2017 Te Whaioranga 2013-2023: Māori Responsiveness Strategy

Tēnā koutou katoa

Since our Māori Responsiveness Strategy began in 2001, we have worked closely with Māori communities to help address their access to and use of medicines. Te Whaioranga has led to some important contributions to Māori health. For example, the health needs of Māori receive active consideration as part of our medicines funding decision framework, the One Heart Many Lives campaign and the He Rongoā Pai, He Oranga Whānau training workshops. PHARMAC has taken an active role in working with others in the sector to address challenging Māori health issues, like rheumatic fever. We are proud of what we have accomplished so far, and look forward to building on our achievements.

Operating within PHARMAC’s overall business priorities, this document provides a framework for PHARMAC to strengthen our engagement and partnerships with Māori communities, empowering Māori whānau through education, information and best practice to make guided and informed choices about best use of medicines.

The PHARMAC Board will continue to support PHARMAC staff and management to put Te Whaioranga into action and ensure it is effective. Progress of Te Whaioranga will be regularly reported to the Board to confirm we are achieving our goals.

Nāku noa

Stuart McLauchlan
Chair, PHARMAC Board

Whakarapopotanga
- Executive summary

Kua tawhiti kē tō haerenga mai, kia kore e haere tonu.
He tino nui rawa ōu mahi, kia kore e mahi nui tonu.

You have come too far, not to go further.
You have done too much, not to do more

Tā Hēmi Hēnare (Ngāti Hine 1989)

The primary goal of Te Whaioranga is to ensure that Māori have access to subsidised medicines and use these medicines appropriately and safely.

Te Whaioranga sets a direction for PHARMAC to move towards its goal over the next ten years, building on the gains made already over the past decade.

PHARMAC recognises its contribution to the wider New Zealand health sector of the Government outcome that “New Zealanders live longer, healthier, more independent lives”.

The Government’s strategy for the medicines system seeks access and optimal use outcomes: that there is equity of access to medicines that are needed (and medicines resources are allocated in a manner that reduces inequality of outcome), and that medicines are used to their best effect (high-quality, safe and effective medicines are chosen, delivered and used in a way that ensures their potential to improve health and prevent illness is maximised, wastage is reduced and resources used more effectively).

Māori are entitled to enjoy the same level of access to medicines as all other eligible New Zealanders. Yet evidence increasingly shows that Māori are disproportionately underrepresented in access to key pharmaceuticals and aren’t always equipped to use these to best effect. PHARMAC has a role within the medicines system to influence these outcomes.

Achievement of Te Whaioranga requires an approach consistent with the health sector¹ focus on whānau ora: supporting Māori whānau to achieve best health and wellbeing through access to, and optimal use of, medicines. This involves a collective approach with everyone active in the process to help build a community of shared responsibility and accountability to empower, educate and support.

The key strategies to do this over the next ten years include:

1. Advance tino rangatiratanga with whānau in health interventions;
2. Establish and maintain authentic strategic connections;
3. Champion evidence based Māori medicine management;
4. Support and engage in indigenous research and development about pharmaceutical management; and
5. Enhance and enable internal expertise and capability in te ao Māori.

As part of these strategies, PHARMAC will work together with Māori communities and the wider Health Sector in pursuit of common purposes to both:

• further and better identify differences in access to medicines treatment by Māori, or their use, that cannot be explained by factors such as demographics and disease burden, and which are specific and remediable; and then
• reduce those differences where we can (within PHARMAC’s funding role and the funding provided).

A detailed action plan every two years will provide milestones to assess progress on these ten year strategies.

----

¹ Ministry of Health He Korowai Oranga – Māori Health Strategy 2002 and Whakatātaka Tuarua 2006.

He kupu whakamihi
- Introduction

Strategies to improve the health of all New Zealanders are relevant to improving Māori health specifically. However, emerging evidence of disparities in the use of medicines for Māori, when compared with other New Zealanders suggests a strong need for ongoing information and action that is specific to Māori.

To redress disparities, Te Whaioranga supports and contributes to the New Zealand Medicines outcomes through:

• Access: New Zealanders have access to the medicines they need, including equity of access to medicines; and
• Optimal use: medicines are used to their best effect.

