Implementing Indigenous community control in health care: lessons from Canada Lavoie, Josee Dwyer, Judith Margaret 2018-07-04T05:50:43Z 2018-07-04T05:50:43Z 2015-11-10
dc.description Copyright the Authors, Journal compilation copyright AHHA 2016. Published under a CC-BY-NC-ND licence: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 ( en_US
dc.description.abstract Objective Over past decades, Australian and Canadian Indigenous primary healthcare policies have focused on supporting community controlled Indigenous health organisations. After more than 20 years of sustained effort, over 89% of eligible communities in Canada are currently engaged in the planning, management and provision of community controlled health services. In Australia, policy commitment to community control has also been in place for more than 25 years, but implementation has been complicated by unrealistic timelines, underdeveloped change management processes, inflexible funding agreements and distrust. This paper discusses the lessons from the Canadian experience to inform the continuing efforts to achieve the implementation of community control in Australia. Methods We reviewed Canadian policy and evaluation grey literature documents, and assessed lessons and recommendations for relevance to the Australian context. Results Our analysis yielded three broad lessons. First, implementing community control takes time. It took Canada 20 years to achieve 89% implementation. To succeed, Australia will need to make a firm long term commitment to this objective. Second, implementing community control is complex. Communities require adequate resources to support change management. And third, accountability frameworks must be tailored to the Indigenous primary health care context to be meaningful. Conclusions We conclude that although the Canadian experience is based on a different context, the processes and tools created to implement community control in Canada can help inform the Australian context. What is known about the topic? Although Australia has promoted Indigenous control over primary healthcare (PHC) services, implementation remains incomplete. Enduring barriers to the transfer of PHC services to community control have not been addressed in the largely sporadic attention to this challenge to date, despite significant recent efforts in some jurisdictions. What does this paper add? The Canadian experience indicates that transferring PHC from government to community ownership requires sustained commitment, adequate resourcing of the change process and the development of a meaningful accountability framework tailored to the sector. What are the implications for practitioners? Policy makers in Australia will need to attend to reform in contractual arrangements (towards pooled or bundled funding), adopt a long-term vision for transfer and find ways to harmonise the roles of federal and state governments. The arrangements achieved in some communities in the Australian Coordinated Care Trials (and still in place) provide a model. en_US
dc.identifier.citation Lavoie, J. G., & Dwyer, J. (2016). Implementing Indigenous community control in health care: lessons from Canada. Australian Health Review, 40(4), 453. en
dc.identifier.doi en
dc.identifier.issn 0156-5788
dc.language.iso en
dc.oaire.license.condition.license CC-BY-NC-ND
dc.publisher CSIRO Publishing en
dc.rights Copyright the Authors, Journal compilation copyright AHHA 2016 en
dc.rights.holder The Authors en
dc.subject Indigenous primary healthcare en
dc.subject Indigenous communities en
dc.subject Aboriginal health services en
dc.subject Aboriginal Australians en
dc.subject Indigenous Canadians en
dc.title Implementing Indigenous community control in health care: lessons from Canada en
dc.type Article en
Original bundle
Now showing 1 - 1 of 1
Thumbnail Image
203.73 KB
Adobe Portable Document Format
Publisher version
License bundle
Now showing 1 - 1 of 1
No Thumbnail Available
1.84 KB
Item-specific license agreed upon to submission