Annual planning - Māori Health
Plan template 2016/17
I.
Background
The mandatory requirements for DHBs in relation to reducing health disparities and
achieving health equity for Māori as outlined in Section 6.0 of the Operational Policy
Framework (OPF) and the PHO Services Agreement between DHBs and PHOs are provided
below.
Summary of mandatory requirements
DHBs must:

create a stand-alone Māori Health Plan to achieve health equity and improve health
outcomes for Māori in line with the guidance given in this template.

demonstrate that the Māori Health Plan is developed jointly with the PHO(s) as
outlined in the PHO Services Agreement

demonstrate that the PHO(s) have actions in place necessary to effect the change
they must achieve to implement the DHB Māori Health Plan (Section 6.2, OPF)

work with Māori at both governance and operational levels (Section 6.3, OPF)

provide for the needs of Māori as set out in section 4 of the NZPHD Act to ensure
there are mechanisms to enable Māori to contribute to decision-making on and to
participate in the delivery of health and disability services, as well as responding to the
Government’s desire to achieve health equity and improve health outcomes for Māori
(Section 6.5, OPF).
The MHP will be expected to include appropriate activities to improve health equity. DHBs
can use the following tools or others at their disposal, to assess each indicator and identify
appropriate actions to focus on health equity.
1. Ministry of Health. (2014b). Equity of Health Care for Māori: A Framework.
Wellington: Ministry of Health http://www.health.govt.nz/publication/equity-healthcare-Māori-framework
2. Whānau Ora Health Impact Assessment 2007
3. The Health Equity Assessment Tool: A User's Guide 2008
For working examples of implementing the tools see www.health.govt.nz/our-work/healthimpact-assessment/whanau-ora-health-impact-assessment
II.
Content of Māori Health Plan
The Māori Health Plan (MHP) should be no more than 15 pages in length and contain the
following sections.
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1. Summary of the DHB/PHO Māori population and their health needs. This
information can be drawn from the DHB Māori Health Profiles 2015, primary health
organisation (PHO) performance programme information as well as DHB and
Ministry data sources.1
2. National indicators. The national indicators will be reviewed annually to ensure
consistency with DHB/PHO performance measures and Health targets. The latest
indicator set and any updates will be provided to DHBs via the Nationwide Service
Framework Library website along with other DHB Performance Measures. In addition
to the national indicators, DHBs with high rates of sudden unexplained death of an
infant (SUDI) will be required to address these conditions.
3. Local indicators: DHBs will be able to put in indicators of importance at a local level.
They should be consistent with the purposes and goals expressed in the first part of
the MHP and also should not already be covered in the national indicators and SUDI
for affected DHBs.
III.
Criteria
National and local indicators must be presented in line with the criteria provided below. 2
Specific criteria for national indicators is outlined in the National Indicator Table found in
Section V of this template.
All indicators listed within the MHP should have (unless otherwise specified):
1. the most recent baseline performance result for the indicator
2. a target that will be achieved within the 12-month term of the plan. Health targets are
set by the Ministry. The other indicators targets are set as part of the Annual Plan
process and will be the same for the total population
3. a list of actions that clearly show what the DHB/PHO(s) is (are) doing or planning to
do, to address the indicator. A mix of universal and tailored interventions will be
required to achieve equity. Activities must be specific, time-bound, and evidencebased and therefore most likely to increase the baseline rate towards the target.
There should be a clear intervention logic outlining how the activities listed will lead to
improved health outcomes for Māori and achieve equity
4. clear statements about how the DHB will monitor (monitoring processes) progress
throughout the year, such as quarterly review of performance data.
5. All indicators must be measured, monitored and reported by Māori and total
population for the DHB/PHO.
1
The DHB Māori Health Profiles can be found on the Ministry’s website www.health.govt.nz/publication/dhbmaori-health-profiles
2
The Ministry’s target champions/assessors use this criteria to assess the quality of the content in the draft
MHP during the MHP approval process.
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IV.
Summary of the DHB/PHO Māori population and their
health needs in the district
Instruction: This section should describe the DHB/PHO Māori population and their
health needs. This section should be no more than four pages in length and
summarise key features of the DHB’s Māori population such as: population size,
growth, age distribution health service utilisation, and the leading causes of avoidable
hospitalisation and mortality. PHO performance programme data should be used.
V.
National indicators
Instructions: National indicators include Health targets, DHB and PHO performance
measures that link to the leading causes of mortality and morbidity for Māori. These
targets and indicators will be agreed on as part of the annual planning process. DHB
performance on the national indicators in the MHP is reported through the existing
