E WAIKATO WOMEN's HEALTH ACTION CENTRE
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e WAIKATO WOMENS HEALTH ACTION CENTRE PAULI NE NORRIS V I V I E N N E M 0 R R E L L CAROLINE MASK ILL THE WAIKATO WOMENS HEALTH ACTION CENTRE (WWHAC) August 1987 - July 1988 Pauline Norris Vivienne Morrell Caroline Maskill Health Services Research and Development Unit Department of Health, PO Box 5013, Wellington, NZ - 1989 g? FOREWORD This report is part of a wider policy evaluation process. In 1986 the Department of Health established the Primary Health Care Initiatives Scheme, to fund a number of projects exploring alternative ways of delivering primary health care. The Initiatives Scheme funded several projects, including in 1987, three womens health centres. These were The Health Alternatives for Women (THAW) in Christchurch, the Dannevirke Womens Health Centre (DWHC) and the Waikato Womens Health Action Centre (WWHAC) in Hamilton. A separate unpublished evaluation report has been compiled on each of these centres. The information available has also formed part of a more comprehensive discussion document, which includes summaries of the evaluations of the three centres. This is published under the title Profiling Womens Health Centres : A Evaluation of a Primary Health Care Initiative. Copies are available from the Health Services Research and Development Unit, Department of Health, P 0 Box 5013, Wellington, for $15. DISCLAIMER The views expressed in this report are those of the authors and do not necessarily represent the policies or views of the Department of Health. ACKNOWLEDGEMENTS This research would not have been possible without the co-operation, time and energy of the women of the Waikato Womens Health Action Centre. Among other things they recorded their activities over the evaluation period, participated in interviews with the researchers, and read and discussed earlier drafts of this report. Thanks are also due to the people of Hamilton and nearby areas who participated in the community response interviews. Julie Bunnell designed the evaluation. She also Conducted some of the research before leaving the Department at the end of 1987. We are grateful to our colleagues at the Health Planning and Research Unit, Christchurch and the Health Services Research Development Unit, Wellington for th eir support. In particular we would like to thank Pauline Barnett and Penny Brander for their comments. Pauline Norris Vivienne Morrell Caroline Maskill SUMMARY OF KEY FINDINGS WWHAC (In Hamilton) officially opened to clients in August 1987. The WWHAC collective was formed from a group which began meeting during 1986. WWHACs main activities were providing information to women, individually or in groups, community work, cervical screening, networking with other agencies and advocacy. This range of activities is described in the report although some activities were difficult to evaluate. Over 90% of visitors and telephone callers were female and about 70% were in the 20-45 age group. Maori visitors and callers were,slightly under- represented compared with the Hamilton population, although ethnicity was not recorded for a third of the clients. The attenders of courses, workshops, seminars, speaking engagements and meetings came from a wide age range. The most common reasons for visits were health information (35%), counselling/support (19%) and inquiries/requests (17%). The most common reasons for telephone calls were inquiries/requests (29%), health information (25%) and counselling/support (13%). Client satisfaction was mainly assessed by the WWHAC workers. Attempts to gain this information from clients themselves were unsuccessful. Fifty-six percent of telephone callers and 64% of visitors were considered to be "very" or "somewhat" satisfied although for one third of the clients, the satisfaction level was not recorded. Ninety-four percent of courses, workshops and seminars and 85% of meetings and speaking engagements were rated as successful by the WWHAC organisers. Of the 24 clients who completed questionnaires, 59% were satisfied. A range of community and health groups were interviewed to gauge support for the centre. Fourteen of the 16 interviewees supported the centres continued existence. They perceived that the main impact of the centre was on women who used the centre, community agencies and support groups. I CONTENTS Foreword Acknowledgements Page Origins of the Well-women clinic initiative 1 The Evaluation - The aims of the evaluation 7 - The methods 7 - The process 9 - Data collected Background of WWHAC 12 WWRACs Account of their history 16 Activities of WWHAC 24 - The New House 24 - Drop-in and Phone Calls 25 - Referral 26 - Lunches 26 - Other Activitiesat the House 27 - Use of the House by Other Groups 27 - Speaking Engagements and Meetings 28 - Courses, Workshops and Seminars 28 - Major Projects 29 - Community Health Groups 31 - Other Activities 31 - Political Activities 32 - The Future 32 WWHAC: The people and the organisation 33 The users of WWHAC:profiles and satisfaction of levels 37 Funding and money 43 Community Response 46 Summary 55 References 57 Appendix A: Summary of log sheet data Appendix B: Record of speaking engagements and meetings Appendix C: Record of courses, workshops and seminars Appendix D: Smear campaign Appendix E: WWRAC Talking with your doctor I - I - WAIKATO WOMENS HEALTH ACTION CENTRE THE ORIGINS OF THE WELL-WOMEN CLINIC INITIATIVE The funding of pilot well-women clinics was part of a new initiative in primary health care. To understand its origins within the Health Department it is necessary to look at both this initiative and the work of the Womens Health Committee of the Board of Health in suggesting and promoting the concept of well-women clinics. The Women s Health Committee In 1985 the Womens Health Committee of the Board of Health was established. It was to advise the Board on matters relating to policy on New Zealand womens health, in particular to identify current and future needs in the area of womens health and to establish priorities. In order to determine the priorities, the Womens Health Committee called for submissions from the public. Many submissions calling for improvements in present services and new health care options for women were received. Thirty-three Iof these called for the establishment of well-women clinics, womens health centres or wellness centres. A member of the Womens Health Committee had visited well-women centres in Australia and the committee considered that this was a. n appropriate model for service delivery. Maria Brucker, secretary to the committee, prepared a paper summarising the submissions that had been made. Submissions suggested that well-womens centres "need to provide alternative types of care to traditional models" and promot[e] ... womens self-health , care". Well-womens clinics were seen to be community-based. Some argued that "the medical profession doesnt consider womens problems to be a priority". A well-womens clinic would provide women with information so that they could make informed health care choices and thus take responsibility for their own health. Clinics were seen as a form of effective illness prevention and health promotion as well as being involved in the early detection of disease. One person thought that centres should be run by lay people because "womens health has progressively become medicalised to the point where women now turn to the experts , for advice, treatment, care, etc on what are perfectly normal experience . s or social problems". I OWAO The following services were suggested: resources on physical and mental health, alternative medicine screening for illness, programmes related to mental health (eg, provide counselling, self-help groups, assertion training etc), advice on non-life threatening matters (eg, menstrual problems, pre menstrual tension, menopause, diet, stress, depression, , access to abortion, pregnancy testing). The Development of the Primary Health Care Initiatives Programme In June 1986 the Director General of Health (George Salmond) approached the Minister of Health (Michael Bassett) about the possibility of funding a new Primary Health Care Initiative. New projects would be given one-off funding as an experiment in alternative method(s) of delivering primary health care. The Minister agreed in principle to fund one or more primary health care initiatives, and requested that proposals be prepared and submitted. $637,000 was allocated to the initiatives. Proposals were developed under the auspices of an informal working party chaired by Dr. Bob Boyd, from the Clinical Services Division of the Department of Health. (Following the 1986 restructuring of the Department, the working party was serviced by the Primary Health Care Programme.) The Well-Womens Clinic Proposal The working party considered that it was appropriate for one initiative to be directed specifically at women and Dr Judith.-Johnston (Chairperson of the Womens Health Committee and Director of the Health Services Research and Development Unit) was asked to develop a proposal. The first proposal she developed outlined three options - a community health centre, well-women clinics, and small grants for womens health activities. Both the Primary Health Care Programme and the Minister of Health supported the well-women clinic proposal. This was outlined in more detail in a further proposal. This noted that women were expressing increasing dissatisfaction with various aspects of health care services, in particular: "the lack of health advice and education for women" "the emphasis on curative rather than preventive medicine