Primary health care and community services

Primary health care and community services aims to investigate the quality of primary health care, health promotion and population health initiatives and has a focus on equity in health access and outcomes, social determinants of health, primary prevention, and health services and policy.

Led by Dr Toby Freeman, this area of research is based on a participatory approach engaging policymakers, practitioners and primary health care clients within primary and community health services. We collaborate with a wide range of government organisations, NGOs, and Aboriginal organisations such as the Poche Centre for Aboriginal and Torres Strait Islander Health and Wellbeing.

Key areas of expertise

Comprehensive primary health care
Research on equity and access to services
Social determinants of health
Health services research

Community development
Regional primary health care organisations (primary health networks)a nd their role in population health planning
Primary health care for migrants and refugees

Current projects

Primary health care for people experiencing homelessness

The Southgate Institute has partnered with Baptist Care SA to review and develop evidence for what works providing primary health care for people experiencing homelessness, including the development of a profile of people experiencing homelessness in Adelaide and South Australia, a literature review on primary health care and homelessness, and an evaluation of Baptist Care SA’s homelessness respite facility trial.

The profile of people experiencing homelessness in Adelaide and South Australia is available here .

Investigators:

Dr. Toby Freeman, Southgate Institute, Flinders University

Dr. Joanne Flavel, Southgate Institute, Flinders University

Prof. Fran Baum, Southgate Institute, Flinders University

Ms. Kristen Foley, Southgate Institute, Flinders University

Prof. Yvonne Parry, Southgate Institute, Flinders University

A/Prof. Lisa Wood, University of Western Australia

Ms. Shannen Vallessi, University of Western Australia

Regional primary health care organisations: population health planning, participation, equity and the extent to which initiatives are comprehensive

In 2013 the Southgate Institute was successful in atttracting over $1 million from the NHMRC project grant scheme to study regional primary health care organisatoins across Australia. The project aims to examine regional population health planning processes for primary health care and the extent to which they incorporate equity, community participation and social determinants of health in their plans and programs, with a special emphasis on three disadvantaged groups: Aboriginal and Torres Strait Islander peoples, newly arrived migrants/refugees, and people with a mental illness. The project will also examine partnerships with other organisations, patterns of interactions and power relationships, and the key driving forces in population health planning and decision making.

Research plan

Given the government announcement that Medicare Locals would be replaced by new primary health organisations after July 2015, the research team reviewed and amended the research plan.

The project involves two stages: Stage 1 (until July 2015) intends to provide a whole picture of Medicare Locals across Australia in terms of policy, strategies and activities, and the extent to what they have incorporated the attributes of CPHC in govenance, health planning, decision making and priority setting. It also examines partnerships with local PHC stakeholders in providing comprehensive care. Once the new PHC Networks are established after July 2015, Stage 2 of the project will monitor population health planning processes and the impact of policy changes on PHC collaboration and planning to address the health needs of local communities.

A mixture of qualitative and quantitative methods will be used. These include policy and planning review, survey and interviews with primary health care staff, and interviews and focus groups with key stakeholders. The study is designed to provide opportunities for knowledge transfer and capacity building in Australian regional PHC organisations concerning the incorporation of CPHC attributes in planning, implementation and evaluation.

Reports and publications

Chief investigators

Prof Fran Baum, Southgate Institute, Flinders University

Dr Sara Javanparast, Southgate Institute, Flinders University

Professor Jeff Fuller, Flinders University

Dr Toby Freeman, Southgate Institute, Flinders University

Dr Tamara Mackean, Southgate Institute, Flinders University

More information about the project

Contact Toby Freeman
Email: toby.freeman@flinders.edu.au
Phone: (08) 7221 8468

Research findings on primary health care

A series of policy events were held to present research findings on primary health care (PHC), including from this project, to stimulate discussion on promoting a comprehensive PHC approach in Australia, and to revive the comprehensive vision of PHC set out in the World Health Organization’s Alma-Ata Declaration.

At this symposium the Southgate Equity Hub was launched.

