1. General Practice Māori Health Plan Guidance

Māori Health Plan Guidance Document

Tūngia te ururua kia tupu whakaritorito te tupu o te harakeke Clear off the undergrowth so that the young shoots of the flax may grow vigorously (Whakatauki gifted to WBOP PHO by Dr Morehu Ngatoko Rahipere)

Māori Health Team & Network Services Team

May 2022

May 2022

Contents Context ............................................................................................................. 1 Why do we focus on Māori Health? ................................................................ 1 Rights: .................................................................................................................... 1 Needs: .................................................................................................................... 1 What is a Māori Health Plan? ......................................................................... 2 Using Data to Ensure Equitable Outcomes - Māori Health Profile .............. 3 Identification of Māori Enrolled with The Practice ............................................ 3 The Health Status of Māori Enrolled with The Practice ..................................... 3 Setting Practice Strategies and Priorities...................................................... 4 Equity Champion(s) ......................................................................................... 5 Rongoā Māori - Traditional Māori Methods of Healing ................................ 5 Key Linkages - Iwi Partnership ....................................................................... 6 National, Regional and Local Strategies ........................................................ 6 Te Tiriti o Waitangi ................................................................................................ 6 Primary Health Care System Principles .............................................................. 7 He Korowai Oranga: Māori Health Strategy ....................................................... 8 Whakamaua: Māori Health Action Plan .............................................................. 8 WBoP PHO Strategy - Te Toi Huarewa ................................................................ 8 Useful Resources ............................................................................................. 9 Appendix 1: Practice Gap Analysis ........................................................................ 10 Appendix 2: Māori Health Practice Snapshot ...................................................... 11

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Context Equity and equality are two strategies we can use to produce fairness. Equity is giving everyone what they need to be successful. Equality treats everyone the same. Equality aims to promote fairness, but it can only work if everyone starts from the same place and needs the same help.

Why do we focus on Māori Health?

All inequities are unfair, unjust, and avoidable. A focus on Māori Health is based on rights and needs.

Rights: • • •

Te Tiriti o Waitangi - founding document of Aotearoa. The Crown has a responsibility that includes the right to parity of health outcomes.

It is in legislation - in the New Zealand Public Health and Disability Act. Human Right - Human Rights dignifies individuals. There is evidence a Human Rights approach saves lives, reinforced by legal obligations.

Needs: •

Evidence/ facts that Māori have on average poorer health outcomes than nonMāori.

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There are a range of reasons for Māori Health inequities. We know that around 20% of health inequities are attributed to health, the other 80% come from social factors such as poverty, cold damp housing etc.

The impact of colonisation is wide reaching and still affects Māori today.

Acknowledging inequities exist is the first step in addressing inequities.

What is a Māori Health Plan?

Foundation Standard Māori Health Plan Tūroro | Patients - Indicator 3: Rights and health needs of Māori A Māori health plan is essential in addressing equity. It describes how the practice plans to reduce disparities and includes the practice’s Māori demographics. The plan can be linked to the local district health board or other primary health organisation’s Māori health plan. Practices should consider how they establish priorities for Māori health with Māori members of the community or Māori health providers. Practice team members should use the plan as a tool to ensure health equity for Māori is a target for new and existing priorities.

The Māori Health Plan Describes How the Practice Will: • •

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Commit to the Treaty of Waitangi and the principles articulated from the Wai 2575 claim.

Address Māori health equity priority areas and specific practice population issues for Māori to improve access to appropriate and affordable primary health services (the Government has identified a range of priority areas in He Korowai Oranga: Māori Health Strategy for improving Māori health).

Implement measures to address equity priority areas as stated in He Korowai Oranga: Māori Health Strategy.

Deliver targeted equitable services for the enrolled Māori population; ensure ethnicity data on Māori are available and robust; and establish priorities for Māori in the practice and set goals that will benefit their health outcomes.

Demonstrate that they are making additional efforts to address the needs of Māori.

