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- Introduction
- Wai Health and Te Whanau O Waipareira
- A Maori Model for Health Care
- Comparison with Mainstream Models
- Barriers to "Best Care" for Maori
- Priority Areas for Health Care for Maori
- Collaboration between Maori Health Care Providers
- Summary
- References
Introduction
This paper attempts to review “best practice†in the management of Maori health and the barriers to its delivery in a way that does justice to the work that is carried out by Te Whanau O Waipareira.
Wai Health and Te Whanau O Waipareira
Wai Health is only one entity within the overall Te Whanau o Waipareira Trust (Waipareira). Other entities include Wai Tech (training and employment), Wai Social Services, Wai Habilitation, Wey-Out (the Weymouth Programme), Wai Corporate (financial and legal advice), Wai Alternative Education Unit and Tiaki Ora Research which is a joint venture between Waipareira and a group of young Maori researchers.
Together these entities make Waipareira a comprehensive establishment which has the ability to "wrap services" around, or provide an holistic health service to, its community. Waipareira can respond to either individual or whanau/extended family group needs from any possible point of entry into the issues that may arise.
A Maori Model for Health Care
Waipareira’s mode of operating is particularly notable for the way it addresses Maori needs through a model which is designed and driven by Maori and which is based within a business infrastructure. Waipareira continually achieves large measures of success in both Maori and non-Maori terms.
In reality, Wai Health is marginalised by the health funding provider. It is inadequately funded both in terms of getting the revenue needed to provide good health care to the population it serves and in terms of getting the funding needed for capital establishment. This would appear to be due to the funder’s inability to recognise and actively support a successful model designed by Maori, and to inappropriate benchmarking of Maori models against mainstream services, which have long histories of funding and therefore have been well established.
Comparison with Mainstream Models
In order to compare Waipareira’s model against the mainstream model, we can consider Waipareira as a single organisation that has several streams of revenue from various funders. This structure enables the ability, noted above, to “wrap around†or provide health care within an holistic model.
These various revenue streams are also all present in the mainstream model; usually described as “intersectoralâ€. However, the difference is that each of the mainstream providers is usually only delivering one specific service, and three (the Children and Young Persons Service (CYPS), the Ministry of Education and the Ministry of Health) are currently undertaking projects to develop mechanisms of integration for youth at risk. Each of these has, individually, a substantial revenue flow. They separately funded to run different projects with similar aims.
Barriers to "Best Care" for Maori
Conditions Contributing to Poor Health
Maori health is a high priority area that demands the contributions of an organisation such as Waipareira. Poor levels of Maori health are directly related to poor housing, lack of skills, education and qualifications, and all the ills that go with being in a low socio-economic group. To measure the poor state of Maori health we need only look at the number of older Maori people alive in comparison to other groups: only about 4.3% of the Maori population is over 60 years of age compared with 17.1% of the non-Maori population. 1
Inequity in Funding
Maori health levels are still not approaching those of non-Maori, by any stretch of the imagination. Mainstream services, while they continually get funding to enhance their operations for Maori service provision or encouragement from funders to improve their services for Maori are not achieving such goals at all. If they were, the poor health statistics for Maori would have been reducing by now and not increasing to the levels they have. This can be seen by looking particularly at the areas of Child Health, Youth Health, Mental Health, alcohol and drug abuse, and the high levels of respiratory diseases, diabetes and heart conditions.
Another example may be found in the level of funding designated for dental care for Maori out of the northern regional health division of the Transitional Health Authority (THA). Of the total sum available for a population that has approximately 14% Maori, only 0.8% is directed to By Maori For Maori providers. The lion’s share goes to mainstream providers. Dental health also reflects the historical picture of increasingly poor health statistics for Maori.
The Transition to a Central Purchaser
The recent transition to central purchasing has not been entirely beneficial: Maori health care providers are now one more level removed from the funder. The regional “shop fronts†have derived some benefits, perhaps, in the areas of purchasing and working with major mainstream organisations.
For an entity such as Waipareira, there has to be “one point of revenue†from the macro-intersectoral level. That would assist more efficient and effective utilisation both of human resources and of the time required to negotiate piece meal throughout a year. This would also make a huge impact and increase the proactiveness of government in purchasing services based on models which have the ability to make significant health improvements for Maori. In summary, there should be direct funding from government to support ‘wrap around’ or similar models versus supply of funds through agencies.
The Impact of the Coalition Health Agreement
The Coalition Health Agreement talks about collaboration and co-ordination which is another way of describing integration. Wonderful rhetoric and I am sure it all has good intent. However the historical reality for Maori is that integration can mean assimilation not participation as we would express it under the terms of the Treaty Of Waitangi.
The Steering Committee on implementing the coalition agreement on health advocates increased regionalisation of hospitals with a focus on community services’ provision. A list of such services included Maori Health and Mental Health as well as many other arenas Maori now provide services within. A positive move would be to “unbundle†Maori revenue from Crown Health Enterprise (CHE) revenue (yes it can be done). A proportion of that revenue would then remain with the CHE for Maori who access their services and a percentage would be designated as “excess†and moved across to Maori providers to budget-hold for contracts as I describe below.
This would be the preferred approach for Maori in the new scheme of things: to budget-hold for service provision, for contracts with mainstream providers. In areas where Maori are clearly a priority group the design of the appropriate health care delivery model should be driven by Maori. Full monitoring and evaluation processes must be established as a part of such a design by including a research unit as an integral component. A research unit as an integral component would ensure that research projects are driven by the providers in a more timely manner.
Priority Areas for Health Care for Maori
One key issues in providing best health care for Maori relates to the delivery of health messages to Maori. Where should Maori health care providers focus their attention? They could start with Child Health, as Maori do have a high youth population. However, the health of Maori adults must be improved to enable them to care for the children and youth and to sustain an adult population for all the purposes of nurturing and raising whanau. So there are no quick answers here.
A good example of a successful strategy aimed at a specific group was Tu BADD (for young Maori males). This was aimed at rangatahi/youth who were “bad†in the eyes of society and wanted to turn their lives around, in this instance through BADD (Brothers Against Drunk Driving), and become “goodâ€. It had four main objectives:
- To raise the awareness of young Maori males about drink-driving issues;
- To encourage them to take responsibility for these issues; this was facilitated by those who had “been there and done thatâ€;
- To maintain street credibility;
- To allow young men to make the transition from bad to BADD.
- To maintain street credibility;
This programme was designed by Maori for Maori and was successful. However, and this is a major issue, the funding was cut.
Collaboration between Maori Health Care Providers
Maori health care providers within each region must start to collaborate and this process must draw on the strengths they each possess. However, just as mainstream providers find, such processes will always be politically fraught. Some providers are already in collaborative relationships that are mutually beneficial eg Te Whanau O Waipareira, Hauora Raukura Tainui and Ngati Whatua form a tripartite entity known as Hapai Te Hauora Tapui.
This is particularly the case in the Auckland region where operation as ‘separate’ providers means that resources are poured into ‘re-inventing the wheel’ or duplicating processes. The joint venture enables the separate providers to share their different strengths. Collectively this group would have substantial leverage in negotiations for improvements in Maori health. A further possible benefit would be the potential for this ‘group’ to move towards an integrated care organisation.
Wai Health has many strategic alliances in West Auckland with mainstream providers at both primary and secondary levels and with Pasifika Fono.
Summary
In summary, Te Whanau O Waipareira provides a sound model for “best practice†in the management of Maori health. It has a depth of experience and breadth of expertise that can be utilised, for the benefit of all others, including mainstream providers.
References
