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maori OH services (‘Our OH findings' 2009 NZOHS, Māori disparities…
maori OH services
‘Our OH findings' 2009 NZOHS, Māori disparities from OH outcomes to access to services. Māori adults 2x likely to be edentulous, more teeth missing due to path, nearly 2x teeth w untreated coronal decay, fewer filled teeth & higher lifetime dental decay (DMFT). Trends like this among indigenous
OH status of Māori is driver for Māori to establish own OH services, Tipu Ora (clinic for babies, Rotorua), Te Manu Toroa (Māori health organisation in Bay of Plenty, child services), Ngatihine Health Trust, Ora Toa (multi-health clinic)
Immunisation programmes targeting Māori , -vely received, owl = messenger of death, no consultation w people targeted, 3 woven flax baskets of knowledge more appropriate
NZ dent services: pre school 0-5 yrs (school dental therapist), primary school 5-12 yrs (school dental therapist), adolescent 12-17 yrs (adolescent OH scheme), adults 18+ yrs (fee for service, some WINZ funding for low income)
NZ SDS: after WW1 in 1922, in past all schools had on-site dent clinic, today in many areas service delivered by mobile clinics, ‘hubs & spokes’ infra-structure
Barriers to access: mobility of service, knowledge of service, not on radar screen, transport, phone com, waiting time North East Valley 3-6 months GA dental tx.. impacts QOL
Māori health providers: 1992 6 w Department of Health contracts, 2016 240 w DHB or MOH contracts
Health reforms 1990s: purchaser – provider split, RHA (regional health authorities), CHE (crown health enterprise)
MOH or RHA to health providers, anyone access funding to deliver health service, HFA (health funding authority), DHB (district health boards)
Now MOH to DHBs to health providers
Whānau, hapū, iwi, tribal organisation, tribal assets, DHB, MOH, contract to deliver health service
NZ pop census 2013: European (2 mil), Māori (500,000) Asian (470,000), pacific (300,000), middle east, latin American, African (45,000), other (70,000)
Mainstream & Māori oral service: whānau choice, Māori com service (whānau ora, central clinic base, mobile service for tamariki, rangatahi, pakeke & kaumatua)
Ka Awatea: New Dawn: Winston Peters Minister of Māori Affairs 1991, report of Ministerial Planning Group to develop recommendations on Govt Policy for Māori Affairs
Terms of ref: describe current position of Māori in society, recommend strategies to improve position
Main outcome of report was recommendation of establishment of specialist Māori agency w responsibility in education, labour market, economic business development & health
1996 General Election w National-NZ 1st Coalition Govt: agreement, Cab (97)359
Māori Health Commission: Govt's Strategic Result, close gaps Māori & non-Māori, programme to meet dental needs Māori, ‘Oranga Niho Māori: Plan For Action’ presented to Minister of Māori Affairs 1998, dentist & dental therapist together as part of existing Māori provider
Budget 1999: integrated dent care, Oranga Niho kids & emergency care low income adults from 1999, Flaxmere in Hastings
Te Taiwhnua o Heretaunga is only nga marae o Heretaunga mandated Hauora…
Maori health provider hastings, oranga niho services dentist, dental therapist, chair side assistant 2001
Contract: whanau based
Te Taiwhenua O Heretaunga Hastings: oranga niho – Māori health service, kaupapa Māori framework, tino rangatiratanga, whanau ora model (mokopuna, tamariki, rangatahi, pakeke, kaumatua), big A’s (accessible, acceptable, appropriate, affordable)
Hauora services replicated around country
Ngāti Porou Hauora integrated service provider, owned by nga whanau & hapu of ngati porou, seen by school dent therapist in mobile clinic, referral
Waka Hauora
Mobile surgical services (MSS), 2001, nurses & doctors together find solutions rural NZ, scope tx incl dent, mainly kids, healthy adults wisdom exo, remote access Te Puia, no longer waiting list for GA
Waha Pai Waha Ora: by Te Hauora Runanga O Wairarapa & Waiora, ‘whakamanatia te whanau hei aumangea kia tipu tonu.., masterton, 2014 Māori in wairarapa highest ASH rates (ambulatory sensitive hospitalisations)