Tairāwhiti He Urupare Rangapu Hauora Maori 2016/17 · Mahi a Atua Missed ... allow whānau to take...

Te Tairāwhiti He Urupare Rangapu Hauora Māori

2016/17

He Urupare Rangapu Tairāwhiti Māori Health Plan 2016/17 Page | 1

He Urupare Rangapu /Tairāwhiti Māori Health Plan 2016/17 Tairāwhiti District Health Board trading as Hauora Tairāwhiti

Published June 2016 by Hauora Tairāwhiti Private Bag 7001, Gisborne, 4010

He Urupare Rangapu is a companion document to the Hauora Tairāwhiti Annual Plan and is available on the Hauora Tairāwhiti

website: http://tdh-hauora.nz/

http://tdh-hauora.nz/


Table of Contents HE WHAKAWHETAI 3 HE KORERO WHAKATAKI 4 PAE ORA 7

Guiding Principles healthy futures HE ANGA MO TE NUINGA TANGATA 9

Population Profile TAIRĀWHITI MĀORI HEALTH PLAN HEALTH INDICATORS 2016-17 10 NATIONAL MĀORI HEALTH PROFILES 11 WHAKAATURANGA HUANGA 12

Data Quality and PHO Enrolments PUTANGA KI TE ORANGA 13

Access to Care HAUORA TAMARIKI 14

Child Health MATE PUKUPUKU 15

Cancer TUPEKA KORE 16

Tobacco WHAKATO KANO ARAI MATE 17

Immunisation HAUORA NIHO 18

Oral Health KAI HONOKOIWI 19

Rheumatic Fever HAUORA HINENGARO 20

Mental Health MATE TĀKAHA INAMATA I ARUARURAA 21

Sudden Unexplained Death in Infancy LOCAL MĀORI HEALTH PROFILES 22

Hauora Tairāwhiti Māori Health Workforce He kai hikareti Smoking He mate hei karo Avoidable Mortality Rates Tino Momona Obesity

KAUPAPA NEW INITIATIVES 25

Healthy Families Horouta Whanaunga and Cultural Motivations Ruia Whānau Initiative Mahi a Atua Missed Opportunities affecting Māori Health Literacy


He Whakawhetai

Ka tuku Whakawhetai ki te Atua Mo te mahana o te ra te kohimuhimu o te hau te waiora o te marangai. Mo te rere takaro o te awa Mo te mana oreore o te moana. Mo te tu totika a te kahikatea. Mo te waiata tioriori a te korimako A tae atu ra Ki te aroha o te tangata mo te tangata, whānau mo te whānau Te tino putake o te Ao Mauri ora! We give thanks to the Lord For the warmth of the sun The whisper of the wind The purity of the rain For the playful flow of the river For the restless power of the sea To the majestic stance of the Kahikatea tree To the sweet morning song of the bellbird Last but not least The love of people for people, family for family The way the world should be Let it be!


He korero whakataki

Tihei Mauriora!

Ki nga uri o nga maunga kamehameha o te rohe o Te Tairāwhiti Ara Ko Hikurangi, te toka whakairo, te maunga pupu tangata, te Iringa waka o Maui Tikitiki a Taranga ko Nukutaimemeha Ara Ko Maungahaumia, ka rapa haumi ka rapa punake, ka kitea haumi ka kitea punake, Ara Ko Manawaru, te waahi tuatahi I onokia ai te kumara e Hinehakirirangi, Ara Ko Te Kuri a Paoa, nga pari ma e mamae ra Tena Koutou Tena Koutou Tena Koutou katoa Tena hoki koutou i te maharatanga o ratou ma kua riro ki te Po Kua riro ki te kapunipunitanga o te Wairua Kua takahia atu ra e ratou te huanui I papatauria ai e te tapuae kauika tangata Kua mihia kua tangihia no reira ko te whakatau noa atu Ko ratou te hunga mate ki a ratou, ko tatou te hunga ora ki a tātou No reira tena tatou katoa.

Anei te purongo mahere e karangatia nei Ko Te Urupare Rangapu Hauora Māori o Te Tairāwhiti. Hei kaupapa hei whakaawe mai I a tatou ki te whai oranga. Mo o tatou hapori katoa, mo o tatou whānau katoa mo o tatou mokopuna hoki. Kia purea ke ai tatou e nga hau tamata e pupuhi mai nei I roto I o tatou wharua. Kia painaina ke ai tatou I raro I te ihi o te uranga o Tamanuitera. Kia whangaia ke ai tatou na te pataka kai o o tatou whenua momona me o tatou rawa moana. Kia whakaaio ai o tatou whakaaro me a tatou korero me te mahurutanga o to tatou noho tahi. Kia horahia ai nga manaakitanga a te Arikinui ki runga ki a tātou. Kia whakahuia mai enei rei katoa ko te whakapuawaitanga o nga moemoea me te whakatinanatanga o nga whakaaro a Kui ma a Koro ma ka hua mai. Ko te Pae Ora tenei!

Tena tatou te hunga ora e noho nei I to tatou rohe ataahua!

No na tata nei kua kaha rawa ke te korure a te hau I te rangai hauora puta noa I te motu. Ko te kaupapa kei te kokiritia he whakanekeneke hei whakapiki ake hei whakakaha ake hei whakapumau ake I to tatou oranga ahakoa nga piki me nga heke o te ohanga Ao kei te pakia mai ki Aotearoa nei. Ko te whainga matua ko te Pae Ora me ona wahanga ara te Mauri Ora, te Whānau Ora me te Wai Ora.

Ko o tatou kohungahunga me o tatou tamariki he taonga kamehameha kia mataara tonu tatou katoa ki te tiaki ki te awhi ki te whangai ki te waiu o te oranga ahakoa nga whakanekeneke hauora I te

motu me nga panonitanga o te Ao kei te whirowhiro haere. Kua huri ke nga whatu o te Hauora Tairāwhiti nei ki nga whakatakotoranga o te oranga ma nga tamariki Māori na reira ke te timata mahi ki te ata aro matawai me pehea ra te whakarereke I te punaha hauora hei whakapiki atu te oranga o te Whānau kia pakari ai te haerere a o tatou kohungahunga a o tatou tamariki I nga parae o o tatou kainga nei.