These efforts might include: o Having specific targets and timelines, for example, measure statins in Māori versus non-Māori. o Encouraging enrolment of Māori patients on specific programmes such as Ministry of Health and district health board programmes in chronic care management. o Identifying and addressing any barriers for Māori to access the practice services (such as inaccessible appointments).

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What the Māori Health Plan Should Include: • • • • • • •

Identification of Māori enrolled with the practice.

The health status of Māori enrolled with the practice.

Description of the use of data and audits to develop health equity initiatives Key linkages (local, regional, and national), for example, with local Iwi. Strategies (both short-and long-term) to address equity issues.

How progress will be delivered, monitored and evaluated.

Examples of how collaborative relationships with Māori such as iwi and/or whānau ora collectives contribute to the wellbeing of Māori patients and whānau.

Reviewing your Māori Health Plan • • •

Review annually, or earlier if required.

Indicate in your plan when it was last reviewed, and next review date Review must be undertaken by the Clinical Governance team and then shared with the practice team

Using Data to Ensure Equitable Outcomes - Māori Health Profile Identification of Māori Enrolled with The Practice Suggest including percentage of Māori enrolled, and demographics such as gender etc.

This information can be found in the Thalamus Patient Enrolment Summary.

See example in Appendix Two: Māori Health Practice Snapshot.

The Health Status of Māori Enrolled with The Practice Undertake a review of Māori versus Non-Māori results across some of your practice’s services. Thalamus is a useful data source to undertake this review / audit. Some of the data points you could consider looking at are: • BOPPDHB ED Presentations • BOPDHB Secondary Care Inpatient • Covid Vaccination – Unvaccinated • Impaired Glucose Intolerance • MMR Fully Immunised (15-29y) • CVDRA • Immunisations – Two-year-olds • Immunisations – 8-month-olds • Cervical Screening • Smoking Brief Advice • Influenza Vaccination • Care Plus Registrations • DARS

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Please see the examples included in Appendix Two: Māori Health Practice Snapshot which identifies results for Māori and Non-Māori against the service areas above and may highlight inequities which could form the basis for equity strategies and action planning.

This reporting also identifies practice strengths.

Please contact your practice liaison or the WBOP PHO (Primary Healthcare Organizations) Māori Health Team if you would like assistance with analysing your practice data using an equity lens.

Setting Practice Strategies and Priorities Your Māori health plan should show how your practice uses data to establish practice strategies and priorities that deliver health outcomes. The WBOP PHO Māori Health Plan Template includes an ‘Actions Register’ to capture these, but these can be evidenced in other ways if preferred. The Network Services Team can support by providing performance reports for Practices.

Include details of any practice strategies (both short-and long-term) to address equity issues. Examples of this may include: • • •

How often and how is performance monitored? E.g., at morning huddles, are dashboard reports emailed/ displayed for staff?

Evidence of priorities for Māori in the practice and set goals that will benefit their health outcomes Evidence of practice making additional efforts to address the needs of Māori: - Having specific targets, strategies, and timelines - Encouraging enrolment of Māori patients on specific programmes such as Ministry of Health and District Health Board programmes in chronic care management.

- Identifying and addressing any barriers for Māori to access the practice services (such as inaccessible appointments).

If we do not measure inequity, we cannot monitor it.

If we are not measuring and monitoring, we cannot drive performance forward

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Equity Champion(s) To meet Foundation Standard 3.1, each practice is required to designate a champion/s for equity.

The Equity Champion position is a key role and plays a part in leading and championing efforts to reduce health inequities for Māori within the practice. The Equity Champion will ensure an evidence-based health equity approach is developed and implemented into tangible quality improvement actions within programmes, initiatives, roles, and existing services across the practice to enable the provision of high-quality services that will meet the needs of the population and in particular for Māori.

Your Māori Health plan should include details on Equity Champion(s) within the practice: • • • •

Who is your designated Equity Champion? What is their role?

How are they involved in contributing into leadership and strategic direction in the practice?

How has their role been clearly defined, with set expectations?

What support is available for them in this role?

For support in this - see WBOP PHO Equity Champion Position Description

Rongoā Māori - Traditional Māori Methods of Healing The Ministry of Health has, in collaboration with representatives from the rongoā sector, developed a voluntary standard that provides clear requirements for providers.

