Sophia would spend the next 14 years in the Kimberley region, working within the network of Aboriginal community-controlled health services (ACCHS) in the region and becoming an advocate for community-led healthcare delivery.
“These are health services established by Aboriginal peoples, for Aboriginal peoples which means that doctors are working within those community governance structures. You don't have that hierarchical structure where the doctor sits at the top and everyone else is at the bottom; it's real teamwork.
“The ACCHS model of care was effectively a game-changer as it flipped the health system power structures towards being more patient-centred, well before the term had even been invented!
“Working within this health workforce structure of predominantly local Aboriginal community members means that the work you do is so much more effective because you're actually embedded within that cultural environment.
“Aboriginal peoples themselves are best equipped to identify the problems that are a priority and who are then able to model the preferred type of health care to address those needs. So having a health workforce made up of majority local Aboriginal peoples or Torres Strait Islanders is absolutely vital to improving health outcomes of their communities.
“We often use terms like Primary Health Care without understanding what they really mean but it is best exemplified by the comprehensive model of care delivered by Aboriginal community-controlled health services in which patients’ healthcare needs are treated as a continuum across their lifespan, in a ‘one stop-shop’ context, that also provides a strong focus on health promotion and preventative health care.”
Closing the Gap with NACCHO
Undertaking further specialist training as a Public Health Physician through the Royal Australasian College of Physicians, Sophia then accepted a position in 1998 as Public Health Medical Officer for the [then] newly formed National Aboriginal Community Controlled Health Organisation (NACCHO), based in Canberra.
Over time, Sophia witnessed the growing relationship between NACCHO and the Australian government which proved to be pivotal in providing impetus to the ‘Closing the Gap’ campaign and initiatives for Aboriginal and Torres Strait Islander health equity that was launched in 2008, and which has now become part of the everyday vernacular in Australia.
“I was fortunate to be part of the original secretariat of NACCHO, and it was incredibly exciting to be a part of something so ground-breaking. It was also a great honour and a privilege to work side by side with the inaugural NACCHO chair, the late Dr Arnold (Puggy) Hunter.
“During my time with NACCHO, I witnessed some tremendous health policy changes, and was fortunate to be part of the establishment and implementation of a range of programs and resources that have made a real difference to people’s lives.
“It has also been fantastic to see positive changes in the relationship between NACCHO and government health authorities, which has moved on from being often adversarial and distant, to one where NACCHO now influences national policy and has strong binding agreements with the Australian Government.”
Expanding the Pharmaceutical Benefit Scheme
One example of a significant change to government policy that was achieved during Sophia’s time with NACCHO was the Closing the Gap (CTG) Pharmaceutical Benefits Scheme (PBS) Co-Payment Measure for Aboriginal and Torres Strait Islander peoples.
“The CTG PBS Co-Payment Measure was introduced in 2008 and continues to this day. The scheme has significantly enhanced access to medications for Aboriginal and Torres Strait Islander peoples who can register for it at GP clinics and ACCHS’s.
“This significant change in government policy and funding came about as a direct result of an earlier NACCHO and Pharmacy Guild partnership initiative known as the QUMAX (Quality Use of Medicines Maximised for Aboriginal Peoples) program which started in 2005.
“The QUMAX program consisted of a range of actions to improve access to medicines, including: co-payment subsidies for medications; cultural awareness training for community pharmacists; assistance with transport to community pharmacies; no cost dose administration aids; and increased access to home medicines review services.
“At the time there was a lot of federal government resistance to doing anything to alter the PBS co-payment scheme in Australia. So, the suggestion that the co-payment be reduced for people of Aboriginal or Torres Strait Islander origin was originally strongly rejected. The only way we could encourage the government’s consideration of amending the PBS co-payment policy for Aboriginal and Torres Strait Islander peoples was to demonstrate its effectiveness at a project level, which is what we did via the QUMAX program.”