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. We followed six Australian primary health care services, five in South Australia, and one in the Northern Territory, over five years (2009-2013) of considerable change. We conducted 55 interviews 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 ten 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 less change with a mix of positive and negative at the non-government organisation. The community controlled service increased their breadth of strategies employed 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.