Ko etahi o nga matapono e whakahauhautia ana I te motu ko enei e whai ake nei. Ko te tumanako ma te whakapuawaitanga me te whakatinanatanga o enei matapono ka ngahoro te hua o te Pae Ora ki roto i o tatou kohungahunga i o tatou tamariki I o tatou whānau.

Kia kaha ra tatou ki te whakatutuki I enei e whai nei - Ko te whakamahi I te ahunga Pae Ora te tino takenga.

Kore rawa te oranga o nga tamariki Māori e taea te tango mai I te oranga o tona whānau. E whakaae ana ki te hiranga o te ohu tuakiri mo tetahi tamaiti Māori te takahitanga tuatahi ki te whakatutuki I te pumanawa nohopuku o tetahi ahunga ko te whānau kei waenganui I to ratou oranga.

Ka taea pea he ukauka panoni he ukauka angitu ma te whānau (a na reira ma nga tamariki Māori) mehemea kei roto te whānau ake I te mahi whakatakotoranga whakaaro hei whakaawe I a ratou.

Na te ahua titiro whakaroto I nga reanga ka marama te kite I te putake o te huhua o nga raruraru kei runga i nga tamariki Māori o naianei, no reira e tika ana me mihia , me whaitia ake.

He huhua nga hanga o tetahi wharatonga ratonga pingore; ko nga whakaritenga matua, kia rata nga ratonga , a, ka taea te whakarereke kia tutuki ai nga hiahia o nga whānau.

Ko te mahi ngatahi me te mahi hoatahi I waenganui whānau, pokapu hapori, iwi, kawanatanga a waenganui, a hau kainga , roopu whakahaere kore kawanatanga a me etahi kaipupuri paanga, kei waenganui enei I te mahi whakamana hononga mo tetahi tukunga ratonga pai rawa.

Ka ahei nga tamariki Māori katoa ki te whiwhi timatanga pai rawa atu pea ki to ratou oranga a ko te whai putanga ki nga ratonga hauora ki nga


ratonga matauranga etahi wahanga nui o taua timatanga.

Tera ka whakapiki ake I nga mea angitu ma nga tamariki Māori me te whānau kia hono atu ai ki to ratou tuakiri Māori.

Mo nga urupare ki nga take oranga ko te whai wahitanga mai o te tangata whenua me te Kawanatanga e mahi tahi ana ko tera te mea e hiahiatia ana. He whakapuakitanga tera o te tino Rangatiratanga me te Kawanatanga.

I nga rangai whakaratonga ko te mea nui rawa kia titiro nga kaimahi ki te hunga takitahi me te mea nei he mema ratou o te whānau a na runga I tera kia whakamahia a ratou waahi mahi kia rata ai ki nga whānau.

Tera e kaha ke atu ana te hapai I te mahi ngatahi I waenganui I te kawanatanga, I te iwi I nga hapori

me te hunga kaipakihi ki te kokiri huarahi ohanga hei rongoa mo te whakatakotoranga o te oranga ma kona ka rirotia ke ai e o tatou whānau katoa te tonuitanga.

Ko te tautoko I nga matua me nga kaitiaki ki roto I te mahi ka utua me te whakawhanake I tetahi ohu mahi ko nga huarahi waiwai e pa ana ki te whakamana whānau.

Ka hiahiatia he arotahi papahueke ki runga I te whakamarama mahi mo te hiki ake I nga tumanako me nga whakatutukitanga o te whānau I roto I te mahi whakatakoto mahere, whakatinana whakaratonga /punaha me te whakamatautau hua o te rangai hauora, te rangai papori me te rangai matauranga.

Tihei Mauriora!

The winds of change are upon us as we strive with you to bring Wellness and Healing to our whānau and community. An integrated pathway of community healthcare services, patient/whānau focused and closer to home is currently being planned. The landscape is changing with greater focus on clinical leadership, supported by evolving technological advancements to create earlier diagnosis and faster and better quality treatment options.

Timely access to these services, responding to unmet needs and building trusted relationships will be key enablers for this in Tairāwhiti. However the greatest and most important change lies with us and our whānau and will come through creating preventative options including better access to health information allowing us greater opportunity to self-manage our whānau health.

Whānau empowerment will be a crucial catalyst to allow whānau to take control of their Wellness from conception to Kaumatuatanga. Being proactive and taking care of ourselves by making the right food choices, exercising, avoiding high risk behaviour, and being proactive with early and regular health checks will help us rein in the current devastating ravages of heart disease, cancer, respiratory disease, diabetes and stroke. Pae Ora (Healthy Futures) and its three interconnected and mutually reinforcing elements of Mauri Ora (healthy individuals), Whānau Ora (healthy families) and Wai Ora (healthy environments) is a vital healing concept that we must implement and embrace every day!

We must focus our energy on our children and mokopuna and give them the best start in life. For

too long the system has failed to recognise and incorporate the refreshing vitality that a Pae Ora approach would bring to our society. We have to shift from being a wealth protecting society to become a health creating society – Total Wellbeing.

Underlying our own cultural change is the urgent need for the social determinants of health to be tackled and remedied. Collaboration between various sectors and fairer distribution of resources will help this. A Social

Investment approach for vulnerable whānau in areas such as access to warmer homes, better income levels, and free medical treatment would help make a lifesaving difference.

The winds of change are blowing: consequently any new integrated community health approach will need to ensure:

Our community (Maori health consumers) is listened to, and Māori values are recognised and valued

Inter-sectoral action in tackling social determinants.

Improving system performance through Pae Ora implementation in planning, service specification, data integrity and Results Accountability measurement.

Workforce development in creating a Pae Ora culture in service delivery.

