Maori Health

Te Whakapapa
With the Tai Tokerau tribes being Kaitiaki of Te Tiriti o Waitangi, it is logical that the Treaty of Waitangi should be the pre-eminent document that informs this plan. To supplement the Treaty, the Maori Health Providers in Te Tai Tokerau have developed the Tai Tokerau Maori Health Strategic Operational Plan 2004 – 2005. Our Treaty partners response comes from He Korowai Oranga – Maori Health Strategy 2002, Whakatataka – Maori Health Action Plan 2002 – 2005 the Northland DHB District Annual Plan 2005 – 2006 and the Strategic Plan Manaia Health PHO 2004 – 2005. The common tenet that all of these strategies has, is to assist the overall goal of whanau ora.

Te Tiriti
The Treaty provides a strategic framework for reducing health inequalities in Tai Tokerau through the three Crown developed principles of partnership, participation and protection:

funding Maori health and disabilities issues
taking account of the Manaia Health PHO population profile and health needs
building Maori provider capacity in service delivery
improving upon quality issues

Te Tahuhu
Tikanga : Manaia Health PHO acknowledges the value of our customs and beliefs as handed down by our ancestors. These taonga will be incorporated in the way we do things as a Company.

Partnership : Manaia Health PHO actively seeks to establish partnerships with other organisations and agencies to ensure that it can achieve its goal of improving the health status of Maori within its rohe.

Quality : Manaia Health PHO adopts a philosophy that emphasizes client focus; a team based approach and ensures the theme of “continuous improvement” is embedded within the culture of the organisation.

Excellence : Manaia Health PHO will strive to achieve the highest standards in its management and clinical practices. Standards should be measured against the following:

Accessibility
Relevance to need
Cultural acceptability
Equity
Efficiency
Effectiveness

Te Iwi
The mana whenua who have direct interests within the Manaia Health PHO rohe are: Te Parawhau, Te Uriroroi, Te Kahu o Torongare, Ngati Hau, Ngati Wai and Ngati Hine. It is their role as Kaitiaki to umbrella all people (manuhiri) belonging to other hapu and iwi during their time living within the Manaia Health PHO rohe. Marae within the Manaia Health PHO rohe are, Takahiwai, Terenga Paraoa, Pehiaweri, Akerama, Toetoe, Te Tarai o Rahiri, Taiharuru, Pataua, Te Maungarongo, Ngararatunua, Whakapara, Ngunguru, Otetao Reti, Tuparehuia, Matapouri, Whananaki, Mokau, Punaruku, Ngaiotonga, Whananaki, Korokota, Te Aroha, Parahaki, Nukutawhiti, Tau Henare.

All of the above hapu, with the exception of Ngati Wai, are hapu of the grouping known as Ngapuhi nui tonu. Ngati Wai, an autonomous iwi, are the descendants of Manaia from whom the PHO has taken its name. Through the passing of time and since Whangarei has grown to become the major commercial centre for Te Tai Tokerau, whanau from other tribal areas have moved to Whangarei to take advantage of the employment, housing and education opportunities. Maori predominate in the suburbs of Otangarei, Tukua o Punga (Tikipunga), Raumanga/Otaika and Onerahi.

Currently Maori representation on the Board of the Manaia Health PHO is via Terenga Paraoa Ltd. The shareholders of Terenga Paraoa are currently representatives from Kia Ora Ngatiwai, the Ngati Hine Health Trust, Te Puawaitanga O Otangarei, Te Parawhau/Uriroroi Trust, Ngati Hau Trust and Te Kahu o Torongare (vacant). While all of these groups represent their respective constituent groupings, it is the intention of Terenga Paraoa Ltd to also become more inclusive of other independent Maori providers like Pa o te Ora, Te Kahui Wahine, SIDS (Maori) etc. This will ensure that coverage is widened to include as many of the so few Maori health professionals get to participate in the process in a meaningful manner.

