Priorities

Engaging whānau voice

Commissioning and contracting

Localities, planning, and coordination

Data, analytics, and sovereignty

2021 survey results show that whānau Māori in Wairarapa see hauora as a broad concept that involves feeling physically and mentally well, both as individuals and as whānau. Core to good health for our whānau is living well as whānau.

“Happiness, laughing, eating well, a healthy home, being active, family time, time with friends and extended whānau, access to medical facilities, resting…”[1]

“A few whānau are doing well, others are not. Some have had regular well-paid jobs and now own homes. Some have not. Some have been incarcerated and that disadvantaged their employment prospects hugely. They now struggle income-wise and are government dependent, and [their] health is very poor.”[2]

A recent study into the lived experiences of tāngata whaikaha Māori (Māori with lived experience of disability) in our rohe, funded by local DHBs, also highlighted a lack of information available to whānau about the services available in the Wairarapa.

“I think we need a directory for anyone who has [a disability] … and not everybody has a laptop and if they’re my age not everyone wants a laptop.”[3]

Based on this information, we know that there needs to be attention placed on improving both the access to the ‘determinants of health’ (the things that keep us well) and to health and disability support services. Figure 1 provides a summary of these issues.

[1] Quote from Wairarapa DHB Māori Health Strategy: Submission data analysis profile (2021)

[2] Quote from Wairarapa DHB Māori Health Strategy: Submission data analysis profile (2021)

[3] Quote from McGregor, B., Jones, B., Baker, G., and Tuuta, M (2023). Less talking, more action: Views and Experiences of Tāngata Whaikaha Māori in Wairarapa (Report prepared for Te Aka Whai Ora). FERNZ, Wellington.

What whānau can expect from us

Engaging whānau voice is a core function for us. Whānau Māori in our rohe can expect:

• Regular opportunities to share views with us. We will aim to make these opportunities as accessible as possible and will use a range of approaches including online surveys, feedback forms in health provider waiting rooms, and in person kōrero
• We will take what we hear seriously, and we will take actions within our remit to address the issues shared with us, including advocating for issues most important to whānau to Crown agencies
• We will be transparent and feed back to whānau regularly on the progress we make, including through advocacy, monitoring of the Crown, commissioning, and decisions around localities.

What we expect of health agencies

We expect that health agencies will act in good faith to support our mahi in engaging with whānau, including through fair and reasonable resourcing.

Part of acting in good faith is respecting our relationship with whānau in our rohe. We know that having multiple agencies trying to extract views and mātauranga can be exhausting and confusing for whānau, so we expect that our partners will cease this type of practice and work with us to engage more thoughtfully with whānau Māori.

We also expect that health agencies will act on issues we raise on behalf of whānau Māori, and report to us on their progress to address the issues we raise. This includes an expectation that Te Whatu Ora will coordinate and work with other government agencies where necessary, so that neither whānau nor Te Poari are left trying to navigate the confusing silos of government.

First year commitments

In the first 12 months of this plan we commit to:

• Developing a communications plan looking at how we will kōrero with whānau, how to get information about our mahi to whānau in our rohe, and how we share insights with Crown partners – in particular Te Whatu Ora
• Providing a digital platform so that all whānau Māori in Wairarapa can access information about Te Poari
• Holding regular gatherings and events across the different communities in the Wairarapa rohe, including those often overlooked by government consultation processes (such as tāngata whaikaha Māori, takatāpui, and rangatahi rōpū).

Within the first 18 months we will also explore how we can best support whānau to access their full rights (including freedom from discrimination and racism) in the health sector. Additionally we are committed to ensuring that tāngata whaikaha Māori and tāngata whaiora Māori have access to the full range of support services and health entitlements.

Many health services are delivered by community-based providers in our rohe (i.e., services provided outside of Masterton Hospital), usually under contract to Te Whatu Ora (although formerly this would have been through contracts to Wairarapa DHB or the Ministry of Health).

