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Cultural Safety in health services


Andrew Harvey

Western Health Alliance Limited, AU
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The western New South Wales NSW region in Australia is one of 31 Primary Health Network PHN regions. Its land area is 441,609 km2 and with a resident population of approximately 310,000 people. Of the 28 Local Government Areas comprising western NSW, 64% are classified as socially and economically disadvantaged while 39% are classified as remote or very remote Health Intelligence Unit, WNSW: Health of the Population, December 2017. In western NSW, 12% of the population identifies as Aboriginal, compared to only 3% for all NSW. Access to health services is a key regional focus particularly for Aboriginal people Western NSW PHN: Needs Assessment, 2017.

In their submission to the Australian Government Department of Health in early 2015 to operate the new Western New South Wales Primary Health Network WNSW PHN, the consortium for operating the new PHN highlighted their commitment to building and driving culturally appropriate services for Aboriginal people across the region, including with existing and prospective mainstream and other primary healthcare providers Debble Institute Canberra: ‘What works’ in partnering to deliver effective Aboriginal health services: The Western New South Wales Primary Health Network experience, 2017.

Much has been written on the approaches to date by health services and related organisations to fulfil this important need. Programs are described in the literature and have included mandatory cultural awareness and sensitivity training, appointment of Aboriginal health workers, increasing the proportion of the workforce who identify as Aboriginal, and involvement of Aboriginal Elders and community leaders in service development, among other strategies. However, programs described are often occurring in isolation, predominantly in hospital settings, and with a considerable focus on antenatal care/midwifery and cardiovascular conditions. There is also limited evidence of evaluations of these initiatives to indicate their success or applicability across a range of health care settings.

In 2016, WNSW PHN’s Aboriginal Health Council recommended that the PHN develop its own comprehensive Cultural Safety Framework. The Framework could then guide all service providers funded by WNSW PHN Aboriginal and other, as well as the PHN’s commissioning framework and the PHN itself in building a culturally safe primary healthcare system in Western NSW.

Cultural safety in healthcare means designing and providing services that meet the needs of patients through a process of self-reflection, awareness of cultural biases and processes to actively respond in a way that will benefit the patient’s health and wellbeing. WNSW PHN is playing a leadership role in the development of culturally safe models of care to ensure access to quality health care and wellbeing programmes for Aboriginal and Torres Strait Islander people.

The WNSW PHN Cultural Safety Framework sets out a continuum for primary healthcare service providers in the transformation to cultural safety, involving three major steps: Cultural Awareness; Cultural Sensitivity; and Cultural Safety. Embedding a cultural safety process in WNSW PHN’s commissioning of health services will play an important role in Closing the Gap between the health outcomes for Aboriginal and Non-Aboriginal People in western NSW. 

How to Cite: Harvey A. Cultural Safety in health services. International Journal of Integrated Care. 2018;18(s2):179. DOI:
Published on 23 Oct 2018.


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