quarterly non-financial reporting database mechanism.
The reporting frequency for the national indicators is directed by the reporting schedule
for performance measures and Health targets so that no new reporting burden is
created.
Data for national indicators that are not Health targets or Performance Measures will
be provided by the Ministry.
National Indicator Table
Note: Current baseline and target information must be provided for each indicator.
Indicator
Ethnicity Data Quality
Key
information
Specific Guidance
Definition
Accuracy of ethnicity reporting in PHO registers as
measured by Primary Care Ethnicity Data Audit Toolkit
(EDAT).
Data Source
DHBs who are implementing the Primary Care EDAT can
submit their data from this initiative and provide appropriate
comment on how they are improving the quality of their
ethnicity data. DHBs not yet implementing EDAT should
provide detailed explanation of how they are monitoring and
improving the quality of their PHO ethnicity data.
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Indicator
Key
information
Specific
Criteria
Specific Guidance
PHO enrolment: Refer to DHB Criteria (Section III) of this
template.
ASH: Actions are best identified through a “whole of system”
approach that engages patients and their families, as well
as community and hospital based services. A number of
activities have been shown to be effective in reducing
avoidable hospitalisations - they include:
1. System or institution-wide programmes to improve
access to health services, especially for children
and other underserved populations.
1. Comprehensive disease management programmes
which are patient-focused and involve
multidisciplinary teams.
2. Education and self-management programmes in
association with disease management programmes.
3. Disease-specific management programmes, in
particular for long-term conditions such asthma and
ischaemic heart disease.
A Systematic Review that identified the effective
interventions for reducing these admissions was published
in 2008 by the Health Services Assessment Collaboration.3
Rationale: High quality ethnicity data has been an ongoing concern for the health and disability
sector in New Zealand. While ethnicity data has been collected for a number of years, there have
been variable levels of data completeness and quality. Collecting accurate ethnicity data in
accordance with the Ethnicity Data Collection Protocols will improve the quality of ethnicity health
data.4
Access to Care (PHO
Enrolments)
Definition
Percentage of Māori enrolled in PHOs
Target
100%
Data Source Primary Health Organisation Enrolment Collection
Specific
Criteria
Refer to DHB Criteria (Section III) of this template.
Rationale: PHO enrolment is the first step in ensuring all population groups have equitable access to
primary health care services and is therefore a critical enabler first point of contact health care.
Differential access to and utilisation of healthcare services plays an important role in health
inequities, and for this reason it is important to focus on enrolment rates for Māori and Pacific
populations.
Access to Care (ASH)
Please note the
Ministry has recently
undertaken a review of
the definition and use of
Definition
Target
Data
Source
Ambulatory Sensitive Hospitalisation (ASH) rates per
100,000 for the age groups of 0–4 and 45–64 years.
DHB-specific based on current Māori ASH Rates
National Minimum Dataset
3
Basu, A., & Brinson, D. (2008). The effectiveness of interventions for reducing ambulatory sensitive
hospitalisations: A Systematic Review. HSAC Report.
4
For the Ethnicity Data Protocols Health and Disability Sector Report see
www.health.govt.nz/publication/ethnicity-data-protocols-health-and-disability-sector
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Indicator
ASH data to ensure
that it remains a
meaningful measure of
system performance.
An update will be
provided to DHBs as
soon as possible.
Key
information
Specific
Criteria
Specific Guidance
Refer to DHB Criteria (Section III) of this template.
Rationale: ASH is a proxy measure for avoidable hospitalisations, and unmet healthcare need in a
community based setting. There are significant differences in ASH rates for different population
groups and a key focus on activities to reduce ASH must address the current inequities.
Definition
Exclusive or fully breastfed at LMC discharge (4-6 weeks)
Exclusive or fully breastfed at 3 months
Receiving breast milk at 6 months
Target
75% exclusive or fully breastfed at LMC discharge
60% exclusive or fully breastfed at 3 months
Child Health
(Breastfeeding)
65% receiving breast milk at 6 months
Data Source
Indicators for the WCTO Quality Improvement Framework.
The data sources are Lead Maternity Carer claims in the
National Maternity Collection and Plunket. Data from DHB
primary maternity providers and Tamariki Ora providers will
be included from 2015.
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Indicator
Key
information
Specific
Criteria
Specific Guidance
Please state the current breastfeeding baselines and the
change in breastfeeding rates since last year’s plan. The
MHP should reflect the current performance and the
improvements that are required for the DHB to achieve the
target(s) for Māori.
Include and outline information that demonstrates a clear
commitment to improved breastfeeding rates among Māori
women. Activities need to be specific to ensure that infants
are exclusively or fully breastfed at 3 months.
Examples of information that you could include in this
section are:

How will the DHB ensure that Māori whānau continue
to have access to appropriate breastfeeding advice
and support after they are discharged from their
LMC?

How will the DHB support breastfeeding services that
are coordinated and delivered with a community
development focus?

How will the DHB link breastfeeding activities to the
childhood obesity activities stated in its Annual Plan?

How will the DHB assess the success of its
breastfeeding measures for Māori whānau over time?

Outline a clear commitment that the DHB's results for
Māori will be equal to or greater than those achieved
within the total population for this indicator.
Rationale: Research shows that children who are exclusively breastfed for around 6 months are less
likely to suffer from childhood illnesses such as respiratory tract infections, gastroenteritis and otitis
media. Breastfeeding benefits the health of mother and baby, as well as reducing the risk of SUDI,
asthma and childhood obesity. Nationally, breastfeeding rates for Māori infants start at a similar
(although slightly lower) rate as the total population, but drop off more quickly than the total
population at the 3 and 6 month time points. Breastfeeding is an important area of focus because
there is significant room for improvement, and breastfeeding has wide-reaching benefits and
potentially results in reduced cost for families.
Definition
Percentage of ‘Māori men in the PHO aged 35-44 years’
who have had a CVD risk recorded within the past five
years.
Target
90%
Data Source
DHB Reporting
Numerator: IPIF
Denominator: PHO enrolment register (IPIF team)
*Performance data for the CVD Risk Assessment indicator
is to be reported quarterly. The Ministry will provide
summary data for the quarter.
Specific
Criteria
Include specific activities (tailored/universal) that focus on
improving performance for Māori men in the 35-44 year age
group.
Cardiovascular disease
(1)
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Indicator
Key
information
Specific Guidance
Rational: The burden of cardiovascular disease (heart and stroke) is greatest among the Māori
population, and mortality is more than twice as high compared to non-Māori. CVD risk assessments
are an important tool to enable early identification and management of people at risk of heart disease
and diabetes. Fast access to treatment for heart related attacks is essential to achieve health equity
and improve health outcomes for Māori.
Definition
Cervical screening: percentage of women (Statistics NZ
Census projection adjusted for prevalence of
hysterectomies) aged 25–69 years who have had a cervical
screening event in the past 36 months.
Target
80% coverage for Māori women
Data Source
National Cervical Screening Register data, available from
the NSU website, published quarterly. NCSP coverage data
is published approximately one month following the end of
the quarter.
Specific
Criteria
Outline information and activities that will support Māori
women to participate in cervical screening. This should
include information on the following 5 areas:
Cancer Screening
(Cervical)

identify women who have not been screened or are
under screened (not screened in the last five years)

promote cervical screening to Māori women

support primary care (including PHOs) to
successfully invite and recall Māori women to
cervical screening

improve the timeliness and experience of
colposcopy for Māori women

support collaborative working relationships between
providers across the cervical screening pathway.
All activities should be ‘SMART’ i.e. be specific, measurable,
achievable, realistic, and have a timeframe. Performance
indicators are needed to help the DHB to identify how they
will know these activities have been successful.
Rationale: In 2012, Māori women were twice as likely as non-Māori to develop cervical cancer, and
2.3 more likely to die from it. Regular cervical screening detects early cell changes that would, over
time, lead to cancer if not treated. Nationally, cervical screening coverage for Māori is 62.2%,
compared to coverage in European/Other populations with coverage at 82.2%. Improving screening
coverage in Māori women is therefore an important activity to improve this equity gap.
Cancer Screening
(Breast)
Definition
Breast screening: 70 percent of eligible women, aged 50 to
69 will have a BSA mammogram every two years.
Target
70% coverage for Māori women aged 50 to 69
Data Source
Breast Screen Aotearoa data available from BSA Lead
Providers or from the National Screening Unit.
*For baseline coverage rates the dates of the period
reported on should be included.
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Indicator
Key
information
Specific
Criteria
Specific Guidance
Outline information and activities to support Māori women to
participate in breast screening. This should include
information on activities that:

