Ngati He and Ngai Te Ahi are two hapu in Tauranga Moana. Together they have formed Ngati He, Ngai Te Ahi Hauora (the Hauora), a kaupapa Maori health organisation to drive improvement in the health and wellness of their whanau. The Hauora has been delivering services to their community for almost a decade and this time has been a time of learning for the trustees, staff and community.
The face of the health sector is changing at both local and national levels, the current set of reforms began in 2001 and these have led to increased focus on locally responsive and led services. As a result, the Hauora trustees have started to consider how their priorities are set and how non-Maori have influenced their decisions regarding service provision.
Western Bay of Plenty Primary Health Organisation (WBOPPHO) recently approached the Hauora along with other kaupapa Maori providers in the area requesting that they conduct a needs assessment of their constituent hapu. The proposed needs assessment was intended to align with previous work conducted by the Bay of Plenty District Health Board (BOPDHB) and the WBOPPHO. However, the Hauora identified that the illness focused indicators of health utilized by these agencies were at odds with the wellness focused, kaupapa Maori approach espoused by their own people.
The Hauora is developing their own approach to needs assessment utilizing their own people’s concepts of health / wellness, identifying their own health aspirations and the support needed to maintain whanau ora. This report details the initial work in this ongoing process. Background The need to address specific health issues within Maori communities has been identified by the Ministry of Health (MoH) (MoH 2000, 2002, 2002b, Public Health Intelligence 2006), BOPDHB (BOPDHB 2005, BOPDHB 2006) and the WBOPPHO (Carter 2005, WBOPPHO 2005).
The evidence to support this need has been gathered through epidemiological processes led by the BOPDHB and the MoH’s Public Health Intelligence Unit, consultation has been undertaken in developing plans however, this has been done at an Iwi level across the Bay of Plenty (BOPDHB 2006) and given that it is the hapu that deliver health services within Tauranga Moana, this has created frustration within the existing kaupapa Maori health organisations.
The New Zealand Health Strategy (MoH 2000) identifies a need for “relevant information to improve decision making… at community level, enabling a greater role in decision making by communities” and this is further developed for Maori in the Regional Health Needs Assessment Project where Mitchell (2001) asserts that “meaningful involvement of Maori in the needs assessment process is a Treaty right, and it is essential to ensure that the needs assessment leads to improved health for Maori”.
The majority of Maori providers have identified that being able to define their own health need is essential in achieving long-term and sustainable gains (Mitchell 2001) and Te Puni Kokiri (cited in Mitchell 2001) echoes this, identifying that “wider holistic concepts of health such as wellbeing and family are [also] considered important factors in health outcomes for Maori”.
Given the above, it is interesting to note that whilst the BOPDHB health needs assessment (2005) identifies the need to work with communities to improve their wellness, it remains focused on illness and fails to take into account Maori concepts of health in its use of indicators and identification of priorities.
The WBOPPHO have utilized similar data to conclude that “Maori have the highest health needs of any ethnic group in the PHO” (Carter 2005) and it is encouraging to note that this organisation has identified that local research on Maori health is needed to ensure that health development is appropriate and evidence based. The disappointment is that the PHO is requesting that kaupapa Maori organisations utilize illness rates as a means of measuring health rather than the holistic wellness focused models used by the Hauora and other kaupapa Maori health providers.