I MASSEY UNIVERSITY DEPARTMENT OF MAORI STUDIES TE PUMANAWA HAUORA EFFECTIVE HEALTH POLICY FOR MAORI 0 A Strategic Framework for the Development of Mãori Health Policy A report prepared for Te Kete Hauora by CW Cunningham and SH Taite May 1997 JSTACK WA 300 [QI CON 1997 / Te Piamanawa Hamm Effective Health Policy For MAori 0 0 0 0 S S • • S • Advice to Te Kete Hauora on a Strategic Frameworkfor the Development ofMaori Health Policy CW Cunningham and S Taite May 1997 Inkmiation Centre Information Managernen Ministiy of Health Table of Contents Executive Summary Effective Health Policy for Mãori 4 Introduction Advice sought by Te Kete Hauora 6 Effective Health Policy for Mãori 7 Existing frameworks - effective health services for Mäori 8 He Taura T(eke - Measuring Effective Health Services for Maori 8 He Anga K7iakamana - A framework for the delivery of disability support services for Maori 12 The CHI audit model - culturally appropriate Public Health Services 15 Guidelines for purchasing personal mental health services for Maori 17 Rationalisation of the frameworks 19 First order criteria 19 Second order criteria 19 Third order criteria 19 Checklist Elements of framework - Effective Health Policy for Mãori 20 Checklist: Effective Health Policy for MAori - Supporting Information 23 Future work 29 Appendix 1: POLICY OUTCOME SUPPORTS MAORI HEALTH GAINS 30 RECOGNISESAND ADDRESSES THE DETERMINANTS OFMAORI HEALTH STATUS 30 ENABLES MAORI WORKFORCE DEVELOPMENT 31 ADDRESSES THE GOVERNMENTS HEALTH PRIORITIES 32 IS CONSISTENT WITH THE GOVERNMENT SMAORI DEVELOPMENTAND TREATY OF WAITANGI POLICIES 33 ADDRESSES HEALTH PRIORITIES OFMAORI 34 PROMOTES MAORI WISHES TO TAKE RESPONSIBILITY FOR THEIR 0 W HEALTH 35 USES A VA ILA BLE NATIONAL STANDARDSAND MEETS GOVERNMENT OBLIGATIONS 35 3 REQUIRES QUALJTYMAORI SOL UTIONSAND SPECIFICALLY SUPPORTS OUTCOMES SPECIFIED IN RELEVANT, EXISTING WISDOM 36 REQUIRES COMPETENT, SAFE AND EFFICACIOUS SERVICES 37 ENABLES MEANINGFUL DATA TO BE COLLECTED 37 PROMOTES GOALS WHICH RELATE TO MEASURABLE OUTCOMES 38 POLICY OUTCOME RESPONSIVE TO MAORI 39 IDENTIFIES MAORIASA RELEVANT TARGET GROUP 39 PROMOTES CHOICE FOR MAORI 40 RESPONDS TO DIVERSE MAORI REALITIES 40 RECOGNISESAND ADDRESSES MAORI DEVELOPMENT PRIORITIES 41 PROMOTES SEAMLESSNESS (OF SERVICESAND BETWEEN HEALTHAND DEVELOPMENT) 42 PROMOTES CULTURAL AFFIRMATION FOR MAORI 42 IMPROVESACCESSIBILITY FOR IvL4ORI BYADDRESSING KNOWN BARRIERS TO ACCESS 43 PROMOTESAND SUPPORTS INFORMED CHOICE 44 PROMOTES IMPROVED COMMUNICATION WITH MA0RI 44 SUPPORTS MAORI PREFERENCES FOR SERVICE PROVIDERS (INCLUDING SERVICES PROVIDED BYMAORI) 44 PROMOTES APPROPRIA TE. USE OF TE REO MAORI 45 PROMOTES LINKAGES TO MAORI INSTITUTIONS 45 POLICY DEVELOPMENT PROCESS RESPONSIVE TO MAORI 46 RESPECTS MAORI INTELLECTUAL PROPER TY RIGHTS 46 ACTIVELY INVOL VESMAORI IN POLICY DEVELOPMENT 46 A CTI VELYINVOL VESMAORI IN DECISION MA KING 47 CONSULTSMEANINGFULLY WITH MAORI 47 AFFIRMS MAORI CULTURAL VIEWPOINTS/IS CULTURALLY SAFE/USES TE REO MAORI CORRECTLY 48 ACKNOWLEDGES THE RIGHTS/SPECIAL NEEDS OF TANGA TA WHENUA 48 IDENTIFIES THE IMPACT ON CR0 WN/TANGA TA WHENUA REM TIONSHIP49 RESPECTS MAORIAND IN TURN DEVELOPS TRUST 49 POLICY DEVELOPMENT PROCESS IS ANALYTICALLY SOUND 50 IS BASED ONA RIGOROUS POLICY DEVELOPMENTMODEL 50 IS CLEARLY BASED ONA FRAMEWORK CONSISTENT WITH MAORI VIE W550 CLEARLY PROVIDES FOR A MONITORING PROCESS 50 MEANINGFULLY USES MAORI SPECIFIC DATA 51 IDENTIFIES MAORIASA RELEVANT TARGET GROUP 51 BIBLIOGRAPHY 52 4 Executive Summary Effective Health Policy for Mãon The Ministry of Healths policy analysts all contribute to the achievement of health gains for Maori through the high quality performance of their craft of policy analysis. In order that the Ministry of Health can better meet its responsibilities to the Government and Mori it is useful to consider that: • all policy developed within the Ministry of Health impacts on Maori in some way - it is not an issue of whether there is an impact but rather how much of an impact there is and how that is managed; yet there are priorities for Maori health; • a Maori analysis is as fundamental to the development of policy within the Ministry as an economic analysis is or at least it should be if the Ministry is to realistically address its commitment to Maori and, to advance Maori health as it is required to do. A framework for informing the policy development process, in order that more effective health policy for Maori is achieved, has been developed. The framework has three principal first order criteria (elements) based on reasonable expectations of effective health policy for Maori. Effective health policy should: • support health gains for Maori (policy outcomes); • be responsive to Maori needs and expectations (policy outcomes and