This standard defines a benchmark of excellence to deliver safe and quality rongoā services. The standard encourages and supports consistency of quality rongoā care and the ongoing development of the rongoā workforce.

The standards support practices to deliver kaiāwhina support for Māori patients, whānau and all health care workers in response to Māori patient requests for cultural assistance and pastoral care.

If your practice supports the delivery of safe and quality rongoā care, you should provide details of any services delivered within your Māori Health Plan – or indicate if this has been identified as an area of future development for your practice.

Things to consider: • • • •

Does your practice deliver safe and quality rongoā services?

What programmes are delivered/ what are the outcomes?

Do you offer kaiāwhina support?

How are the rongoā needs of your Māori population identified and delivered?

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Key Linkages - Iwi Partnership As a Bay of Plenty General Practice, we serve a large and diverse Māori population. It is acknowledged that we cannot achieve this journey towards equity on our own, and that developing relationships and increasing our partnerships with iwi, hapū, whānau, Māori community and other organisations is essential. This is a key part of ensuring Māori are the decision makers in their health and wellness journeys.

Your Māori Health Plan should include details of any collaborative relationships with iwi and/or whānau ora collectives, and how these relationships contribute to driving actions for your Māori patients and whānau.

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Do you have examples of whānau engagement or co-design activities? What were the outcomes – how did this make a difference?

If your practice has one, Iinclude a Memoranda of Understanding (MOU) between practice and Iwi. Please note: Ngāi te Rangi and Ngāti Ranginui are joint venture partners with Western Bay of Plenty Primary Care Providers Inc (Provider Inc) and together sets the strategic direction for Western Bay of Plenty PHO. It may help to refer to the PHO list of Kaupapa Māori Health Providers in Te Moana a Toi (Bay of Plenty)

National, Regional and Local Strategies Te Tiriti o Waitangi Te Tiriti o Waitangi is New Zealand’s founding document and forms part of New Zealand’s constitutional fabric. It is important that the Practices understand the Te Tiriti o Waitangi Articles and relevance to the Practice setting.

Article 1: Kawanatanga Supports meaningful Māori representation, kaitiakitanga and participation at all levels of our health system.

Article 2: Tino Rangatiratanga It is about self-determination. Implementing article 2 involves: addressing institutional racism within the Aotearoa New Zealand health system, applying Māori-centered models of health; using strength-based approaches that engage and involve Māori communities; and recognizing that Māori control and authority are critical to successful interventions.

Article 3: Ōritetanga This article is about equity and guarantees equity between Māori and other citizens of Aotearoa New Zealand, it requires action to work towards a steady improvement intentionally and systematically in Māori health. This involves considering the wider determinants of health, access to health care and the quality and appropriateness of services.

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Article 4: This article confirms the protection of Māori custom and the position of wairuatanga and of te reo and tikanga Māori.

Primary Health Care System Principles The above Articles provide a framework for meeting obligations under Te Tiriti, however, there is a national shift (recommended by the 2019 Hauora Report: Chapter 3) for the primary health care system to align with the following principles, applicable to the wider health and disability system: Tino rangatiratanga: The guarantee of tino rangatiratanga, which provides for Māori self-determination and mana motuhake in the design, delivery, and monitoring of health and disability services.

Equity: The principle of equity requires the Crown to commit to achieving equitable health outcomes for Māori.

Active protection: The principle of active protection, which requires the Crown to act, to the fullest extent practicable, to achieve equitable health outcomes for Māori. This includes ensuring that it, its agents, and its Treaty partner are well informed on the extent, and nature, of both Māori health outcomes and efforts to achieve Māori health equity.

Options: The principle of options, which requires the Crown to provide for and properly resource kaupapa Māori health and disability services. Furthermore, the Crown is obliged to ensure that all health and disability services are provided in a culturally appropriate way that recognises and supports the expression of hauora Māori models of care.

Partnership: The principle of partnership, which requires the Crown and Māori to work in partnership in the governance, design, delivery, and monitoring of health and disability services. Māori must be co-designers, with the Crown, of the primary health system for Māori.

