Increasing the quality and uptake of Aboriginal and Torres Strait Islander Health Assessments is a key objective of the National Aboriginal and Torres Strait Islander Health Plan 2021-2031¹. Annual Health Assessments help to identify and manage health risks, providing an opportunity for detection, prevention and early disease management. Health Assessments are currently underdelivered nationally², however specific data for mainstream general practices is not publicly available. Data suggest many First Nations peoples may prefer to attend mainstream services for health care³. This research aims to understand how Health Assessments are implemented in mainstream general practice. De-identified medical record data was extracted from 79 practices across NSW, QLD, and VIC. Of 7,459 First Nations clients, 44% had a Health Assessment recorded in the previous 12 months. This was higher than the combined national rate of 28%². Odds of having an up-to-date Health Assessment increased with client age, number of visits to the practice, and number of chronic conditions. Clients with an up-to-date Health Assessment were significantly more likely to have been screened for blood pressure, cholesterol, cardiovascular disease risk and diabetes than those with no Health Assessment. Findings support the utility of Health Assessments in improving preventative care. Further exploration of the provider and system factors which influence Health Assessment delivery and quality, and experiences of First Nations clients in this setting is needed.

1. Department of Health. National Aboriginal and Torres Strait Islander health plan 2021–2031. Canberra, Australia: Australian Government, 2021.
2. Australian Institute of Health and Welfare. Health checks and follow-ups for Aboriginal and Torres Strait Islander people. Canberra, Australia: AIHW, 2024.
3. Australian Institute of Health and Welfare & National Indigenous Australians Agency. Measure 3.17 Regular general practitioner or health service, Aboriginal and Torres Strait Islander Health Performance Framework, 2020.

The research team recognises the knowledge and strengths of Aboriginal and Torres Strait Islander peoples in determining what is best for the health and wellbeing of their Communities. Aboriginal leadership is ensured through representation in the Investigator team as Chief Investigators of the research grant, and an Aboriginal Reference Group which has oversight over all aspects of the research. The Aboriginal Reference Group is comprised of 8 members (including authors MG, TR, RD, TH) and provides relevant cultural perspectives, guidance and direction to the research. The presenting author (MG) is Chair of the Aboriginal Reference Group. The Aboriginal Reference Group have been engaged in the project from development and are involved in all aspect of the research from project design to review, interpretation and dissemination of data. The research team and Aboriginal Reference Group have co-developed Data Use and Authorship guidelines for the project. Data Stewardship is undertaken by the Aboriginal Reference Group, providing oversight and approval for the use and dissemination of data arising from the research project. This work was undertaken as part of a broader research project which was also reviewed and approved by the University of Newcastle Aboriginal Health Research Community Panel. This Panel is comprised of a diverse group of local Aboriginal and/or Torres Strait Islander community members with expertise to provide essential cultural and community oversight to research. The review process ensures research is ethically sound, culturally appropriate, and has real potential to benefit the local Aboriginal and Torres Strait Islander community. This research was approved by the Aboriginal Health and Medical Research Council Ethics Committee (1969/22). The research has been conducted in accordance with the Australian Institute of Aboriginal and Torres Strait Islander Studies’ (AIATSIS) Code of Ethics for Aboriginal and Torres Strait Islander Research.

Background: The PATHWAY project for Aboriginal and Torres Strait Islander Hearing Health was created in response to national and community-identified priorities related to ear health inequities experienced by Aboriginal and Torres Strait Islander people. The project aims to map the journeys, waiting times and out of pocket healthcare expenditure for Aboriginal and Torres Strait Islander families accessing otitis media (OM) services across rural and remote areas in the far west of South Australia. This project also aims to engage with stakeholders in the OM care pathway, including care-givers, children, young people, educators, health administrators and health educators, to inform a regional approach to service delivery that meets the needs of far west communities.

Objectives: To describe the insights gained from yarning with health professionals working in the OM care pathway in the far west of South Australia and how these insights may inform changes to policy and practice in the region.

Methods: Indigenous and non-Indigenous researchers worked together at the Indigenous and Western Knowledge Interface in all phases of the research process. This study used Indigenous research methods, including yarns and yarning circles, to engage with health professionals across a number of local and visiting health services involved in the OM care pathway. Transcripts of the yarns and yarning circles have been thematically analysed.

Results: The preliminary outcomes of the thematic analysis will be discussed in light of existing literature and the regional context.

Conclusion: This research will describe the experiences and insights gained from health professionals working in the OM care pathway across the far west of South Australia. De-identified study outcomes will be made available to Aboriginal health and community organisations across the far west of South Australia, to inform quality improvement activities and advocate for essential OM services and resources.

