Ngā Kōrero
Mai i Te Kete Hauora
Māori Health Business Unit
No. 16 December 2013
ISSN 1177-9128 (print)
ISSN 1177-911X (online)
A fresh look at He Korowai Oranga: Māori Health
Strategy
He Korowai Oranga: Māori Health Strategy was first published in November 2002 to help set
the direction for Māori health development in the health and disability sector.
For the past decade, the strategy has provided a framework that assists health providers and
government agencies to work together with iwi, Māori providers, communities and whānau to
increase the lifespan of Māori, improve their health and quality of life, and reduce disparities
with other New Zealanders.
In February this year, Te Kete Hauora met with Minister Turia to discuss the next steps for He
Korowai Oranga. The framework resonated strongly and has served the sector well in its first
decade, and the Ministry were asked to refresh the strategy to ensure it continues to serve the
sector as well over the next 5 to 10 years.
This led to the Ministry facilitating a number of internal and external workshops with key
stakeholders recently to review the strategy together. As part of this process, throughout
October Te Kete Hauora hosted a cross-Ministry workshop, an external workshop with expert
leaders in Māori health from across the sector, and a meeting with Tumu Whakarae (Māori
General Managers from each DHB) at the end of the month.
The purpose of the workshops was to test the validity of the strategy’s framework and to identify
expert sector leaders’ views on the priorities for Māori health for the next 5 to 10 years.
Professor Sir Mason Durie, Merepeka Raukawa Tait, Mariameno Kapa-Kingi and Dr David
Jansen were included in the sector leaders’ workshop and were also asked to advise the Ministry
on priorities for Māori health for the future.
The Ministry is now working to provide advice to Minister Turia on the next steps for refreshing
He Korowai Oranga following feedback from these hui.
We will keep you informed as this process continues.
In the meantime, you can learn more about He Korowai Oranga on the Ministry website at the
following address: www.health.govt.nz/publication/he-korowai-oranga-Māori-health-strategy
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From the Deputy Director-General
Tēnā anō tā au me ngā mihi anō mō te Kirihimete me te Tau Hou. Ngā mihi ki te wāhi ngaro
rātau kua whakairohia i ngā tohu o te mate Haere atu ra, haere haere haere.
Kua oti ano ngā mahi mō tēnei tau me taku mihi anō ki a koutou katoa i awhi mai nei ki a oti ai
ngā wawata o te whānau ora.
Welcome to the final issue of Ngā Kōrero for 2013.
As we wind into the final weeks of the year, the content in this particular issue of Ngā Kōrero
provides a great reminder of what Māori health is all about and what it is that we are working to
support and achieve through the health sector for New Zealand communities.
We’ll profile some of the research that’s been under way this year and what we’re beginning to
learn as a result – with a particular emphasis on the importance of health literacy and creating
environments that support and promote greater health literacy for patients and practitioners.
Following the changes to Whānau Ora that were the focus of our last issue, we follow up on
some of the hui that have been happening around the country with Health Navigators and some
of the Māori PHOs. We also introduce you to a couple of the newly elected Māori board
members for DHBs.
On top of this, we end this issue with a closer look at some of the achievements and initiatives
that are emerging from New Zealand communities and really committed Māori health
providers. It’s here that we see some very real examples of Whānau Ora at work and it really is
worth celebrating.
As is often said, there’s a lot that is being achieved across the health system but there is still a lot
more than needs to be done. As we come to the end of the year, let’s celebrate the successes,
learn from the challenges, and all the while keep very clearly in our minds the mums, dads,
tamariki and rangatahi that we are doing all of this for. The future belongs to them, and it is up
to us to do all we can to give them every chance at creating a healthy, sustainable society that
they can pass on to their children.
There’s much to do, and we look forward to sharing the next leg of the journey with you. In the
meantime, I wish you a safe, relaxing holiday with your own friends, family and whānau. See
you again in 2014.
Teresa Wall
Deputy Director-General
Māori Health
Message from the Associate Minister of Health
Tēnā koutou katoa.
Nga mihi o te wā raumati ki a tātou katoa.
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Whānau Ora is set to move to the next phase under its new commissioning for results model
announced earlier this year. Three non-Government commissioning agencies will be announced
– one in the North Island, one in the South Island and a Pacific focused agency.
This approach represents the philosophy and vision that Whānau Ora is whakapapa-focused
and that families are empowered to set their own goals and plans for the future.
