Background
Method
Inclusion criteria
Indigenous populations are communities that live within, or are attached to, geographically distinct traditional habitats or ancestral territories, and who identify themselves as being part of a distinct cultural group, descended from groups present in the area before modern states were created and current borders defined. They generally maintain cultural and social identities, and social, economic, cultural and political institutions, separate from the mainstream or dominant society or culture ([22](para. 1)).
socially appropriate, universally accessible, scientifically sound first level care provided by health services and systems with a suitably trained workforce comprised of multi-disciplinary teams supported by integrated referral systems in a way that: gives priority to those most in need and addresses health inequalities; maximises community and individual self-reliance, participation and control; and involves collaboration and partnership with other sectors to promote public health. Comprehensive primary health care includes health promotion, illness prevention, treatment and care of the sick, community development, and advocacy and rehabilitation ([23](para. 3)).
Types of studies
Search terms
Search strategy
Study selection
Charting of data
Results
Description of studies
Characteristics
Accessible Health Services
• ensuring a broad range of services are available [50], in a variety of locations and settings [29, 30, 37, 41, 47, 49, 56, 71‐73, 78, 80‐82, 84, 87], including increased opening hours, walk in appointments [41, 47, 52, 60, 68, 76] and transport [47, 60, 72]. |
Community Participation
• ensuring Indigenous ownership of health services which enables Indigenous peoples to own and manage their health service [85], and ensures the service is accountable to the community [54]. • establishing Indigenous governance [30‐32, 34, 35, 40, 60, 61, 64, 70, 82] including members from local community on governing boards, in order to encourage community involvement and ownership, while at the same time building capacity within local communities [41, 50, 53]. • facilitating community consultation, engagement and collaboration in order to establish a strong relationship with the community [32, 84] and facilitate sharing of information [83, 88] ensuring that programs were culturally appropriate, accessible, engaging and empowering, and designed to take account of the local context and needs [34, 47, 54, 58, 74, 80, 82, 87]. |
Continuous Quality Improvement
• collecting and utilising data not simply to improve health outcomes but also meet the needs of each community by undertaking program evaluation [29], participating in quality improvement initiatives [28], reporting on performance [43], identifying clients who require a specific service, follow-up visits and client tracking [62], service planning and implementation [42, 64, 82], and service impact [42]. • evaluating services to measure health benefits for the community [54], assessing economic outcomes, baseline demographics in relation to increased service utilisation, health assessments and chronic disease care plans [42]. • undertaking research to strengthen health systems in order to meet the needs of the community with an emphasis on translating research findings into practice [28]. • establishing quality improvement processes with a focus on chronic conditions, monitoring health programs as well as management and follow-up care [43, 62], and community involvement in developing indicators [64], that also focus on cultural aspects of care, traditional approaches and receiving care in language [80]. |
Culturally Appropriate and Skilled Workforce
• employing a range of skilled staff both health and non-health personnel who are able to meet the needs of the local community [30, 36, 41, 49, 50]. • establishing an Indigenous workforce comprising Indigenous Health Workers, mental health workers, social workers, nurses, doctors, administration staff, managers and traditional healers, all who are central to the delivery of services, providing a diverse range of care [37, 38, 41, 47, 50, 78, 81, 88], and within some service models, conducting the majority of the clinical work with clients [31, 38]. • recognising that Indigenous staff often have responsibilities and obligations in relation to family and community, which were often conducted within the health service [54], such as interpreting and acting as mediators [78]. • providing training and development opportunities for all staff [30, 32, 41, 47, 49, 50, 61, 64, 70, 74, 88], such as cultural awareness training for non-Indigenous staff [38, 58, 81], and comprehensive training for staff working in remote areas or in isolation who require additional skills and knowledge to deal with an array of more complex needs [61]. |
Flexible Approaches to Care
• tailoring approaches to identify [36, 50, 55, 66, 72] and meet the needs of the local community [29, 38, 41, 47, 48, 50, 52, 54, 58, 64, 69, 70, 83, 87], and delivering a range of services [29], that are relevant, culturally appropriate and effective [36, 82]. |
Holistic Health Care
• providing comprehensive primary health care, which is holistic [32, 34, 37, 80, 82], supports the health and wellbeing of not only the individual but also their family and community [34, 49‐51, 54, 66, 69, 73, 85], and includes mental, emotional and spiritual needs alongside physical wellbeing [57, 60, 80, 84]. • offering a diverse range of services to clients [57], such as prevention and health promotion through to chronic disease care [29, 31, 34, 41, 53, 57, 62, 71], maternal and child health [34, 41, 49, 56, 57, 59, 82], oral health [39, 42, 50, 53, 57, 64, 65, 82], ear health [53, 56, 64] sexual health [53], mental and social health [34, 41, 56, 57, 59, 78], alcohol and other drugs treatment [50, 53, 82], pharmaceutical services [44, 56, 69, 78, 80], aged care [29, 36, 41] and disability services [41, 82]. • including prevention and health promotion initiatives developed and tailored to the needs of the local community, including general screening programs [29, 38, 63, 72, 77, 82] healthy lifestyles programs [56] needle exchange programs [29, 33, 56, 82], women’s and men’s health programs [29, 34], healthy eating, exercise and smoking cessation programs [31, 32, 49, 52, 56, 71, 77], oral health [65], injury prevention [74], and supporting people to manage their own health [71]. • improving health literacy particularly in relation to early warning signs of suicide [70], increasing HIV/AIDs awareness [32], providing information about the harm that comes from alcohol, tobacco and other drugs [73], understanding food labelling [83], maintaining health and ensuring that people could detect early warning signs and understanding when to seek health care advice [71, 83]. • providing traditional healing as one option within the health service [36, 52, 59, 63, 64, 70, 72, 73, 77, 79‐82, 84‐88]. • advocating for clients [29, 52], especially in relation to clients moving between other primary, secondary, tertiary, and essential non-health services [60, 84]. • engaging with the social determinants of health by supporting clients in accessing housing, employment, education, social security payments, and supporting people through the justice system [29, 41, 49‐51, 53, 56, 57, 59, 73, 80, 82], specifically for or customised to meet the needs of the community they served [32, 47, 84, 88]. • providing advice in relation to public health initiatives not within the normal scope of mainstream PHC including sanitation system construction and maintenance, disease surveillance, environmental health, food distribution, and transportation [59]. |
Self-determination and Empowerment
• facilitating self-determination and empowerment of Indigenous communities in order to establish and manage their own Indigenous health services [30, 32], enabling clients to take control of their own health, at an individual and family level [69], building resilience [53], and enabling empowerment of clients through program engagement [34, 40, 47, 59, 74, 77, 83, 87]. • providing employment and training to promote the development of the local Indigenous health workforce, and build the capacity of the community [32, 40, 41, 87]. |