Opening address: the Honourable Greg Hunt MP

Dr Toby Freeman: Primary health care and equity; practice, policy and politics

Panel session: Implementing comprehensive primary health care in Australia

Prof Fran Baum AO: The Southgate ten-point plan for reform of PHC in Australia

Prof. Fran Baum AO: Alma-Ata context and current relevance to Australia

Dr Matt Fisher: Primary health care and equity; practice, policy and politics

Prof. James Macinko, University of California: Learning from global experiences in primary health care

Panel session: Implications for fugture policy. Ways forward

Prof. David Sanders, University of Western Cape: The global context of primary health care; history, current trends and implications

Dr Sara Javanparast, A. Prof. Anna Ziersch and Dr Tamara Mackean: Planning for primary health care and equity

The contribution of civil society engagement to the achievement of Health for All Project

The aim of this qualitative project was to document the narratives of long term people's health movement health activists, in order to understand in a detailed way the processes, motivations, necessary learning, dilemmas and strategies, impact and achievements of health activism.

View the final project report

Final paper

Investigators

Prof Fran Baum, Southgate Institute, Flinders University

Dr Connie Musolino, Flinders University

Dr Toby Freeman, Southgate Institute, Flinders University

Professor Ron Labonte, Flinders University

Professor David Sanders, Flinders University

Centre for Research Excellence on the Social Determinants of Health Equity

The NHMRC Centre for Research Excellence on the Social Determinants of Health Equity (2015-2020) examines how government policies can work more effectively to address the social determinants of health, so as to improve health and reduce health inequities.

It includes policy case studies on the Northern Territory Emergency Response and the Closing the Gap strategy. The Lowitja Institute is a partner in the Centre.

Visit the Centre for Research Excellence on the Social Determinants of Health Equity

Past projects

Comprehensive primary health care in local communities (CPHC)

The Southgate Institute for Health, Society and Equity, in collaboration with other South Australian, interstate and international investigators, conducted a National Health and Medical Research Council funded project to examine ways to assess the effectiveness of Comprehensive Primary Health Care (CPHC) in local communities.

The project was conducted in partnership with six primary health care services. A program logic model for CPHC in Australia, along with site-specific models, were developed, and a suite of evaluation methods including client surveys and workshops, case tracking of clients with diabetes and depression, collection of indicator data, and staff surveys and interviews were conducted at each site to evaluate services against these logic models.

A series of policy events to present research findings were organised, including a primary health care symposia. View the videos from this symposia.

View final briefing paper - Aboriginal health in Aboriginal hands

CPHC briefing paper - Evaluating the effectiveness of comprehensive primary health care in local communities

Publications

Freeman, T., Baum, F., Labonte, R., Javanparast, S., Lawless, A., & Barton, E. (2020). The contribution of group work to the goals of comprehensive primary health care. Health Promotion Journal of Australia, doi: 10.1002/hpja.323.

Freeman, T., Baum, F., Mackean, T., Ziersch, A., Sherwood, J., Edwards, T., & Boffa, J. (2019). Case study of a Decolonising Aboriginal Community Controlled Comprehensive Primary Health Care Response to Alcohol-Related Harm. Australian and New Zealand Journal of Public Health, 43, 532-7. Doi: 10.1111/1753-6405.12938

Barton, E., Freeman, T., Baum, F., Javanparast, S., & Lawless, A. (2019). The feasibility and potential use of case tracked client journeys in primary health care: a pilot study. BMJ Open, 9:e024419. Doi: 10.1136/bmjopen-2018-024419

Bentley, M., Freeman, T., Baum, F., & Javanparast, S. (2018) Interprofessional teamwork in comprehensive primary healthcare services: Findings from a mixed methods study. Journal of Interprofessional care, 32, 274-283. Doi: 10.1080/13561820.2017.1401986

Freeman, T., Baum, F., Labonté, R., Javanparast, S., & Lawless, A. (2018). Primary health care reform, dilemmatic space, and risk of burnout among health workers. Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine, 22, 277-297 doi: 10.1177/1363459317693404