Co-investing opportunities for inter-sectoral stakeholders.


An integrated and sustainable community health approach would anchor the following:

The application of Pae Ora is fundamental.

The wellbeing of Tamariki Māori is inextricable from the wellbeing of their whānau.

The importance of collective identity for a Māori child is the first step in realising the potential of a whānau centred approach to their wellbeing.

Enduring change and success for whānau (and Tamariki Māori) is possible where whānau themselves are engaged in decisions that affect them. The intergenerational nature of many problems facing Tamariki Māori be acknowledged and addressed.

Flexible service provisions can take a number of forms; the key requirements are that services are responsive and can adapt to the needs of whānau.

Collaboration and partnership between Whānau, community agencies, Iwi, local and central government, non-government organisations and other stakeholders is central to empowering relationships for delivering effective service.

All Tamariki Māori are entitled to have the best start in life, and high quality accessible healthcare is an important part of such a start.

Responses to wellbeing issues require the involvement of Tangata Whenua and Government working together, which is an expression of Tino Rangatiratanga and Kawanatanga.

Increasing opportunities for tamariki Māori and whānau to connect with their Māori identity.

Focussing more collaboration between government, iwi, communities and business on economic solutions that have proven to be effective.

In the service sector it is crucial that staff view individuals as members of whānau and accordingly make their work environments whānau friendly.

Supporting parents and caregivers into paid employment opportunities and workforce development are essential ways of empowering whānau.

A relentless focus on and accountability for raising whānau aspirations and achievements is needed in planning, implementation and evaluation in the health, social and education areas.

The winds of change are creating a vision of a future society. A social justice approach provides a vision of what is socially desirable, a society based

on equity, empowerment, the overcoming of structural disadvantage, freedom to define needs and have them met and the definition and guaranteeing of rights.

Providing an environmental perspective will provide a vision of what is feasible and outline the kind of society which will be viable in the long term: namely a society that will be based on holism, sustainability, diversity and balance.

A community based approach is a natural outcome of a commitment to decentralisation and participatory democracy. Participatory democracy requires that there be viable structures at a level which relates to people’s day to day experiences, where people will be able to participate effectively in decisions affecting their lives. For this the structures need to be meaningful for the people concerned, who need to experience a feeling of belonging and acceptance, otherwise genuine and effective participation will not eventuate. Such structures then reflect the commonly accepted elements of a community.

Community is consistent with empowerment models of change as it provides a framework for people to take effective decisions, and also with a needs based perspective, it can enable people more readily to define and articulate their felt needs and aspirations.

Let’s work together to create a community model unique to who we are as a people and which reflects our integral relationship with our environment.

Kia Kaha Ra Tatou!

PAE ORA GUIDING PRINCIPLES HEALTHY FUTURES

Te pae tawhiti, whaia kia tata Te pae tata whakamaua kia tina!

Aspire to future goals But first – consolidate the present ones

Hauora Tairāwhiti The Principle What It Looks Like?

WHAKARANGATIRA AWHI KOTAHITANGA AROHA

An inclusive approach that provides services and opportunities to all families and whānau.

Requires agencies to work together to meet the needs of the whole whānau rather than a single focus on individuals.

Whānau have the capacity to achieve the life they aspire to

Services flexible enough to support the direction whānau desire.

Supporting whānau to reinstate whakapapa, and strengthen relationships with marae, iwi and hapu.

Promote identity and support whānau to be self-sustainable and self-managing.

Develop strong whānau that are linked to their lands and seas instilling a strong sense of their environment

Understand the intrinsic link between identity and whānau wellness.

Building whānau collective capacity and strengths to enable whānau to achieve their economic, social and cultural aspirations and goals.

Utilise the strengths of whānau to influence and support the needs of individuals within the context of whānau.

Intergenerational transfer of local tikanga, knowledge and skills to increase improved health status in whānau

An educated and well informed whānau is well placed to prevent the prevalence of negative influences but instead focus on healthy lifestyles in the next generation.

The Kaitiaki (navigational) role is an important component as it assists whānau to identify strengths within the whānau

Listen to, assist and help facilitate whānau aspirations.

In Practice Hauora Tairāwhiti undertakes a co-design methodology to develop Pae Ora services, ensuring whānau

views and perspectives are integral in the wellness process.

Pae Ora is best supported when an integrated approach to care is enabled through outcome based

funding models that support holistic service provision for whānau.

There is a commitment to making a paradigm shift from delivering “whānau related” services to a more

purposeful “whānau centred approach” presenting as an opportunity to employ effective intervention

techniques.

Hauora Tairāwhiti actively encourages all providers including secondary care services to apply Pae Ora

principles in their everyday activity.


Hauora Tairāwhiti will develop and maintain an effective relationship with Te Pou Matakana1 the national

commissioning agent for Pae Ora to ensure a transparent flow of information is available at a local level to

whānau in Tairāwhiti.

Hauora Tairāwhiti will develop and implement its own Pae Ora strategy independent but congruent with

Te Pou Matakana concepts in order that whānau and providers gain maximum access to whānau centred

care at each level.

Hauora Tairāwhiti supports Tairāwhiti providers and whānau to develop a direct relationship with Te Pou

Matakana in order to increase whānau potential.

Hauora Tairāwhiti Actively supports Pae Ora initiatives that are being coordinated through the Pae Ora Collectives.

Continues to actively participate in inter sectoral initiatives with other partner agencies to improve social

determinants.

Supports Pae Ora Kaitiaki (navigator roles) as key contact points for whānau

Will align workforce strategy to support the capacity and capability building of a Pae Ora workforce

The Pae Ora philosophy requires a systems and contracting transformation to a collective outputs based

measurement of success.

Re-orientating practice and service provision to whānau centred models will need to address systemic

issues to enable a platform where all health workforces are empowered to actively support Pae Ora

principles and practice. This will require a significant shift in mind-set but also strong leadership for

success.