identify women who have not been screened or are
under screened
 promote breast screening to Māori women
 work with primary care (including PHOs) to ensure
data matching with BSA Lead Providers.
 participate in the regional planning process with
BreastScreen Aotearoa providers and the
Independent Service Providers.
Activities should have an evidence base which shows they
are effective at increasing breast screening coverage.
All activities should be ‘SMART’ i.e. be specific, measurable,
achievable, realistic, and have a time frame. Performance
indicators are needed to help the DHB to identify they will
know these activities have been successful.
While the majority (15) of DHBs are not contracted by the
Ministry of Health to provide breast screening services
directly it is expected that all DHBs will have linkages to
breast screening activities through regional coordination,
managed by the 8 Breast Screen Aotearoa lead providers.
Rationale: Historically, Māori women have significantly higher incidence and mortality from breast
cancer compared to non-Māori. Inequities in access to screening services need to be addressed to
ensure Māori women experience the benefits of early detection of breast cancer.
Smoking
Definition
Smoking cessation: Percentage of pregnant Māori women
who are smoke free at two weeks postnatal.
Target
95%
This target is reported by ethnicity and the expectation is
that all DHBs achieve the 95% target for Māori.
Data Source
Indicator 19 of the WCTO Quality Improvement Framework.
Please refer to the link below to learn more about this
indicator and assess your DHB’s current performance
against this target.
http://www.health.govt.nz/publication/indicators-well-childtamariki-ora-quality-improvement-framework-march-2015
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Indicator
Key
information
Specific
Criteria
Specific Guidance
State your DHB’s current baseline. The MHP plan should
reflect the current performance and the improvements that
is required for the DHB to achieve the 95 percent target for
Māori.
Include and outline information that demonstrates a clear
commitment to reduce smoking rates among pregnant Māori
women.
Examples of information that you could include in this
section are:
1. How will the DHB ensure that the pregnant Māori
women continue to have access to appropriate
cessation services after delivery and remain smoke
free?
2. How will the DHB support the whanau of pregnant
Māori women to remain smoke free?
3. How will the DHB support its staff in delivering the
above activities? For example what training and
resources will the DHB provide for DHB employed
midwives to ensure that they are capable of
providing smoking cessation advice to all pregnant
Māori women?
4. How will the DHB assess the success of its
cessation measures for pregnant Māori women over
time?
5. Outline a clear commitment that the DHB's results
for Māori will be equal to or greater than those
achieved within the total population for this
indicator.
6. Outline examples of how the DHB is engaging with
the local stop smoking services in their area.
Rationale: Māori pregnant women have very high smoking prevalence (three times higher than the
national prevalence). Smoking during pregnancy increases the risk for pregnancy complications and
tobacco smoke harms babies before and after they are born.
Immunisation (1)
Definition
1. Percentage of infants fully immunised by eight months of
age (ht).
Target
95 Percentage of infants fully immunised by eight months of
age (ht).
Data Source
The National Immunisation Register Datamart reports
Specific
Criteria
Outline actions to reach and maintain 95 percent Māori
coverage rates measured at age 8 months, including:


