Te Toi Hauora-nui provides information about innovative service approaches to improving Māori health, with particular emphasis on cardiovascular and diabetes mellitus programmes delivered in the primary care setting.
The report outines key findings, critical success factors that providers use to achieve successful results, and areas for improvement.
The specific objectives of the project are:
Producing a literature review that provides an overview of what is happening in the area of innovative service approaches for indigenous populations. In particular, the literature review will look at services/programmes delivered in the primary care setting that are involved in the management of chronic conditions, such as cardiovascular disease and diabetes.
Carrying out a study that looks at models of practice used by Māori health providers to improve Māori health outcomes and attain whānau ora. The study will focus on service approaches in the primary care setting where programmes to address cardiovascular disease and diabetes exist.
Based on the literature review and information gathered in the study, provide a report on innovative service approaches to improving Māori health. The report will document critical factors that lead to successful results. The report will inform policy and service development planning and will assist the health sector in their advice, monitoring frameworks, contracting and decision making processes, particularly relating to Māori health providers.
This project required that models of provider practice especially those which are being used to improve Māori health outcomes and attain whānau ora be documented. It is particularly focused on service delivery practices, systems and approaches and cultural aspects employed by Māori health providers to address chronic care management. Of major interest are the distinctive approaches that are being used which present a "point of difference" between Māori health providers and other providers. The approach taken by MKTA included:
- a review of relevant literature
- engagement of a group of Māori health providers to participate in this study
- case studies of Māori health provider practice
- analysis of material gathered through the case studies and other documented sources
- assessment of patient related feedback, and
- the preparation of a final report.
Throughout this study, MKTA has drawn on the advice of a Reference Group comprising representatives from the Ministry of Health and the Counties Manukau District Health Board.
There is much to do and on a number of fronts to directly address the health inequalities experienced by Māori. The challenge is considerable and must be an ongoing priority for the health and disability sector.
A notable development over the past two decades has been the critical role Māori health providers have played towards whānau ora – supporting Māori families to achieve their maximum health and wellbeing.
Chronic conditions contribute the major share of the disparity in life expectancy between Māori and non-Māori. There are significant disparities between Māori and non-Māori in disease rates and outcomes for CVD and Type 2 diabetes.
Māori health providers offer a range of services in response to the growing chronic disease burden. Primary care GP services aimed at empowerng patients and their whānau to take greater control of their health and wellbeing feature prominently.
Māori health providers are distinctive because they are
- kaupapa Māori inspired and Māori led
- culturally authentic and responsive
- dedicated to achieving whānau ora - supporting Māori families to achieve their maximum health and wellbeing
- committed to fostering, building and maintaining trusting relationships with patients and their whānau, and with other interests and organisations
- holistic in approach to the assessment, monitoring and treatment of patients and their whānau
- utilising multidisciplinary teams with a mix of clinical, non clinical and community workers
- preferential employers (where possible) committed to increasing the Māori health workforce
- investing in professional development opportunities for all staff including non-Māori staff to understand and practice Māori cultural values, and
- committed to community buy in and involvement in the design, development and implementation of their services.
Māori health providers also rely on strong leadership both at a governance and management level, dedicated and skilled staff and voluntary assistance to deliver its services
A concern from this study is the lack of available supporting clinical data and evidence to assess the effectiveness of interventions for improving cardiovascular and diabetes amongst Māori. This area requires immediate attention.
On the whole, the Māori health provider sector continues to evolve moving from a period of establishment to a phase of consolidation and maintenance. There are areas including governance, management, accountability and reporting systems, IT systems, financial systems and processes, and workforce capability that require ongoing investment and support.
Because of their networks and their track record of working with whānau, Māori health providers have the potential to be influential organisations in the future. This is particularly so as more iwi settle Treaty claims and look at delivery models and organisations that will assist their beneficiaries on a number of fronts.
The Ministry of Health and District Health Boards have an ongoing responsibility to support Māori health providers to achieve whānau ora.