It also aligns with the overall aim of the Ministry of Health’s He Korowai Oranga: Māori Health Strategy of whānau ora: “Māori families supported to achieve their maximum health and wellbeing through the safe and appropriate use of medicines”.

Ngā hua ā te whaioranga
- Successes of te whaioranga

PHARMAC has had the opportunity to:

• Make people aware of the opportunities to get access to medicines
• Reduce the barriers, and
• Educate people how to use medicines appropriately.

PHARMAC’s ability to implement Māori responsiveness work has been facilitated by:

• Recognition of the Treaty of Waitangi
• A commitment to the reduction of Māori health disparities as well as the facilitation of Māori health aspirations
• Leadership within PHARMAC for Māori responsiveness
• Engagement and communication with Māori
• Staff training and development for Māori responsiveness
• Organisational support for Māori responsiveness
• Evidence-informed decisions.

Some key highlights of the last ten years of Māori Responsiveness work within PHARMAC include:

• PHARMAC’s prioritisation process; Decision Criterion 2 actively considers Māori access within its overall evidence-based approach.
• Greater awareness of the impact of our work on Māori access to health care, and identifying opportunities to improve access and optimal use of medicines.
• Acknowledgement of whānau / hapū / iwi driven initiatives.
• Incorporation of Whānau Ora into its whānau engagement and delivery of whānau centred services.
• Initiating and consolidating the One Heart Many Lives programme.
• Collection of data and evidence that provides baseline credibility for investment in access and optimal activity.
• Initiating the medicines information training programme, He Rongoā Pai He Oranga Whānau, to improve access to subsidised medicines and help people understand how to use their medicines.
• Incorporating a need for Māori responsiveness into contracts PHARMAC holds with other providers such as BPAC which provides information to GPs and primary care nurses.
• Picking up the challenge of inequality issues such as rheumatic fever.
• Recruiting and retaining key staff with strong links with Māori communities.
• Signing a Memorandum of Understanding with Te Pū o Te Wheke Whānau Ora Collective as a commitment to improving the wellbeing of Māori in the rohe of Ngāpuhi (far north). This MOU provides an exemplar of how partnerships work positively for Māori.
• The gifting of a PHARMAC waiata by Whetu Tipiwai.
• The fifth year of celebrating Matariki, the Māori New Year.

Te Tiriti o Waitangi - Treaty of Waitangi

Partnership – forging and maintaining enduring relationships with whānau, hapū and iwi.

Protection – ensuring Māori have the same access to medicines as non-Māori and receive at least the same level of health outcomes through advancing tino rangatiratanga.

Participation – respecting and trusting each other’s ability and knowledge about how best to do the work to achieve shared outcomes.

Declaration on the rights of indigenous peoples

The New Zealand Te Tiriti o Waitangi is complemented by the Declaration on the Rights of Indigenous Peoples adopted by the United Nations General Assembly in 2007 and supported by the New Zealand Government in April 2010. The Declaration provides international support to Te Tiriti on responsible government, tino rangatiratanga and equal rights for all, including for health (articles 21, 24 and 43 of the Declaration).

Mahi Rangatira

Te Whaioranga is underpinned by the following guiding principles, Mahi Rangatira, which is the physical manifestation of the following cultural values:

Kia pai te whakatere i te waka
Kei pariparia e te tai te mōnenehu o te kura

Caution as you launch the canoe
Lest the tide buffer it about and spoil the plumage on the prow

Te kitenga, te whainga me ngā matapono
PHARMAC - Vision, Mission and Values

----

² Tino rangatiratangā = self-management

³ Matauranga Māori= knowledge founded on a Māori world view

⁴ Whaia te iti kahurangi = pursuit of excellence

⁵ A proverb about sharing resources to achieve wellness

Te Whaioranga strategy 2013-2023

1. Advance Tino Rangatiratanga with whānau through health interventions

Te Whaioranga recognises the desire by Māori to have control over their own health and wellbeing, and seeks to support Māori through encouragement; empowerment, facilitation and service based on respect, trust and shared mutual purposes.

2. Establish and maintain authentic strategic connections

Strategic stakeholder engagement and authentic communication is core to what we do. We will work with partners in pursuit of mutual purposes. Our strength is our ability to make linkages between different groups in the health sector, across sectors and with various community groups. Current programmes such as One Heart Many Lives and He Rongoā Pai, He Oranga Whānau are examples of communities in action. We will invest in strengthening communities through encouraging flexibility, creativity and innovation. This will enable us to do more in an enhanced way.

