Te Tai Tokerau / Northland Health Promotion Stocktake A report to inform the development of health promotion within Northland Primary Health Organisations October 2004 Authors: Russell Holmes, Te Tai Tokerau PHO Julie Palmer, Kaipara Care Incorporated PHO Ngaire Rae, Manaia Health PHO He Whakatauki Ehara taku toa i te toa takitahi, engari he toa takimano. Mine is not the strength of the individual, but the result of collective effort. Acknowledgement To the many health promoters who gave their time to contribute to this report, we were encouraged by their willingness to collaborate and share. We hope this report will be of use to all health promoters who work within Northland. We especially acknowledge Wendy Salter, employed up to September 2004, as the Northland Health Public Health Unit health promotion adviser to PHOs, who contributed in the initial stages to the formation and data gathering components of this report. We would also like to acknowledge the assistance of Gerry Philpott, Northland Public Health Unit administration support officer, and Karen Giles, Manaia Health PHO administrator who assisted with the report compilation. To our respective managers and boards we appreciate the support given to the process undertaken. Although the process has been protracted due to other priorities and projects taking precedence, our commitment to working together has strengthened and developed close relationships between our PHOs. Te Tai Tokerau/Northland Health Promotion Stocktake, October 2004 2 Contents Page Part One 1.1 Executive Summary 4 1.2 Introduction 7 Objectives 1.3 Background 7 PHO development PHOs and health promotion 1.4 Methodology 13 Process Strengths Limitations 1.5 Findings and Recommendations 15 Appendices Questionnaire 24 References 25 Part Two Organisational Listings 2.1 Regional / National A-Z 2.2 Manaia / Whangarei A-Z 2.3 KCI / Kaipara A-Z 2.4 Tai Tokerau / Mid and Far North A-Z Te Tai Tokerau/Northland Health Promotion Stocktake, October 2004 3 1.1 Executive Summary This report is in two parts. The first part describes the results of discussions with over 50 organisations involved in health promotion delivery within Northland. The second part is a directory providing basic information on each of these providers. This report was compiled by three PHOs – Manaia Health, Kaipara Care Incorporated and Te Tai Tokerau – all recently established within Northland. The objectives of this project were: 1. To identify what health promotion is occurring in Te Tai Tokerau to address the 13 New Zealand Health Strategy priority health objectives and to determine priority areas for development and action. 2. To identify organisations providing health promotion within the Tai Tokerau region. 3. To identify gaps and opportunities for PHO health promotion activity. 4. To inform current health promotion providers about PHOs and their potential health promotion role. 5. To establish relationships between health promotion providers and PHOs. 6. To contribute to the development of health promotion within Te Tai Tokerau. Although over 50 providers are covered in this report it is not a complete coverage of all health promotion providers. The Primary Health Care Strategy (Ministry of Health, 2001) includes a strong call for collaboration and co-ordination between services. This survey indicates that this is still an issue. The challenge will be to ensure that collaboration and co-ordination occur. This new health promotion funding is an opportunity for Northland to introduce new models of health promotion delivery that address health need; there is also a corresponding risk that PHO health promotion will duplicate existing services. The findings of this survey are briefly summarised below: • HP organisations in Te Tai Tokerau tend to focus their activities at the whole population end of the public health continuum with some operating across the entire continuum; • Decisions determining what HP activities are undertaken are guided by a range of factors, over half of which are either based on empirical / objective information or government priorities / MoH contracts; • Most organisations consult widely with other agencies, community and consumers, using a variety of methods such as surveys, face to face and public meetings and focus groups; • Most organisations report that their work is underpinned by either the Treaty of Waitangi or the Ottawa Charter, as well as other Maori models; • Most organisations are engaging in either one or more evaluation processes, utilising surveys, evaluation forms and consumer feedback, with a significant number using external evaluation; Te Tai Tokerau/Northland Health Promotion Stocktake, October 2004 4 • Most organisations see gaps and barriers occurring in the area of collaboration