Primary Health Networks and the undermining of self-determination in First Nations health

Stream: Indigenous research
Date: Monday, 9 September 2019
Time: 11.30 am – 12.30 pm


This paper examines how the Commonwealth Government’s Primary Health Networks (PHNs) have impacted Aboriginal Community Controlled Health Services (ACCHSs).

The relevant literature on Aboriginal Community organisations and the determinants of Indigenous health inequity situates ACCHSs as indispensable vehicles for the improvement of First Nations health. This literature locates ACCHSs’ ability to enact Indigenous self-determination as a fundamental difference between these Aboriginal organisations and comparable non-Aboriginal health-service providers. Aboriginal Community Control, understood as local-level self-determination, has been identified as a core element underlying ACCHSs’ effectiveness.

This paper argues that the PHNs, a new national network of funding administrators, have undermined Aboriginal self-determination in health, extending the power of the Federal Government in the process. This conclusion is based on the findings of a series of 23 interviews with CEOs and managers at ACCHSs in NSW. The interview cohort was made up of predominantly (69%) Indigenous people, in keeping with the ethics of the decolonising methodology that informs my research. According to ACCHSs representatives, the PHNs present new challenges for ACCHS. These stem from the unequal power dynamics that characterise interactions between ACCHSs and PHNs. The PHNs hold significant and increasing amounts of Indigenous-specific health funding and have absolute discretion over which organisations to fund. Some PHNs have also excluded ACCHSs from decision-making processes relevant to Aboriginal health. ACCHSs are also concerned by the PHNs’ apparent lack of Indigenous health expertise. This has troubling policy implications for the delivery of culturally-appropriate, holistic primary health care to First Nations communities.


David Coombs (Presenter), UNSW Sydney
David Coombs is a student of public policy and politics and has a particular interest in Aboriginal and Torres Strait Islander health. His PhD research project focuses on the government policies that affect the Aboriginal Community Controlled Health Services, looking specifically at funding models.