Apunipima Article Published in Healthnet
Following is an extract from an online article; "Building capacity towards health leadership in remote Indigenous communities in Cape York" published in January 2009. This paper describes an established approach for building capacity used for the first time with Health Action Teams (HATs) in three remote indigenous communities in Cape York. A key purpose was to determine if the approach was an appropriate and practicable ‘tool' in an Aboriginal context. This is not a research study but rather the reflections on a project evaluation to collect and interpret information recorded during workshops to build and measure the capacity of the HATs using eight domains. The domains represent those aspects of the process of capacity building that allow the HATs to better organise and mobilize themselves towards gaining greater control. The analysis of each domain included a description and visual representation of capacity. There were similarities in the measurement of capacity between the three HATs in five domains. This was because each HAT was at an early stage of development and generally had a low capacity. Importantly, each HAT was able to develop a realistic strategy with which to move forward to build capacity with clear roles, responsibilities and timeframes. The key to building HAT capacity was the use of strategic planning based on the eight ‘domains' and the use of an appropriate means of visual representation. This is discussed in detail in the paper and provides encouragement for an empirical study into the application of capacity building approach. The importance of Aboriginal community control in service delivery to improve health outcomes has been recognised in both State and Federal Government policy for some time. Underpinning this health reform process is the need to build community capacity for Indigenous people to take control of and be responsible for their own health. There is a broad body of literature in regard to the definition of community capacity, for example, Labonte and Laverack define capacity building as the ‘increase in community groups' abilities to define, assess, analyze and act on health (or any other) concerns of importance to their members'. Community capacity is seen by several authors as a process that increases the assets and attributes that a community is able to draw upon. The capacity of a group is also dependent on the resource opportunities or constraints (social, political and economic) and the conditions in which people live. Community capacity is not, therefore, an inherent property of a particular locality, nor of the individuals or groups within it, but of the interactions between both. Interest in community capacity building as a strategy for sustainable skills, resources and commitments in various settings has developed because of the requirement to prolong project gains [6]. These qualities exist in relation to specific people and groups, issues and concerns, activities or projects. For an outside service, the task is not to create a new project called ‘capacity-building'. Rather, the task is to examine how its practice can support the development of capacity-building. Capacity building becomes the process by which the end result of increasing community control and project sustainability can be achieved through, for example, increasing knowledge and developing skills and competencies. Whilst there is a substantial body of literature on the definition of community capacity, there is less on the practical application of approaches, particularly in an Indigenous context. Concepts such as capacity building are hard to make operational because of their ambiguity and because as social constructs they are less tangible than commonly measured health indicators. The approach discussed in this paper was used as a tool to build and measure capacity in three recently established Health Action Teams (HATs): Kowanyama; Coen and Lockhart River. HATs are to act as local health advisory groups in remote Aboriginal communities in Cape York, Far North Queensland. It is envisaged that there will be a gradual shift in focus of the HATs, as they build their capacity and confidence, towards more community based action around locally perceived health needs. The HATs aim to have representation that considers the cultural make up of each community and draws from as many families and clan groups as possible. They also strive to involve representation from existing community based organisations including the council, men's and women's groups, justice groups, aged care and homelands. Members must be recognised by the community as local Indigenous people. The National Strategic Framework for Aboriginal and Torres Strait Islander Health focuses on community control of health services and building communities' capacity to take control of and be responsible for their own health outcomes. Apunipima Cape York Health Council (ACYHC) was identified as the most appropriate community controlled organisation to plan, prioritize and manage primary health care services and resource allocation in Cape York. The ACYHC aims to promote the ability of Cape York communities to expand the range of choices they have available to them to improve their lives and health. It is not about making choices on their behalf, but to give communities more control over the decisions that influence their lives that will contribute towards a broader health reform process for the Cape York region. In particular, ACYHC have been working with communities to develop the capacity of HATs. Objective The Royal Flying Doctor Service (RFDS) was contracted by the Australian Department of Health and Ageing to undertake the Cape York Health Leadership project in close collaboration with ACYHC. The purpose of the project was to support the process of health leadership in the transition to community control by providing leadership training to Health Action Teams. Three objectives were identified within this project: To collaborate with ACYHC to build capacity around health leadership. To support ACYHC in the establishment and sustainability of HATs in targeted communities. To facilitate the provision of leadership training to HATs in the target communities. It is important to note that this was not a research study but rather the reflections on a project evaluation to build and measure the capacity of the HATs. A key purpose was to determine if the approach was an appropriate and practicable ‘tool' in an Aboriginal context. The first six months of the project involved RFDS staff building relationships with community members, with the HATs and with ACYHC, through regular community meetings in order to develop an understanding of the HAT needs. This resulted in HAT members completing 5 training modules (Governance; Community Development; Advocacy; Effective Communication and Marketing, Promotion and Submission Writing). In addition, HATs came together for three regional workshops to share experiences and consolidate new knowledge and skills. Method The process of community capacity is influenced by several characteristics or ‘domains' that significantly contribute to its development. In particular, the organisational characteristics that influence community capacity provide a useful means to build and measure this concept. The ‘capacity domains' represent those aspects of the process of community capacity that allow individuals and groups to better organise and mobilize themselves towards gaining greater control of their lives. The method used for measuring and building the capacity of each HAT was an established participatory approach employing eight domains. These were originally categorized from a textual analysis of the literature and the validity of this data was cross-checked by other researchers using a confusion matrix. The ‘capacity domains' are robust and collectively capture the essential qualities of a capable community and further information on their use and definition is provided elsewhere. A meeting was held with RFDS and ACYHC staff to adapt each domain to the cultural appropriateness of the setting. Each domain was then discussed with each HAT prior to implementation to further adapt their interpretation. A brief description of each domain is provided in Table 1 and the details of the forty statements used to measure each domain in an Aboriginal context are provided elsewhere. The domains serve as a framework for building HAT capacity and the approach was implemented in three remote Indigenous communities: Kowanyama; Coen and; Lockhart River in far north Queensland. All three communities are characterised by remoteness, with access only by flights or long drives, and all experience several months of the year where they are cut off by road due to the wet season. Each community has a primary health care centre managed and funded by Queensland Health. There are also a range of other outreach services including child health, drug and alcohol, community liaison development, health promotion and mental health. Each HAT was asked if they were interested in utilising this approach and their consent verbally received before they participated in its implementation. The verbal consent of each HAT member was also received after reading this paper prior to submission for publication.