WHĀNAU ORA WHAT DOES IT MEAN IN PRACTICE ?

Dr Heather Gifford HSRAANZ Dec 2013

“Improving indigenous health and reducing disparities in health are key goals in both Australia and New Zealand, as well as in other countries. Indigenous-led health services research makes a significant contribution to our understanding of how to make health gains for indigenous peoples”

“Whānau Ora, an indigenous approach to wellbeing, is the most significant shift in thinking and acting that we have experienced in health services for Māori over the past two decades”

WHY ME?

• Whakauae: a well-established tribal research centre – indigenous research with indigenous people

• Engaged in action research with 3 Whānau Ora sites

across NZ • Have completed research with two sites and almost

finished research with a third site • Builds on previous research we have conducted on

whānau ora

• 1980s public sector reform

• Biculturalism and mainstreaming debate

• Māori demand for greater autonomy

• 1993 Establishment of kaupapa Māori services

• 2000 NZ Health and Disability Act

• 2002 He Korowai Oranga, the Māori Health Strategy-

Whānau Ora

• 2008 Whānau Ora adopted as policy

• 2010 launch of ‘Whānau Ora: Report of the Taskforce on

Whānau-Centred Initiatives

WHĀNAU ORA POLICY CONTEXT

• 2010 Whānau Ora collectives representing 150 providers

engaged

• Action researchers engaged to work alongside each

provider

• 2011 further budget allocation

• 2013 additional 8 collectives

• Now 34 collectives representing 180 providers

WHĀNAU ORA POLICY CONTEXT

Minister Responsible for Whānau Ora

Minister of Māori Affairs

Governance Group

Regional Leadership

Groups

Te Puni Kōkiri Regional Staff

Whānau Ora Collectives

Whānau

Re

gio

nal

WHĀNAU ORA LANDSCAPE

Wellington

MINISTER TARIANA TURIA

‘It takes a village to raise a child’ ‘..believe in change and in transforming lives’ ‘Restoring trusting relationships within whānau, between whānau, providers and navigators, & with state agencies’ ‘No-one else can do it for us’ ‘The most important thing is to achieve good outcomes for whānau'

Governance &

Leadership

Whānau Centred Practice

Work Force

Infrastructure &

Quality

Achieving Outcomes

Whānau Ora

THEME CONNECTIONS

• Whānau empowered to plan for, and take actions, to achieve their collective goals and aspirations

• Investment in collectives of providers to develop whānau-centred services

• building capacity and capability of providers to deliver services to whānau rather than individuals

• Support for cross sector and internally cohesive services

• Need for ‘joined-up’ policy, planning, service delivery approach

WHĀNAU ORA APPROACH

• Works with whānau as collective • About self-management and self-determination • Focus on life-course and intergenerational determinants • Strengths based approach • Coherent and competent service delivery • Based on cultural values and norms

WHAT ARE THE UNDERLYING PRINCIPLES?

WHAT’S DIFFERENT

Individuals Whānau

Transaction Transforming

Advocating Empowering

Issue focus Solution focus

Output Outcome

Funder driven Whānau driven

• Whānau are self-managing

• Whānau lead and live healthy lifestyles

• Whānau are participating fully in society

• Whānau are participating fully in Te Ao Māori

• Whānau are economically secure and successfully involved in wealth creation

• Whānau are cohesive, resilient and nuturing

WHĀNAU OUTCOMES

WHĀNAU ORA OUTCOMES

Whānau are Self-Managing and Empowered

Government Agencies are Effective in Designing and Implementing Whānau Ora

Providers are Effective in Delivering Whānau Ora

WHAT’S HAPPENED SO FAR

• A growing confidence in a collective approach • Navigation driving organisational change • A developing workforce combining inherent skills with

professional practice

• Whānau planning as a ‘change’ tool for whānau

• Resourcing and capacity needing to match whānau-centred service delivery

PROVIDER COLLECTIVES

34 collectives representing more than 180 providers; had to overcome a number of challenges

“We were kind of pushed together. We’ve had to have time to absorb that we are focused on building relationships, of establishing trust first, before trying to do anything else ... that takes time”

PROVIDER COLLECTIVES

Starting to see advantages of working together

“They weren’t as open as I thought but after I got to know them, I think trust has grown. You know, there’s more honesty and transparency – you don’t have to worry about them cutting your throat to get anything because you’ve all got the same thing in mind”

NAVIGATORS

What are the attributes for the role? “She’s everybody’s aunty, in a really good way. The results that we’ve had with some really difficult people have been because of the type of personality that she has ... her empathetic style and immediate acceptance by clients of her and the ability for whānau to feel relaxed and respected, means she is able to make progress with whānau who are struggling with social issues as well as the immediate health concern with which they present”

NAVIGATORS

What do they do?

• supporting whānau by assessing needs • assisting whānau to develop a plan • brokering services • Working with other agencies to ensure

effective service delivery • helping whānau to monitor plans • working towards autonomy

WHĀNAU ORA WORKFORCE

The workforce to drive Whānau Ora is currently being upskilled- this is a complex role that requires a wide range of skills and knowledge

CONTRACTING ENVIRONMENT

Whānau Ora is being implemented in what is still a competitive contracting environment with multiple reporting requirements and poor recognition of the additional work required to implement whānau ora

The system is slow to respond

WHĀNAU PLANS

Whānau planning can be an intervention in its own right; it is important to get whole whānau involvement; role of the provider is to support the development of goals and to work with the whānau to provide direction towards achieving them.

WHĀNAU ORA

Whānau are Self-Managing and Empowered- we are still working towards this and have mechanisms in place for this

to be achieved

Government Agencies are Effective in Designing and Implementing Whānau Ora- there has not been significant progress with this outcome and the wider environment has not changed sufficiently to meet the challenges of Whānau

Ora.

Providers are Effective in Delivering Whānau Ora- there has been a significant amount of change in the provider sector

over the last three years and we are reasonably prepared for the next part of whānau ora

CHALLENGES GOING FORWARD

Workforce capacity Continued commitment by government Need for structural changes that can support whānau

ora Changes will need to build on the work done over the

last two-three years and be clearly communicated to all stakeholders

Bed in emergent changes that have already occurred for the collectives

Need whānau and communities who are ready to embrace the opportunities being provided under whānau ora

MINISTER TARIANA TURIA

‘..believe in change and in transforming lives’ ‘No-one else can do it for us’ ‘The most important thing is to achieve good outcomes for whānau'