About this chapter
The aim of this chapter is to guide the further development of health promoting
community health centres as settings that provide:
- a focal point for primary health care activities
- quality treatment, and
- public health programs which focus on early intervention, prevention and health
promotion
This chapter provides advice about how to:
- promote teamwork and networking
- encourage a community health centre environment that is safe, comfortable and accessible
to all members of the community
- be informed about the policies that guide and support work
- support best practice by sharing stories about Primary Health Care in action
- encourage local involvement and community control
What is a healthy health centre?
A healthy health centre is a place in which staff:
- implement Primary Health Care based on THS Essential Primary Health Care Service
Standards
- provide a high standard of clinical care
- acknowledge local Aboriginal culture (knowledge, attitudes, beliefs, practices) in all
aspects of work
- find ways to work in community settings outside the health centre
- work together as a team, making the most of each other's skills, experience, knowledge,
personal attributes and cultural background
- provide training and education for health, using the principles of adult learning ·
provide services that are flexible and responsive to individual, group and community needs
- emphasise the collection and use of health information that is accurate, appropriate, up
to date and takes into account the THS Information Privacy Code of Conduct
- share health information with individuals, groups and the community in a meaningful way
- understand and apply government and organisational policies
- encourage and support local community members to participate in planning, running and
evaluating their own health programs
- support the development of local health committees and district or regional health
boards
- ensure that all people have access to health centre services
- promote and model healthy living practices
- support the work of others whose activities are also important to the health of
individuals, groups and the community
The health centre represents THS at the community level. However health is not just the
responsibility of THS. Progress towards better health is made when everyone works together
to address the underlying causes of poor Aboriginal health.
Primary Health Care
In this resource the term Primary Health Care (PHC) means "a philosophy permeating
the entire health system, a strategy for organising health care, a level of care and a set
of activities" (Chamberlain and Beckingham in Wass 1994:9).
| Primary Health Care includes at least: education concerning the
prevailing health problems and the methods of preventing and controlling them
promotion of food supply and proper nutrition
an adequate supply of safe water and basic sanitation
maternal and child health care, including family planning
immunization against the major infectious diseases
prevention and control of locally endemic diseases
appropriate treatment of common diseases and injuries; and provision of essential drugs...
WHO 1978:4 |
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Also see 'Glossary' |
Territory Health Services has a policy of supporting the provision of Primary Health
Care (NT Aboriginal Health Policy 1996). We need to strengthen and extend our primary health care
services by:
- focusing more on early intervention, prevention and health promotion
- increasing community participation and strengthening community capacity
- adhering to recognised standards in the delivery of all services
Essential primary health care services
THS recently commissioned the WHO Regional Training Centre for Health Development to
determine essential health care services for remote Aboriginal communities in the NT.
The report aims to:
- define essential PHC services for remote Aboriginal communities in the Northern
Territory;
- identify minimum standards to be used in the delivery of these services;
- develop a list of essential equipment required to ensure acceptable services and
standards;
- identify suitable training methodologies to implement the essential primary health care
services and standards;
- identify a suitable system for costing the essential primary health care services.
Freeman and Rotem 1999:5 |
The report lists primary health care essential services to be provided in remote
Aboriginal communities as follows (pages 60 - 66):
Primary Clinical Care
- First contact treatment of illness and injury, including dental, using evidence-based
regularly reviewed standard treatment manuals
- 24 Hour emergency care
- 24 Hour access to the advice of a doctor either on site or via telecommunications
- Confinement for women presenting too late for transfer to hospital
- Ongoing management of chronic disease
- Provision of essential drugs
- Attendance for acute care, as culturally appropriate, is used as an occasion to carry
out health screening and education for the patient and family members
Public Health
While each of the health promotion and public health programs listed below should be
provided in each community the emphasis given to each program will depend on local need
and community council preference.