For guidance on this see: • Hauora Report - Chapter 3 provides further context and insight • Ministry of Health Te Tiriti o Waitangi webpage.

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He Korowai Oranga: Māori Health Strategy Whakamaua: Māori Health Action Plan He Korowai Oranga: Māori Health Strategy sets the overarching framework that guides the Government and the Health and Disability system to achieve the best health outcomes for Māori, with the overarching aim of Pae Ora – healthy futures for Māori.

The Ministry of Health has a 5-year Māori Health Action Plan - Whakamaua: Māori Health Action Plan 2020-2025 The action plan guides the Ministry of Health (MoH), the whole Health and Disability system and Government to give effect to He Korowai Oranga. It sets out a suite of outcomes, objectives and priority areas for action that will contribute to the achievement of Pae Ora – healthy futures for Māori.

Whakamaua means ‘to secure, to grasp, to take hold of, to wear’. It is also widely associated with the whakataukī used in this plan; ‘Ko te pae tawhiti, whāia kia tata. Ko te pae tata, whakamaua kia tīna – Seek out the distant horizons, while cherishing those achievements at hand.’

The plan is underpinned by the MoHs new Te Tiriti o Waitangi framework – which provides a tool for the Health and Disability system to fulfil its stewardship obligations and special relationship between Māori and the Crown. Te Tiriti o Waitangi not only describes Crown obligations and Māori rights but is also a key improvement tool for achieving health equity and wellbeing for Māori.

Whakamaua is a living document with the ability to evolve in collaboration with Māori and the Health and Disability sector to ensure it meets existing and emerging needs and is well placed to achieve better health outcomes for Māori. The Ministry of Health will measure and report progress regularly as the plan moves forward.

WBoP PHO Strategy - Te Toi Huarewa Key activities below to improve Māori health outcomes: • •

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Māori models of health e.g., Te Whare Tapa Wha and how it could be incorporated.

Consumer engagement and Co-Design - ensuring patients and whānau who are directly impacted have a voice - WHY? Because we are all experts in our lives and should have the opportunity to play an active role in decisions that shape our lives.

Training - WBOP PHO Cultural Training Videos.

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Module 1 - Te Tiriti o Waitangi and Cultural Competence

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Module 2 – Racism and discrimination in all its forms, All forms of biases: conscious and unconscious biases

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Useful Resources •

Western Bay of Plenty Equity Policy Template

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Western Bay of Plenty Cultural Safety and Competence Policy Template

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Western Bay of Plenty – Equity Statement Example

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Patient/Whānau Survey Template (Te Mana Taurite)

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Equity Module 2021.1 Guidelines (Te Mana Taurite)

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WBOP PHO Bilingual Signage Guide

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Aramaho Health Centre - Draft Māori Health Plan 2021 - 2024

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Whakamaua: Māori Health Action Plan 2020-2025 | Ministry of Health NZ (New Zealand)

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2017/18 Māori Health Plan - Auckland and Waitemata DHB (District Health Boards)

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WBOP PHO Te Toi Huarewa

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Hauraki PHO – Annual and Māori Health Plan 2020-2021

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Primary Care Ethnicity Data Audit Toolkit

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Appendix 1: Practice Gap Analysis This is an optional tool that can be used to show how practices carry out gap analysis to identify priorities and plans.

Area of Analysis

Current State

e. g., Recruit a diverse workforce that meets their enrolled population needs

e.g., Does the practice have a strategic plan for recruiting a workforce to best support Māori patients and their whānau?

Ideal Sate Practice has a culturally intelligent team and team members acknowledge the importance of te reo Māori

Current State Compared to Ideal State The practice currently has one nurse who knows some te reo Māori

Gap Identified?

Yes

Gap Analysis

Plan to Address Gap

How can we increase Te Reo Māori capacity and capability within the Practice?

What support and training are required?

Support current team members to learn te reo Māori.

Deliver a Te Reo Māori Programme to support the Practice Team

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Appendix 2: Māori Health Practice Snapshot

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