Overview

Improving Māori Access to Health Services

Background

According to the World Health Organization, ‘in both poor and industrialised countries in which they live, the health status of indigenous peoples is invariably lower than that of the overall population’ (World Health Organization, 2011).

In Aotearoa New Zealand the unequal health outcomes experienced by Māori have been documented in a number of academic and government documents (Ministry of Health, 2010; Robson, B & Harris, R (Eds.), 2007).

The focus of the present research was the contribution that health services can make to the reduction of Māori health inequalities through ensuring equity of access to health care (Ministry of Health, 2002, p. 21).

The aim of this project was to answer the question,

How can access to health services be improved for Māori?

The objectives of the project were to:

  1. Increase the health sector’s understanding of the issues affecting Māori access to health and disability services
  2. Provide an evidence base for action to improve access to health services for Māori
  3. Provide solutions to improve access to health services for Māori

Method

Forty-seven key informants working in cancer, CVD, diabetes, Māori health, funding and planning, Ministry of Health, and health research were also interviewed. Key informants were asked about their knowledge of evidence- and practice-based interventions to improve access to health care for the general population, as well as more specifically for Māori.

The research examined the recent (post-2006) literature on interventions to improve access to cardiovascular, diabetes, and cancer health care for Māori, Indigenous peoples, and ethnic minority (largely Hispanic American and African American) groups. These interventions were profiled across the continuum of care for each condition.

Findings

Patients

Intervention research and health practitioners dispelled the notion that Māori do not care about their health and wellness. Key informants described the cost of health services, lack of transportation, and health service characteristics as barriers to Māori access to health care. Interventions that address financial and logistical barriers have been found to be effective at increasing access to healthcare.

Health literacy was described by key informants as being about health providers’ ability to provide culturally responsive information and services to Māori patients and their whānau. Tailoring information in response to patient-specific health care barriers supports health literacy. Home-based tools, and holistic interventions for patients and their whānau can also support patients’ self-management of their health condition.

Health Practitioners

Establishing relationships is the foundation of working with Māori in a culturally responsive way. This facilitates the building of rapport, good communication and Māori-centred clinical practice.

Community health workers can help bridge the cultural ‘gaps’ between non-Māori health practitioners and Māori patients and communities. Good relationships between community health workers and Māori patients also provide a platform for education initiatives with patients about self-management of their health.

The culturally competency of health practitioners facilitates rapport and communication with Māori patients. Education can improve the communication skills of health practitioners, as well as their ability to deliver culturally responsive care. Decision-making tools and guidelines can also support health practitioners provision of equitable health care.

Health Organisations

Within health organisations a commitment by leadership to the reduction of Māori health care disparities is an important driver of organisational responsiveness. This is informed by the organisation’s analysis and use of their local data to plan and monitor services.

Health organisations can engage with Māori patients and whānau by investing in people who can reach Māori, such as community health workers, and in services that are culturally responsive. Navigators can also connect Māori with health care and other services, while organisations can work to make their own services and clinical pathways clearer so they are easier to navigate.

Participation of health practitioners in teams where some team members are culturally competent can facilitate the delivery of culturally competent health care by all team members. When this happens organisations need to ensure that team members are respectful of each others’ knowledge and expertise.

Important roles are played by nurses working in the community and in health care organisations. Patient satisfaction increases and referrals to general practitioners decrease when nurse practitioners are able to take a lead in patient care.

The cultural tailoring of health organisation policies and health care models enhances access. Organisational changes that improve adherence to guidelines, implement case management, ease time pressures, and support cultural sensitivity training also improve access.

Health organisations benefit from having networks with other health organisations, and other agencies and organisations whose services impact upon Māori health and access to health care.

Regional networks can engage with local communities to provide comprehensive approaches to health care, including the reduction of cost and logistic barriers.

Health System

The articulation of a health system commitment to the elimination of disparities is foundational to improving Māori access to health care. The establishment of universal health targets also supports a focus on health care access for Māori.

Regulatory reform and policy drivers can shift health organisation practice, including the collection of accurate ethnicity data, the development of local level plans and initiatives, and engagement with Māori leaders and communities.

Changes in health workforce roles and health funding formulas may improve access, especially changes that support the roles of nurses.

Public campaigns can be successful at raising awareness, increasing knowledge, and promoting family and community discussions and decision-making and accessing health care.

Conclusion

Māori access to health care is about the entry of Māori into health care, as well as their journey through health care. Overcoming financial (e.g., cost) and logistical (e.g., transportation) barriers to access is important.

Māori access to health care can be facilitated through intermediaries such as community health workers, navigators and health practitioners who have the time to build relationships of trust with Māori patients and their whānau.

Changes in health organisation policies, structures and practices can further improve Māori access when the changes reflect an understanding of Māori health needs and aspirations.

The health system can support Māori health care access by articulating expectations (through strategy, policy and funding formulas) that health organisations will engage with Māori in the development, implementation, and monitoring of local initiatives to improve Māori access to health care.

References

Cram, F. (2014a). Improving Māori access to health care: Research report. Auckland: Katoa Ltd.

Cram, F. (2014b). Improving Māori access to cancer, diabetes and cardiovascular health care: Key informant interviews. Auckland: Katoa Ltd.

Cram, F. (2014c). Improving Māori access to cancer health care: Literature review. Auckland: Katoa Ltd.

Cram, F. (2014d). Improving Māori access to diabetes health care: Literaure review. Auckland: Katoa Ltd.

Cram, F. (2014e). Improving Māori access to cardiovascular health care: Literature review. Auckland: Katoa Ltd.

Ministry of Health. (2002). Reducing inequalities in health. Wellington: Ministry of Health.

Ministry of Health. (2010). Tatau Kahukura. Māori health chart book 2010. 2nd Edition. Wellington: Ministry of Health.

Robson, B & Harris, R (Eds.). (2007). Hauora: Māori standards of health IV: A study of the years 2000-2005. Wellington: Te Rōpū Rangahau Hauora a Eru Pōmare.

World Health Organization. (2011). Health and Human Rights. Indigenous peoples right to health. Retrieved 4-May 2011 from World Health Organization.

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