Maori Health Plan

2 September 2003

In the coming 12 months from July 2003 to June 2004, Kaipara Care Incorporated (KCI) will achieve the outcomes outlined on page (4). In developing these objectives, KCI acknowledges the MOH document, He Korowai Oranga, input from staff and management of Te Ha O Te Oranga O Ngati Whatua, and a KCI board sub-committee dedicated to making this plan relevant and achievable. This plan also refers to the KCI Services to Improve Access and Health promotion plans, which have already been approved. In addition the plan includes KCI’s commitment to reporting against as many as possible of the Ministry of Health’s clinical performance indicators for PHOs. This is important because over time we intend to show steady improvement in health status for Maori.

Rangatiratanga, Building on the Gains, and Reducing Inequalities are 3 key threads that are “woven” throughout the He Korowai Oranga strategy. KCI’s commitment to these three themes can be demonstrated in our new governance structure, our history as a health coordination organisation, and our plans under Services to Improve Access and Health Promotion.

Thread 1 – Governance
Rangatiratanga (…Maori) control over the direction and shape of their own institutions, communities, and development as people)
The KCI board of 12 has two members from Te Runanga o Ngati Whatua and one representing Maori Health provider, Te Ha O Te Oranga O Ngati Whatua. This is an increase (since March 2003) of two. These board members have been represented on every KCI sub-committee since its inception as a PHO. These sub-committees include Health Promotion, Services to Improve Access, Nursing Innovations Employment, and Project Manager PerformanceReview. In addition, one is acting Chairperson for the PHO.

Thread 2 - Building on the Gains
KCI has 6 year history of coordinated care and shared contracts through its asthma and immunisation programmes, and diabetes projects. In addition, Te Ha and Dargaville Medical Centre have a long history of combined medical and nursing clinics hosted at the Te Ha premises in Dargaville and at outreach clinics at Ahikiwi, Waipoua, Pouto, Tinopai and Naumai.

The Asthma project works across Te Ha, DMC and KCI, with Te Ha the asthma specialist nurse provider, KCI the administrator/database holders, DMC the referrers and other primary providers. All are represented at two monthly project meetings to review progress and plan further enhancements. Currently, Maori being visited regularly with asthma outnumber non-Maori for the Kaipara by 207 to 155.

The immunisation project incorporates DMC and Te Ha efforts to achieve the highest possible completed childhood immunisation rates. A two monthly meeting reviews what is working and where possible gaps exist. Te Ha has a qualified home vaccinator who performs many catch-up immunisations on an outreach basis. Comparing lists between DMC and Te Ha is an important factor in achieving the current levels of completed vaccinations. Of the 729 0-2 year olds registered 211 or 29% are Maori.

The free Annual Diabetes Check is performed by a diabetes nurse specialist working from the medical centre. Our known diabetes population is 367. Of these 121 are Maori. 47% of Maori with diabetes took advantage of their free annual check last year. 64% of non-Maori had theirs. This disparity is consistent nationally.

Joint clinics at Te Ha and at outreach clinics are provided on a “koha” basis, meaning patients can pay a suggested $10 fee if they can afford it, but will not be asked to pay if they cannot. Through these clinics, which have long provided better access to those who are more comfortable in a culturally appropriate setting, or who have not had the means to pay at the Medical Centre, more complex and severe pathologies are often reported by DMC clinicians and Te Ha nurses.

Thread 3 - Reducing Inequalities
Through its Services to Improve Access and Health Promotion strategies, KCI demonstrates its commitment to improve Maori health. Each SIA project KCI will fund has had to demonstrate how it would satisfy Maori and high deprivation issues. The spend is summarised in the table below.

Summary of SIA Spend

SIA Projects

* $5000 allocated is contingent upon total yearly SIA funding yielding $103620 or more.

“Wrap Around” Services (3) from the list above will be offered by Te Ha in the form of a
Kori Kori a Iwi (exercise) and eating Programme for Kuia/Kaumatua (older population) and a parent/whanau group programme for young families. A coordinator will be employed to manage both activities

The Health Promotion spend in the first 12 months is dedicated to a project in Te Kopuru, a town of 1100 registrants of whom approximately 900 are Quintile 5 and 300 are Maori.

Consultation
A provider consultation hui has already been scheduled by Te Ha O Te Oranga O Ngati Whatua for July 28th. This consultation hui occurs regularly and is attended by Kuia and Kaumatua of Ngati Whatua in the Kaipara region, along with staff and management of Te Ha. This plan will be presented at this hui. After initial consultation KCI plan to facilitate or co-facilitate two hui per year to report on progress against the plan.

Clinical Performance Indicators and Targets
The table below summarises our approach to this nationally standard set of clinical indicators, and our ability to comply in the first year. A number of clinical indicators could have been chosen, but KCI recognises the need to benchmark with other organisations. In choosing these indicators for our Maori health plan our collection of these indicators for the whole registered population is implied, as comparisons will be apparent between Maori and non-Maori as well as Quintile variables. We think smoking status and cardiovascular risk will involve significant effort in providing complete data, and that it may take longer than 12 months to make progress in these areas.

Some of the performance indicators require more precise definitions.

Clinical Performance Indicators and Achievement Targets for KCI

(1) From: MOH-J Primrose Update Presentation to DHBNZ PHO Workshop 26th June