The Board of Terenga Paraoa Ltd also needs to be cognisant of the fact that Maori in the 0 to 25 year old age group number some 60% of the Maori population within the Manaia Health PHO rohe, so will have to also have a voice in the deliberations and discussions that affect their future. As well as the above intentions to be inclusive, the Board of Terenga Paraoa still needs to find a mechanism that allows Maori feedback to occur directly to Manaia Health PHO as and when the occasion might arise.

Snapshot of Maori Health
Maori experience poorer health in almost every category compared to other people in Northland. In Northland, Maori rates are almost double the total rates for adult mortality, ischaemic heart disease and cancer mortality, pneumonia and schizophrenia discharges. Recent research seems to suggest that despite the high number of Maori presenting with ischaemic heart disease issues, very few are referred to, or access coronary artery by-pass and graft procedures.

Condition	Year	Northland DHB		New Zealand
Condition	Year	Maori	Total	Maori	Total
Mortality
0 – 14 years	1996 – 98	170,2	101.7	105.9	66.9
15 + years	1996 – 98	1921.6	985.2	1497.4	920.7
Suicide rate	1996 – 98	25.0	18.3	18.3	14.8
IHD >15 years	1966 – 98	429.1	240.3	350.8	219.2
Cancer >15 years	1966 – 98	516.9	274.2	385.2	253.6
Unintentional injury >15 years	1966 – 98	68.0	44.6	22.4	11.6
Hospitalisation
Ambulatory Sensitive Hospitalisation	2000	1155.0	490.2	628.	355.9
Asthma	2000	455.5	239.5	331.8	200.6
Pneumonia	2000	831.8	422.7	558.4	293.9
Schizophrenia	2000	205.3	114.8	128.0	46.1
CABG	2000	65.0	62.2	55.9	66.9
Other
New Entrant hearing failure screening rate	1999 – 2000	19.1	13.7	13.1	7.7
Teenage pregnancy 16 – 19 yrs (per 1,000 live births	2001	69.6	48.6	68.7	33.4
Low birth weight	2000	7.6	6.3	7.6	6.6

The Whangarei District has a higher unemployment rate, lower incomes and poorer education levels than the National average. Maori are markedly disadvantaged in all areas.

Maori have a considerably shorter life expectancy than non Maori in both Tai Tokerau and New Zealand. Within the Northland context this disparity becomes more marked and Kuia can expect to live longer than Kaumatua.

	Northland		New Zealand
	Maori	Non Maori	Maori	Non Maori
Male	64.5	77.3	68.6	76.1
Female	69.2	82.4	73.3	81.3

The conditions where mortality is considered most preventable by primary health care are diabetes, ischaemic heart disease, coleo rectal cancer, suicide, cervical and breast cancer, and stroke.

Te Matarehu (Vision)
Whaia te huarahi ki te whei ao, ki te ao marama
Te Tahuhu (Mission)
Kia kotahi te hipapa o nga hoe