Hauora Tairāwhiti supports Pae Ora models That Are:

Integrated – can be applied across agencies or multi-disciplinary teams to ensure that service delivery is

joined up in way that it is easier and more accessible for whānau.

Comprehensive – ensuring whānau can access a full range of services or support and ensure strong

relationships with other providers enhance outcomes for whānau.

Operate within Te Ao Māori – services are confident in Te Ao Māori in their everyday work and create

opportunities for whānau to utilise the same principles within their own whānau

Focused on supporting the whānau as a whole and in its widest context.

Builds on whānau strengths and opportunities for whānau to achieve goals.

Increases whānau capacity – Kaitiaki (navigation) roles will support whānau to transition to independence

from services.

1 Te Pou Matakana the North Island Whānau Ora commissioning agency

http://www.tepoumatakana.com/


HE ANGA MO TE NUINGA TANGATA POPULATION PROFILE

Ka tere raoa ka tere pipi whaakao The strength of the people is in the

multitudes

Tairāwhiti is New Zealand’s most eastern district and has a land area of roughly 3% of the country with a

population density of 5.6 people per km2.

Tairāwhiti has a significantly higher proportion of residents identifying as Māori (48%) than the rest of the

country (15%).

Our Māori population is mostly young with around 48% under the age of 25 years, but we have a growing

ageing population.

Te Tairāwhiti Health Service Providers


Tairāwhiti Māori Health Plan Health Indicators 2016-17

Waiho ma te tāngata koe e mihi Let the community voice do the talking

Manake Tohu 2014/152 2015/16

3 2016/17

Pironga Māori Non

Māori Māori Non

Māori

Whakaaturanga Huanga Data Quality

% of Māori enrolled in PHOs 100% 96% 99% 97% 100%

Putanga ki te Oranga Access to Care

ASH rates per 100,000 for Māori4

0-04 yrs. 7,652 8,291 7551 7615 TBC

ASH rates per 100,000 for Māori 45-64 yrs.

5,881 3,625 5439 3486 TBC

Hauora Taitamariki Child Health

% 6 Weeks (fully or exclusively breastfed) 63% 74% 71% 72% >75%

% 3 Months (fully or exclusively breastfed)

51% 60% 45% 54% >60%

% 6 Months (receiving breast milk at 6 months)

62% 66% 65% 67% >65%

Mate Pukupuku Cancer

Breast Screening Rate, 50-69 Age Group 68% 73% 67% 73% ≥70%

Cervical Screening Rate, 25-69 Age Group 66% 78% 68% 73% ≥80%

Tupeka Tobacco

percentage of Māori mothers smokefree at 2 weeks postnatal

5

59% 72% 58% 69% >95%

Whakato Kano Arai Mate Immunisation

percentage of 8 Month babies fully immunised

91% 93% 94% 94% >95%

percentage of population 65 and over who are immunised against influenza

6

60% 62% 49% 41% >75%

Kai Honokoiwi Rheumatic Fever

Reduction in 3 year average of Rheumatic Fever Hospitalisations

7

8.5 per 100,000 8.4 per 100,0008 2.8 per

100,000

Hauora Niho Oral Health

Increase in preschool children enrolled in DHB funded dental services

90% 93% 88% 93% >95%

Hauora Hinengaro Mental Health

Mental Health Act: Section 29: Community treatment orders

49 16 40 11 Reduce disparity

Sudden Unexplained Death in Infancy (SUDI)

Decrease in the five year average rate of SUDI deaths per 1000

9

2.46 per

1000

0 per 1000

3.52 per

1000

0 per 1000

0.4 deaths per 1000

Māori live births

Percentage of Caregivers provided with SUDI information at Well Child Tamariki Ora Core Contact 1

10

New Measure for 2016/17

50% 68% 70%

2 2014/15 Baseline rates are as at 30 June 2015 unless otherwise stated

3 2015/16 results are as at 31 December 2015 unless otherwise stated

4 2015/16 ASH Rates are current as at 30 September 2015

5 Smoking rates at 2 weeks post-natal are as at 30 March 2015 for the 2014/15 year and as at 30 September 2015 for the 2015/16 year.

6 2015/16 65+ Influenza data was taken from the National Immunization Register and is for the 2015 Calendar year, these numbers do not include flu shots given by Pharmacists as they are not recorded on the NIR as yet or flu shots given at workplaces or community events. As such we would expect our true rates to be higher. 7 Rheumatic Fever target for 2016/17 is a two-thirds reduction in hospitalisations from the 3 year average, our 3 year average is 4 cases per year

8 2015/16 Rheumatic Fever rate current as at 31 March 2016.

9 The 5 year average rate for SUDI runs from 2005-2009 and 2010-2014 10 WCTO SUDI baseline is at 30 December 2014


NATIONAL MĀORI HEALTH PROFILES

The following priorities and associated indicators for Māori health have been identified nationally.

Within each of these profiles we have identified key actions, the whakaroa that underpins these, and the partners who will work alongside to achieve the desired outcomes for these actions.

Each profile has been structured in such a way to demonstrate Pae Ora as a meaningful holistic approach in improving the wellbeing of Māori.


WHAKAATURANGA HUANGA DATA QUALITY AND PHO ENROLMENTS

He waka eke noa We are all in this together

What do we want to achieve? We can ensure the care we deliver to patients and their whānau is appropriate to their level of need by, improving the quality of ethnicity data which will assist in informing service planning and the monitoring of activities.

Why is this important? Primary health care providers will only be fully engaged when whānau are at the centre of healthcare provision. A trusted and well-functioning relationship with a primary health team allows for conditions to be addressed at early stages. This will enable for the continuation of a long and happy life.

Who will we work with? PHO and primary care practices enrolment statistics are provided on a quarterly basis to our primary care partners, this allows the tracking of patient enrolment changes across district.

MEASURING OUR PERFORMANCE

How will we know we’re successful? How will we achieve this?

100% of Maori in Tairawhiti are enrolled in a PHO

Data Source: Ministry of Health PHO enrolment pivot tables

Hauora Tairāwhiti and primary care partners will ensure PHO enrolment levels for Māori remain at 100% through quarterly reporting to our local alliance team during 2016/17.

