Aboriginal Community Control
The definition of ‘community control’ in the National Aboriginal Health Strategy (1989) is as follows:
“Community control is the local community having control of issues that directly affect their community. Implicit in this definition is the clear statement that Aboriginal people must determine and control the pace, shape and manner of change and decision-making at local, regional, state and national levels.”
Implicit in this definition is the clear statement that Aboriginal people must determine and control the pace, shape and manner of change and decision making at [all] levels. Essentially, community control is the process through which the community determines the nature of the health and medical service, and is able to participate in the planning, implementation, and evaluation of those services.
Community control has been widely accepted as a key requirement in strategies to overcome Aboriginal health disadvantage. Implicit in this is the understanding that much of the morbidity and premature mortality experienced by Aboriginal people is not amenable to medical or other interventions imposed from outside the community.
The Philosophy of Community Control
Bulgarr Ngaru Medical Aboriginal Corporation (BNMAC) is a community controlled health service. Essentially, BNMAC perceive community control as the ability of the people who are going to use BNMAC to determine the nature of the service, as well as participate in the planning, implementation and evaluation of the service. Inherent to this philosophy is the principle that Aboriginal people must be able to determine and control all aspects of change and decision-making at all levels.
BNMAC ensure community control through:
- The incorporation of BNMAC as an independent legal entity.
- A constitution which guarantees control of BNMAC by Aboriginal people and which guarantees that BNMAC will function under the principle of self-determination.
How it Works
- BNMAC is incorporated with the Office of the Registrar of Aboriginal Corporations.
- BNMAC is run by a Board of Directors who represent the communities that BNMAC service.
Aboriginal Community Controlled Health Services (ACCHSs) provide culturally appropriate primary health care services to Aboriginal people and communities. Each service has been established by and is managed by members of the local Aboriginal communities from the region in which the service is located. The services provided are based on needs and priorities of the community as determined by the community.
ACCHSs are controlled by the community, and are independent of each other and of government. Aboriginal Community Controlled Organisations are an assertion of the right of Aboriginal peoples to self determination, and are driven by a community development approach.
The first ACCHS was established in Redfern in 1971 by Aboriginal health activists and their non-Aboriginal allies. The motivating factor behind this development was concern about Aboriginal people’s access to mainstream services, which were perceived as racist, discriminatory and expensive (where they existed at all). ACCHSs initially began with little, if any, government funding, and offered medical services through a roster of volunteer doctors and nurses. Within a few years ACCHSs were established in other areas around Australia.
Aboriginal communities operate more than 130 ACCHSs across Australia. They range from large multi-functional services employing several medical practitioners and providing a wide range of services, to small services without medical practitioners, which rely on Aboriginal Health Workers and/or nurses to provide the bulk of primary care services, often with a preventive, health education focus. ACCHSs form a network, even though each is autonomous and independent both from one another and from government. The integrated primary health care model adopted by ACCHSs is in keeping with the philosophy of Aboriginal community control and the holistic view of health that this entails.