Health promotion
- A locally applied health promotion setting approach with a focus on strengthening
community capacity to create and sustain health
- This local approach is guided by all relevant policies and program guidelines and covers
a range of topics which depend on community vision and capacity
- Advice to individuals and families integrated with screening activities and acute
clinical care
- Information made available to raise awareness of the effects of alcohol, tobacco, petrol
sniffing, cannabis and other substances, and linking substance use to health effects. Harm
minimisation strategies to be promoted
- A key focus on development of a culture of health, and modification of the community
environment to make healthy choices easier to make
Communicable Diseases Control
- Provision of immunisations integrated with child health surveillance/promotion and adult
screening
- Notification, local controls and management of infectious diseases
Health Screening and Early Intervention
- Antenatal and postnatal care
- Child health surveillance/promotion for children aged 0-15 years
- Adolescent screening
- Well women's screening
- Well men's screening
- Older adults screening
- All health staff skilled to carry out brief interventions addressing tobacco use and
harmful consumption of alcohol
Food and Nutrition
- Programs that link nutrition with health promotion in culturally appropriate way
- Promotion of good nutrition to all members of the community
- Promotion of good food supplies through stores and locally available foods such as bush
tucker and local gardens
- Supplementation and meals for high risk groups.
Sexually Transmissible Diseases
- Screening
- Treatment of acute cases
- Recall
- Counselling
- Follow up of case contacts as culturally appropriate
Safe Water, Sanitation and Food Hygiene
- Informal emergency, routine inspection and basic maintenance
Mental Health
- Community events encouraged to strengthen social cohesion
- Personal and family counselling provided
- Health staff and community member trained in counselling methods
Oral Health
- Primary prevention for all children 0-15 years
- Monitoring and early intervention for antenatal and breastfeeding women
Aged and Disability Services
- Provision of meals for those at risk
- Provision of rehabilitation and specific lifestyle aids
- Follow-up on financial entitlements or other help
Men's and Women's Health
- Provision of integrated health promotion and education programs
- Provision of contraception
- These services provided as wanted by community members and integrated with health
screening and education
Visiting and referral services
- Visiting Specialists and allied health professionals
- Medical specialists and Allied Health
- Public health program support
- Medical evacuation services
- Access to regional hospital, diagnostic and specialist services
- Family, Youth and Community Affairs
Support systems
- Management Systems
- Information Systems
- systematic and quality data recording to enable screening and recall program monitoring
and evaluation
- regular feedback of information to the community in a culturally appropriate way
- Workforce Development /Human Resources
- effective recruitment, orientation, continuing education, supervision, staff relief,
conflict management, fair disciplinary procedures and termination practices
- cooperation between services to share common resources
- Logistic and Transport Systems
- reliable system for drug supply and pathology specimens
- close liaison with referral centres
- funding for patient transport and accommodation to attend regional referrals as part of
budget for remote community health centres
- Support Staff
- Infrastructure
Quality improvement processes for primary health care services
THS is committed to implementing quality improvement processes throughout the Territory
(Territory Health Services 1998:37).
An Australian Health and Community Service Standards (QIC) review focuses on the
process of providing a quality PHC service. The full review process involves:
- internal assessment and education through self reflection and analysis of achievements
and areas for improvement
- collaborative assessment between the service and an externally selected peer review team
- feedback: the review team compiles a report which includes commendations for good
practice, achievements and areas for development, recommendations, suggestions for
improvement and levels of attainment for each standard reviewed
- taking action: the service compiles a development agreement and action plan, and
provides regular progress reports
| History of CHASP and QIC standards The Community and Health
Accreditation and Standards Program (CHASP) began in 1987 using a continuous quality
approach to assist organisations with primary health care service development. In 1997
CHASP became the Quality Improvement Council Inc (QIC) with CHASP as one of its programs.
Service standards developed or revised since 1997 are no longer called CHASP, but have
been renamed Australian Health and Community Service Standards. They are national
standards. The program operates throughout Australia. The Institute for Healthy
Communities Australia Inc in Queensland is the accrediting organisation for QIC covering
the NT, Queensland and Western Australia. Community services accredited under QIC receive
national recognition for their commitment to best practice.
In the NT the modules currently used for assessing service standards are: Health and
Community Service Core Module
Community and Primary Health Care Service Module
Integrated Health Service Module
Information provided by
Institute for Healthy Communities Australia Inc., Qld |
For more information, contact your regional manager or the Institute for Healthy
Communities Australia Inc. 07 3844 2222.