Javanparast, S., Maddern, J., Baum, F., Freeman, T., Lawless, A., Labonte, R., & Sanders, D. (2018). Change management in an environment of ongoing primary health care system reform: A case study of Australian primary health care services. International Journal of Health Planning and Management, 33, e76-e88. Doi: 10.1002/hpm.2413

Baum, F., Freeman, T., Lawless, A., Labonte, R., & Sanders, D. (2017). What’s the difference between comprehensive and selective primary health care? Evidence from a five year longitudinal realist case study in South Australia. BMJ Open, 7, e015271 doi: 10.1136/bmjopen-2016-015271

Freeman, T., Baum, F., Lawless, A., Labonté, R., Sanders, D., Boffa, J., Edwards, T., & Javanparast, S. (2016). Case study of an Aboriginal Community Controlled Health Service in Australia: Universal, rights-based, publicly-funded comprehensive primary health care in action. Health and Human Rights Journal, 18, 93-108

Baum, F., Freeman, T., Sanders, D., Labonté, R., Lawless, A., Javanparast, S. (2016) Comprehensive primary health care under neo-liberalism in Australia, Social Science & Medicine, 168, 43-52. Doi: 10.1016/j.socscimed.2016.09.005

Freeman, T., Baum, F., Lawless, A., Javanparast, S., Jolley, G., Labonte, R., Bentley, M., Boffa, J., & Sanders, D. (2016). Revisiting the ability of Australian primary health care services to respond to health inequity. Australian Journal of Primary Health. 22, 332-338. Doi: 10.1071/PY14180

Freeman, T., Baum, F.E., Jolley, G.M., Lawless, A., Edwards, T., Javanparast, S., & Ziersch, A. (2016). Service providers’ views of community participation at six Australian primary health care services: Scope for empowerment and challenges to implementation. International Journal of Health Planning and Management, 31, E1-E21. Doi: 10.1002/hpm.2253

Anaf, J., Baum, F., Freeman, T., Labonte, R., Javanparast, S., Jolley, G., Lawless, A., & Bentley, M. (2014). Factors shaping intersectoral action in primary health care services. Australian and New Zealand Journal of Public Health, 38, 553-559. Doi: 10.1111/1753-6405.12284

Freeman, T., Edwards, T., Baum, F., Lawless, A., Jolley, G., Javanparast, S., & Francis, T. (2014). Cultural respect strategies in Australian Aboriginal primary health care services: Beyond education and training of practitioners. Australian and New Zealand Journal of Public Health, 38, 355-361. Doi: 10.1111/1753-6405.12231

Jolley, G., Freeman, T., Baum, F., Hurley, C., Lawless, A., Bentley, M., Labonte, R., Sanders, D. (2014). Health policy in South Australia 2003 - 2010: Primary health care workforce perceptions of the impact of policy change on health promotion. Health Promotion Journal of Australia, 25, 116-124. Doi: 10.1071/HE13088

Baum, F., Freeman, T., Jolley, G., Lawless, A., Bentley, M., Vartto, K., Boffa, J., Labonte, R., & Sanders, D. (2014). Health promotion in Australian multi-disciplinary primary health care services: Case studies from South Australia and the Northern Territory. Health Promotion International, 29, 705-719. Doi: 10.1093/heapro/dat029

Lawless, A., Freeman, T., Bentley, M., Baum, F., & Jolley, G. (2014). Developing a good practice model to evaluate the effectiveness of comprehensive primary health care in local communities. BMC Family Practice, 15:99, Doi: 10.1186/1471-2296-15-99

Freeman, T., Jolley, G., Baum, F., Lawless, A., Javanparast, S., & Labonte, R. (2014). Community assessment workshops: A group method for gathering client experiences of health services. Health and Social Care in the Community, 22, 47-56. Doi: 10.1111/hsc.12060

For more information

For more information about the project, please contact us.

Primary health care and community services

Key areas of expertise

Primary health care for people experiencing homelessness