Hauora Tairāwhiti will undertake cultural audits of Palliative Care and Mental Health service providers using the He Ritenga cultural audit tool by June 2017. During the next three years this tool will be applied to services audit across Tairāwhiti.

Turanga Health and Ngati Porou Hauora provide health care in non-traditional settings such as maraes, shearing sheds and horticulture fields through mobile clinics and rural health nurses. As part of this service a person’s primary care enrolment status is checked, those without ac current primary care provider are encouraged and referred to local practices.

Health care providers across Tairāwhiti are increasingly working within the work place, i.e. flu jabs in the Gisborne Fisheries and at these opportunities a person’s enrolment status with primary care is checked and referred if necessary.

Enrolment with primary care partners is available at birth through the Badgernet maternity system in place at Gisborne Hospital.


PUTANGA KI TE ORANGA ACCESS TO CARE

I Te Aratauwhāiti, i Te Pūmotomoto ki Tikitiki-o-rangi

The entrance to the Upper Heaven is open

What do we want to achieve? Reducing Tairāwhiti Ambulatory Sensitive Hospitalisation (ASH) rates further towards the national rates requires improved interfaces between primary and secondary services. Improving access to primary care providers will allow for increased early interventions for Māori resulting in reduced ASH rates.

Why is this important? Any admission of a whānau member to hospital has an impact on family. With support from primary care providers Whānau can proactively manage certain conditions, such as those in the tables below. Whānau management of these conditions can help reduce disruption to whānau daily life that admissions to hospital can cause.

Who will we work with? Monthly reporting of ASH rates is provided our local alliance team. This provides for practice specific interventions to reduce avoidable admission rates.



ASH Rates for Maori in our region are at or below the national average.

Data Source: Ministry of Health Quarterly Reporting

The nurse practitioner Aged Care works across all facilities to reduce avoidable admissions from aged care facilities by supporting staff to reduce admissions from falls by Kaumatua/Kuia.

ASH rates are reported to local alliance teams monthly which highlights movements in ASH conditions. This reporting will be available at practice level by December 2016 allowing for targeted interventions in individual practices.

Reducing our high asthma and wheeze admission rates is a focus area for Hauora Tairāwhiti in 2016/17.

The E Tipu E Rea project will provide vulnerable children with oral health services by December 2016 which will impact our high rates of avoidable dental admissions

The advanced Primary Options programme supporting provision of a suite of services will be implemented by October 2016 and targeted at reducing avoidable admissions in areas such as cellulitis, asthma and diabetes.

Hauora Tairāwhiti will work collaboratively with primary care, secondary care and community NGO teams to reduce the incidence and burden of diabetes for our population through prevention, early identification and effective self-management services.


HAUORA TAMARIKI CHILD HEALTH

Tamariki koa, tamariki ora A happy child is a healthy one

What do we want to achieve? That every child in Tairāwhiti is given the best start in life.

Why is this important? Breast milk is considered the most complete food for infants, by encouraging the ‘breast is best’ message; our children will have a healthy start in life and have lower risks of SUDI, childhood obesity, type two diabetes later in life, and associated co-morbidities.

Who will we work with? Breastfeeding is promoted by all health care services as the safest, most appropriate infant feeding method from birth.


How will we know we’re successful? ≥75% of pepi are exclusive/fully breastfed at LMC Discharge ≥60% of pepi are exclusive/fully breastfed at 3 months ≥65% of pepi are receiving breastmilk at 6 months Data Source: Well Child Tamariki Ora Reporting

How will we achieve this?

Ensure the Well Child Tamariki Ora quality improvement framework is consistently applied across all providers in our district.

Improving breastfeeding rates is a focus area for the Well Child Tamariki Ora steering group (that contains DHB, primary care and community representatives) and rates will be monitored during their 2016/17 quarterly meetings.

Gisborne Hospital and Te Whare Hauora o Ngati Porou will aim to maintain their Baby Friendly Hospital accreditation for 2016/17 which helps ensure all mothers are fully supported with breastfeeding and will lead to improvements in our 6 week breastfeeding rates.

The E Tipu E Rea project will continue to provide wrap around services to support to mothers during pregnancy and into early childhood during 2016/17.

Hauora Tairāwhiti will continue to provide access to lactation consultants for mothers in Tairāwhiti during 2016/17. These consults impact directly on the drop off in breastfeeding rates currently seen in our 3 month rates.

A local pathway for addressing tongue ties in babies is well established and will be continue to be promoted as a way of increasing breastfeeding rates in Tairāwhiti during 2016/17.

Improving Tairāwhiti breastfeeding rates will be a focus area of the Tairāwhiti SUDI prevention plan to be developed by June 2016.

MATE PUKUPUKU CANCER

Kei muri te kiri The truth is revealed

What do we want to achieve? To reduce the impact of cancers on women in Tairāwhiti by increasing screening coverage rates for both breast cancer and cervical cancer.

Why is this important? If a woman develops breast or cervical cancer the impact on the whānau can be immense and unintended negative consequences can occur. Whānau engagement will help ensure our coverage rates improve resulting in cancers been picked up at earlier stages leading to the 5 year survival rate of cancer patients improving.

Who will we work with? Maori women and their whanau, community groups, PHO’s, health promoters, screening providers, Maori health providers and screening service funders.



≥80% of eligible women aged 25-69 have had a cervical screen in the past 3 years ≥70% of eligible women have had a breast screen in the past 2 years

Breast Screening Rates as at 31 December Data Source: National Screening Unit Coverage Data

Hauora Tairāwhiti will facilitate linkages across the district between PHOs, Māori NGOs, other community service providers and the new breast screen promotion services provider to provide a smooth integration to the district.

Cervical Screening

To reduce barriers to cervical screening for Māori women, funding is available to ensure priority women continue to receive free cervical screening.

