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As a leading community health provider, cohealth has a deep commitment to providing high quality, low to no cost healthcare to those who need it.
We have a proud reputation for providing welcoming, interdisciplinary, high quality women’s health care.
cohealth works with women from diverse backgrounds every day and continually looks for opportunities to increase access and connect people with the services they need as close to home as possible.
cohealth is a committed partner in Victoria’s women’s health agenda, with the cohealth Chief Executive a member of the Victorian Women’s Health Advisory Council – a group tasked with leading the rollout of the Victorian Government’s investment in women’s health.
cohealth, a leading Victorian community health organisation, submits this report to the Women’s Pain Inquiry to highlight critical gaps in services supporting women’s health in Victoria. We emphasise the urgent need for culturally sensitive services, particularly for women from diverse communities, who often face significant barriers to accessing adequate healthcare.
Access to healthcare is an increasingly pressing issue across Australia. The increasing cost of living means people cannot afford to access the healthcare they need and often delay or avoid GP appointments. In 2023, 10.2 million standard GP consultations occurred in Australia during the first six months – 2 million less than the same period in 2019.
These barriers are even higher for women and girls, who disproportionately experience delayed diagnosis, overprescribing, and a failure to properly investigate symptoms. Many do not have access to timely, affordable, or culturally safe healthcare, including sexual and reproductive services.
Further, when women finally do get access, health services are often letting them down – with surveys showing that one in three women in Victoria experiencing insensitive and disrespectful practitioners who left them feeling dismissed and unheard1.
cohealth exists to break down barriers and offer free and low-cost health services for all. Specialising in the community health model, cohealth provides team-based, multidisciplinary healthcare that integrates GPs, allied health, nurses, dental, mental health, and alcohol and drug support. These integrated services make it easier for people to get holistic support in their community, addressing all interconnected aspects of their health and wellbeing.
With extensive experience working with diverse communities, cohealth has developed programs and models of care that respond to the specific needs of individuals and the communities that support them. Our culturally sensitive approaches ensure that healthcare is accessible, respectful, and effective for everyone, regardless of their background.
This submission to the Women’s Pain Inquiry draws on cohealth’s experience to respond to critical gaps in the health system and develop models of care that respond to complex and high-risk health issues and highlight gaps and opportunities to support women’s health in Victoria. This submission emphasises the urgent need for culturally sensitive services, especially for women from diverse communities, who often face significant barriers to adequate healthcare.
1. Community Health Funding for Inter-Disciplinary Teams in Primary Health Care
To enhance primary health care services and address the barriers our clients face, it is imperative to establish inter-disciplinary teams within community health settings. An exemplary model is the existing inter-disciplinary team for pelvic pain at the Royal Melbourne Hospital (RMH). However, this service is downstream and not readily accessible to many of our clients due to various barriers, including referral processes, geographical limitations, and wait times.
By creating similar inter-disciplinary teams in primary health care, we can provide timely, holistic, and accessible care directly within the community. These teams would include general practitioners, nurses, physiotherapists, psychologists, and other relevant health professionals working collaboratively to deliver comprehensive care. This approach will not only improve health outcomes but also reduce the burden on secondary and tertiary health services.
2. Developing Culturally Competent Care Models
Women’s trust in health services’ interest and ability to address their pain needs to be rebuilt. Integrating cultural competence training for healthcare providers is essential for delivering effective and respectful care to women from diverse backgrounds.
Additionally, increasing the number of training places and incentivising employment of a multilingual women’s health workforce can greatly enhance communication and trust between patients and providers. Establishing partnerships with community leaders is also crucial, as it helps to design and deliver culturally appropriate services that truly meet the needs of the community.
3. Enhancing Community Engagement
Funding to support collaboration with community organisations and community health providers to work directly with community on service design that supports care coordination. Deploying community health workers from diverse backgrounds is also essential, as they can bridge gaps in care and ensure that services are more accessible and responsive to the needs of all women. These strategies will help create a more inclusive and effective healthcare system.
Building capacity for effective communication and building trust is an ongoing process. It requires empathy, humility, and a commitment to understanding diverse perspectives. By creating culturally safe spaces, effective and culturally sensitive communication, and actively engaging with clients, health professionals can improve their access to care and promote positive health outcomes.
