We can work together, talk together: Reforming Primary Health Care in a remote Aboriginal community

Mr Greg Smith1

1Maningrida Health Centre, winnellie, Australia


The purpose of the presentation

Aboriginal peoples, particularly those living in remote and very remote areas, experience poor health – higher rates of chronic illnesses and avoidable hospitalisations compared to non-Aboriginal Australians. Improving access to and effectiveness of primary health care (PHC) is critical to improving these health outcomes. The Australian Government’s Health Care Home reform is a PHC model associated with improved access, better clinical outcomes and reduced costs. Simultaneously, national accreditation standards and Northern Territory Government policies mandate increased patient involvement in service design and delivery of care to assure cultural safety.


The nature and scope of the topic

Qualitative enquiry was guided by an Aboriginal advisory group in a large Arnhem Land community. We undertook focus groups co-facilitated by an Aboriginal co-researcher. The project structure ensured representation from the major language groups. Dual coding and deductive thematic analysis identified desired PHC service improvements during Health Care Home implementation.


The issue or problem under consideration

Current PHC delivery is poorly aligned with patients’ cultural beliefs and expectations of care, limiting acceptability and access to care.


The outcome or the conclusion reached

Patients desire a PHC delivery model based on the concept of “Gurrutu” – love and respect. This could be achieved by establishing multidisciplinary care teams for patient panels based on language groups. Language group-based Aboriginal Health Practitioners (AHP) are needed in new roles: self-management support, care navigation/coordination, health coaching and as cultural mentors to non-Aboriginal staff.

Community members identified PHC delivery reforms that align with comparable best-practice Health Care Homes models of care internationally. Implementation would require transitioning the nursing workforce from vertical program delivery to generalist panel managers working to the top of their license.


Greg has worked at Maningrida Health Centre as a Primary Health Care Nurse since 2010. Interested in alternative service delivery models that supports greater Aboriginal involvement in health care, Greg completed a community consultation to understand the community’s experience of health care, and to elicit opportunities for improvement.

Nominal s: Ba Nursing, Grad Dip Quality Management, Grad Dip Mental Health Nursing, Master Public Health

Email: gregory.smith@nt.gov.au