‘Drivers’ of wellbeing: transport key for Aboriginal and Torres Strait Islander communities accessing primary care

  • Bus travelling on a desert road
By
Dr Deb Wong
National Centre for Aboriginal and Torres Strait Islander Wellbeing Research, The Australian National University
Issue
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In remote outback communities, temperatures can soar to over 40 degrees Celsius. Without access to a vehicle, and in the absence of a public transport system, getting to the local clinic to seek routine health care or medications means a long walk in the heat. Add on the need, for example, a wheelie-walker, no proper footpaths or an elderly client trying to get to an appointment and you can understand why health outcomes and access to care for those living in regional and remote areas continue to show disparities compared to those living in major cities.

Aboriginal and Torres Strait Islander people are less likely to have access to a motor vehicle; this is more pronounced in remote and very remote areas. Only 61% of Aboriginal and Torres Strait Islander people in very remote areas are able to easily get to places when needed.

The practical, basic barriers to healthcare that people face in many First Nations communities still persist and cannot be ignored. Having clinic services available even with regular outreach programs and home visits is not enough; it is vital that those in the community are able to physically get to the clinic doors, access the full range of services and benefit from the community of the clinic. Fortunately, there is a ready solution that can not only address access to healthcare but more uniquely, engage clients in prioritising their wellbeing – clinic bus drivers.

Our research to explore what supports good chronic disease care for Aboriginal and Torres Strait Islander people highlighted that many organisations in the Aboriginal Community Controlled Health Sector have identified the importance of providing transport to their clients. There is a clear recognition that physical access to clinics is essential to ensuring clients receive the care they need, when they need it, whilst also optimising clinic operations.

Aboriginal Community Controlled Health Organisations across the country have established the coordination and provision of free transport for their local clients from home to and from clinic. This often includes a regular procedure of checking for recall patients from a list of those who need follow up, picking up clients for their appointment and dropping them home. This is provided free of charge to service users. Generally, these initiatives are funded from general resourcing to clinics and not through any dedicated transport funding scheme. 

The role of transport officers or clinic bus drivers is also key - aside from driving the vehicle (often a minivan, sometimes a fleet of clinic sedans) drivers are usually from the local community. They become familiar with the clients going to the health service and can broker connections between clinic staff and community members. In some cases, they act as an extension of the clinic staff, encouraging people to attend or allay their fears in going to clinic which can be intimidating for some community members who may have had negative experiences with seeking healthcare in the past. They may also provide health promotion messages, information about visiting specialist services or other health supports.

Driver programs are clinic-based initiatives that address shortcomings in transport and health care access for those living in remote or regional areas. This work requires funding and support to remain sustainable. There may also be  further opportunities to upskill clinic drivers in health promotion and providing health information to increase access, acceptability and engagement in care. 

Our research can be read here

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