Embedded in our communities, our Aboriginal Community Controlled Health Services (ACCHS) are often the first port of call for diverse matters underpinning health and wellbeing.

The 2025 Western Australian (WA) State Election offers the government the opportunity to profoundly impact the lives of Aboriginal people in WA by embracing new ways of working in partnership and collaboration with the ACCHS Sector to achieve the Four Priority Reforms of the National Agreement on Closing the Gap (National Agreement).

AHCWA calls on the incoming WA Government to address key priority areas for the ACCHS sector and act on commitments made under the National Agreement. These priorities align with the Sustainable Health Review and other key WA Strategies and Frameworks by focusing on discrete funding asks to invest in preventative care and community health care closer to home.

Our key priorities are:

• Culturally Safe Short-Stay Accommodation for Pregnant Women

Many pregnant women from regional and remote locations travel to larger regional centres or metro areas to give birth or attend antenatal appointments, particularly if the pregnancy is classed as high-risk.

However, there is a lack of maternity specific short-stay accommodation in these regions, and women who travel when pregnant often end up staying in unisex hostels alongside people experiencing other issues. In Perth, accommodation options are also largely unsuitable, as they are either not family-friendly, have limited facilities and support, or non-Aboriginal specific.

The impacts of women travelling for birth, away from family and Country, contribute to an isolated and lonely birth experience, compounding stress and lacking cultural safety. Supporting the safety and mental health of mothers will, in turn, ensure that babies are getting the best start to life.

It is imperative that there is maternity specific and culturally safe accommodation located close to the hospital available to women who need to travel to give birth. As such, AHCWA suggests that the Government funds culturally safe short-stay accommodation specifically for pregnant Aboriginal women who need to travel to regional and metro centres to give birth.

• Affordable and Appropriate Housing

Access to affordable, appropriate, safe, secure and good-quality housing is crucial to ensuring positive outcomes across several areas, including health, social and emotional wellbeing, education and employment. Currently, the lack of available and affordable housing has led to a number of high-risk populations, such as pregnant women and elderly people, experiencing insecure housing or homelessness.

Housing issues are not isolated to Aboriginal people; a recent cost of living report published in September 2024 found that the two most important issues facing WA residents were cost of living and housing, followed by health. This is, however, greatly felt by Aboriginal people and communities who are more likely to experience financial stress and homelessness at 8.8 times the rates of non-Aboriginal people.

Future housing planning and investment must respond to the needs of Aboriginal people and their communities. This includes sharing decision-making with Aboriginal people regarding housing solutions, and identifying capacity-building opportunities for Aboriginal community members to manage and maintain the dwellings in which they live.

AHCWA calls on the incoming WA Government to work with Aboriginal Community Controlled housing organisations to reserve housing in metro areas specifically for Aboriginal people. There is also a need to undertake a comprehensive analysis of Aboriginal housing needs in metropolitan, regional and remote WA communities, as well as an audit of the existing housing stock in Aboriginal communities to determine the improvements needed to extend the life of existing assets and ensure they are safe and of a high quality.

• Funding for the Aboriginal Environmental Health Model of Care and Community Capacity Building for Remote Maintenance

In Western Australia, rates of preventable diseases due to poor living conditions are higher among Aboriginal people than non-Aboriginal people. This is due to factors such as community remoteness and limited access to services, overcrowding, lack of adequate housing and home health hardware, lack of access to tradespeople and repairs, and the cost of infrastructure maintenance.

Improving environmental health conditions for Aboriginal communities will have a positive impact on disease prevention and overall health outcomes. Poor environmental health conditions have a detrimental impact on the burden of disease for Aboriginal people, contributing to diseases such as gastroenteritis, scabies and other skin conditions, acute rheumatic fever, and rheumatic heart disease trachoma/ trichiasis and otitis media. Addressing poor environmental health conditions must be considered a priority to reduce the burden of disease that disproportionately impacts Aboriginal people.

Currently, there is a reliance on fly-in-fly-out maintenance providers, which can lead to significant delays in repairs, resulting in further building and hardware deterioration. It also adds significantly to costs, with much being spent on unnecessary travel. Transitioning asset maintenance to community would enable a preventative approach, and align with the WA Aboriginal Empowerment Strategy, in relation to ensuring that work should be undertaken by local people on Country.