specific plans to improve timeliness of 6 week, 3
month and 5 month immunisation events to be
delivered by the age of 6 months so that the 8
month target is achieved
evidence of collaborative work across NGOs,
government agencies and/or other community
agencies to increase immunisation coverage.
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Indicator
Immunisation (2)
Key
information
Specific Guidance
Definition
2. Seasonal influenza immunisation coverage rates in the
eligible population (65 years and over).
Target
75 percent of the eligible population (65 years and over) are
immunised against influenza annually.
Data Source
Immunisation benefit claims data or the National
Immunisation Register datamart reports.
Specific
Criteria
Outline specific actions to improve Māori seasonal influenza
immunisation coverage rates for those aged 65 years and
older.
*Refer to DHB Criteria (Section III) of this template.
Rationale: Childhood immunisation coverage shows that in 2014, at the age of eight months, 88.0
percent of Māori children had completed age-appropriate immunisations compared with 91.9 percent
of the total New Zealand children. Health equity for Māori has not yet been achieved. The current
equity gap at 8 months is around 2 to 3%
In 2014 Māori had the second highest rate of influenza confirmed hospitalisation, 49.2 per 100,000 5.
The 65 years and over age group also have the highest rates of influenza admissions to ICU. A 75
percent influenza vaccination rate is required to provide the best protection for this age group and in
particular for Māori. Only 69% of those aged over 65 years were immunised against influenza in
2014. For the 2016 Influenza Immunisation Programme NIR reports are being developed to more
accurately measure influenza immunisation coverage by ethnicity.
Rheumatic fever
Definition
Number and rate of first episode rheumatic fever
hospitalisations for the total population
Target
The 2016/17 target is first episode rheumatic fever
hospitalisation rate two-thirds below baseline (3-year
average rate 2009/10–2011/12)
Data Source
National Minimum dataset
The Ministry will provide the hospitalisation numbers and
rates to DHBs every 6 months in February/March and
August/September.
Specific
Criteria
The Māori Health Plan is expected to be consistent with the
DHB’s rheumatic fever prevention plan.
As the actions that support this indicator are likely to be the
same as those included in the DHB rheumatic fever
prevention plan please reference the DHB prevention plan
and indicate where this can be found (either on your DHB
website or the Ministry's website). All Rheumatic Fever
Prevention Plans are published on the Ministry of Health's
website at http://www.health.govt.nz/our-work/diseases-andconditions/rheumatic-fever.
Key criteria


5
Clear commitment to achieving DHBs’ 2016/17
target – a two-thirds reduction from baseline
Clear commitment to delivering the actions specified
in the DHBs’ refreshed rheumatic fever prevention
plan
Source: ESR, Influenza surveillance report in New Zealand 2014.
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Indicator
Key
information
Specific Guidance
Rationale: Rheumatic fever is a serious but preventable illness that mainly affects Māori and Pacific
children and young people aged 4 to 19 years. Reducing rheumatic fever will contribute to achieving
equity of health for Māori. .
Definition
Percentage of Māori pre-school children enrolled in the
community oral health service (COHS).
Target
95% of Māori pre-school children enrolled in the COHS at
December 2016 (aligns with the target for all pre-school
children).
Data Source
DHB reporting (annual for year ended 31 Dec)
With effect from 2016/17 the variable COHS enrolment
targets by DHB and by ethnicity will be replaced by a single
national target applicable to all DHBs and all ethnic groups.
This target takes effect formally from 30 June 2016 (to align
with Well Child/Tamariki Ora Quality Improvement
Framework Measure 5) but will be measured at 31
December 2016 (in accordance with the established oral
health reporting cycle).
Oral health
Specific
Criteria
Refer to DHB Criteria (Section III) of this template.
Rationale: Nationally at December 2014, 76% of all pre-schoolers and 64% of Māori pre-schoolers
were enrolled in the COHS. The target of 95% enrolment, while difficult for many DHBs to achieve
by December 2016, is considered to be achievable through a combination of strategies including
multiple enrolment programmes at birth via maternity providers, general and targeted promotion of
the COHS, and work with community groups to ensure whānau awareness of and enrolment of
children into the COHS.
Mental health
Definition
Mental Health (Compulsory Assessment and Treatment) Act
1992: section 29 community treatment order. Reduce the
rate of Māori on the mental health Act: section 29
community treatment orders relative to other ethnicities.
Target
No targets set for 2016/17
Data Source
PRIMHD and Statistics New Zealand population data
Specific
Criteria
The DHB must:
1. Outline what the DHB believes are factors driving
the rate for Māori under compulsory treatment
2. provide two or more actions that could lead to a
reduction in the use of compulsory treatment
(actions specific to addressing the drivers)
3. outline how the DHB will monitor progress
*Reporting on drivers and actions taken to reduce the rate of
community treatment orders will be required in the PP26
Rising to the Challenge quarterly reporting - focus area four.
Rationale: New Zealand has very high rates of compulsion under the Mental Health Act, compared
with similar jurisdictions. Māori are nearly three times as likely as non-Māori to be treated under a
community treatment order which represents a significant disparity. There are regional and local
differences, not necessarily related to population mix, which DHBs need to understand and work to
reduce. The mental health indicator also supports implementing the priority actions for Māori in
Rising to the Challenge, and the Mental Health and Addiction Service Development Plan 2012-2017
(page 34) including other actions in the plan that relate to addressing disparities or self-management.
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Indicator
Key
information
Actions to
address SUDI
are required
from these
DHBs.
Definition
SUDI
Target
Specific Guidance
Counties Manukau, Northland, Waikato, Lakes, Hawke’s
Bay, MidCentral, Hutt Valley, Whanganui, Bay of Plenty,
Tairawhiti, Taranaki and Capital and Coast.
*These DHBs have five year average Māori SUDI rates
which are significantly above the national non-Māori SUDI
rate for the same period. When the confidence interval of
the DHBs five year Māori SUDI rate overlaps with the
confidence intervals of the national non-Māori SUDI rate
then the DHB will not be required to take additional actions
for Māori.
1. Most recent five year average annualised SUDI
infant deaths by DHB region of domicile, Māori and
total population
2. Caregivers provided with SUDI prevention
information at Well Child Tamariki Ora Core Contact
1