GOAL	ACTIVITIES	TIMELINE	MILESTONES
1. Whakatairanga Hauora Maori (Improving Maori Health Status)	1.1 Maori health status assessed through the accurate collection of ethnicity data and disease management activities		1.1.1 Focus on ethnicity data collection and appropriate disease management activities in conjunction with whanau
	1.2 Focus on agreed NDHB (Northland District Health Board) and TTMAPO (Tai Tokerau MAPO health gain priority areas, including supporting population health activities		1.2.1 Plan, implement, monitor and review increased focus on funding of services to Maori, especially approved health gain priority areas, including supporting population health activities
	1.3 Maori health needs prioritised together with Maori		1.3.1 Manaia Health PHO andTerenga Paraoa Ltd and Maori participate in ongoing Needs Assessment and Planning & Review processes
	1.4 Changes in Maori health monitored with Maori		1.4.1 Manaia Health PHO and Terenga Paraoa Ltd agree on monitoring programs 1.4.2 Manaia Health PHO and Terenga Paraoa Ltd actively pursue robust research into Maori health needs and programs through joint application to HRC and other research funding entities
2. Korero Ngatahi (Communication)	2.1 Develop and implement effective working relationships with Maori input		2.1.1 Agree and implement MoU (Memoranda of Understanding) with Maori Providers, Independent Maori service providers, marae and hapu 2.1.2 Interact regularly with a range of internal and external Maori communities
	2.2 Develop and implement effective funding and policy frameworks with Maori input		2.2.1 Have completed and implemented effective funding and policy frameworks with Maori
	2.3 Ensure support for continuum of care approach to whanau and clients		2.3.1 With Maori have implemented primary/secondary/tertiary interface and protocols so that whanau access to, receipt of, and discharge from hospital is managed to ensure continuum of cover
	2.4 Work with Maori Providers to support Maori led community development, in conjunction with other agencies		2.4.1 have completed several community development opportunities via Maori Providers (who one would assume best know their communities)
3. Mahi Ngatahi (Working Together)	3.1 Tiriti based relationship with Terenga Paraoa Ltd and Whangarei IPA at governance and operational levels		3.1.1 Completed MoU with Terenga Paraoa and Whangarei IPA that is treaty based
	3.2 Encourage and foster relationships with Maori community organisations and Maori Providers		3.2.1 Completed visits to at least 4 clusters of marae per year
	3.3 Gather and disseminate Maori specific information		3.3.1 Have completed a list of Maori for mail outs and sent out regular newsletters. 3.3.2 Developed a Manaia Health PHO website with a Maori bulletin board
4. Pukenga Kaimahi (Developing Workforce Potential)	4.1 Support Maori Provider and independent Maori service provider workforce development		4.1.1 To have assisted to develop, fund and implement Training Plans for Maori Provider groups
	4.2 Support the workforce development of Maori staff within the Manaia Health PHO		4.2.1 Developed and implemented HR Strategic directions ie career pathways for Maori staff
	4.3 Provide Tiriti and cultural appropriateness training opportunities for Manaia Health PHO staff and mainstream providers		4.3.1 Developed and delivered Tiriti and cultural appropriateness training for Manaia Health PHO and mainstream providers
	4.4 Encourage Maori to choose health careers as real opportunities		4.4.1 Have worked with Maori Providers and communities to develop and implemented strategies that increase the number of Maori health professionals within the Manaia Health PHO rohe
	4.5 Encourage Health and Education funders and institutions to engage with Maori on courses and training opportunities		4.5.1 To demonstrate effectiveness in assisting Maori to work with training institutions to address the imbalance of Maori in the health workforce within the Manaia Health PHO rohe. 4.5.2 Have established at least two scholarships to assist Maori studying in Nursing or Medicine
5. Hei Manu Kura (Being a Leader)	5.1 Ensure that clinical and cultural best practice guidelines, including ethnicity data collection and Maori pathways to care are developed, implemented and evaluated		5.1.1 Manaia Health PHO is recognised as a regional and national leader in Maori service provision with widespread Maori satisfaction at the quality of clinical and cultural practice
	5.2 Quality and accreditation processes meet Maori requirements		5.2.1 Ethnicity data collected and influences and informs funding and service planning 5.2.2 Maori requirements of quality and accreditation programs met with Maori involvement
	5.3 Sustainable Maori Provider development occurs		5.3.1 Sustainable Maori Providers and services developed with productive PHO/Provider relationships evident
	5.4 Develop internal and external Maori accountability frameworks and policies and ensure that they are met		5.4.1 to have satisfied Maori Providers, independent Maori service providers, marae and hapu that the accountability framework reflects Maori values and ethos and that they work successfully
	5.5 encourage, develop and evaluate innovative models of service integration		5.5.1 Have completed and delivered innovation workshops with the shareholders of Terenga Paraoa Ltd that develop innovative service delivery programs for Maori