Self-determined health care for First Nations communities

The role of nurses in ACCHOs 

Mia Dhillon, APNA General Manager 

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Aboriginal Community Controlled Health Organisations (ACCHOs) have delivered culturally safe, holistic, and community-led health care to First Nations communities across Australia since the early 1970s. What began as grassroots advocacy and service delivery has evolved into a national movement of 146 organisations. The sector offers a compelling and meaningful model of primary health care for nurses, midwives and nurse practitioners (NPs) to work alongside medical and allied health practitioners.  

At the heart of ACCHOs is the principle of self-determination. Each organisation is governed by a locally elected board of Aboriginal and Torres Strait Islander people, ensuring services are responsive to community needs. These services provide more than just clinical care; they address the physical, social, emotional and cultural well-being of individuals, families and communities. The focus is not just on illness, but on wellness and empowerment.^¹ 

The sector’s origins can be traced to 1971, when the Aboriginal Medical Service Redfern was established by a group of volunteers in Sydney. Demand for its culturally appropriate model quickly grew, prompting similar services to open in Melbourne, Alice Springs, and Brisbane in the early 1970s. These early initiatives laid the foundation for a nationwide network of ACCHOs.^² 

These 146 organisations are supported by peak bodies in each state and territory, with the National Aboriginal Community Controlled Health Organisation (NACCHO) serving as the national peak. NACCHO plays a critical role in advocating for community-led health policy, providing strategic budget advice to government, and supporting the development of the workforce and services across the sector. Importantly, NACCHO is also a major employer of Aboriginal and Torres Strait Islander people – of the 6,000 staff working in ACCHOs, more than 3,500 identify as First Nations.³ 

Innovation and impact 

ACCHOs are distinguished by their innovative, community-informed approaches to primary health care. Governance is one such example: local Aboriginal people become members of their ACCHO and elect the board, which determines the organisation’s strategic direction and performance expectations. This structure ensures true community control. 

Service design within ACCHOs is equally progressive. Rather than focusing solely on individual treatment, many ACCHOs take a family or social group approach, embedding cultural safety in clinical practice. Elders are often consulted on service models, and programs are adapted to meet the complex, intergenerational health needs of communities.^⁴ 

Likewise, the research and data gathering work of ACCHOs often challenges traditional research paradigms by valuing community knowledge, lived experience, and cultural insight. This has contributed to advances in understanding the social and cultural determinants of health and how to address them effectively.  

The sector’s coordinated and culturally informed response to the COVID-19 pandemic exemplifies its strengths. Drawing on lessons from the 2009 flu pandemic, ACCHOs implemented rapid, targeted strategies to keep communities safe. This response resulted in significantly reduced illness and mortality among Aboriginal and Torres Strait Islander people, even in urban areas – a success recognised internationally.^⁵ 

Nurses leading change 

Multidisciplinary care is standard within ACCHOs, where nurses, midwives and NPs are vital to service delivery. Nurses form the largest component of the clinical workforce and, compared to other primary health care settings, ACCHOs employ more midwives and NPs. According to APNA’s 2024 Workforce Survey, 5% of respondents working in ACCHOs are NPs, compared to 1% in general practice.^⁶ 

This gives nurses significant opportunities to work to their full scope, take on leadership roles, and provide culturally safe, person-centred care. Many roles are in urban and regional areas; a common misconception is that ACCHO work is limited to remote settings. 

Ivan Denker is an NP who works at Winnunga Nimmityjah, an ACCHO providing services to Aboriginal clients in Narrabundah, Australian Capital Territory. Ivan takes a whole-person, multidisciplinary approach to care. He says the range of services and the multidisciplinary nature of the team means that there is ‘such a lot of variety in what nurses can do.’ 

He describes the work as ‘interestingly challenging – not just rubber stamping,’ with essential support given to him and the whole team so that he can spend time with each person coming in for care, whether a walk-in patient with an acute symptom or someone reviewing their care plan. 

For an NP, that means pathways to grow and develop, rather than being locked in, according to Ivan. He also notices the strong leadership and collaborative culture that holds the whole team and the organisation together.  

Closing the Gap: Pathway to equity 

NACCHO recognises that enabling nurses to practise at the top of their scope is critical to improving health outcomes for Aboriginal and Torres Strait Islander communities. Closing the Gap – the national framework aimed at reducing inequality – remains an urgent goal. 

While health gaps persist in areas like life expectancy, infant mortality and chronic disease, there have been encouraging improvements. These include better outcomes in maternal and child health, reductions in smoking and alcohol misuse, and improved management of circulatory, kidney and respiratory illnesses. ACCHOs have been central to these gains.⁷ 

As every nurse knows, good health outcomes underpin good life outcomes. The ACCHO model, grounded in community, culture, and continuity, offers a blueprint for effective, inclusive primary health care. 

A future built on strengths 

After more than 50 years of evolution, the ACCHO sector has proven its value not just to Aboriginal and Torres Strait Islander communities but also to the broader health system. Described as a ‘world-leading example of comprehensive primary health care,’ the ACCHO model is a testament to the power of community-led solutions. 

As of June 2024, ACCHOs employ approximately 9,000 full-time-equivalent staff, half of whom are Aboriginal and Torres Strait Islander. For nurses, midwives and NPs, the sector offers not only a deeply rewarding career but also an opportunity to be part of a transformative movement grounded in equity, respect, and cultural strength.8 

Access the Reference List for this article.

Mia Dhillon would like to acknowledge Dr Jason Agostino, NACCHO Senior Medical Advisor for his valuable contributions to the drafting of this article, which greatly enhanced the quality of this work.  

 

Ivan Denker is an NP who works at Winnunga Nimmityjah in the ACT. He enjoys the variety that his role offers.