I want to mihi to the whānau who have worked with Whānau Ora providers and have stepped up
to make great changes in their lives – and to the providers who are absolutely committed to the
health and wellbeing of whānau and are supporting families to become resilient and selfdetermining. Ngā mihi nui ki a koutou katoa.
Work on reducing the harmful effects of smoking on our families is ongoing, including plain
packaging legislation. I am proud of the work the Wainuiomata community is undertaking in
their smokefree vehicles campaign: Smokefree Cars – That’s How We Roll.
Earlier this year, I attended their campaign launch and most recently the launch of their report,
produced by the University of Otago. The results show that this community campaign has been
vital in creating awareness of the impact of smoking in cars and a reduction in those smoking in
cars while carrying passengers. I did note also that the report concluded that achieving fully
smokefree vehicles will probably require smokefree vehicle legislation.
The rangatahi in Wainuiomata must be congratulated for taking leadership and promoting the
smokefree cars message. I am pleased that the Wainuiomata Rugby League Club is also behind
the campaign. Sport plays a major role in our communities, and it is great to see rugby league
commit to this kaupapa. It is another positive step towards reducing the extreme harm caused
by tobacco and achieving our long-term goal of a smokefree Aotearoa by 2025.
I wish you all a safe and happy holidays with your whānau.
Noho ora mai rā.
Celebrating with Turanga Health
Turanga Health recently picked up a community service prize at this year’s Gisborne business
awards. They were awarded the top prize in the community excellence category of the Westpac
Business Excellence Awards in October.
‘We wanted to test ourselves with others in the marketplace and test our capability against other
local businesses in terms of best business practice. Lo and behold, we came out on top,’ explains
Reweti Ropiha, Turanga Health Chief Executive.
For Reweti, the award, which recognises management excellence in public and private sector
organisations, is testament to the hard workof Turanga Health’s staff.
‘The team work really hard for the wellbeing of whānau and patients. It’s given us all the
confidence in the world that the things we’ve been doing are on track and that all the hard slog
the team have put in over the years makes sense. It’s a great affirmation.’
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Turanga Health was formed in 1988 and is owned by three iwi in the region: Ngai Tamanuhiri,
Rongowhakaata and Te Aitanga a Mahaki.
‘We’ve come a long way. Our initial opening balance was $300,’ Reweti recalls, ‘$100 from each
of the iwi. It’s always been about supporting health and wellbeing in a way that extends to future
generations. With such a grand vision in mind, we’ve always worked from the principle that 10
percent of something is better than 100 percent of nothing.’
‘We may not be able to change the world overnight, but there is always something we can do,
some small step we can take, that will make a difference. So we do that, and then we measure it
and learn and progress from there.’
Turanga Health offers free general practice services, operating from the Waikohu Health Centre
in Te Karaka. It also provides smoking cessation, mental health and Well Child services out of
Three Rivers Medical Centre in Gisborne. The centre’s customers truly come first, and Turanga
Health is committed to meeting the needs of the local community in the way that will be most
effective from the patient’s point of view.
‘If you only want to work Monday to Friday, eight till five, well that’s fine – just don’t expect it to
work for your customers. You’ve got to evolve. We work weekends; we’re available after hours.
During daylight savings, we get out there in the fields with the broccoli pickers and provide
services on the spot. If you really care about the customer, then you meet them where they are
and make sure you’re available where and when they need you,’ Reweti adds. ‘If it means going
into a picking field or if it means going onto the marae, then we have to make sure we have the
aptitude to be there.’
On receiving the award, Turanga Health was also congratulated by the Gisborne Mayor, Meng
Foon. Mr Foon praised the team for helping bring health to the forefront of people’s minds and
attributed the number of people getting the critical heart and diabetes checks to the time and
effort of the Turanga Health team.
When asked what encouragement he would give other health providers considering how they
can best work with and support their surrounding communities, Reweti is quick to respond.
‘Go to the space where no one is – occupy that space and be prepared to do things differently.
Dare to have a go. We can’t just do more of the same. You might be surprised at what you
achieve.’
You can learn more about Turanga Health on their website at: www.turangahealth.co.nz
Message from the Tumu Whakarae Chair – Riki Nia Nia
As another year draws closer to an end, it’s useful to reflect on the year . . .