or co-ordination of services, many seeing a need for services to combine and deliver a co-ordinated and collaborative plan of action, both at local and regional levels; • The most common health issue seen as having a gap in service provision is nutrition; • Priority populations identified are: youth, families, Maori, older people and men; • PHOs were identified as having a key role in the facilitation of collaboration and the stocktake was mentioned as a useful tool for progressing partnerships and co- ordinated programmes; • Suggested opportunities to strengthen health promotion include: training, workforce development and mentoring, utilising community development methods to engage and work with communities, research into effective programmes and strategies, and that health promotion should move ‘beyond health education and look at structural issues’; • Many people see the development of PHOs as an opportunity for HP organisations to provide training to the primary healthcare workforce. Recommendations The authors of this survey make the following recommendations based on the findings: WORKFORCE DEVELOPMENT 1. That the PHO HP staff present the findings of the stocktake to the Tai Tokerau Health Promotion Network and the Tai Tokerau Public Health Association (PHA) branch, for consideration and discussion. 2. That the PHOs advocate to funders and HP training providers for increased training and workforce development for health promotion within Tai Tokerau. 3. That the PHOs, in conjunction with the Tai Tokerau HP Network and the Tai Tokerau PHA branch, facilitate the dissemination of information on effective HP theory and practice. 4. That the PHOs facilitate HP training opportunities for people in sectors outside the HP workforce. COLLABORATION 5. That the PHOs, along with the Tai Tokerau HP Network and the Tai Tokerau PHA, facilitate collaboration at local, regional and national levels. 6. That the PHOs enhance links between HP / community organisations and primary healthcare practitioners (especially practice nurses) to develop and strengthen HP skills. 7. That the PHOs where possible undertake consultation with providers who have similar communities of interest to avoid duplication and strengthen outcomes. Te Tai Tokerau/Northland Health Promotion Stocktake, October 2004 5 HEALTH PROMOTION DEVELOPMENT 8. That the PHOs support HP providers, especially regional providers, by facilitating access to primary health practitioners and communities. 9. That the PHOs work to strengthen HP activities which address national (NZHS 13 health objectives); regional (NDHB priorities - oral health, mental health, diabetes, cardiovascular); and local (community) priorities. 10. That the PHOs ensure their HP activities cover the public health continuum. 11. That PHO HP plans are based on Treaty of Waitangi principles, with consideration to the Ottawa Charter and other Maori models. 12. That the PHOs allocate resources to integrate external evaluation processes when planning interventions and programmes. 13. That the PHOs explore and participate in interventions, in collaboration with other agencies, which address the structural determinants of health (eg housing, nutrition). COMMUNITY PARTICIPATION 14. That the PHOs work collaboratively to strengthen participation of all their communities, including whanau, hapu and iwi, through appropriate and ongoing consultation and partnerships, including the involvement of community leaders in decision-making. Te Tai Tokerau/Northland Health Promotion Stocktake, October 2004 6 1.2 Introduction This Health Promotion (HP) stocktake has been undertaken by health promoters from Te Tai Tokerau PHO, Manaia Health PHO, and Kaipara Care Inc PHO. When the term ‘PHOs’ is used throughout this report it is in reference to these three PHOs. This report contains two parts. The first is a summary and analysis of discussions held with over 50 organisations delivering health promotion within Tai Tokerau. The analysis describes the consultation and evaluation processes, and the frameworks and evidence base underpinning HP decisions. We also explore where current HP in Northland occurs along a continuum of public health action, from individual through to a whole population approach. The gaps, barriers and opportunities for HP are identified, and a comparison is made between the NZHS 13 priority health objectives and existing HP within Te Tai Tokerau. From these findings recommendations have been developed. The second part provides a brief outline of each contributing organisation and information about the health promotion they undertake within the communities of Northland. This could provide a useful directory of health promotion providers. The objectives of this project were: 1. To identify what health promotion