3. Champion evidence based Māori medicine management

Strengthening the evidence base relating to Māori use of medicines is a way that PHARMAC can make a positive contribution to Māori health. By prioritising key Māori health priority areas ensures that the area of greatest need is appropriately targeted.

4. Support and engage in indigenous research and development about pharmaceutical management

PHARMAC has contributed to empowering Māori communities through the transfer of knowledge that is meaningful to communities. There is potential to further explore research and development opportunities in understanding pharmaceutical management and to share this.

5. Enhance and enable internal expertise and capability in te ao Māori

PHARMAC staff must have the competence to work in both worlds – te ao Māori and te ao Pākehā. A unique skill set is required in order to advance tino rangatiratanga with whānau. This unique skill set needs to be supported with on-going professional development and support in both worlds.

References

Brougham, M. (2011), Reflections on the effectiveness of the Māori Responsiveness Strategy: Lessons Learnt – Opportunities for the Future.

Cram, F. (2010), PHARMAC and Māori Responsiveness: Policies, procedures and outcomes.

Human Rights Commission (2011), Te Mana i Waitangi: Human Rights and the Treaty of Waitangi.

Human Rights Commission (2008), United Nations Declaration on the Rights of Indigenous Peoples. http://www.hrc.co.nz/hrc_new/hrc/cms/ files/documents/30-Jan-2008_10-39-35_UN_Declaration_on_Rights_of_ Indigenous_People_english.pdf

Marshall, C. and Hoerara, R. (2012), Review of PHARMAC’s Te Whaioranga Māori Responsiveness Strategy and Plan.

Metcalfe, S., Laking, G. and Arnold, J. (2013), Variation in the use of medicines by ethnicity in 2006/07; a preliminary analysis (submitted to the New Zealand Medical Journal).

Ministry of Health (2002), He Korowai Oranga: Māori Health Strategy.

PHARMAC (2012), Our Framework for Success.

PHARMAC (2011), PHARMAC Regional Forums: Summary of Feedback.

PHARMAC and Te Pū o Te Wheke (2011), Memorandum of Agreement.

PHARMAC (2007), Te Whaioranga: Māori Responsiveness Strategy Action Plan.

Consultation

He Rongoā Pai He Orangā Whānau wānanga, 2010-2012.

Māori Women’s Welfare League National Conference, Gisborne, September 2010.

PHARMAC National Forum, February 2012.

PHARMAC Regional Forums, September – October 2011.

Te Matatini, Whānau Hauora Village, February 2011.

Te Roopu Āwhina Māori hui (2011-2012).

Te Tīmatanga: The Beginning

The waiata is conceptually similar to the haka performed by the team before every match and spins off well-known Māori folklore relating to the creation of the world the separation of Ranginui and Papatūānuku by their children.

The waiata talks about climbing to the highest peaks of lofty mountains resonating achievement and ambition.

The waiata goes further to describe the importance of whānau and the achievement of all-round wellness embracing the Whare Tapa Whā holistic health model created by Professor Mason Durie.

Te Timatanga

Ū, ū
E te tīmatanga e (echo)
Ko te pō nui, ko te pō roa
Āue ko te kore.
Wehe nga mātua e
Here ngā tāngata e
He toa rangatahi
He toa rangatira

Whakakī ki te maunga
Tae atu ki te whenua
Āue
Hoki ki te rangi
Tae ki te puke runga
Piki ake ki te ara poutama
Ki ngā taumata e. (2x)

Wairua hinengaro
Me te tinana e.
Tae ātu ki a tātou katoa
Āue, te whānau e.
Ū, ū

The Beginning (simple translation)

Be established
In the beginning
There was the big and long darkness
And there was the nothingness
Through the separation of the parents
Came the permanence of the human form
Youthful passion
The creation of a chief

Be fulfilled by the mountain
As it is on the land
Great balls of fire
Return to the heavens
As you rest
(However) ascend along the path of achievement
and fulfill your ambitions

The spiritual intent,
the mind and the body
are infused in all of us
as well as our family
Let us rest and rejoice