This year, Tumu Whakarae has done some great work championing Māori health improvements
across DHBs and the wider health sector. We have embraced the standardised approach to
Māori health plans and looked to collectively put in place a robust performance framework as an
endeavour to accelerate performance against the standardised indicators.
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This has seen the introduction of robust quarterly Māori Health Plan reporting, which has
enabled us to see objectively where as a country we need to improve performance in Māori heath
and also where potential centres of excellence and best practice exist. What we have tended to
see is that where a strong commitment to specific indicator performance exists along with clear
accountability and robust and determined leadership, generally performance improves.
What has also been heartening has been the willingness by various stakeholders to share their
learning and innovations. This willingness is a key to the acceleration of performance across
DHBs.
Strong clinical and strong Māori leadership is also essential in accelerating Māori health
performance. Tumu Whakarae has made good collaborative connections with key national DHB
executive networks, such as the Directors of Nursing and Chief Medical Officers. Our vision is
that this will result in more focused shared priorities, greater collaboration and joint leadership
and of course an accelerated improvement in achieving Māori health outcomes.
The fact remains however that, while our health system is funded to perform, it needs to
improve drastically if we are to reduce persisting and annoying inequities and accelerate the
achievement of Māori health outcomes. Tumu Whakarae will remain steadfast in the coming
year in its conviction to champion Māori health improvements and to work more collectively
with our health sector colleagues to improve sustainable system performance against the Māori
Health Plan Indicators.
I look forward to reporting our progress in the first Ngā Kōrero for 2014.
In closing, I want to acknowledge the recent passing of Capital & Coast DHB kaumātua Sam
Jackson. We had the real pleasure of having Uncle Sam as our DHB’s kaumātua for the past
seven to eight years. One of the things I appreciated about Uncle Sam was his use of our cultural
practices to include people, to welcome people and to uplift people. No matter where anyone
was from or their different backgrounds, Uncle Sam and Aunty June have always made all
people feel important and respected. He was a wonderful person and respected by us all.
Nā reira, e te rau o tītapu, e te taonga a te mate, Uncle, haere, haere, whoatu!
Tātou o te ao ora, tēnā anō rā tātou katoa.
For any other information, you can contact Tumu Whakarae regional leads:
Marty Rogers (Northern)
Marty.Rogers@waitematadhb.govt.nz
Janet McLean (Midlands)
Janet.McLean@bopdhb.govt.nz
Riki Nia Nia (Central)
Riki.Nia_Nia@ccdhb.org.nz
Donovan Clarke (Southern)
donovan.clarke@southerndhb.govt.nz
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Targeting the early stages of life for long-term wellbeing
A recent report highlights the key factors that influence wellbeing in the early stages of life. The
report incorporated a wide-ranging review of existing research literature and conducted
interviews with a range of stakeholders.
The research aims to provide a better understanding of how early interventions and support in
infancy might set the scene for greater health across a person’s whole life. ‘Early physical, social
and cognitive development lays a critical foundation for health and wellbeing throughout our
life,’ Associate Minister of Health, Tariana Turia explains. ‘Improving the support and services
we provide in these early stages of life will help prevent negative outcomes later in life. This is of
particular interest for Māori maternal health as we know low birth weights, preterm birth,
stillbirths and neonatal mortality are more common for Māori.’
The research report Hapū Ora: Wellbeing in the early stages of life identified three key priorities
for further work, in addition to more intensive data collection for ongoing research, monitoring
and evaluation. These include:




addressing societal conditions
supporting the mother, the baby and whānau
improving services – ensuring we offer best practice maternity and newborn support.
The findings also identify several key factors in improving hapū ora – the health and
wellbeing of both the mother and child.
‘We need to identify vulnerable mothers and more effectively meet their needs, and we need to
focus on supporting and maintaining positive maternal mental health as well as attending to the
obvious physical needs. Anyone who has been through pregnancy and childbirth knows it can be
an incredibly vulnerable and stressful journey at times – we need to do everything we can to
understand and reduce these pressures for all parties,’ Mrs Turia adds. ‘Taking a life-stage
approach provides a perspective on maternal health and wellbeing that is much more in keeping
with the natural rhythms and cycles we live through.’
The report was developed by Massey University’s Whāriki Research Group and jointly funded by
the Ministry of Health and the Health Research Council of New Zealand. It is available on the
Ministry of Health website: www.health.govt.nz
Census findings and Māori social survey
Earlier this year, Statistics New Zealand published their release schedule for specific detailed
information following on from the 2013 Census results.