Data matching will continue to be provided using practice records and National Cervical Screening Register records. This process will be used to work with providers to identify and screen priority group women who are unscreened or under-screened.

Turanga Health will continue to provide community outreach smear clinics during 2016/17 as part of their contracted service.

As part of the Hauora Tairāwhiti missed opportunities (previously called Did Not Attend) project, barriers to Māori women attending colposcopy services will be investigated and actions put in place to increase attendance.

Breast screening

To increase the number of Māori women in Tairawhiti breast screened the breast screening promotion provider will be supported to develop links with existing services. The prime objectives are the targeting of Māori women who are either under-screened or have yet to receive a screen.

Hauora Tairāwhiti will facilitate data matching between PHOs in our region and breast screening services providers to enable the identification of Māori women who remain unscreened or under screened.

Hauora Tairāwhiti will work with BreastScreen Aotearoa and the National Screening Unit to increase the geographic depth of reporting to enable more targeted initiatives to be put in place.


TUPEKA KORE TOBACCO

Kei riro i te taniwha huna i te po Lest we be taken by the hidden ogre

What do we want to achieve? To help achieve Smokefree Tairāwhiti 2025 we will focus on smoking cessation for hapu women, whānau and Smokefree environments.

Why is this important? Providing advice to smokers around quitting is shown to increase the chance of a quit attempt and providing support for this improves the likelihood of it being successful. Whānau can play a big part in supporting quit smoking attempts through not smoking in the home or the car, not smoking around younger family members and actively supporting those wishing to quit smoking. Reducing the opportunity for people to smoke reduces the likelihood of smoking initiation in younger generations.

Who will we work with? The focus for 2016/17 is to build closer working relationships for smoking cessation services with Lead Maternity Carers (LMCs), hospital midwife, GPs and Radiologists. With all services working together and sharing the same message we can move closer towards achieving Smokefree 2025.



≥95% of Maori mothers are Smokefree at 2 weeks postnatal

Data Source: Ministry of Health Report on Maternity 2014

Continue to support LMCs and primary care practices to provide active support during 2016/17 to pregnant women who smoke to quit as early as possible in pregnancy.

Increased alignment of cessation services during 2016/17 through the Tairāwhiti Tobacco Control plan will see our Māori smoking rates during and post pregnancy decrease.

The Tairāwhiti Tobacco control plan provides an emphasis on stopping smoking pre pregnancy, the success of this plan will impact on our 2 week postnatal smoking rates.

The Tairāwhiti SUDI prevention plan to be produced by June 2016 will have smoking cessation as a focus area as smoking has been shown to impact on the risk of a SUDI event.

Te Aka Ora – a Māori health provider - will lead whānau cessation support activities targeting young hapu women to be Smokefree in 2016/17.

The DHB will continue to provide Hospital sonographers with cessation training during 2016/17 allowing them to provide brief advice to pregnant women who smoke and refer them onto smoking cessation services.


WHAKATO KANO ARAI MATE IMMUNISATION

Rongo - whakatika i a Tu Be ever prepared

What do we want to achieve? At least 95% of infants have completed their primary course of immunisations at 8 months of age; and at least 75% of our 65+ population are vaccinated against Influenza.

Why is this important? Older people, young children, pregnant women, and people with certain medical conditions are at a higher risk of developing serious complications from vaccine preventable diseases than other population groups. If young or elderly become ill with a vaccine preventable disease the whole whanau will be impacted.

Who will we work with? The E Tipu E Rea (Conception to 5 Years) and NCHIP (National Child Health Platform) projects along with the NIR database will enable immunisation providers in Tairāwhiti to monitor our most vulnerable 5 years and under population’ allowing more opportunities to increase immunisation rates



≥95% of infants have completed their primary course of immunisations at 8 months of age; ≥75% of our 65+ population are vaccinated against Influenza.

The DHB immunisation team provides monthly monitoring reports to primary care partners in the district ensuring coverage rates are visible at all times.

A new immunisation governance forum with increased social sector presence will be established by June 2017.

The Māori Women’s Welfare League promote the importance of childhood immunisations as part of a national effort to ensure the 8 month target is met

Recording the Immunisation status of children seen by secondary care and providing opportunistic immunisations where applicable provides another avenue to ensuring immunisations targets are met.

The National Child Health Information Platform (NCHIP) will be fully operational during 2016/17 providing another tool to monitor childhood immunisations and reduce the number of missed immunisations through their child location service.

Increase the number people aged 65 years and over receiving free influenza vaccinations for the 2016/17 flu season through primary care providers such as Community Pharmacists.

Iwi Health providers will continue to promote and deliver influenza vaccination programmes at maraes and other settings during 2016/17 to ensure Kaumatua and Kuia receive free influenza vaccinations.

HAUORA NIHO ORAL HEALTH

Ko Tara-tara Kae tōna tohu He is identified by his teeth

What do we want to achieve? Our focus is on: Achieving the national target, and reducing the number of children overdue for their scheduled examinations.

Why is this important? Enrolling children at a young age with dental services establishes a habit of dentist visits for life and assists in ensuring teeth last a lifetime. By including the whole whānau during appointments we can demystify trips to the dentist, resulting in increased attendances and better oral health outcomes for our people.

Who will we work with? Our services are mobile and provide treatment at schools in the East Coast and Western rural areas by working alongside our primary care partners we can continue to increase access to those areas currently with low rates.



≥95% of children aged 0-4 years are enrolled in DHB funded dental services.

Data Source: Ministry of Health Quarterly reporting

Reducing the current arrears rate of children overdue for their scheduled examinations during 2016/17.

The Hauora Tairāwhiti Oral Health team leader is on the Ministry of Health national steering committee to supply toothbrushes/toothpaste to low decile neighbourhoods. These resources will be distributed before December 2016.

Continue the use of light illuminated dental mirrors delivering fluoride at kōhanga reo on the East Coast during 2016/17.

Monitor enrolments rates and provide referral outcomes to referrers at the end of each month during 2016/17.

