The primary health care concept in Darwin rural district
: rhetoric or reality

  • Victor Percival Feldman

    Student thesis: Coursework Masters - CDU


    During the 1970's it became clear that many of the health care models, especially the medical model, were unable to meet both the continuing and emerging problems associated with the provision of health care. A new model had to be found which would overcome problems associated with over specialisation and over investment in costly, high technology hospital based care. 

    In the latter part of the 1970's following the Declaration of Alma-Ata, Primary Health Care (PHC) emerged as the alternative to the medical model of health care because it did not focus on the treatment of disease and infirmity, it was not dependent on the "top down" introduction of technology or of regulation, and the locus of control did not rest with a small group of "experts" and "specialists". PHC shifted the locus of control from the "experts" to the "clients" of the existing health care system. 

    The PHC model was chosen by Darwin Rural District to be the means by which it would provide services to bring about an improvement in the health status of their Aboriginal clients. 

    This study examines the attempts of Darwin Rural District to implement PHC over the period 19986-1994 and determines whether they have succeeded in their endeavour. It does not attempt to examine the effectiveness of PHC as a means of improving the health status of Aboriginal people or analyse the reasons for their poor health status. 

    The study reviews relevant PHC literature in order to examine its background, determine the level of International and National commitment to it and identify its key components. As a result of this examination, a model to evaluate the extent to which different projects and initiatives might impact or have impacted on PHC is developed. 

    The added complexity of providing PHC services to people from a different cultural background was also examined, including the origin and equity of Aboriginal people and the many aspects of their culture. An empirical model developed by Hofstede to analyse different cultures was introduced and subsequently used to analyse the differences between Anglo-Australian and Aboriginal culture. This analysis concluded that PHC could not be successfully implemented in Aboriginal communities unless services were developed and delivered in accordance with Aboriginal beliefs, values and customs. 
    The history of Darwin Rural District between 1986 and 1994 and the development of anAboriginal health and PHC policy during that time is presented and analysed. A detailedevaluation of a large number of District projects and initiatives utilising the PHC EvaluationModel is then undertaken and concludes that the District had been 75% effective inimplementing PHC throughout its Aboriginal communities.  

    Finally, the study makes a number of suggestions to address the cultural requirements of delivering services to Aboriginal people and reduce the impediments to implementing PHC policy.  

    Very little research has been undertaken in relation to Aboriginal cultural dimensions and their effect on management practices and the effectiveness of implementing PHC. Hopefully this study will stimulate further research in these areas.  

    Note: Please note: Abstract -- "19986" was a typographical error from original text.
    Date of Award1995
    Original languageEnglish

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