4. Implementing Holistic and Integrated Care
Creating interdisciplinary teams to deliver comprehensive care involves integrating diverse expertise to address various aspects of a patient’s health. This approach is complemented by a focus on patient-centred care, which respects and prioritises individual needs and preferences, ensuring that treatment plans are tailored to each person’s unique circumstances.
Holistic, integrated care means fewer women experience wrong doors, denial of their symptoms, or shouldering the burden of navigating a complex of the existing service system.
5. Improving Health Literacy and Education
Health services should empower women and girls to identify and manage their pain in the way that suits them.
In cohealth’s experience, conducting targeted health literacy workshops for Culturally and Linguistically Diverse (CALD) communities can bridge gaps in understanding and access to healthcare services. These workshops empower women and girls by providing them with essential knowledge to navigate the healthcare system effectively and make informed decisions about their health and well-being.
cohealth’s extensive experience working with diverse communities has shown that healthcare providers must receive effective training in cultural competence to better understand and respect these diverse needs. Effective training enables providers to better understand the diverse needs of women and girls experiencing pain, and to provide support that really meets these needs.
Employing multilingual staff who understand cultural nuances also significantly improves communication and trust between patients and healthcare providers. This in turn ensures that all patients feel understood and respected, enhancing the overall quality of care.
cohealth’s deployment of community health workers who share the cultural backgrounds of the communities they serve has proven effective in bridging gaps in understanding and access. These workers provide crucial support and education, making healthcare more accessible and effective. Evaluations of cohealth’s bicultural worker program have found that bicultural workers are valuable for gaining community trust and improving outcomes because they can engage the community in a culturally appropriate way, and connect with the right people to ensure community members have access to the support they need2.
Community engagement is another critical aspect of improving healthcare for women and girls. Through our work, cohealth has established successful partnerships with community leaders and organisations, building trust and ensuring that services are culturally appropriate. These partnerships help design and deliver services that truly meet the needs of the community.
Holistic and integrated care is vital for addressing the complex health needs of women and girls. cohealth’s model of care involves creating interdisciplinary care teams that include GPs, mental health professionals, and specialists, providing more comprehensive and coordinated care. These teams can address multiple health issues simultaneously, leading to better health outcomes. Furthermore, cohealth emphasises a patient-centred approach that respects the unique needs and preferences of each woman, leading to greater satisfaction with care. This approach ensures that healthcare is tailored to the individual, making it more effective and responsive to each patient’s specific circumstances.
The current service delivery system often fails to meet the healthcare needs of women and girls. The current fragmentation of services results in a lack of coordination between different healthcare providers. This fragmentation requires individuals to have high levels of health literacy and the ability to self-coordinate and advocate for their healthcare needs across multiple health services and providers. Consequently, many women and girls, especially those from vulnerable communities, struggle to navigate the healthcare system effectively.
Another barrier to safe and comprehensive models of care that adequately respond to the health needs of women is inadequate funding. There are insufficient resources allocated to specialised and culturally sensitive women’s health management and mental health services. This lack of funding means that many women and girls do not receive the comprehensive care they need, particularly those who require culturally appropriate services that take into account their unique backgrounds and experiences.
Geographical disparities also play a significant role in limiting access to healthcare. In rural and regional areas, the availability of services is often severely limited. Women and girls living in these areas face additional challenges in accessing timely and appropriate care, further exacerbating health inequities. These geographical barriers make it difficult for them to receive consistent and coordinated care, which is essential for managing chronic pain and other health issues effectively.
cohealth’s Sexual and Reproductive Health Hub (SRHH) at Laverton specialises in services that assist in managing all matters related to women’s sexual and reproductive health.
cohealth’s SRHH is a nurse-led model, based on a philosophy of empowering women to take control of their sexual and reproductive health.
At the SRHH, qualified Sexual and Reproductive Health Nurses work in collaboration with a General Practitioner and a Sexual Health Physician to provide bulk billed nurse-led comprehensive contraception and early medical abortion services.