Data Source
0.4 SUDI deaths per 1000 Māori live births. This is
the five year rate achieved by non-Māori (95%CI
0.34-0.52)
All caregivers of Māori infants are provided with
SUDI prevention information at Well Child Tamariki
Ora Core Contact 1
Mortality Data Group, Ministry of Health Well Child Tamariki
Ora reporting data.
*The Ministry will provide the DHB with the five year
average annualised rates of SUDI 2010-2014 and Well
Child Tamariki Ora coverage 2014 in December 2015.
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Indicator
Key
information
Specific
Criteria
Specific Guidance
The DHB must outline how:

Health services in the DHB region have safe sleep
policies, and train staff in SUDI prevention.

Health services provide accessible and appropriate
antenatal and early parenting education to Māori
women and whanau (which incorporates safe sleep
practice, breastfeeding and smoke free health
literacy).

Early enrolment is prompted with and quality of
service provision by Lead Maternity Carers and Well
Child Tamariki Ora providers (WCTO). A check of
baby’s safe sleep environment in the first week and
provision of safe sleep advice by LMCs and WCTO
nurses are core actions.

Health services ensure that safe sleep practice is
implemented in healthcare settings, and that baby’s
sleep environment is checked at first home visits as
per the Well Child Schedule.

Developed pathway for a local health professional
response when whanau are identified as requiring
supported access to a safe sleep space for their
infant’s first year, or referral for tobacco cessation
support.

They have engaged with PHOs and the following
key stakeholders: WCTO providers, non-DHB lead
maternity carer services and (if applicable) Work
and Income New Zealand (WINZ), Local Public
Health Units and mortality review committees.

The DHB plans to monitor progress and quality
improvement. Ideally this will include one clinical
audit of safe sleep practice in the health service
setting.
Rationale: Sudden Unexpected Death in Infancy is the leading cause of preventable post-neonatal
death in infancy. Māori infants are 5 times more likely to experience SUDI than non-Māori infants in
New Zealand, with around 40 SUDI deaths among Māori per year. These deaths can be prevented
through access to a safe sleep space, smoke free pregnancy and environment, placed on back to
sleep, and breastfeeding.
VI.
Local indicators
Instruction: DHBs will also have the flexibility to develop their own local indicator set
which reflects the specific needs of the Māori population in their district. The format for
local indicators should be the same as for national indicators (local indicators must be
presented in line with the Criteria provided in section III of this template).
Local indicators should be quantitative, specific, measurable and changeable by the
DHB/PHO(s). DHBs should also state clearly how improvement within the indicator
translates into Māori health gain. Ideally, a small number of high-priority local
indicators should be used. It is recommended that a DHB has no more than three local
indicators.
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