Over the past four years, a $6 million short-fall in government funding to East Coast health services has had a significant impact on Ngati Porou Hauora (NPH). In the following article Ngati Porou Hauora Chairman, Teepa Wawatai discusses why he believes this situation is unjust and what efforts are being made to address this issue, in addition to the other challenges faced by the Iwi health provider.
HEALTH A CROWN RESPONSIBILITY
In April 2012, as a result of the Treaty Settlement legislation, Ngati Porou Hauora became a subsidiary of Te Ru-nanganui o Ngati Porou. Since then the Runanganui has provided a lifeline to Ngati Porou Hauora, through the provision of loans and other financial relief totalling in excess of $6 million to cover the funding deficit.
Ngati Porou Hauora Chairman, Teepa Wawatai says the organisation is appreciative of the support provided to alleviate NPH’s financial pressures, however states, “It was never envisaged that the Runanganui would subsidise public health provision, and it is unsustainable for this situation to continue for much longer.”
Teepa believes Ngati Porou Hauora’s government health funding does not adequately take into account the East Coast’s neglected and underfunded infrastructure – let alone the area’s dire health outcomes.
“More than 90% of the population in New Zealand has good public infrastructure. Other regions have good roads, reliable communications systems, reliable power supply, broadband in every home, high speed broadband for all essential services and businesses. None of those things exist in our rohe – yet those are the things that every other citizen in our country takes for granted.”
Teepa rejects the view that the deficit should be bridged by Ngati Porou.
“We should not be filling the funding gap for health services, every other citizen in this country takes for granted. It is an outrageous, double injustice.”
As part of the team who negotiated Ngati Porou’s Settlement, which included the Health Accord provision, the former Te Runanganui o Ngati Porou Chief executive says he knows how much work went into reaching an agreement with the Crown.
“It’s not an easy process and everyone knows that the amount of redress an iwi gets in a settlement amounts to only a fraction of the value of loss sustained by them.”
Health is a Crown responsibility, Teepa says. “Ngati Porou can’t continue to do it anymore and they shouldn’t have to.”
His concerns are reflected in ongoing analysis, by groups such as Te Runanga Whakapiki ake i te Hauora o Aotearoa (NZ Health Promotion Forum), into institutionalised prejudice within the health sector.
Dr Heather Came, Programme Leader in Community Health Development and lecturer at Auckland University of Technology, competed a study in 2013 showing that Maori health providers are held to a higher standard of accountability than District Health Boards (DHBs).
“DHBs and the Ministry of Health have access to discretionary and one-off public health funding. The survey findings showed over 40% of Māori providers reported rarely or never receiving discretionary funding, compared with all Public Health Organisations.”
Dr Came’s study reported that iwi health providers had submitted rigorous analysis and commercially viable proposals but their applications for discretionary funding had been knocked back.
NGATI POROU DIRE HEALTH STATISTICS
In September, Ngati Porou Hauora released figures showing the East Coast has the worst health outcomes in New Zealand. The Ngati Porou Hauora Dashboard Report was commissioned to pull together all the disease-state data, social statistics and economic information available.
“The results were staggering but not surprising,” says Teepa. The report says rural Natis die younger than any other group in New Zealand and suffer more through co-morbidity factors on the way to an early death.
“The data says poor people have poorer health. There’s a direct link. When those people live in remote areas, they have even poorer health.”
The Dashboard research reveals the average New Zealander is well off in comparison with people of the East Coast.
“When you have money, you have more choices. They can choose where they live and what sort of house they live in, hopefully one that is warmer and drier, close to facilities including things like transportation links and hubs, supermarkets, medical centres, banks, motor mechanics, trades people, professional services, recreational facilities, etc. These are all services that lift quality of life and the prospect of better health outcomes.”
EAST COAST HEALTH REVIEW REPORTS
The Dashboard Report is the latest in a series of reviews undertaken by the Hauora. Earlier reports concentrated on the whole of Te Tairawhiti which masked the extent of the problem and its true impact on nga hapu o Ngati Porou.
“It is an unacceptable indictment on health policy and funding particularly in areas of high need. This was the missing information needed for the East Coast Review which would have had a marked impact on the package of solutions formulated,” Teepa says. The first East Coast Review looked at a sustainable health service delivery. The preferred model centered around Te Puia supporting a network of health clinics.
“The fundamental flaw of the East Coast Review was that it failed to establish the current health status of the resident population based on epidemiological evidence. Instead, the review looked at a much narrower ambit of financial affordability,” says the Hauora Chair.
The second review used an Expert Reference Group of GPs working in isolated communities around the country. It considered a detailed model of care, and the feasibility of a Te Puia-based network. The Board of NPH and TRONPnui accepted the geotechnical report recom-mending Te Puia as the location of the hub but rejected the proposed model of care, instead – outlining an alternative.
“At issue was our belief that the proposed model would fall short of meeting the needs of our people and would cause long-term harm to us. At the time, we weren’t able to clearly articulate the reasons for taking this position apart from a belief that further critical information was needed. This feeling of unease was sufficient to compel the Board of NPH to pause and conduct further research.”
SCARCITY OF RURAL CLINICIANS
NPH is also having to grapple with the nationwide scarcity of rural doctors and locums. General Practice New Zealand data shows a $26 million shortfall in government funding of the costs of clinical practice throughout the regions. An estimated quarter of health centres in country areas are short of at least one doctor. The situation is set to worsen as rural GPs retire and medical graduates opt to work in cities. Teepa says, this has profound repercussions for communities on the Coast.
“When we do find someone it is difficult to retain them because they can feel lonely, professionally isolated and the weight of responsibility is significant.”
A long-time member of the board of Ngati Porou Forests, he says many Ngati Porou entities face the same challenge.
“Finding professional people, whether they be doctors, engineers, management specialists or scientists to live and work on the Coast is a massive challenge. Most non-Ngati Porou people don’t want to live and work here.”
He says a fit-for-purpose facility at Te Puia will help attract health professionals.
“We want to use our strong relationship with Otago Medical School to develop a research and teaching centre focused on Maori and Rural health to create a pipeline of future doctors.”