Priority reform area 2 - Building the Community Controlled sector

Outcome statement

NSW Health values and consistently invests in the Aboriginal Community Controlled Health Services (ACCH) sector as an essential partner for improving health and wellbeing outcomes for Aboriginal people.

Reform priority

1. Reform Priority 2.1- The ACCH sector
   To elevate how NSW Health values and invests in the ACCH sector.

Why is this important?

The ACCH sector in NSW is already well established, delivering holistic, culturally safe and responsive healthcare to Aboriginal people and communities in NSW for over half a century, becoming a key part of the NSW health system in the process ^{27, 28}. ACCH services are highly innovative and often go beyond what mainstream primary care services typically offer – delivering integrated family and community services, health promotion activities, and action on the social and cultural determinants of health ^{29, 30}.

While it is well understood that –compared to mainstream primary care services –ACCHOs often deliver better outcomes and are the preferred care settings for many Aboriginal people³¹, as well as being highly cost-effective^{32, 33}, the availability and scale/scope of ACCHOs varies greatly between regions. This can prevent Aboriginal peoples in some communities from accessing Community Controlled health services.

For these reasons, as well as the importance of community control to self-determination, Priority Reform Two of the National Agreement refers to ‘building the sector’ as a commitment to support growth and strengthen Aboriginal Community Controlled service sectors, including by increasing the proportion of services delivered to Aboriginal people from ACCHOs³⁴.

CTG commitments under this priority reform centre around:

• sustained capacity building and investment
• dedicated and identified Aboriginal and Torres Strait Islander workforce
• community-controlled organisations are supported by a Peak Body, which has strong governance and policy development and influencing capacity
• community-controlled organisations have a dedicated, reliable and consistent funding model designed to suit the types of services required by communities.

The National Health Plan and the NSW Closing the Gap Implementation Plan mirror this commitment, acknowledging that ACCHOs are recognised as preferred healthcare providers for Aboriginal communities and should be supported to reach their full potential^{35, 36}. A key aspect of supporting the ACCH sector is the provision of stable, equitable, long-term funding so ACCHOs can operate in a financially and logistically sustainable manner ^{37, 38, 39}.

Stakeholders in the health system of NSW acknowledge ACCH and public health services have important reciprocal relationships –whereby ACCH and public health services support each other to deliver effective healthcare to Aboriginal people in each region. In this way, ACCH’s provision of culturally appropriate primary healthcare services assists NSW Health address health priorities and improve health outcomes for Aboriginal people across the state as a whole⁴⁰.

Reform priority 2.1 - The ACCH sector

To elevate how NSW Health values and invests in the ACCH sector

What does success look like?

NSW Health investment in the ACCH sector recognises the sector as a provider of high quality comprehensive primary health care services. It extends on Commonwealth funding and, in combination, is commensurate with need and complementary to NSW Health delivered health services.

How success will be achieved

• Identify and address the power differential between NSW Health and the ACCH sector, along with the responsibilities to rebalance this at each level of the health system.
• Review and make recommendations in partnership with the ACCH sector on the sustainability, transparency and appropriateness relative to need of NSW Health and Commonwealth funding into the ACCH sector.
• Implement recommendations from the review of funding into the ACCH sector and evaluate the impact of investment.
• Identify and utilise opportunities to invest in and expand ACCH sector models of care and service delivery as best practice across the NSW health system.