Amohia Boulton

Indigenous participation in the 'new' New Zealand health structure.

Objectives This paper presents preliminary evaluative findings from research on key areas of concern to Māori and forms part of a wider project on the 2001 health system reforms in New Zealand. The paper reports on the development and implementation of the Māori Health Strategy, representation in decision making at governance level in District Health Boards, the inclusion of the Treaty of Waitangi in legislation and workforce issues. Methods Key informant interviews with 35 MMāori and non-Māaori respondents, in addition to data from five case study districts, were thematically analysed to gain an understanding of views on the health system reforms to date. Results The development of a Māori Health Strategy and the mandatory inclusion of Māori in governance and consultation processes have had a positive effect on Māori participation in the public health sector. Whereas previously Māori participation was concentrated in health service provision, the inclusion of specific provisions in the New Zealand Public Health and Disability Act 2000 has resulted in greater Māori inclusion in governance, planning and decision-making roles. However, there are concerns over strategy implementation, sustainability and workforce development. Conclusions Overall, the findings at this stage indicate that there is support for the post-2000 model. Māori and non-Māori alike have identified positive features of the model that could go some way towards contributing to improved Māori health. However challenges still remain.

Taking account of culture: The contracting experience of Māori mental health providers

The major reforms in the New Zealand health sector during the 1990s resulted in a burgeoning in the numbers of Māori health providers, many of whom worked in the area of mental health. Occurring alongside these health reforms was an increased concern with public accountability and interest in measuring the performance of Crown (New Zealand Government) agencies. During 2001–2004, research was undertaken that sought to understand the mental health contracting experience from the point of view of Māori health providers. The research examined the experience of Māori mental health providers as they contract to deliver Māori mental health services in a health sector dominated by ‘Western’ or mainstream approaches to accountability, contracting, and performance measurement. This article presents one of the key findings from this research: that Māori mental health providers regularly and routinely work outside the scope of their contracts to deliver mental health services that are aligned with those values and norms enshrined in Māori culture.1 The types of additional burdens and responsibilities Māori face in contracting for mental health services within a mainstream health system, as well as the reasons for these ‘extra-contractual’ activities, are discussed. The article concludes that in the New Zealand health sector a contracting framework—one that takes account of the unique role tikanga (customs, practices) and kawa (protocols) play in Māori mental health service delivery—is required.

Assessing the capacity of the health services research community in Australia and New Zealand

BackgroundIn order to profile the health services research community in Australia and New Zealand and describe its capacity, a web-based survey was administered to members of the Health Services Research Association of Australia and New Zealand (HSRAANZ) and delegates of the HSRAANZs Third Health Services Research and Policy Conference.ResultsResponses were received from 191 individuals (68%). The responses of the 165 (86%) who conducted or managed health services research indicated that the health services research community in Australia and New Zealand is characterised by highly qualified professionals who have come to health services research via a range of academic and professional routes (including clinical backgrounds), the majority of whom are women aged between 35 and 54 who have mid- to senior- level appointments. They are primarily employed in universities and, to a lesser extent, government departments and health services. Although most are employed in full time positions, many are only able to devote part of their time to health services research, often juggling this with other professional roles. They rely heavily on external funding, as only half have core funding from their employing institution and around one third have employment contracts of one year or less. Many view issues around building the capacity of the health services research community and addressing funding deficits as crucial if health services research is to be translated into policy and practice. Despite the difficulties they face, most are positive about the support and advice available from peers in their work settings, and many are actively contributing to knowledge through academic and other written outputs.ConclusionIf health services research is to achieve its potential in Australia and New Zealand, policy-makers and funders must take the concerns of the health services research community seriously, foster its development, and contribute to maximising its capacity through a sustainable approach to funding. There is a clear need for a strategic approach, where the health services research community collaborates with competitive granting bodies and government departments to define and fund a research agenda that balances priority-driven and investigator-driven research and which provides support for training and career development.

Indigenous Peoples’ Health Care: New approaches to contracting and accountability at the public administration frontier

Abstract This article analyses reforms to contracting and accountability for indigenous primary health care organizations in Canada, New Zealand, and Australia. The reforms are presented as comparative case studies, the common reform features identified and their implications analysed. The reforms share important characteristics. Each proceeds from implicit recognition that indigenous organizations are ‘co-principals’ rather than simply agents in their relationship with government funders and regulators. There is a common tendency towards more relational forms of contracting; and tentative attempts to reconceptualize accountability. These ‘frontier’ cases have broad implications for social service contracting.

CONDUCTING EXCELLENT RESEARCH WITH INDIGENOUS COMMUNITIES Balancing Commitment to Community and Career

There has been a growing trend in New Zealand/Aotearoa for health research involving Māori (the indigenous people) to be conducted in partnership with Māori communities, iwi (tribes), hapū (sub-tribes) and whānau (extended families). Achieving excellence in indigenous health research which meets the standards both of the indigenous communities who partner in the research and the standards set by the academy, is often a complex and demanding objective. In this paper two Health Research Council Māori Postdoctoral Fellows explore the various challenges and tensions they have faced as researchers committed to undertaking excellent indigenous research in community-based settings, while at the same time growing their professional careers as academic researchers. The paper begins by briefly introducing the researchers and summarising the critical success factors they have shared in their respective academic journeys and the values they hold that have led to their involvement in community-based research. Two case studies of engagement in community-based research are then presented to illustrate the types of challenges faced by indigenous researchers who work both with communities and within university settings. The first case study is an iwi-based health and social services research centre while the second involves growing a research culture within an urban Māori community setting. The concept of indigenous research excellence is explored with particular reference to excellence as described by the communities themselves and to the criteria for excellence used by the Health Research Council of New Zealand to assess Māori health research proposals. The authors argue that while tensions do exist in trying to meet differing standards of excellence, managing the interface between these differing standards is a crucial activity undertaken by indigenous academic health researchers. The paper concludes by outlining the lessons and implications for the academy and the community of attempting to meet a set of dual aims, noting that while both aims can be realised, this requires researchers to skilfully balance their obligations to career and to community.

Indigenous research methodologies [Book Review]

Review(s) of: Indigenous research methodologies by Bagele Chilisa. Publisher/year: Sage, Los Angeles, 2011. Extent/type: 368 pages, paperback. Price: A

Maori Health Promotion: Challenges for Best Practice

56.95/NZ

Analysing contractual environments: lessons from Indigenous health in Canada, Australia and New Zealand.

81 from Footprint Books which offers a 15% discount to AES members, phone 1300 260 090 (within Australia) or +61 2 9997 3973 (from outside Australia), email , website for the latest prices ISBN: 978-1-4129-5882-0

Enacting Kaitiakitanga: Challenges and Complexities in the Governance and Ownership of Rongoā Research Information

Aim: This article presents results from an evaluation of a Māori obesity prevention initiative, Te Kahui Whai Ora—Healthy Lifestyles & Tamariki Programme, and questions whether the use of children as agents of change in health-promotion activity is best practice for Māori health promotion. Methods: Health promotion programme evaluation collected information on the activities, characteristics, context and impact of the programme. We report on data from document reviews and from interviews with 24 programme participants. Results: Improved self-esteem in children, enhanced cultural identity, emerging youth leadership qualities, strengthening of family relationships, and positive changes to lifestyle behaviours. Conclusions: Children can be very powerful agents of change in public health interventions; however, Māori health-promotion best practice demands that we be mindful of our responsibility to protect children and encourage healthy lifestyles in a way that empowers every member of the whānau (family). Collective effort, in conjunction with timely and appropriate stakeholder support, is necessary to reduce the burden of obesity on our population.