The release schedule began in October and this month, December 2013, Statistics New Zealand
is releasing a further range of specific information packages, including ‘Quick Stats about
Māori.’
The information, available from 3 December, includes a wide range of social and demographic
data (such as age, language, income, qualifications, employment, iwi and other information). It
can be found on the Statistics New Zealand website www.stats.govt.nz/Census/2013census/release-schedule.aspx and is also available in te reo.
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In 2014, the findings of Te Kupenga (previously known as the Māori Social Survey) will also be
published. We expect this information to be available around the middle of 2014. This survey
collects information on a wide range of topics to help give an overall picture of the social,
cultural and economic wellbeing of Māori in New Zealand.
Over 5000 Māori participated in the survey. For more information, visit the Statistics New
Zealand website: www.stats.govt.nz/browse_for_stats/people_and_communities/Māori/tekupenga.aspx
Whānau Ora Navigators hui
During October, the Ministry of Health convened the first Whānau Ora Health Navigator hui.
Navigators and managerial staff from six Whānau Ora collectives met with the Ministry to
discuss the relevance of Whānau Ora Navigators and their work to overcome some of the
challenges associated with access to health services. Representatives from the Ministry of Social
Development and Te Puni Kōkiri were also present for the discussion.
The primary role of Whānau Ora Health Navigators is to provide a single point of contact for
families navigating health services and to work with whānau to identify their needs and then
help develop a plan to address those needs and broker their access to a range of health and
social services.
Attendees at the hui all agreed that Navigators are integral to the Whānau Ora service model
and crucial in ensuring the development of independence in whānau, especially in cases where
whānau are in crisis. The collectives noted that an important aspect of the working relationship
with Te Puni Kōkiri is that contracts permit some flexibility in the development of navigator
roles, enabling positions to be specifically tailored to each region’s particular population and its
needs.
Another dimension of the navigator role is to support an organisation to be whānau centred and
to endorse the principle that whānau are the determiners of their own health and wellbeing. The
development of independence and self-determination for patients and their families should be
the focus.
The majority of the collectives saw the Navigators working with whānau in the early stages of
their plan, acting as a gateway to all services. The long-range aim is seen as developing
leadership within the whānau so that ultimately whānau will be able to manage access to health
services independently.
Hui attendees noted that the role of a Health Navigator is varied and that the needs of the
whānau can be not only varied but also complex. A crucial first step in assisting families in need
is identifying and addressing some of the key issues that may have been preventing whānau
from accessing appropriate services. Needs assessment is another key step, with Navigators
finding that many whānau do not know what services are available to them to address their
issues.
A Navigator’s tasks may include connecting whānau to services, advocacy, community
consultation, assisting with employment, budgeting, providing education about services, clinical
planning, assistance with driving licences, working with rangatahi and older people, developing
parenting skills and computer skills, and assisting with enrolment in training courses. Working
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on each of these areas eases access to health services, which helps improve health outcomes for
those most in need.
During the hui, Te Taiwhenua o Heretaunga reported on their interpretation and
implementation of Whānau Ora objectives in the Hawke’s Bay community.
Since its inception in June, they have focused on investing time in building a rapport with
whānau, assessing whānau needs, identifying strengths, building trust and good relationships,
and developing whānau plans. From these interactions, the team has learnt that, in this
community, poverty is a significant factor and that whānau have difficulty in identifying dreams
and aspirations, tending to focus on the present, rather than working to build a better future.
Additionally, many whānau do not have a GP and many are unaware of what community
services may be available to them. From a service perspective, community services do not
collaborate to support whānau nor do they generally understand Whānau Ora approaches.
The primary goals of whānau based in this community focus on health, finances, living free from
violence, learning their whakapapa, education and employment. Some of the strategies
identified that may assist whānau in this particular region include working to streamline forms
and marketing; some strategic planning in adopting a Whānau Ora approach; development of
an Integrated Data System; and consultation with community and other services such as
Corrections, Probation, counselling, and Internal Affairs.
In this way, Te Taiwhenua o Heretaunga provides a great example of the Whānau Ora initiative
in action: the issues and concerns of whānau are being identified and addressed in order to
improve access to health care and improve future health outcomes. Whānau are working with
Navigators to develop, and ultimately take responsibility for, their own health plans.