Leadership and Collaborations in Aboriginal Health Equity Frameworks

This paper draws from health equity research undertaken with the Health Equity Research Development Unit (a partnership between the International Centre for Future Health Systems, UNSW Sydney and Sydney Local Health District) and the NSW Ministry of Health Centre for Population Health.

The paper is written by the Lead Aboriginal researcher and provides an Indigenist standpoint perspective of privileging Aboriginal voice and Aboriginal self-determination in research.

Aboriginal Controlled Health Organisations (ACCHOs) have been at the core and forefront of progressing equitable access to health care services for Aboriginal & Torres Strait Islander peoples since 1971 with the first Aboriginal Medical Service being established in Redfern. Since then, their advocacy has resulted in public health authorities and NGOs being required to work in partnership with the Aboriginal Community Controlled health sector to progress Aboriginal health equity through genuine and applied change.

This paper provides a summary of examples of Aboriginal Health Equity Frameworks as a tool for planning and implementation of health equity strategies and actions. It also highlights how Aboriginal voices, and self-determination are placed in these frameworks. Thematic analysis identified emergent themes including role in the health system, human rights, health rights and social justice, self –determination, culturally safe and accessible health services, wellbeing, trauma informed care, economic, social and cultural determinates of health, workforce capacity, sustainability, partnership development, needs and place-based initiatives.

Models of Care are foundational in these frameworks and include: Comprehensive Primary Health Care, Family centred care, Aboriginal models of wellbeing, Patient centred care, Co-ordinated and connected care.

The intent of the paper is to frame the discussion in terms of how the leadership and knowledge of Aboriginal determined and collaborative health equity could be of value for a more systems-based approach to health equity for marginalized or vulnerable population groups.

Aboriginal Governance
This paper is drawn from desk-based research conducted by an Aboriginal researcher following Indigenist Standpoint Theory. Indigenous Data Sovereignty in this paper is reflected in the detailed referencing all of sources of information and with their being a sole Aboriginal author of this paper.

Between 2016 and 2018 Central Australian Aboriginal Congress (Congress) reformed its delivery of comprehensive primary health care (CPHC) in Mparntwe (Alice Springs) with the aims of improving continuity of care, access, and quality of care for a population with high levels of need.

The reforms saw the decentralisation of care from one large clinic by establishing an additional three ‘satellite’ clinics in geographically-decentralised locations in the town. Each new clinic served around 2,000 clients, with around 5,000 clients continuing to be served by the existing central clinic. This was based on national and international evidence about the effectiveness of smaller, localised PHC services for Indigenous communities.

A number of key aims underpinned the new model including:
• improved continuity of care, through each clinic providing care to a smaller, more personally-known group of clients
• integrated multidisciplinary team-based care with a focus on preventative care and chronic disease management
• improved quality of care through more efficient use of care providers time, and increased financial sustainability allowing the employment of more providers.

A mixed method evaluation to assess the effectiveness of the reforms was carried out between 2021 and 2023 by Congress and the Menzies School of Health Research. The evaluation found:
• better continuity of care under the new model, including through improved consistency of GP provider and increased rapport between clients and care providers
• improved access to CPHC
• improvements in the delivery of planned, preventative care, and clinical aspects of chronic disease management, although non-clinical aspects of quality care could still be improved.

Despite these successes, there were a number of management challenges in operating the decentralised model. It was difficult to implement the new model consistently across all sites with fidelity. Further work has since been undertaken to develop a consistent service delivery model across all sites based on multidisciplinary ‘pods’ of care providers.

Aboriginal Governance, data sovereignty and cultural appropriateness
Central Australian Aboriginal Congress (Congress) is an Aboriginal community-controlled health service, governed by a Board elected by the Aboriginal community.

For over 50 years, Congress provided health services and advocacy for Aboriginal people in the struggle for justice and equity. Since that time, Congress has developed a comprehensive, holistic and culturally-responsive primary health care service for Aboriginal people living in Mparntwe (Alice Springs), and nine remote communities: Amoonguna; Ntaria (Hermannsburg); Wallace Rockhole; Ltyentye Apurte (Santa Teresa); Utju (Areyonga); Mutitjulu; Imanpa; Kaltukatjara (Docker River); and Yulara.

Today, we are one of the most experienced Aboriginal primary health care services in the country, a strong political advocate for the health of our people, and a national leader in improving health outcomes for all First Nations.

All research carried out by Congress or in which Congress participates is approved by the Congress Board in strict accordance with the principles of Aboriginal data sovereignty and cultural responsiveness.

In 2017, residents of the small remote Aboriginal community of Imanpa, located halfway between Mparntwe (Alice Springs) and Uluru, were left without health services as the local Northern Territory (NT) government-run clinic closed its doors. Traditional Owner Tanya Luckey said at that time: “It makes us feel really bad, makes us feel like no-one really cares about Imanpa or the people who live here. It makes us feel like we're nothing.”