There is a large body of evidence that these contracting arrangements have disadvantaged Māori in the past. This includes a finding from the Waitangi Tribunal in 2019 that:

“The funding arrangements for the primary health care system do not adequately provide for kaupapa Māori models of care.”[1]

A big feature of the health sector reforms has been to put an emphasis on good quality commissioning rather than ad hoc contracting to address some of these concerns.

We know that this can sound like jargon! For us what this really means is that there will be:

• Intentional service design, based on the needs and aspirations of whānau and hapori Māori
• Sensible contract processes (without too many bureaucratic loopholes) and a focus on partnership and co-design
• Fair prices paid for services by government funders
• Effective performance monitoring – to make sure providers can show the positive impacts they are making for whānau Māori.

Te Poari will have an integral role in identifying and evaluating the health priorities of our rohe, alongside Te Whatu Ora. Through this collaborative effort, we will strive for more suitable contracting of all health services. It is our expectation that as a result contracted providers will better align their services with the needs and aspirations of whānau Māori.

In turn, this will mean more fairness in monitoring and accountability. High quality commissioning means that all providers will need to demonstrate their effectiveness and contribution to improved Māori health outcomes and the elimination of health inequities.

This priority area also reflects the interests of Te Poari in supporting the capacity and capability development of Kaupapa Māori providers in the Wairarapa. We believe in empowering these providers to expand their reach and enhance their services, ultimately contributing to the overall growth and well-being of our community. Through strategic partnerships and investments, we aim to create an environment that nurtures and facilitates their growth, ensuring that they can effectively meet the evolving needs of our whānau.

[1] Waitangi Tribunal (2019), p 116

What whānau can expect from us

As an IMPB, Te Poari are committed to fostering growth and development within our community. For whānau, a well-run commissioning process should lead to services from providers in the community that make more sense, are easier to find and use, and are more responsive to whānau Māori needs and aspirations.

Better commissioning means:

• More confidence that providers are meeting performance expectations and achieving outcomes that matter to whānau Māori
• More options, with a greater range of services offered through Kaupapa Māori providers, and in culturally safe ways (even if they seek services from mainstream providers)
• Removing or reducing the cost barriers to community health services.

What we expect of health agencies

We expect the health sector’s funding agencies (Te Whatu Ora) to take a collaborative approach to commissioning in our rohe. We expect to be at the table when key decisions on commissioning are made that affect whānau Māori in the Wairarapa.

We also expect that these agencies will:

• Design services around the needs, aspirations, and strengths of whānau and communities, based on the priorities identified through our whānau voice mahi
• Collaborate with other sectors so that there can be unified responses in our rohe to broad issues affecting hauora (such as housing and tāmariki wellbeing)
• Adopt approaches that reflect a commitment to Te Tiriti o Waitangi, including working in partnership with us and with kaupapa Māori providers and ensuring the level of investment in the Wairarapa rohe reflects and responds to the level of whānau health need in the area
• Be supportive of Māori models of care and interventions that focus on prevention of illness and supporting the wellbeing of whānau Māori (even when it falls outside of the Western medical model government is most comfortable with)
• Undertake effective monitoring of all health services, to make sure that wherever whānau Māori access services they can have trust and confidence that they will be accessing high quality, culturally safe care, free from racism and discrimination of any kind.

First year commitments

In the first 12 months of this plan, our focus will be on building our ability to lead and partner with health funding agencies on commissioning activity in the Wairarapa rohe.

This will rely heavily on our mahi to capture and share whānau voice (discussed in priority one), and will also include:

• Establishing a small commissioning team to lead the day-to-day mahi around commissioning on behalf of the Board (as part of building up essential infrastructure for commissioning)

Issuing the first of what we expect to be annual advice to government funders on whānau priorities for commissioning.

Localities have been introduced by the government to connect service providers, Iwi, and other stakeholders to collectively improve community health and wellbeing outcomes through better service design, planning, and coordination.

For whānau, hapū and Iwi, locality planning provides a more formalised way to be part of setting an agenda for health services in Wairarapa.

Te Poari intends to co-lead the development of a locality approach for the Wairarapa to be implemented by July 2024.