Similarly, Pacific Trust Canterbury explained that their goal is to ‘empower, support and mentor
whānau so that they themselves become ‘navigators’ and achieve self-determination,
independence and overall better outcomes for their families and communities.’
All in all, the hui strongly confirmed the central role of the Health Navigators in supporting the
self-determination, independence and greater health outcomes for families and whānau in New
Zealand.
Although it highlighted some of the challenges we continue to face in achieving Whānau Ora, it
also showcased some powerful examples of the difference we are already seeing in a number of
communities. There is plenty yet to do, but there is also much to celebrate.
Health literacy – Skin infections
Another recent study, published in November, has confirmed health literacy as one of the key
barriers preventing New Zealanders accessing and understanding the health information and
services they need.
The full report, titled Health Literacy and the Prevention and Management of Skin Infections, is
available on the www.health.govt.nz website.
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‘If we want to see more people managing their own health and wellbeing, we need to support
greater health literacy and access to good health information and advice,’ Associate Minister of
Health Tariana Turia says.
Health literacy refers to the degree to which people are able to access and understand essential
health information in order to make informed and appropriate health decisions. Over 1.5 million
New Zealanders are estimated as having low levels of health literacy.
‘The report highlighted difficulty reading and understanding health information, poor
communication between health professionals and their patients and information overload as the
key health literacy barriers,’ Mrs Turia explains. ‘Improving health literacy is a combination of
ensuring we provide easily accessible health information and advice for patients and their
whānau and working to improve communication between health professionals and their
patients,’ Mrs Turia explains.
The report focused particularly on health literacy experiences among people with skin infections
arising due to common skin conditions like eczema. New Zealand has one of the highest rates
for childhood skin infections in the western world. It is estimated that 60,000 children visit
general practices every year for treatment of skin infections.
The need for a review of the information provided regarding skin infections was identified by the
Ministry of Health. Initial research indicated that New Zealanders’ general awareness regarding
the management and prevention of skin infections was low and that this lack of information
contributes to high rates of skin infections and complications – particularly for Māori.
The New Zealand health literacy provider Workbase was engaged to research and highlight
possible interventions or approaches for meeting the health literacy needs of Māori and their
whānau and help prevent and manage skin infections.
‘We want to improve the way we present information so that it is easily understood and useful
for everyone,’ Mrs Turia adds. ‘It’s about making it as simple as possible to navigate our health
system so that people can easily find and use the information they need to make healthy
decisions for themselves and their whānau.’
The review was undertaken by Workbase in partnership with three DHBS: Auckland, Counties
Manukau and Capital & Coast. A full copy of the report is available from the Workbase website:
www.workbase.org.nz/
Navigators lead the way
Whānau Ora action research is indicating a change or shift in provider transformation and the
impact on whānau.
Action Research Reports – for June to August 2013 – show that some whānau and families are
learning self-management through whānau planning, giving them the capacity to make
decisions and the motivation to access services and information. In one case, a mother who is a
heavy drug and alcohol user involved in criminal activities is now engaging with a Whānau Ora
Navigator and developing her ability to set goals, make better life choices and maintain
improved life changes.
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The reports also found that the Whānau Ora Navigator role is pivotal in facilitating
organisational change to whānau-centred practice. For example, Whanganui provider collective
Te Oranganui Iwi Health Authority has employed a ‘clinical navigator’ to develop processes and
procedures focused on improving whānau outcomes through collaboration between the Whānau
Ora team, primary health care and social support networks.
The research also highlighted other ways in which changes to existing services are being made
more whānau-centred, such as by providing services at venues closer to where people live and
teaching them to use tools that will help them take greater control of their lives. And an example
is the Whānau Ora collective Ngā Mataapuna Oranga Kaupapa Māori PHO computer course
now being provided at a local marae.
Whānau Ora – Supporting emerging talent
Our Contracts Manager, Ana Morrison, who also happens to be Kura’s aunt, was the initial
catalyst for making the connection between Tipu Ora and Kura.’
‘Kura was tossing up her future direction. Her mum had always been keen for her to go into
dentistry. Kura was definitely interested in health but hadn’t settled on a particular option yet,’
recalls Sonia Rapana, Clinical Manager for Tipu Ora. ‘We have a research partnership with the
University of Otago, which includes 5th-year dental students being placed in Māori oral health
providers for their final community placement. We saw this as an opportunity for Kura to spend
some time in the practice and see what she thought.’
