Aboriginal and Torres Strait Islander Community Control

Why is Aboriginal Community control important?

Historically, Aboriginal and Torres Strait Islander communities have experienced high levels of surveillance, racism and intervention from state agencies. This included the areas of welfare and health service provision. Oral and written histories document the ongoing distress and mistrust felt by many Aboriginal and Torres Strait Islander peoples towards service providers, which often leads to a failure to access both prevention and treatment in health.

Most health agencies now recognise the importance of community consultation and culturally appropriate communication and service provision. In addition, services such as Aboriginal Medical Services (AMS) extend the level of control, which Aboriginal and Torres Strait Islander communities can exercise in health and well-being.

What is an Aboriginal Medical Service?

Any health service, which is funded primarily to work with Aboriginal and Torres Strait Islander people can be referred to as an Aboriginal Medical Service. In one of our focus groups the Chairperson of an Aboriginal Medical Service defined his service as follows:

Basically it’s a culturally appropriate place for Aboriginal people to go and seek medical help. Its somewhere for them to be comfortable - there’s Aboriginal staff and they can go to that place.

He also linked the AMS operation to a very specific understanding of the health needs of his community:

The centre itself has a focus in terms of the Aboriginal health problems to follow up with the clients coming in. So we are talking about chronic disease - asthma, diabetes, all those type of things that are prevalent in Aboriginal communities.

Who can attend an Aboriginal Medical Service?

Although media and community stereotyping presents Aboriginal Medical Services as part of the “Special Treatment” that exclusively services Aboriginal and Torres people our communities were very clear that non-Indigenous people were also welcome as clients:

When we did receive funding, 80% of that funding was for Aboriginal people. The other 20% was for people like their partners, regardless of whether they were Aboriginal or not.

View an audio-visual vignette: Bourke Aboriginal Health Service

Where are Aboriginal Medical Services located?

• Click here to see a map showing the location of the Aboriginal Medical Services in Australia

In New South Wales, most Aboriginal Medical Services are also controlled by Aboriginal communities and are part of the National Aboriginal Community Controlled Health Organisation (NACCHO).
For membership of NACCHO an organisation must be:

• Initiated by a local Aboriginal community;
• Based in a local Aboriginal community;
• Governed by an Aboriginal body which is elected by the local Aboriginal community;
• Delivering a holistic and culturally appropriate health service to the Community which controls it.

Many members of our community focus groups were affiliated with an Aboriginal Medical Service. Some stressed the importance of their organisation’s membership with NACCHO and their commitment to the NACCHO aims.

NACCHO has a philosophy that:

The success of personal approach

Our community members believed that the success of an Aboriginal Medical Service depended on its ability to make Aboriginal and Torres Strait Islander clients feel welcome and to see the Service as an extension of their community.

You walk in that door, you know everybody… It’s a meeting place. People come in and sit down and just have a yack [talk] in the waiting room. The doctor will come out and the nurses too - it’s a very personal approach too, the way things are done.

The limitations of the services

While community members were proud of the successes of their local Aboriginal Medical Services they were also concerned at the effects of high demand and limited funding could have:

We were always going to end up with too many people to service… It’s important that we get to see as many people as we can but I’m always worried about the quality of service. If we get to a situation where we don’t have the ability to have those long consultations, where we can look at the family and go, “Ok, what are the other extenuating circumstances?” So its housing, it’s over-crowding, its Dad couldn’t get a job. If we’re into a situation where all we are doing is rushing people through then we are going to fail our communities.