Case Study on Indigenous Community
Socially inclusive nursing roles in Aboriginal Community Controlled Health Services
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Case Study on Indigenous Community
Introduction
In all countries with a history of colonization, the indigenous people are affected
with an identity loss among many other things. Australia has not recognized the impact of
colonization on aboriginal people and inhabitants of the Torres Strait for a long time
particularly in the matter of health and education. For example, comparison of life
expectancy among Aboriginal peoples and other residents of the Australian coast, show a
negative gap between 10 and 15 years. According to the report on the 2017 health
performance framework ("2017 HPF Report - 3.12 insular and island people from the
Torres Strait to the health workforce", 2019), Aboriginal people and islanders of the
Straits of Torres are having less representation among the health workers. As a result this
community is not getting the desired medical facilities. A number of studies conducted on
this aspect have found that people prefer to see health workers coming from the same
community to take care of their health-related issues. The gender of the health worker
also plays an important role as the indigenous people prefer health care personnel of the
same gender to listen to their problem. ("Improving the accessibility of health services in
urban and regional environments for indigenous peoples", 2019).
Detailed Discussion
a. Background for the formation of ACCHS
The indigenous workforce is required to ensure proper healthcare system for the
aboriginal people and the inhabitants of the Torres Strait. Indigenous healthcare
professionals can apply their special technical and socio-cultural abilities to improve
healthcare for their own community people and ensure more appropriate care and
services in comparison to their non-native counterparts (Miller & Speare, 2012).
It has often been suggested that indigenous health outcomes improve with the rise of
the indigenous labour force and Torres Strait Islanders at all levels. Cultural acceptability
is an important factor for using the necessary health services for indigenous peoples.
Among the ethnic group of people, who had difficulties in getting health services, still
believe they do not rely on the available medical service, as it is not culturally
appropriate. There are many reasons for this community people not getting desired health
services. These include a lack of recognition of the differences between non-indigenous
and indigenous health notions, lack of knowledge due to the effects of colonization still
persistent and the lukewarm response of non-indigenous health professionals towards the
ethnic group. There is also a lack of respect and mutual trust and poor intercultural
communications between these two communities. Health professions from the indigenous
community can understand better the health-related issues of their own community
people because of physical, mental, emotional, spiritual, and cultural bonding.

Case Study on Indigenous Community
The best way to solve this issue is to allow local communities to come forward and
take part in the health care system to manage their own health problems. This is the logic
behind the creation of health services controlled by the local community (ACCHS),
which has so far allowed more than hundred aboriginal communities throughout
Australia to control their care.
b. Promotion of evidence-based health care interventions
The fundamental concept according to each ACCHS is to establish a primary care
facility that is created and managed by the local indigenous people to provide integral and
appropriate medical attention to their own community people. The principle of self-
determination has helped people to achieve their own objectives. From the conceptual
stage itself , ACCHS was always thought to be more than a health centre and each
ACCHS has four key functions: community support, primary clinical care and special
needs programs (Ware, 2013).
A separate health policy for indigenous people is essential since the policy applied
for non-indigenous people cannot be applied to non-indigenous people. Many of them are
still not at home for medical service in hospitals and therefore, are reluctant to take
necessary medical assistance. Moreover, it is difficult to access healthcare due to
geographical isolation or want of proper transport system. Many of them live below the
poverty line, so the services offered is too costly for them to bear. Another factor is that it
is difficult to provide services to Aboriginal people that are offered to the non-indigenous
people, because of cultural and language disparities.
The important healthcare policy components in the ACCHS consist of the health of
the indigenous population along with initiatives from educational campaigns to
immunizations and disease detection.
Each ACCHS designs their services based on local requirements and priorities. In
addition to that, some related issues such as poor nutrition or abuse of banned substances
are to be addressed. Other programs are tailor-made for specific types of people, such as
young mothers or old-age people. The flexibility of creating special area-based services
allows each ACCHS to identify and address the major health issues in its area which is
possible when health care professionals belong to the same community.
Inadequate funding by government agencies is one of the major problems. Though
there is a significant increase but still per capita medical expenditure for this community
is much less than that for other general communities. Another major issue faced by
ACCHS is the difficulty of recruitment of doctors and nurses to run the services.
According to the recent Government bulletin, a mere 65% of indigenous community
controlled health services currently have a doctor. Hence, proper planning is to be