policy development process); and, be analytically sound (policy development process). A checklist for policy analysts and supporting information are presented. The primary checklist, which appears on the following page (and page 23), interprets the meaning of the first order criteria identified above. A more comprehensive checklist (page 24-29) is intended to assist analysts by identifying the information needed by them and recommending the types of measures which may be incorporated into the specific policy. Finally, the bibliography (Appendix 1) references statements drawn from the background literature in support of the elements of the checklist. "5 Effective Health--------- ------------ Policy For Maori V. policy outcome supports Mãori policy outcome is responsive health gains to MAori • recognises and addresses the determinants of • identifies Maori as a relevant target group Maori health • promotes choice for Maori • enables Mãon workforce development • responds to diverse Maori realities • addresses the Governments health priorities • recognises and addresses Maori development • is consistent with the Governments Mãori priorities Development and Treaty policies • promotes seamlessness (of services, and, • addresses health priorities of Maori between health and development) • promotes Mäori wishes to take responsibility for • promotes cultural affirmation for Mãori their own health • improves accessibility for Maori by addressing • uses available national standards and meets known barriers to access Government obligations • promotes and supports informed choice • requires quality Maori solutions and specifically • promotes improved communication with Maori supports outcomes specified in relevant, existing • supports Maori preferences for service providers wisdom (including services provided by Maori) • requires competent, safe and efficacious services • promotes appropriate use of te reo Mori • enables meaningful data to be collected • promotes linkages to MAori institutions • promotes goals which relate to measurable outcomes policy development process is policy development process is analytically sound responsive to Mãori is based on a rigorous policy development model • respects Maori intellectual property rights (management sign-off, consultation with Te Kete • actively involves Maori in policy development HauoralMaori Advisors (audit trail)) • actively involves Maori in decision making • is clearly based on a framework consistent with Mãori views (Treaty of Waitangi, Whare Tapa • consults meaningfully with Maori Wha) • affirms Maori cultural viewpoints • clearly provides for a monitoring process • is culturally safe; uses te reo Maori correctly • meaningfully uses Maori specific data • acknowledges the rights/special needs of tangata • identifies Maori as a relevant target group whenua • identifies the impact on Crown/tangata whenua relationship • respects Maori and in turn develops trust • all policy developed within the Ministry of Health will impact on Maori in some way therefore it is not an issue of whether there is an impact but rather how much of an impact there is and how well we manage that impact; • a Maori analysis is as fundamental as an economic analysis to the development of policy within the Ministry if we are to realistically address our commitment to Maori and, to advance Maori health as we are required to do. introduction AdYice sought by Te Kete Hauora A number of frameworks have recently been proposed to describe effective health services for Maori. These frameworks are listed in Table 1, and include He Taura Tieke: Measuring Effective Health Services for Maori which was produced by the Ministry of Health in 1995/62. Table]: Frameworks - Health Services for Maori. Senice Area• - - : Framework . - Author .. Personal Health is f-Ic Taura Tieke: Population Health Measuring Effective Health Services. Ministry Services for Mori Health Mental Health Services Ic Ptirnanawa Hauora for thei.Ministry ot I kahh The advice sought from Te Pumanawa Hauora was the reconciliation of these frameworks and the development of a central framework for the development of strategic Mori health policy which takes the same approach to policy development that these frameworks take to service delivery. Importantly, many of these frameworks take the approach of enabling service providers themselves to analyse and improve their own delivery by encouraging self audit. The frameworks also provide information based on expectations of Maori as service consumers. Population Health Services Section (1995), He Taura Treke - Measuring Effective Health Services for Mabri, Ministry of Health, Wellington. 2 11e Taura Tieke is currently being evaluated by Te Pumanawa Hauora. 3 M Ratima, MR Dune, GR Allan, PS Morrison, A Gillies