He Korowai Oranga - Māori Health Strategy

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Date of Publication: November 2002 It is also available as a PDF file to download or print.
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Te Ara Tuatoru – Pathway Three Effective health and disability services

This pathway aims to ensure that whanau receive timely, high-quality, effective and culturally appropriate health and disability services to improve whanau ora and reduce inequalities.

Effective health and disability services for Māori will be co-ordinated around the needs and realities of whanau and will incorporate Māori cultural values, beliefs and practices.

These services will be highly competent and will know how to address inequalities in outcomes and access to services, that many Māori currently experience.

DHBs are expected to put processes in place to make sure that high-quality services are delivered to whanau in a timely manner.

Key aspects in achieving effective services are:

• addressing health inequalities for Māori

• improving the effectiveness of mainstream services

• providing the highest quality service

• improving Māori health information.

Addressing health inequalities for Māori

Objective 3.1


Inequalities between the health status of Māori and other New Zealanders are well documented. Across New Zealand, health inequalities are greater for those in more deprived socioeconomic groups. Whanau are not only over-represented in the more deprived groups, but also appear to experience further inequalities over and above those experienced in the same socioeconomic groups.

Other pathways provide direction on addressing the wider determinants of health inequalities (including policy to address the impacts of poor health on whanau, and intersectoral initiatives). Within the health and disability sector specifically, efforts need to be focused on a manageable number of Māori health priorities, which reduce risk, prevent or better manage disease and improve outcomes.

Nationwide population health priorities for Māori are listed in Appendix Three. They include the 13 population health objectives in the New Zealand Health Strategy, the eight Māori health-gain priorities areas and the additional Government Māori health priorities. The latter includes rangatahi health, sexual and reproductive health, and alcohol and drug use. Support for disabled Māori and their whanau is the final priority area.

DHBs are expected to address these nationwide priorities over time, taking into account the health needs assessments of their local population and the views of their Treaty partners, Māori communities and providers. It will be important to identify which services need to be expanded or developed to address the priorities, timeframes and available budgets. Some priorities will require DHBs to collaborate with other sectors.

Toolkits have been developed to provide guidance to DHBs on how to effectively monitor progress and achieve these objectives, including for Māori.



Improving mainstream effectiveness

Objective 3.2


Since the majority of Māori continue to receive most of their health care from mainstream services, considerable ongoing effort is required to reorient mainstream services, providers and systems to prioritise Māori health needs.

Mainstream services have begun working with Māori providers and communities to take greater responsibility for Māori health in many areas.

For example, publicly funded hospitals and major primary health care organisations have been required (through their contracts) to specify how they will identify and meet the needs of Māori. Many hospitals now have Māori and whanau units, which focus on ensuring the services better meet the needs of Māori patients and that cultural safety issues are addressed. These initiatives need to continue alongside the relationships with the Māori community organisations, providers and communities.

Mainstream services will be expected to work with DHBs to identify and remove barriers experienced by Māori in order to adapt services to meet the needs of Māori. Primary health organisations will be key players in improving services for Māori.

In the provision of disability services, areas identified as needing further work include the need to:

• develop needs assessment processes and criteria appropriate to Māori

• improve service co-ordination between primary care services, disability providers and Māori community health initiatives.

Other mainstream services that are considered important for whanau ora include palliative care, mental health and public health services.

A combination of factors will impact on mainstream service progress, such as:

• the quality of partnership relationships between DHBs and iwi and Māori communities

• the effectiveness of the working relationships with Māori providers

• improved collection of ethnicity data.

Primary health care

Primary health care plays a crucial part in reducing health inequalities.

There is a particular need to ensure primary health care services meet the needs of Māori whanau more effectively. This is where many conditions can be prevented or managed early. DHBs are working with communities and providers to develop new primary health organisations that address the health needs of Māori populations they serve. This will require a population health approach, and the involvement of iwi and Māori communities to find ways to improve health.

It is expected that some Māori health providers or organisations will move towards primary health organisation development over time. This will involve working with other providers to enhance service delivery. Primary health organisations are expected to improve health outcomes for Māori with high needs.



Providing highest-quality service

Objective 3.3


Growing evidence demonstrates the need to significantly improve the quality of services for Māori patients and whanau. High-quality care is about performance and user satisfaction: the right thing, for the right people, in the right way, at the right time. The outcome of quality services is that:

• the right result is obtained

• care is delivered efficiently

• adverse events are minimised.

The New Zealand Health Strategy, the New Zealand Disability Strategy and He Korowai Oranga are committed to the development of a health and disability support sector that embraces a culture of continual improvement in the delivery of services.

This must:

• be system wide

• use a risk management approach to reduce preventable harm

• foster consistency of practice through shared learning, benchmarking and clinical governance within a standards framework

• take account of whanau, hapu, iwi and Māori community views on quality of care

• take account of the need for cultural as well as clinical safety.

There are mechanisms at all levels in the health and disability sector that are designed to assure safe, quality care. These include:

• regulation to ensure safety of services, by setting and enforcing minimum standards of facilities, medicines and professional practice
• clinical review, as part of regular business planning.

A more recent development is the decision of many providers (including Māori providers) to seek accreditation for establishing quality assurance processes in the management and delivery of services and systems.

In addition, individuals have fundamental rights within a quality health care system. They include rights recognised in the Health and Disability Commissioner Act 1994, and cover the right to:

• be treated with respect
• freedom from discrimination, coercion, harassment and sexual exploitation
• dignity and independence
• services of an appropriate standard
• effective communication
• be fully informed
• make an informed choice and give informed consent
• support
• make complaints
• rights in respect of teaching or research.

Most of the progress in ensuring clinical safety and effectiveness for Māori will come from the teams of health professionals and community workers working and learning together to establish agreed protocols and processes and to share best practice initiatives.

In addition, DHBs, providers and public health agencies will need to look wider than financial performance and legislative requirements. They must establish processes to gather information on Māori patient satisfaction, clinical pathways and decisionmaking processes, and organisational capacity and capability. This information will assist ongoing monitoring and development of the capacity of mainstream and other providers to address Māori health priorities.



Improving Māori health information

Objective 3.4


Improvement in whanau ora is a long-term goal, which will take time to achieve. Comprehensive, high-quality Māori health research and information is necessary to inform the Government and to assist whanau, hapu and iwi to determine and provide for their own health priorities. Whanau will need access to relevant information about their health if they are to better manage their own health.

Measurement of whanau ora includes:

• indicators of mortality, morbidity and disability

• levels of income, housing, education, and access to social support

• environmental measures

• measures of participation in society, including te ao Māori

• a secure identity, a sense of belonging, high self-esteem

• control over one’s destiny.

Other ways of measuring whanau wellbeing include comparisons with non-Māori, progress over time, whanau adversity, whanau potential, whanau functioning and whanau capacities (Durie 1999).

Most measures of health status are population or individually based. Many aspects of whanau ora are at a level between these two extremes. Some are intangible, and the health and disability sector does not yet have good indicators for measuring them. The Ministry of Health will be working with Māori, DHBs and other sectors concerned with Māori wellbeing to develop appropriate measures in the second phase of development of He Korowai Oranga.

The health and disability sector must substantially improve the way it gathers information about whanau ora and Māori health status, including ethnicity data collection. From Strategy to Reality – the WAVE Report (Ministry of Health 2001) identifies strategic information goals for the health and disability sector and the steps needed to achieve them. The report focuses on the information management infrastructure needed to facilitate integrated care initiatives, increasing knowledge management capabilities and community access to data. One of its 10 key recommendations is to improve the reliability of ethnicity data.

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