Revisiting the ability of Australian primary healthcare services to respond to health inequity

Abstract

Equity of access and reducing health inequities are key objectives of comprehensive primary health care. However, the supports required to target equity are fragile and vulnerable to changes in the fiscal and political environment. Six Australian primary healthcare services, five in South Australia and one in the Northern Territory, were followed over 5 years (2009–2013) of considerable change. Fifty-five interviews were conducted with service managers, staff, regional health executives and health department representatives in 2013 to examine how the changes had affected their practice regarding equity of access and responding to health inequity. At the four state government services, seven of 10 previously identified strategies for equity of access and services’ scope to facilitate access to other health services and to act on the social determinants of health inequity were now compromised or reduced in some way as a result of the changing policy environment. There was a mix of positive and negative changes at the non-government organisation. The community-controlled service increased their breadth of strategies used to address health equity. These different trajectories suggest the value of community governance, and highlight the need to monitor equity performance and advocate for the importance of health equity.

Case study of a decolonising Aboriginal community controlled comprehensive primary health care response to alcohol‐related harm

“…Data were drawn from a larger study on comprehensive PHC that partnered with five South Australian services and Congress 4,21–23 . The six PHC services were selected to maximise diversity and because they had existing relationships with the research team that would make participation in a five‐year research project (2009–2014) feasible.…”

“…b) Congress staff interviews . There were two rounds of staff interviews, one in 2009–2010, including 14 interviews with Congress staff and board members 25 and one in 2013–2014, including 15 interviews with Congress staff and board members 22 . The first round explored implementation of comprehensive PHC principles at the service, while the second round focused on how this had changed in the intervening four years.…”

What is the difference between comprehensive and selective primary health care? Evidence from a five-year longitudinal realist case study in South Australia

“…The details of the interviews have been reported elsewhere. 14 In 2013, a total of 63 interviews were conducted with service practitioners and managers in the seven PHC sites, and regional and central health executives.…”

Are changes in Australian national primary healthcare policy likely to promote or impede equity of access? A narrative review

“…Our review found a number of studies showing that community-controlled CPHC services deliver health and access benefits for Aboriginal people (e.g. Parker et al 2012;Kelaher et al 2014;Bath and Wakerman 2015;Freeman et al 2016). Collaborative models of care between ACCHSs, PHC and acute care services also have been shown to improve service access and health outcomes for Aboriginal people in a remote setting (Reeve, et al 2015).…”