This withdrawal of primary health care (PHC) services – and the calls from community leaders and Traditional Owners – sparked the case for change. The process for transitioning the health service at Imanpa, along with NT government-run remote PHC services at Kaltukatjara (Docker River) and Yulara, commenced in 2019 with a scoping exercise led by the Central Australian Aboriginal Congress (Congress). This was approved by the NT Aboriginal Health Forum, and the necessary funding to support the transition process was provided by the Australian Government.

In mid-2023, PHC services at Imanpa, Kaltukatjara and Yulara transitioned from government to Aboriginal Community Control under Congress.

This paper will outline the benefits to remote Aboriginal communities as a result of these transitions, including:

• Population increases, as community members move back to their communities from Mparntwe as a result of improved health services
• Increased staffing profile (FTE) with greater coverage by Remote Area Nurses and General Practitioners
• Increased employment opportunities for local Aboriginal people
• Increases to health service accessibility and acceptability because of culturally appropriate care
• Strengthening self-determination and the voices of Aboriginal people through local governance of PHC services.

Aboriginal Governance, data sovereignty and cultural appropriateness

Central Australian Aboriginal Congress (Congress) is an Aboriginal community-controlled health service, governed by a Board elected by the Aboriginal community.

For over 50 years, Congress provided health services and advocacy for Aboriginal people in the struggle for justice and equity. Since that time, Congress has developed a comprehensive, holistic and culturally-responsive primary health care service for Aboriginal people living in Mparntwe (Alice Springs), and nine remote communities: Amoonguna; Ntaria (Hermannsburg); Wallace Rockhole; Ltyentye Apurte (Santa Teresa); Utju (Areyonga); Mutitjulu; Imanpa; Kaltukatjara (Docker River); and Yulara.

Today, we are one of the most experienced Aboriginal primary health care services in the country, a strong political advocate for the health of our people, and a national leader in improving health outcomes for all First Nations.

All research carried out by Congress or in which Congress participates is approved by the Congress Board in strict accordance with the principles of Aboriginal data sovereignty and cultural responsiveness.

Reference:
1. Hose, N (29 September 2017), Medical clinic closure in remote NT community leaves residents frustrated. Australian Broadcasting Association. Available from: https://www.abc.net.au/news/2017-09-29/medical-clinic-closure-in-remote-community-residents-frustrated/9001482

Billions of dollars are spent annually on Indigenous programs, services, and initiatives. Despite the need, there needs to be more evidence on how to define effective and quantify program effectiveness for improving Indigenous health and wellbeing outcomes. Indigenous leaders have called for 'more and better' evaluations of Indigenous programs and commissioning processes that engage Indigenous peoples. To date, few research studies have sought to characterise the commissioning practices of government and non-government organisations in contracting evaluations for Indigenous health and wellbeing programs. Fewer still have investigated the role of Indigenous engagement and leadership during and resulting from the commissioning process despite Indigenous leadership's calls to do so. This project aimed to identify how commissioning practices can support Indigenous leadership in evaluating health and wellbeing programs in Australia.

The project was conducted in multiple phases, which included a comprehensive scoping review, in-depth interviews with relevant stakeholders (commissioners, evaluators, and Indigenous service providers), and four detailed case studies of Commissioned evaluations.

We will present the five commissioning models identified from an NHMRC-funded, Indigenous-led project: Indigenous engagement and leadership in evaluating Indigenous health and wellbeing programs: Taking steps to improve government and non-government commissioning practices. The models include Indigenous-led, delegative, co-design, participatory and top-down.

For Indigenous health and wellbeing evaluations, evaluations are often culturally unsafe. Therefore, they are of little use to Indigenous people and organisations; the very people the evaluated programs are meant to assist. To improve the mortality and morbidity gap of Indigenous, the impact of the program investment should be evaluated. The findings have significant potential to increase the number and quality of evaluations by improving the commissioning process. It also has the potential to strengthen the evidence base on effective Indigenous programs and inform future investments to improve health equity for Aboriginal and Torres Strait Islander people.

Aboriginal and Torres Strait Islander governance
This project was led by Dr Summer May Finlay, an Indigenous early career researcher. Dr Finlay began work on this project as a post-doctoral researcher, developing the skills that allowed her to take on the role of Principal Researcher. Indigenous researchers Professor Bronwyn Fredericks, Professor Yvette Roe, and Dr Amohia Boulton were members of the research team for this project, offering their expertise in data collection and analysis throughout the project. The Project Advisory Group (PAG) was chaired by Tom Calma and comprised around 50% of Indigenous members who assisted in the research strategy for this project.

We also worked closely with each Aboriginal and Torres Strait Islander organisation involved on how they would like the research conducted at their site.