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- Key Issues for Purchasers in Providing Best Care for Maori
- Areas of Successful Progress in Maori Health
- Delivery of Services for Maori
- Relationships Between Maori Provider Groups
- Purchasing of Maori Health Services – From RHAs to Health Funding Authority (HFA)
- Goals for Maori Health – A Need for Improved Evaluation
- References
Key Issues for Purchasers in Providing Best Care for Maori
Effective Policy
The overall issue is, of course, to improve the health status of Maori. To achieve this, work must take place across the matrix of relevant ministries including Health, Education, and Maori Development. Effective policy for improving Maori health cannot be developed in isolation within each ministry. While Te Puni Kokiri plays a role in achieving this liaison between ministries, its role tends to be at a higher level of strategic policy planning.
Other issues include the following:
Workforce development
In the area of services for Maori by Maori, a shortage of trained health professionals has been an ongoing problem. This is currently being addressed by a three-year workforce training plan that operates alongside the purchaser’s strategic plan. There are skilled people available but there is a need for further resources. Maori health workers have a good idea of the training which is required but this is not always what the mainstream can provide.
While projects like the Vision 2020 bridging proposal at the Auckland Medical School, which aims to increase numbers of Maori in health professions, will assist in expanding the workforce, there is also a need to promote careers in health to children at school level.
Maori respond best to face-to-face consultation and, as a result, working with Maori is very people-intensive. This requirement further emphasises resourcing issues.
Access to quality information
Access to valid information is vital for purchasers to allow them to develop the overall picture of the health needs of Maori (and indeed everyone) in their region. There needs to be a concerted effort on the part of all providers to ensure that ethnicity data are collected. These data impact strongly on purchasing planning and a lack of quality data in the past has been a barrier to progress.
Southern Regional Health has developed a document profiling Maori in the region and has also developed a strategic plan. This information provides a picture of what needs to be purchased.
Need for holistic services
There has been a problem, particularly in the provision of crown health enterprise (CHE) services, where services do not respond to the needs of Maori in that holistic services are not provided.
The holistic approach is the key to advancement in Maori health and has been difficult to introduce. Mainstream services have not always been quick to recognise the need for integration. The provision of an integrated continuum of care is the key to a successful service delivery model.
Other issues
A number of areas outside the purchaser’s brief impact on the health of Maori. These include housing, employment and education. A key issue facing purchasers in providing best care for Maori is to work in with these agencies to adopt an integrated approach to health care.
Areas of Successful Progress in Maori Health
Since the introduction of the health reforms, Maori have taken the opportunity to participate. There have been a large number of new initiatives put forward by providers in the Southern Region. Examples of the new initiatives include:
- Asthma education provided on the West Coast by the Maori Women’s Welfare League
- Tipu Ora in Christchurch which provides care for pregnant women, and pre-school children and their parents
- Taringa Turi for Maori who are hard of hearing. This programme, which is based in Christchurch, provides education, health promotion and awareness services
- Marae-based services centred around a wellness model and including public health services such as cervical screening and diabetes testing
- A West Coast based Maori registered nurse who offers home visits and support for parents
- Interchurch council on hospital chaplaincy
- A regional co-ordinator to reduce Sudden Infant Death Syndrome (SIDS) in Maori
- A consultation contract with Te Runanga O Ngai Tahu to undertake all Southern Regional Health consultation with Maori
- Workforce training.
Establishment of the above services followed an extended process of strategic planning on the part of Southern Regional Health. Extensive consultations, hui and interviews were used to ensure that the health needs of the Southern region Maori community were well understood and that the services for which the available budget was used were evidence-based and selected to best meet the community’s needs.
These initiatives have improved Maori access to services. But in addition, the services are now providing models of service delivery which are beginning to impact on mainstream providers.
It is heartening to see an increase in the number of agencies now expressing an interest in working alongside Maori and at the links beginning to operate between Maori providers and mainstream agencies.
