The development of Māori primary care services

This paper provides a broad overview of the development of Māori primary care services over the last decade and an outline of the current scope of Māori primary care services. The paper also récognizes the number of challenges and opportunities that face Māori providers and will briefly discuss three that are relevant to all providers: frameworks, information and effectiveness. Developing frameworks for contract specification and performance criteria that reflect Māori models of health and well-being, intersectoral approaches and the use of kaupapa and tikanga Māori in service development and delivery is a major challenge. Current approaches, while acknowledging these areas, for example in contracts, are based within the frameworks of a Western medical model. We have yet to clearly identify how we can meaningfully incorporate these philosophical and practical approaches to providing services into contractual arrangements. Providers have identified a need for information. The providers pass significant amounts of information to the funding agency, however many feel that very little information is returned from the funding agencies to the provider organizations. These providers could well use information feedback from the funding agency when they are reviewing and developing their services. There are also other types of information, for example having access to detailed local epidemiological and demographic information, that would be very useful to providers who are reviewing existing programs and developing new services. The third 'universal' challenge is the need to begin to collect information about how effective current Māori health strategies are, and how effectively services are caring for Māori clients. Developing information on effectiveness could utilize a multi-faceted approach, with information being collected at the provider level as well as at population level. Other questions relate to the effectiveness of our health promoting, disease preventing or disease management interventions. These points are relevant to all providers, but information on the effectiveness of mainstream health services is just as limited. The disparity between Māori and non-Maori health status however, suggests that these services (both public and personal health services) have not been as effective as they could have been.