Following a review of the WA Aboriginal Environmental Health Program, the Community Controlled Sector and the WA Department of Health have co-designed a new Model of Care for Aboriginal Environmental Health which requires further funding for implementation. Hence AHCWA requests funding to support the implementation of the Aboriginal Environmental Health Model of Care and emphasises that this is an opportune time to work with Environmental Health Aboriginal Community Controlled Organisations and communities in relation to capacity building projects which empower communities to undertake minor repairs themselves rather than relying on non-local contractors

• Free Dental Care for all Aboriginal people in WA

Aboriginal people have dental disease at up to three times the rate of non-Aboriginal people across metro, regional and remote areas. Poor dental health also contributes to oral cancer, which is the eighth most common cancer in Australia.

ACCHS report that barriers to dental treatment include cost, shame, lack of access to services and long waiting lists. Lack of accessibility to services is the most significant factor contributing to the current gap between the oral health of Aboriginal and non-Aboriginal people.

Dental care for Aboriginal people is fragmented across the State with a reliance in regional and remote areas on a mix of visiting services from the Royal Flying Doctor Service, the WA Dental Health Service (DHS) and in the Kimberley, philanthropic dental organisations. However, DHS currently only supports people with a health care card or pension concession card with a maximum subsidy of 75 per cent.

There is a great need for dental reform across the State and for both State and Commonwealth Governments to invest in new and sustainable approaches to dental care for Aboriginal people, particularly those on low incomes and in regional and remote areas. AHCWA also advises that dental treatment should be available free of charge to all Aboriginal people across the State and people on low incomes.

• Social and Emotional Wellbeing and Family and Domestic and Sexual Violence Program Funding

In 2020, the ACCHS sector developed the SEWB service model (the Model) and received funding from the Mental Health Commission to pilot this Model across five ACCHS. Preliminary findings from the Pilot Evaluation show compelling SEWB outcomes for both clients and the broader community, but emphasises that sustainable long-term funding is needed to ensure the SEWB program meets its full potential and for the SEWB workforce to feel adequately equipped. AHCWA’s Member Services also support the continued funding for SEWB services and an extension of the Pilot Program into other ACCHS and areas of WA. This ensures culturally safe and community led supports alongside interventions and programs to address intergenerational trauma and support healing.

Violence against women is a significant issue throughout society disproportionately affecting Aboriginal communities, specifically Aboriginal women and children, with Aboriginal women 33 times more likely to be hospitalised due to family violence. ACCHS are well placed to deliver programs that are place based and culturally secure and safe. Preventing and responding to violence in communities has a significant impact on mental health, suicide risk and SEWB, as well as on overall health-reducing chronic conditions and life expectancy gap.

In 2022, the WA Government recognised the need to address violence in communities providing funding for ACCHS across WA to develop and deliver programs to address Family, Domestic and Sexual Violence. This is currently underway at six pilot sites, and despite this being a challenging space to work in, the pilot sites have made significant progress in engaging with their communities and shifting the experiences of violence. However, there is a need for continued, sustainable funding to continue the work started in these pilot sites and to expand to other Member Services.

Given that a number of ACCHS are already partaking in the SEWB and FDSV pilot programs, and can demonstrate the success of this programs, AHCWA proposes that the Government provides sustainable funding to continue and expand these programs. This aligns with Priority Reform 2-Building the Community Controlled Sector and will help to progress towards Targets 13 (reducing family abuse and violence by 50% by 2031) and Target 14 (reducing suicide towards zero) of the National Agreement.

• Improved Child Development Services

The first five years of a child’s life are critical for positive life outcomes. During this time, children build the foundations for lifelong learning, health, and wellbeing, making this an important time to support children and families to prevent problems in later childhood, adolescence, and adulthood.

Biological and environmental factors impact a child’s development, as well as social determinants, and the impact of political and historical factors. As such, a critical component of improving Aboriginal people’s health and wellbeing is to ensure Aboriginal children are assessed for health and development issues and, where necessary, referred to high-quality, culturally safe services as early as possible.

However, Aboriginal children are slipping between widening gaps. Recent data from the Productivity Commission reflects the shortfall in the 10-year Closing the Gap target of having 55 per cent of Aboriginal and Torres Strait Islander Children meeting national early development goals, with just 34.3 per cent meeting the threshold in 2021, down from 35.2 per cent in 2018. In WA, only 31.3 per cent of Aboriginal children were assessed as developmentally on track across all five domains in 2021, a decrease of 0.1 per cent from 2018.

ACCHS are well placed to provide initial primary care level developmental screening for Aboriginal children. The model of care is comprehensive, community centred, collaborative and culturally safe. But ACCHS child health service provision is variable across the State due to inadequate and sporadic funding, an issue that continues even after diagnosis with further barriers to receiving support.

For Aboriginal children to have the best start in life, there must be a commitment for child development services to partner with ACCHS to ensure the culturally safe provision of services and programs to support children and families.