Oral health services are included in the E Tipu E Rea project, and through this coordinated approach ‘at risk’ children will be targeted for a range of services including oral health during 2016/17.

KAI HONOKOIWI RHEUMATIC FEVER

He mate takere haea A death that cripples all

What do we want to achieve? Māori children are about 20 times more likely to be hospitalised for rheumatic fever than non-Māori children. Nationally the goal is to reduce rheumatic fever by two-thirds by 2017.

Why is this important? If left untreated it can lead to rheumatic heart disease and lifelong problems. Māori children and young adults (aged 4-19 years) have the highest rates of rheumatic fever in the country. Tairāwhiti’s rates reflect its high Māori and high deprivation population.

Who will we work with? There are a number of children and youth specific services already underway or planned all requiring primary care, secondary care and community involvement.



Our Rheumatic Fever Rate will be reduced to 2.8 hospitalisations per 100,000 people.

Data Source: Ministry of Health Better Public Services Rheumatic Fever Reports

The Tairāwhiti Rheumatic Fever Plan will be refreshed by December 2016 with involvement from DHB, PHO and Community partners.

A nurse led Rapid Response throat swabbing programme, is in place in all primary care practices across the district and will continue during 2016/17. This provides early intervention for positive swabs reducing the number of Rheumatic Fever cases.

The DHB will continue to support the community based Kaiawhina position during 2016/17.

The rheumatic fever governance group with representatives from DHB, Primary Care and Community will monitor rates and evaluate initiatives to reduce rheumatic fever rates across the district on a regular basis during 2016/17.

Rheumatic Fever cases are reported monthly to the Hauora Tairāwhiti Board ensuring this condition remains in the spotlight.

Please see the Tairāwhiti Rheumatic Fever Prevention Plan 2016-18 for more details on these activities. The plan is available at: http://www.tdh.org.nz/assets/Documents/Reviews-and-plans

http://www.tdh.org.nz/assets/Documents/Reviews-and-plans/TAIRAWHITI-RHF-PREVENTION-PLAN-2016-TO-2018.pdf


HAUORA HINENGARO MENTAL HEALTH

Kotahi te hiringa, ko Te Hiringa i te Mahara The truest power is that of the mind

What do we want to achieve?

Reduce the use of compulsory treatment orders (CTO’s) under the Mental Health (Compulsory Assessment and Treatment) Act 1992. Māori males are 4 times more likely to be subject to CTO’s under section 29 of the Mental Health Act 1992 than non-Māori.

Why is this important? Tairāwhiti’s high Māori population means the impact on whānau here is more far reaching. Compulsory treatment can be viewed as a form of punishment and reducing the use of these orders may help whanau partner with mental health services more effectively.

Who will we work with? A collaborative effort between clients, their whanau and mental health services during and following treatment is required to reduce our section 29 compulsory treatment rates.



The disparity between Maori and Non Maori Section 29 compulsory treatment rates is reduced.

Data Source: Hauora Tairāwhiti Mental Health Service monthly reporting

Mental Health Service providers will continue to ensure all people with serious mental illness and/or addiction write and use Recovery Action Plans by the end of 2016/17

Hauora Tairāwhiti will promote and grow the Mahi a Atua approach when dealing with Māori presenting to Mental Health services. This approach will expand into other areas of the DHB by the end of 2016/17.

Hauora Tairāwhiti will increase the support offered to service users by the Indigenous Psychiatrist during 2016/17 as part of the Mahi a Atua approach.

Provide service users with access to more cultural support staff through a realignment of roles to be completed by the December 2016.

The Whānau Ora advisor employed by Turanga Health has a voice in mental health and addiction service planning and evaluation and will participate in all sentinel event follow-ups where necessary during 2016/17.

All DHB mental health staff undertake cultural training by the end of 2016/17.

The equity framework will be embedded into practice for service reviews and redesign by the end of June 2017.


MATE TĀKAHA INAMATA I ARUARURAA SUDDEN UNEXPLAINED DEATH IN INFANCY

Maroro kokoti ihu waka tau The small fish crosses the path of death

What do we want to achieve?

Tairāwhiti has the fourth highest rate of SUDI incidences in the country. By promoting the 3 key messages in the Tairāwhiti SUDI plan, Safe Sleep, smokefree homes and breastfeeding our SUDI rates will decrease.

Why is this important? The impact of the death of a Pepi is felt by the whole Whānau, therefore the whole Whānau must be proactive to reduce the risk factors of SUDI – smokefree homes, baby has its own bed, is breastfed and sleeps on their back. Ensuring the whole Whānau are aware of preventative measures to reduce SUDI can help to prevent the upheaval felt upon the loss of a child.

Who will we work with? To reduce SUDI rates in Tairāwhiti, Lead Maternity Carers, Midwifes, GPs, Well Child Tamariki Ora providers, DHB staff and other child health staff need to be promoting the same messages – Safe Sleep, Breast feeding and Smokefree homes.



Our rates of SUDI reduce from 2.8 deaths per 1000 live births to 0.4 deaths per 1000 live births.

Increase the promotion of the Safe Sleep, breastfeeding and smokefree messages at all opportunities – during Well Child Checks, GP visits, LMC visits during pregnancy, community events etc.

At least 1 SUDI training workshop to be run with Whakawhetu before December 2016 to be attended by Midwifes, Nurses and other Child Health Providers

Continue to promote the use of Wahakura and Pepi Pods as safe sleeping areas for babies.

The Tairāwhiti SUDI plan to be developed by June 2016 will focus on promoting smokefree pregnancies, smokefree homes and breastfeeding messages as part of reducing our SUDI rates.

The DHB will review antenatal education available in our district and safe sleep policies in place by December 2016 to ensure consistent messages are being provided to Hapu Mama in terms of safe sleep, smokefree and breastfeeding.

Data Source: 2005-2009 SUDI Information sourced from Mortality Collection, Ministry of Health. 2010-2014 SUDI information sourced from NZ Mortality Review Data Group, University of Otago.


