Magazine article Public Sector

Improving Health and Combating Inequality in the Bay of Plenty - Toi Ora

Magazine article Public Sector

Improving Health and Combating Inequality in the Bay of Plenty - Toi Ora

Article excerpt

Toi ora, optimum health and well-being for Maori, has been a strategic priority for the Bay of Plenty District Health Board since the inception of DHBs in 2001. The BOPDHB has as its vision the creation and maintenance of "healthy, thriving communities", explains Chief Executive Officer Phil Cammish.

"While this vision can be quantitatively measured, the vision's more important dimensions are qualitative. As a DHB, we have adopted a culturally based approach to the initiatives we take, to move our communities into this healthy and thriving state.

"For our Maori population, spread across the whole Bay of Plenty and encompassed by 18 iwi, this permissive, enabling and culturally oriented approach has seen a more ready acceptance of the health messages and our input into the well-being of their communities."

Critical to the success of the Toi Ora programme has been an enabling structure and the establishment of the DHB Maori Health Planning and Funding Unit. Janet McLean, the unit's General Manager, has direct accountability and responsibility for all Maori health funding and contracts and works with a dedicated Maori Health Planning and Funding Team.

A number of factors have driven Toi Ora, says McLean. "We have the highest number of iwi and the highest number of Maori providers compared with any other DHB. Maori represent 25 per cent of our population, the national average is 15 per cent, and there are a number of health-related inequalities between Maori and non-Maori, so there are some compelling drivers.

"Today's success has been a long time in the making, and involved three key phases," she says.

Phase One: Tino rangatiratanga - Maori will achieve toi ora

"The first phase was establishing meaningful partnerships with all 18 iwi, then building a strong working relationship between Maori Health Runanga representatives and the DHB to develop a joint strategy. Underpinning this was adopting Maori kaupapa through He Pou Oranga our 'Tangata Whenua Determinants of Health Framework' developed by the runanga, Maori leadership, tools and approaches to drive the change."

In hindsight, McLean believes that was key. "It's easy to take that relationship for granted. I hear stories of how other DHBs struggle with iwi partnerships. What has been really helpful has been establishing a Maori Health Runanga to represent all 18 iwi. The runanga provides strategic advice to the BOPDHB on issues that impact on BOP iwi and Maori communities. For that, I give credit to our Runanga Chairperson, Punohu McCausland, and also the 18 delegates representing the 18 iwi.

"We have spent a lot of time in the first three years building the capacity and capability of the runanga and that was time well invested."

This work included supporting a number of runanga-led initiatives, such as the development of the He Pou Oranga Framework, He Ritenga (a cultural audit tool), and iwi health plans.

McLean says this approach included ensuring Maori are involved at all decision-making levels within the DHB.

"Ensuring appropriate structures to facilitate effective Maori leadership at board and governance level with the Maori Health Runanga, at executive and operational levels with the Maori Health Planning and Funding Unit, and within the hospital itself was essential. Establishing Regional Maori Health Services and kaupapa Maori services for good cultural advice and practice at a hospital and provider level was also important."

Runanga Chair Punohu McCausland says the approach has been a success. "The runanga's goal is to improve the well-being of Maori. We believe to achieve toi ora for BOP Maori we must reduce health inequalities between Maori and non-Maori and through our initiatives we are starting to see the fruits of our efforts, 'Ka Puawai nga Hua'."

Phase Two: He ranga hua hauora - Building the capacity and capability of Maori providers and Maori communities

"The BOPDHB is proud of the fact we are the highest DHB investor of Maori non-governmental organisation providers in the country," continues McLean. …

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