Kura’s story is a great example of the broader picture of what Whānau Ora means in terms of
supporting individuals, whānau and local communities to attain their own aspirations for
collective health and wellbeing.
Tipu Ora could see an obvious need for future resourcing and capability in the region. Kura was
at a key time in her life when she needed to begin making some longer-term choices that would
shape her future career path. Through the community, they were easily connected and it was a
win-win situation for everybody.
‘Mum’s always wanted me to do dentistry, but I didn’t really think I had the brains to do it. I was
clever enough at school, but I didn’t always apply myself. I wasn’t sure I’d have what it takes,’
Kura recalls. ‘Anyway, I was talking to my aunty who works in the practice, and she suggested I
see if I could do some volunteer work. So I went in and talked to Sonia and the team, and they
were really happy with the idea. I got to experience life in a dental clinic for myself. That’s when
it clicked,’ she explains.
‘During that time, I got to observe the dentists at work and also spend time with the dentistry
students that were on placement from Otago. They were really encouraging, and if they could do
it then I thought I could too.’
The other key turning point came when Kura picked up a part-time role within the clinic on
Friday afternoons, working on the dental reception and helping process some of the data.
‘That experience – dealing with customers and looking at the data – gave me a much clearer
perspective of the overall health state for Māori. I also came to see how few Māori dentists we
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have in New Zealand. All of these things began to really motivate me. These were things I
wanted to help change!’ Kura says.
Today, not only has Kura gained entrance into the University of Otago’s programme through the
Tu Kahika Scholarship, but she has also survived the initial foundation year course and
successfully gained a further scholarship for the coming year. She has much to be proud of, and
her mother, Megan, is especially pleased.
‘I’m just so proud of her. I’ve been really impressed with her determination. She’s been really
focused this year, and I think being in an environment where everyone around her is on the
same kaupapa has been beneficial. They all seem to feed off each other and want to see each
other succeed,’ says Megan.
‘After settling in with the other students I think she surprised herself when she cracked a few
tests with excellent results. Her goal was to get a scholarship, so she needed really high grades,
and she did it. They have their fun of course, but there is such a strong study ethic, and they
know they have to achieve,’ Megan adds. ‘Kura has an enormous amount of support behind her,
but equally, in the end we can all help open doors and point to opportunities, but she’s the one
who has grab it and make it happen. Kura has such sheer determination. We might have helped
her get there, but she’s truly succeeded on her on merits.’
Kura is equally clear about where she wants this to lead once all of the study comes to an end. ‘I
know that, as soon as I get my degree, I want to go back to the places that helped me become
who I am. I want to go back to Māori communities and Tipu Ora and help support some of these
changes.’
‘Understanding the wider Māori health picture is the thing that really got me interested; really
motivated me. Until coming to Dunedin, I never understood how different people’s lifestyles are
– and how different life can be for Māori in certain places. I want to help improve some of these
things,’ Kura states.
‘It’s a bit like the story of the man walking along the beach among hundreds of washed up crabs
and starfish, occasionally stopping to pick one up and throw it back into the sea. When someone
asks him why he bothers when there are so many still left on the sand, he simply replied, “Well,
it made a difference for that one,” as he threw another one in. I want to be part of that kind of
changing, too.’
Māori PHO hui
Also during October, the Ministry met with a number of Māori Public Health Organisations
(PHO) for a Māori PHO hui to discuss a range of issues concerning Māori health.
The hui was attended by Ngāti Porou Hauora PHO, Ora Toa PHO, National Hauora Coalition
PHO, Ngā Mataapuna Oranga PHO, Counties Manukau DHB, Bay of Plenty DHB, Tairawhiti
DHB and the Ministry.
The hui began with a summary of their activities from Ngāti Porou Hauora. Highlights of the
presentation included an announcement that a centre of excellence has been established.
Named Taumata Wananga ki Hikurangi (the pinnacle of critical thinking), the centre is
dedicated to the late Dr Paratene (Pat) Ngata who was a strong advocate for Māori public health
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and worked to encourage Māori into health professions. Ngāti Porou Hauora also reported that
a clinical advisory group has been established, which will be chaired by Dr Julia Carr.
Ngāti Porou Hauora also summarised a number of challenges common to other PHOs – the
integration of contracts, recruitment and retention issues, and IT connectivity.
Cathy O’Malley, Deputy Director-General for the Sector Capability and Innovation group at the
Ministry of Health reflected on recent changes to the primary health care sector.