The SRHH also offers telehealth services, particularly for blood borne viruses and sexual/reproductive health by a General Practitioner.
cohealth’s extensive suite of services includes social work and psychology services, physiotherapists with expertise in pelvic pain and continence issues, as well as dietitians and endocrinologists. These services are all available via phone for secondary consult at the SRHH.
Recognising the diverse population of Melbourne’s western suburbs, interpreting is available, and longer appointment times allow women the time they need to fully consider their options and decisions.
Case study
A cohealth client, a 33-year-old woman originally from Liberia, has been helped by the Sexual and Reproductive Health Hub since she arrived in Australia seeking asylum in 2018. This client still has chronic pain and still experiences severe pain at times and reports ongoing frustrating experiences with tertiary health services. However, the client has been able to access support and healthcare through cohealth services to address these ongoing issues. cohealth staff have worked to assist with her two complex pregnancies, recurrent pain issues, sexual and reproductive health, FGM issues and significant mental health concerns and liaised with her legal team and tertiary hospital services. cohealth has been able to do this by providing a holistic approach to care, provided by wrap around teams that are trauma informed, culturally safe and have experience working with refugees.
An important aspect of wraparound team based primary care is having mental health practitioners situated at a site where a CALD client already attends and feels comfortable. In the case mentioned above – continuity of care from a consistent team of practitioners together with a community based mental health practitioner has been very important.
cohealth has a women’s health Physio that treats pelvic pain. This resource provides limited support but provides an important service that could be expanded. cohealth has also previously run a program called ‘Branching Out’ which was an interdisciplinary program for people from Refugee background experiencing pain.
The learnings from this program demonstrated that the response needs to be trauma informed and consider the settlement and refugee experience. There needs to be an element of care coordination in this response to address the multiple contributing factors to the pain experience and support individuals to navigate the health system. Team members require capacity building to ensure core competencies of the model of care e.g., modern understandings of pain, refugee context, mind body connect, and trauma informed care.
cohealth FARREP program:
The cohealth FARREP, funded by the Department of Health and Human Services, works with communities affected by Female Genital Cutting/circumcision (FGC) practices and aims to prevent the practice from occurring. The program also works with health professionals/clinicians within cohealth and outside agencies to improve knowledge and communication in supporting women/girls affected by FGC to access appropriate health services and improve their health and wellbeing.
FGC is the practice of partially cutting or totally removing the external female genitalia. There are 4 different types of circumcision. FGC is illegal in every state and territory in Australia; it is also illegal to take a child to another country for female circumcision.
Women and girls are increasingly migrating to Australia from countries where female circumcision was practiced, so there needs to be timely and culturally appropriate healthcare, support and community education. cohealth has developed a culturally safe program where trained workers build trusted relationships across communities and predominantly work face to face to do this. This is essential to be able to provide education and connect individuals to health and social support services, including mental health services. cohealth’s experience in this program demonstrates the importance of culturally sensitive workers and building trusted relationships with clients and the broader community.
Health Literacy and Education Initiatives
cohealth is dedicated to increase health literacy, promoting mental health awareness and understanding of mental illness, particularly focusing on the reduction of stigma towards women and girls from diverse cultural backgrounds, raising awareness on mental health and sexual reproductive health, encouraging help seeking and service access. The organisation achieves this through a range of projects such as:
These initiatives involve cohealth’s partnerships with the Water Well project, Multicultural Centre for Women’s Health, and Centre for Ethnicity and Health, as well our nurses and community workers.
Through these collaborations, cohealth conducts informative and educational sessions within the community, reaching out to the community of CALD backgrounds, focusing on sexual reproductive health issues and mental health/mental illness support. This approach ensures that crucial information and support are provided to those who need it the most.
The importance of co-designing our programs with community ensures that these programs build trust and safety, especially for programs that are about what can be considered taboo topics within some communities. Through these programs, the relationships that are built can lead to linking individuals to service they require.
Based on cohealth’s experience providing comprehensive, culturally safe holistic care to communities across Victoria the following gaps have been identified in current women’s health services.
1. Limited Access to Specialised Pain Management
2. Insufficient Mental Health Support
3. Barriers to Accessing Sexual and Reproductive Health Services
4. Lack of Education and Awareness
Collingwood