LOCAL MĀORI HEALTH PROFILES


HAUORA TAIRĀWHITI MĀORI HEALTH WORKFORCE

E raka te mauii – e raka te katau The left is adept – the right is skilful

The community prospers from the skills of all its people

Data Source: Hauora Tairāwhiti Human Resources Data Source: Central TAS DHB Workforce reports

Māori make up 24% of the Hauora Tairāwhiti Health Workforce, Nationally this rate is 6%

The largest occupation grouping for Māori at Hauora Tairāwhiti is largely in Support Services (38.9%).

Hauora Tairāwhiti is focused on increasing the number of Māori employed in areas other than the Support

services and Allied Health areas. While these remain important areas we need to ensure we continue to

build the capacity of our Māori Workforce in both senior clinical and management areas.

HE KAI HIKARETI SMOKING Smoking is a major contributor to preventable illnesses and long term conditions, such as cancer, respiratory disease, heart disease and strokes. Cancer is the leading cause of death in New Zealand (29.8%), and is a major cause of hospitalisation and driver of cost. Cancer also highlights continuing inequities, with Māori experiencing a higher incidence (20% +), higher mortality and higher stage at presentation. Supporting our population to say “no” to tobacco smoking is our foremost opportunity


HE MATE HEI KARO AVOIDABLE MORTALITY RATES

Tao rakau e karo – Tao korero te karo Some conditions can’t be avoided and some can

Avoidable mortality includes deaths of those

less than 75 years old that could potentially have been avoided through preventive and curative interventions at an individual level. 47% of deaths each year in New Zealand are considered avoidable with Māori rates twice that of non-Māori rates. These rates are also shown to increase with deprivation levels. Tairāwhiti’s rates for both Māori and Total populations are higher than national rates. Locally in Tairāwhiti there are two projects underway that aim to reduce the number of avoidable admissions each year these are focused on: Reducing the number of Missed Appointments and improving Patient Literacy.to target improvements in the health of our population and to reduce health inequities for Māori.

TINO MOMONA OBESITY Ponokia te ringa raupa Trust hard workers

Maintaining a healthy lifestyle is vital to preventing obesity and needs to include both regular exercise and a healthy diet. Obesity can cause diabetes, high blood pressure, cancers, arthritis, stroke and heart disease. The 2014/15 New Zealand Health Survey reports that: almost 1 in 3 adults nationally (aged 15 years and over) are obese (30%) and 1 in 10 children nationally (aged 2–14 years) were obese (10%) with children living in the most deprived areas 2.7 times as likely to be obese as children living in the least deprived areas

11.

11 Annual Update of Key Results 2014/15: New Zealand Health Survey | Ministry of Health NZ

http://www.health.govt.nz/publication/annual-update-key-results-2014-15-new-zealand-health-survey


KAUPAPA NEW INITIATIVES Kei muri i te awe-mapara he tangata ke Behind the pigment is the new world

HEALTHY FAMILIES HOROUTA WHANAUNGA AND CULTURAL MOTIVATIONS

Hauora Tairāwhiti is part of the Healthy Families – Horouta Whānaunga Initiative aimed at reinvigorating cultural motivations around diet and exercise.

RUIA WHĀNAU INITIATIVE Ruia Taetea kia tu ko Taikaakaa anake Strip away the mess to reveal the core

The Ruia Whānau Initiative is a project underway in Tairāwhiti which aims to improve outcomes for gang affiliated whanau by: Building the capability and capacity of whānau to meet their needs now and into the future; Promoting access to services that can support whānau to make positive change; and Improving the responsiveness and effectiveness of services that are funded to support whānau. Improving employment opportunities for priority whānau.

MAHI A ATUA I noho tata-pu nga atua The gods live in restriction

Hauora Tairāwhiti’s Mental Health Services are collaborating to strengthen the overall capabilities and confidence of our community regarding mental health and wellbeing. Mahi a Atua is an approach that prioritises indigeneity as usual care for Māori whānau presenting to mental health services. This way of being accesses Māori creation and custom stories to better engage whaiora and their whānau in a partnership that best meets their healing needs. This approach promotes a clinical environment where the reinstatement of Māori psychology is implemented to address the impact of historical and sociocultural factors that impact Māori wellbeing.

MISSED OPPORTUNITIES AFFECTING MĀORI

Me mate ururoa kei mate wheke Engage in life.

The rate of missed opportunities by Māori is of concern. These high rates can result in poorer health outcomes. A project underway in Tairāwhiti is looking to understand the issues causing missed appointments and provide solutions to reduce this rate. It will look to identify and remove the barriers to accessing services by engaging with key stakeholders.

HEALTH LITERACY Ma te korero ka ora ai te reo The life of a language will come from speaking

Improving the Health Literacy of Tairāwhiti Consumers in Tairāwhiti is a focus area for 2016/17 and beyond. Health Literacy is defined the capacity to obtain, process and understand basic health information and services in order to make informed and appropriate health decisions

12. Individuals and whānau face a series of

demands on their health literacy when navigating their way through the health system. These demands impact on consumers’ ability to access health information, care and services. A health-literate organisation makes health literacy a priority and integral to quality service improvement. It makes health literacy part of all aspects of its service planning, design, delivery, and performance evaluation. Becoming a ‘Health Literate’ organisation requires a complete change in focus from the needs of the service, to the needs and perspective of the consumer. It is a transformative change, in line with the direction of Hauora Tairāwhiti.

12 Health Quality and Safety Commission. Consumer engagement. Health Literacy. http://www.hqsc.govt.nz/our-programmes/consumer-engagement/work-streams/health-literacy

http://www.hqsc.govt.nz/our-programmes/consumer-engagement/work-streams/health-literacy

http://www.hqsc.govt.nz/our-programmes/consumer-engagement/work-streams/health-literacy

Tairāwhiti He Urupare Rangapu Hauora Maori 2016/17 · Mahi a Atua Missed ... allow whānau to take...

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