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Table 1 Characteristics of indigenous PHC service delivery models

From: Characteristics of Indigenous primary health care service delivery models: a systematic scoping review

Accessible Health Services
 • providing affordable health care [61, 87] at either no cost or low cost [85].
 • ensuring a broad range of services are available [50], in a variety of locations and settings [29, 30, 37, 41, 47, 49, 56, 71,72,73, 78, 80,81,82, 84, 87], including increased opening hours, walk in appointments [41, 47, 52, 60, 68, 76] and transport [47, 60, 72].
 • delivering acceptable care which focused on building trust with communities [87] ensuring patients felt supported [38] providing assurances in relation to privacy and confidentiality [38, 80], and implementing services underpinned by cultural respect, social justice and equality [47].
 • ensuring awareness in the sense that communities know the service exists by providing outreach and mobile services [82], participating in community events and holding screening days [38], encouraging patients to share their positive experiences and promote the service to others [71].
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 [30,31,32, 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].
 • respecting the role and status of elders [36] and facilitating their involvement in the work and governance of services [45, 63, 66].
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].
 • training Indigenous Health Workers [30, 32, 49, 50, 61, 70] as a capacity building exercise [88], including more specialised health care such as dental [33, 39] or maternal health [47].
 • recognising the need to build and grow the Indigenous workforce of the future by establishing long term strategies to mentor and recruit Indigenous students into health careers [80], leading to Indigenous staff going on to further training or study [32].
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].
 • integrating health care services [38, 69, 76, 78, 80, 84], with a multidisciplinary team approach [34, 49, 62, 67,68,69, 76], case management [33, 46, 67, 72, 76, 80], and continuity of care [47, 48, 53, 56, 67, 68, 81, 84].
 • partnering and linking with other services to promote integration and cooperation between all support services, providing holistic care through a social view of health [39, 41, 47, 51, 80].
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, 49,50,51, 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, 79,80,81,82, 84,85,86,87,88].
 • 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, 49,50,51, 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].
 • collaborating with other organisations such as schools, youth groups, prisons, disability and aged care services [29, 32, 81], and with councils, liquor outlets and grocers to reduce the supply of harmful products while increasing the availability of healthy options [29, 36, 47, 61].
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].
 • facilitating leadership opportunities to ensure that Indigenous health care staff take on leadership roles within their communities [32] and provide positive role models for other Indigenous peoples [32, 70].
 • promoting community development through the organisation of activities beyond health care [36, 49], such as cultural days and camps, reconciliation events and other community activities enable communities to draw on culture, increase social connectedness, and have pride in their identity [41].