Cathy highlighted the potential of the alliance approach as a recognised strategy to facilitate
worthwhile discussions at a district level. She also encouraged participants to be active in
upcoming sector activities involving development of the Performance and Incentive Framework.
Cathy also acknowledged feedback from PHO representatives concerning changes to the Very
Low Cost Access payments and other issues relating to funding and audit processes. These
issues can be complicated by the fact that Māori health providers often hold multiple contracts
with agencies, which can lead to more complex reporting and auditing process. This is a key area
of interest for the integrated contracts initiative.
One of the most significant discussions during the hui regarding funding and delivery of health
services was debate regarding the best approach to ensuring optimum health outcomes for
Māori.
Participants noted that the typically broader service delivery base of Māori health providers,
their diverse approach to service delivery and their differing business model as compared to
mainstream health providers don’t always fit naturally with typical funding and service models.
Building on this, participants then joined a further discussion regarding the tension between
running GP clinics that are typically based on episodic, individualised care and how this model
fits with the broader aspirations for Māori health providers in terms of supporting broader
community transformation.
The hui was a valuable opportunity for all participants to engage in a wide-ranging but highly
relevant conversation regarding the challenge of overcoming the status quo and genuinely
finding new ways to meet the needs of people, their whānau and the surrounding community.
The hui ended with a shared agreement about the necessity for achieving greater integration of
health services and that real integration means a lot more than just co-location.
Newly elected Māori DHB board members
Following the recent DHB Board member elections in October, we spoke with two of the newly
appointed Māori DHB board members, Maaka Tibble and Jacoby Poulain.
DHBs are required to have at least two Māori board members, supporting the board from a
specific Māori health perspective. For board members, the role offers a great opportunity to
contribute to the health of their district and to Māori within that district.
Maaka and Jacoby shared some of their thoughts with us in relation to their recent
appointments.
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DHB Māori board member profile – Maaka Tibble
Maaka Tibble (Ngāti Porou, Te Whanau a Apanui) has been elected to the Tairawhiti DHB.
Maaka’s own blindness is a driving force in his advocacy for the blind and visually impaired. In
1992, he received the Sir Winston Churchill Fellowship Award as well as the Cyril White
Memorial Trust Award to complete a comparative study of Māori blind persons and blind
indigenous persons in Canada and the USA.
‘Community involvement is an important way of keeping in touch with the current issues facing
the Gisborne community,’ Maaka explains, and playing a variety of leadership roles within the
Māori community, Maaka exemplifies his own call for community involvement.
Formerly the General Manager of Māori Health at Tairawhiti DHB, Maaka spent his working life
in the health and disability sector and the mental health, drug and alcohol services field.
His career has spanned all levels of health administration, the disability sector, social work,
policy and strategic development, including a number of key advisory roles in the health sector.
Maaka was also involved in the development of the New Zealand Disability Strategy and, more
recently, the Māori Disability Strategy. In 2002 he was awarded the Queen’s Jubilee Honour
and became a Member of the New Zealand Order of Merit in recognition of his services to
people with disabilities.
Medical students at the University of Otago are one group that benefits from Maaka’s
involvement; as a professional practice fellow, he provides teaching, pastoral care and student
support. He is also the current Chair of the Tairawhiti Police Māori focus forum. For Maaka,
staying involved at the community level is critical, and it also allows him to stay in touch with
the wide range of issues that affect families and whānau in Gisborne.
‘Health is a community issue, and greater engagement, communication and collaboration in the
community are required to improve health outcomes,’ Maaka explains. ‘A healthy workforce
drives a healthy economy,’ he adds.
‘Regular health checks are fundamental in ensuring long-range health benefits, and long-term
health conditions (such as stroke, cardio vascular, diabetes, obesity, addiction and mental
health) require long-term strategies. We have to think more broadly about how we tackle these
issues together.’
For Maaka, this means keeping one eye on the immediate practical realities that need to be
managed now, while at the same time looking ahead to the needs of the coming generations.
‘We need to continue to make ongoing upgrades of diagnostic equipment, and secondary and
tertiary care are crucial for improving long- term health outcomes. Equally, our children are our
future, and issues such as parenting and adolescent wellbeing cannot be ignored,’ Maaka adds.
Noting that both Māori and people with disabilities are under-represented in key leadership
roles in the health and disability sector, Maaka looks forward to helping bridge this disparity.