In many ways, this is something our tīpuna have advocated for since the Crown established its health systems more than a century ago. Whānau in the Wairarapa always fought for what was best for the health and wellbeing of our whānau, approaching all the decision-makers we could.

The Waitangi Tribunal, for example, notes several examples of Māori communities calling for greater access to services and health supplies in the 1880s through to the early 1900s – often to have these ignored by Ministers and government officials.

“In 1910, Mihi Reita, Tangi Matutaera, and 17 others based at Whakataki petitioned… to have medicines supplied through the local public school, as it was too difficult for them to travel to Masterton. There appears to have been no official response…”[1]

The geographical boundaries for localities are being determined in consultation with communities, Iwi Māori Partnership Boards, and local authorities. And we will be central to this discussion in the Wairarapa.[2]

We will also take a critical role in developing, with local service providers, community groups, and agencies who can contribute to hauora, a locality plan that shapes the services provided in the Wairarapa. The plan will focus on wellness, reflecting the needs and aspirations of whānau, ensuring joined up care and support services, and seek to improve the physical location of services so they are easier for whānau to access regardless of where in the Wairarapa they live.

[1] Waitangi Tribunal (2010) The Wairarapa Ki Tararua Report (Wai 863), Volume 1 (p. 340).

[2] Initially, twelve localities were selected to test how localities will work. These include a locality nearby in Horowhenua. However, there has not been a confirmed approach for localities in Wairarapa.

What whānau can expect from us

For whānau, the locality approach should mean that services offered in the Wairarapa are easier to access, more joined up (i.e., whānau will have to go to fewer places to seek support) and make more sense to everyone.

We know from the survey data Wairarapa DHB and Iwi Kainga collected in 2021, that for many whānau Māori in our rohe a locality approach would include looking at the health of our environment.

“More healthy kai, mara kai. Collective impact so more agencies/services [are] working smoothly together.” [1]

We will use this holistic approach to guide our work in locality planning.

Whānau can expect our first year of locality planning to mean:

• Whānau voices and priorities are reflected in plans and are given more prominence by local health service providers
• A focus on improved access to services, for example improved physical accessibility, longer or more useful service hours, and reduced waiting times to access services.

We know, for example, improved oral health, more transport options to primary care and hospital services, better access to disability support services, and better care of te taiao are issues for whānau in our rohe –this will be reflected in our locality planning.

What we expect of health agencies

The approach to localities is being run by Te Whatu Ora and we expect we will work in partnership with this agency to make decisions on the locality and its planning.

The support we understand health agencies will provide includes:

• Sharing examples of what has worked in other localities, and supporting us to work with other Iwi Māori Partnership Boards to learn from their experiences
• Providing tools such as Te Whatu Ora’s locality digital collaboration hub
• Supporting relationships between Te Poari and local health, social services, disability support service providers, and local councils. The support we will need will vary – at times we will be looking to Te Whatu Ora to facilitate relationships between us and contracted health services or other government agencies, while at others we will be expecting the health agencies to move aside so we can exercise rangatiratanga and build on our existing relationships.

First year commitments

In the first 12 months of this plan, we undertake to work with our partner agencies to:

• Develop and confirm a locality approach for our rohe
• Identify local priorities for the locality – based on whānau voices, health needs and aspirations
• Ensure the first Wairarapa Locality Plan incorporates a broad understanding of hauora and includes strong performance monitoring.

Within the first 18 months we will also establish an approach to monitoring the performance of the health system for whānau Māori in our rohe, against our locality plan, and share the results regularly with whānau.

[1] Quote from Wairarapa DHB Māori Health Strategy: Submission data analysis profile (2021)

Data tells stories. While in pre-colonial times we had control over our own data and stories, government processes have meant that for many decades data about Māori individuals and groups has been held in government archives and databases and, crucially, out of Māori hands. And similarly, the stories the data tells have been created by the Crown and not by whānau, hapū and Iwi.

