What we know

  • Accessible health services are those that are physically available, affordable (economic accessibility), appropriate and acceptable. Health services can be inaccessible if providers do not acknowledge and respect cultural factors, physical barriers and economic barriers, or if the community is not aware of available services.
  • There are many strategies for successfully improving Indigenous access to urban and regional health services. Individual service providers need to consult with their local community to identify the specific issues relating to their context and selectively adapt the strategies outlined in this report.

What works

Few evaluations have been set up to specifically assess accessibility. Even so, a rich body of research and documented practice experience suggests that health services can effectively promote the four main facets of accessibility.

  • Addressing physical and economic barriers through strategies such as:
    • providing services locally
    • providing transport to health services
    • having flexibility in setting appointments
    • using home visitation as part of a multi-faceted engagement strategy
    • increasing services that do not require co-payment
    • improving access to private health insurance and private health services.
  • Addressing cultural competence, acceptability and appropriateness through strategies such as:
    • developing services around the holistic model of health and wellbeing
    • building therapeutic and clinical relationships based on trust and mutual respect
    • employing Indigenous health professionals and health workers to promote culturally safe service delivery
    • where feasible, providing a choice between Indigenous-specific and non-Indigenous–specific health professionals and services
    • adopting strategies that support cultural competency and safety at the systemic, organisational and individual levels, including appropriate communication styles, and working through community Elders and kinship networks
    • providing services in non-traditional settings.

What doesn’t work

Even given the limited number of evaluations, available literature indicates that the following strategies can be ineffective in improving Indigenous access to health services:

  • fee-for-service approaches—these can prevent many low-income Indigenous clients from accessing needed care
  • short consultation times coupled with poor health literacy—complex and chronic conditions require longer consultation times
  • highly structured programs
  • a purely biomedical approach to health promotion and treatment—such an approach fails to acknowledge and demonstrate respect for holistic Indigenous understandings of health and wellbeing
  • assumptions that fluency in English means effective communication can occur around culturally specific biomedical conceptions of health and the treatment of illness—Indigenous cultures can differ from non-Indigenous cultures in their views and communication practices about the treatment of illness
  • ignoring the importance of kin and kinship systems in caring for an individual patient.

What we don’t know

  • Although cross-cultural miscommunications between Indigenous clients and non-Indigenous health professionals are commonly documented, there is limited literature providing the necessary range of strategies to overcome these issues.
  • Although there is a large amount of literature citing the need for culturally secure services, few authors attempt to define how such services might be practically implemented in any rigorous or comprehensive way.
  • There are few evaluations of programs aimed specifically at improving Indigenous access to health services. The available literature describing strategies for improving cross-cultural communications is contained in ‘Additional reading and resources’ towards the end of this resource sheet.