Combining a wealth of health and disability sector knowledge and experience with a passion to
improve the health and wellbeing of those living in the community, Maaka hopes to make a
positive contribution to the health outcomes for those living in Te Tairawhiti.
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‘My challenge, and our challenge, is to turn disadvantage into advantage, disparity into parity,
disability into ability, discomfort into comfort and disharmony into harmony,’ Maaka adds.
DHB Māori board member profile – Jacoby Poulain
Born and raised in Hawke’s Bay, Jacoby has been elected to the Hawke’s Bay DHB. Jacoby has
accumulated an extremely strong set of professional skills, which she uses to help effect change
for those in the greatest need within the community.
She initially trained as a lawyer through Otago University, and after her admission to the bar,
she went on to volunteer in humanitarian and disaster relief work in Indonesia.
‘There I witnessed poverty, destitution and despair that no person, child or family should ever
have to live through. This experience cemented my resolve to return to New Zealand and
contribute as meaningfully as I could to help others and make others’ lives better,’ she explains.
Returning home, Jacoby worked for the Māori Land Court and became active in a range of youth
advocacy roles. In 2010, she was elected as a councillor for the Hastings District Council and
represented the East Coast region on the Māori committee of Local Government New Zealand.
She also serves on a variety of other boards and committees and often features as a columnist
for Hawke’s Bay Today.
Jacoby describes herself as passionate about community advancement and the progression of
issues and people. She aims to bring diversity and professionalism and ‘to draw on my
governance experience so that issues and areas important to the community can be articulated
and advanced more effectively’. These motivations are clearly reflected in her decision to put her
hand up to serve on the Board of her local DHB as well as a second term as a city councillor.
‘I enjoyed my first term on council but feel I can do more for the community, in terms of
development and advancement, by also working on the district health board,’ Jacoby explains.
‘In terms of social indicators, the Hawke’s Bay tends to lag behind the rest of New Zealand. This
is true for education, household income, economic growth and also our health statistics. We
have an increasingly ageing population and also an increasing young Māori population. These
demographic changes and patterns have implications for the health needs and service demands
in our community, and it’s important we address them,’ Jacoby reflects. ‘I want to do what I can
to support that.’
New Mamaru practice hits the mark for local community
Earlier this year, Te Hauora O Te Hiku O Te Ika community trust opened a new general practice
clinic in Mamaru, Northland. It’s brought a range of health services together in a single,
convenient location.
‘We have a very busy practice out there now, and the feedback from the community has been
entirely positive,’ Dr Bruce Gregory, Chairman of Te Hiku, explains.
The clinic was officially opened by Dr Pita Sharples, Minister of Māori Affairs, in July this year
and provides an excellent showcase for a community-centred approach to local health care.
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‘It’s probably been 12 or 13 years that we’ve been working towards realising the vision of making
this range of services available in a single setting,’ Bill explains.
Te Hiku operates as a charitable trust and ensures that all profits from the clinic are invested
directly back into the community. This ranges from providing funding for the purpose-built
clinic through to providing scholarships for aspiring GPs and dentists.
The clinic itself was designed by renowned Māori architect Rau Hoskins and built by local
companies and tradesmen and is adorned with motifs by local artist Richard Murray. These
motifs capture the history and relationships between Ngāti Kahu and the other Far North iwi.
‘It had always been our intention to develop a one-stop shop; we simply didn’t have the room
before. We’re currently adding a treatment room to rent out to physios, podiatrists,
acupuncturists and others. We’re also in the process of adding a pharmacy to the clinic which we
expect to open in the New Year,’ Bill adds.
Having developed a successful practice in Kaitaia previously, Bill and the rest of Te Hiku had
been working to establish a similar service in Mamaru for some time. They opened an initial
clinic in 2003 with just a single GP. However, their focus on providing affordable but first-class
services has been received so eagerly by the community that it wasn’t too long before they
outgrew their initial premises.
‘The initial clinic grew to two GPs and continued from there. Alongside the general practice, the
site now includes acupuncture services, dental services and, shortly, a pharmacy as well – truly
creating a one-stop health centre for the local community,’ adds Bill.
The design of a new, purpose-built clinic presented Te Hiku with an opportunity to improve its
facilities and offer an even wider range of health services from a single location: an opportunity
that seems to have been welcomed warmly by the people of Mamaru and the surrounding
communities.
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