Case Study on Indigenous Community
undertaken to recruit doctors and nurses to run these services and the recruitment should
be preferably from this community. (Freeman et al., 2014). The nurses recruited are
trained in most of the aspects of health care needs particularly relating to issues of the
indigenous people. The nurses have to take care of the health related issues as they are
the people who are important to the community. Even in some places, there may not be
any doctor available. They have to provide the necessary service based on their
knowledge and experience. They are the important persons in the workforce of primary
health care, providing both medical and primary health services to people, their families
and community groups (Durey et al., 2016).
The roles identified for the nurses and other health workers under ACCHS are
general nurses, mental health nurses, health worker for family, nurses for sexual health,
specialist education officer, agents for hospital connectivity , nursing against drugs and
alcohol abuse, environmental health worker, community worker, maternal and perinatal
health worker, health worker in nutrition and healthcare coordinator etc. (Weightman,
2013).
After the formation of ACCHS, there is a significant increase in employment for
many indigenous peoples. Currently, 56% of the workforce is native. The largest
representation is in the category of non-clinical staff. A lot of efforts are required to
develop proper career paths to get more physicians, nurses and other health professionals.
Throughout Australia, there are only 170 doctors, 2,190 nurses and 730 other health
professionals.
There are reasons why the Government has started this community-controlled health
service (ACCHS). There is plenty of opportunities to be associated with the community
which is a must to achieve success in this initiative. Moreover, if the workforce belongs
to the same community, it is a motivational factor for them. The need for such kind of
health service is long overdue and it is an initiative in the right direction. (Alford, 2014).
c. Effects of ACCHS on management of risk of individuals and communities and
solution to other symptoms of poor health management
ACCHS health workers are not like other health workers. They are trained in clinical
skills to perform different types of tasks.They can administer child vaccinations under the
supervision of a doctor, collect blood samples and perform health checkups. There are
opportunities to experience conducting health programs specific to areas whereas in case
of Government hospitals these health professionals are confined to one area or managing
transportation and social assistance.

Case Study on Indigenous Community
Aboriginal women have been empowered to participate in numerous programs. The
settings of the ACCHS allow greater autonomy from the very beginning to set up and
implement health programs. Nurses have successfully planned and executed need based
special programs, such as a program for women about breastfeeding, an awareness
program to stop smoking, a project on cleanliness and also on infectious disease. These
programs were designed with innovative approaches to create awareness among the
community. For example, health workers have started a community breakfast program
named cancer week and they also participate in a weekly special program on health care
of a local radio station(Cioffi, 2013).
ACCHS health workers also offer widespread community-wide coverage services,
at jails, small l camps and youth detention centres. They have the opportunity to travel to
workshops and conferences to expand their knowledge and skills, as well as create
professional networks.
Health workers at ACCHS have great community expectation. They are compelled
to take on many roles at the same time and are considered "everything for everyone".
Older nurses may not take in good spirit the contribution of younger workers; instead of
taking it in the negative sense, they should impress their juniors by sharing their
experience. This type of behavioural issues crops up at the workplace.
Bearing the burden of community expectations can be very tiresome when the
nurses have to manage the responsibilities of managing community service as well as
family. They cannot leave after work and relax, since community members may come
and discuss their problems at home. (Wilson, Kelly, Magarey, Jones and Mackean, 2016).
When a conflict arises within a community, people tend to shy away from ACCHS
if the health worker belongs to a different community. These problems can be frustrating
and can have an effect on the sense of professionalism of workers' health.
Conclusion
In spite of all these challenges, the ACCHS community engagement process proves
that the active participation of the aboriginal community is key for the success of
government initiative for improving local health services for aboriginal peoples
(Campbell, Hunt, Scrimgeour, Davey and Jones, 2018). The training of ACCHS was a
success factor in the participation process and resulted in the opportunity for the
aboriginal community to show leadership, promote the process and communicate the
concerns of the indigenous people about health services to providers of services The
action, more than mere planning, was a key role of the group (Panaretto, Wenitong,
Button & Ring, 2014). Health service providers worked with community members to

Case Study on Indigenous Community
improve the cultural safety of their services. The established feedback cycle encouraged a
sense of responsibility, transparency and confidence and led to improved healthcare for
the native community.
References
2017 HPF Report - 3.12 Aboriginal and Torres Strait Islander people in the health workforce.
(2019). Retrieved from
https://www.pmc.gov.au/sites/default/files/publications/indigenous/hpf-2017/
tier3/312.html
Alford, K. (2014). Economic value of Aboriginal community controlled health services.
Canberra: National Aboriginal Community Controlled Health Organisation. Viewed 15
May 2014.
Campbell, M. A., Hunt, J., Scrimgeour, D. J., Davey, M., & Jones, V. (2018). Contribution of
Aboriginal Community-Controlled Health Services to improving Aboriginal health: an
evidence review. Australian health review, 42(2), 218-226.
Cioffi, J. (2013). Being inclusive of diversity in nursing care: A discussion
paper. Collegian, 20(4), 249-254.
Durey, A., McEvoy, S., Swift-Otero, V., Taylor, K., Katzenellenbogen, J., & Bessarab, D.
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Freeman, T., Edwards, T., Baum, F., Lawless, A., Jolley, G., Javanparast, S., & Francis, T.
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Improving the accessibility of health services in urban and regional settings for Indigenous
people. (2019). Retrieved from http://dro.deakin.edu.au/eserv/DU:30069870/ware-
improvingtheaccessibility-2013.pdf
Miller, A., & Speare, R. (2012). Health care for indigenous Australians. In Understanding the
Australian Health Care System, 2nd Edition (pp. 149-160). Elsevier Australia.

Case Study on Indigenous Community
Panaretto, K. S., Wenitong, M., Button, S., & Ring, I. T. (2014). Aboriginal community
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