Over the past twenty years, we have had access to a wide range of data on Māori health – thanks to improved ethnicity data collected through health providers and hospitals. This improvement has often been driven and advocated by Māori. However, there are still significant limitations in the data collected by the health sector. This includes a lack of data to show what is happening for tāngata whaikaha Māori, and a lack of good quality analysis that helps us determine the nature and extent of health inequities for Māori compared with non-Māori.

Through this priority area Te Poari will enhance data gathering, analysis, and sovereignty practices to ensure the governance, collection, management, and utilisation of data aligns with ethical standards and respects privacy while providing valuable insights. We will also embed tikanga me to mātauranga Māori practices into data we have responsibility for.  As part of this priority area, we will also work with Iwi across the motu to make sure they have access to information about whānau Māori with whakapapa connections to places outside of the Wairarapa.

For more information on Māori data sovereignty visit the website of Te Mana Raraunga (the Māori Data Sovereignty Network) – www.temanararaunga.maori.nz

This priority closely aligns to our priority around whānau voice, and the importance of looking at hauora from multiple viewpoints to get a more accurate and strengths-based picture of the needs and aspirations of whānau Māori.

The first year to 18 months of this priority area will involve understanding the data that is currently available through health and other government data, and ensuring it is analysed in a way that allows whānau Māori to be well informed and in control of the narratives around the data held by the Crown.

What whānau can expect from us

For us, a focus on data is about seeing more accurate reflections of the health priorities, needs, and aspirations of whānau Māori in our rohe, and greater accountability of health and other publicly funded services that contribute to hauora.

Whānau can expect that we will:

• Ensure high quality analysis of local health data, with a focus on ensuring equitable outcomes for whānau Māori
• Advocate for the collection of high quality, meaningful data – which includes supporting tāngata whaikaha Māori communities from our rohe to be part of national kōrero on disability data collection and analysis
• Work with our Iwi partners and Te Whatu Ora to ensure appropriate mechanisms are in place for Māori data sovereignty and so that Ngāti Kahungunu ki Wairarapa and Rangitāne o Wairarapa as mana whenua can exercise governance over collection, storage, access to and analysis of Iwi data.

What we expect of health agencies

We know that getting data issues right is an important to our government partners. We know that there is work already underway, for example, to further improve ethnicity data collection and that there is Kaupapa Māori Research underway looking into the best way to collect data for tāngata whaikaha Māori. We expect this to continue.

We also expect that:

• Te Whatu Ora will provide data we request, in easy to use and easy to understand formats
• There will be investment in local infrastructure to support Iwi data governance
• A commitment across all health and disability sector agencies to align with principles of Māori data sovereignty
• Greater accountability to whānau, hapū and Iwi for the use and publication of Māori data by government agencies.

First year commitments

In the first 12 months of this plan, we undertake to work with our partners to develop a monitoring dashboard for health services in our rohe. Related other activities include:

• Assessing the effectiveness and appropriateness of data collection methods in our rohe to ensure high quality analysis of local health data, with a focus on ensuring equitable outcomes for whānau Māori
• Establish a process to monitor and report on data quality, integrity, and insights for the rohe, so that eventually these can be shared quarterly by Te Poari
• Work with our Iwi partners and Te Whatu Ora to ensure appropriate mechanisms are in place for Māori data governance, in line with Te Kahui Raraunga Māori Data Governance Model.[1]

[1] Te Kāhui Raraunga resources on Māori data governance are available online, here.

The four priority areas of Toitū te Tangata are interrelated. For example, gathering and sharing whānau voice supports the needs assessment stage of commissioning, provides key information for service design and planning, and provides context to administrative health data. In the same way, monitoring progress in these priority areas needs to take a holistic approach.

Between now and July 2027, we see our work having three different phases, as set out in this diagram

Every six months, from December 2023, we will provide a summary of our activity and progress to whānau Māori, kaupapa Māori providers, hapū, and Iwi in our rohe. The summary will be focused on the key performance indicators set out in this plan.

We welcome feedback on how you would like to receive this information and encourage any thoughts be shared with us on [email address].