Delivery of Services for Maori
The Steering Committee Report on implementing the Coalition Agreement on health outlines a dual strategy to provide appropriate services for Maori through culturally effective mainstream services and services from Maori providers. 1
The issue for the purchaser is to ensure that all providers offer a good quality service that is sustainable and meets the special needs of Maori. Maori need to have input to, and to be able to monitor, a service that may or may not be delivered by Maori.
The reality for Maori in the south is that services will continue to be purchased for Maori across the spectrum of mainstream, bi-cultural and Maori services.
Relationships Between Maori Provider Groups
Relationships between Maori provider groups are important. Maori providers have always networked; they have never seen themselves as competitors but as groups working together to try and improve the health status of Maori.
Southern Regional Health is currently involved in an Invercargill based integrated-care pilot for Maori with drug and alcohol problems. This programme links with a number of other mainstream services including methadone services, the CHE, the Salvation Army, etc. More recently there has been encouragement from the Maori community to integrate mental health services into the programme.
Southern Regional Health is committed to provider development and recently held training and provider development workshops throughout the region. The Southern Regional Health fulfils an important role in provider development, working alongside providers to implement the coalition health policy and to ensure that the infrastructures exist to implement planned initiatives.
Purchasing of Maori Health Services – From RHAs to Health Funding Authority (HFA)
Strengths in the previous system of Regional Health Authorities (RHAs) included the ability to have a good overview of each region. The Maori Health Unit at Southern Regional Health has an extensive knowledge of Maori organisations and structure, a good understanding of local Maori politics, and the trust of the people of the region.
The major weakness in the RHA system related to the lack of national consistency in purchasing and service provision.
With the shift to a transitional health authority (THA), and subsequently to the Health Funding Authority (HFA), the four regional divisions (the former RHAs) continue to be responsible for purchasing in their region. One difference from the previous arrangement is that regions are now working towards more national consistency.
A key success factor in the changes is the ability within the new structure to build on the gains already made regionally.
Maori managers throughout the country are continuing to work together and are looking at issues of national consistency. The Maori Health Unit of Southern Regional Health is now responsible nationally for the Maori Health Strategic Plan, and for the Maori component of activities in mental health, communications, audit/monitoring and contracting.
Developing the national Maori Health Strategic Plan involves considering the content of the strategic plans from the four divisions of the HFA and working from these to create a national strategy. A first goal will be to set the benchmarks for Maori health. A goal of equal health status with non-Maori is often referred to but this may not be the ideal aim. More appropriate alternatives may be based around a "wellness" model of health.
Provided that the national purchasing agency continues to build on the unique qualities and maintains both a regional focus within a broader framework of national consistency and a regional presence, there should be few weaknesses in the new system.
Developing the Maori Health Unit at Southern Regional Health was an achievement. The Unit has built internal relationships and has input at a senior level into different policies. This is a strategic way of influencing the purchasing from within the organisation. Externally, the Unit works well with other agencies (education, employment, housing, etc) and is always looking to have the best impact for Maori health.
Goals for Maori Health – A Need for Improved Evaluation
Areas emphasised in Maori health have included smoking, asthma, SIDS, family violence, and alcohol and drug abuse. Each priority area listed is equally important in this context and each area impacts on the other. All are areas which Southern Regional Health is actively working on.
Disparities in Maori versus non-Maori health status have long been a focus of attention but only recently has anything actually been done about it. It has been recognised for some time that measuring the health status of Maori is fraught with difficulty. Efforts to improve the measurement of Maori health status, both definition and data collection, will allow purchasers to identify health improvements. "Improvement" in health, based on a "wellness" model rather than equity with non-Maori, should be the goal.
An improvement in the way that Maori health need is evaluated should be strongly encouraged before a different approach is considered.
References
- Poutasi K, et al. Implementing the Coalition Agreement on health: the report of the steering group to oversee health and disability changes to the Minister of Health and the Associate Minister of Health. Wellington: Ministry of Health, 1997.
