Annual planning - Māori Health Plan template 2016/17

  1. Background

Equity is a cross-cutting dimension of quality and quality improvement. The DHB Planning Package guidelines for 2016/17 strongly highlights the importance of equity across Annual Plans and Regional Service Plans.

Equity is an explicit expectation in the Annual Plan where DHBs have been specifically asked to adopt the New Zealand Triple Aim for Quality Improvement and outline in their Annual Plan how they will improve health and equity for all populations; improve quality, safety and experience of care; and deliver best value for public health system resources. Please ensure that the activities and actions identified in your MHP align and are linked to the activities outlined in your Annual Plan priority areas.

The mandatory requirements for DHBs in relation to reducing health disparities and achieving health equity for Māori as outlined in Section 1.3 of the Annual Plan Guidelines (APG), Section 6.0 of the Operational Policy Framework (OPF) and the PHO Services Agreement between DHBs and PHOs are provided below.

Summary of mandatory requirements

DHBs must:

  • create a stand-alone Māori Health Plan to achieve health equity and improve health outcomes for Māori in line with the guidance given in this template.
  • include condition specific activity and actions to resolve inequities of access to and utilisation of health services more generally (Section 1.3 APG).
  • demonstrate that the Māori Health Planis developed jointly with the PHO(s) as outlined in the PHO Services Agreement
  • demonstrate that the PHO(s) have actions in place necessary to effect the change they must achieve to implement the DHB Māori Health Plan (Section6.2, OPF)
  • work with Māori at both governance and operational levels (Section6.3, OPF)
  • provide for the needs of Māori as set out in section 4 of the NZPHD Act 2000 to ensure there are mechanisms to enable Māori to contribute to decision-making on and to participate in the delivery of health and disability services, as well as responding to the Government’s desire to achieve health equity and improve health outcomes for Māori (Section 6.5, OPF).

The MHP will be expected to include appropriate activities to improve health equity. DHBs can use the following tools or others at their disposal, to assess each indicator and identify appropriate actions to focus on health equity.

  1. Ministry of Health. (2014b). Equity of Health Care for Māori: A Framework. Wellington: Ministry of Health
  2. Whānau Ora Health Impact Assessment 2007
  3. The Health Equity Assessment Tool: A User's Guide 2008

For working examples of implementing the tools see

Whānau Ora

The Whānau Ora Partnership Group, made up of representatives from the Iwi Chairs Forum and six Ministers representing the Crown, has agreed to a set of 5 indicators to support Whānau Ora, 3 are included in the MHP. These are:

  1. Mental health - reduced rate of Māori committed to compulsory treatment relative to non-Māori.
  2. Tobacco - better support for pregnant women to quit smoking.
  3. Asthma - reduced asthma admission rates for Māori children (ASH 0-4 years).

The other 2 indicators, oral health (caries-free at age five) and childhood obesity, are in the Annual Plan.

  1. Content of Māori Health Plan

The Māori Health Plan (MHP) should be no more than 15 pages in length and contain the following sections.

  1. Summary of the DHB/PHO Māori population and their health needs. This information can be drawn from the DHB Māori Health Profiles 2015, primary health organisation (PHO) performance programme information as well as DHB and Ministry data sources.[1]
  2. National indicators. The national indicators will be reviewed annually to ensure consistency with DHB/PHO performance measures and Health targets. The latest indicator set and any updates will be provided to DHBs via the Nationwide Service Framework Library website along with other DHB Performance Measures. In addition to the national indicators, DHBs with high rates of sudden unexplained death of an infant (SUDI) will be required to address these conditions.
  3. Local indicators: DHBs will be able to put in indicators of importance at a local level. They should be consistent with the purposes and goals expressed in the first part of the MHP and also should not already be covered in the national indicators and SUDI for affected DHBs.
  1. Criteria

National and local indicators must be presented in line with the criteria provided below.[2] Specific criteria for national indicators is outlined in the National Indicator Table found in Section V of this template.

All indicators listed within the MHP should have (unless otherwise specified):

  1. the most recent baseline performance result for the indicator
  2. a target that will be achieved within the 12-month term of the plan. Health targets are set by the Ministry. The other indicators targets are set as part of the Annual Plan process and will be the same for the total population
  3. a list of actions that clearly show what the DHB/PHO(s) is (are) doing or planning to do, to address the indicator. A mix of universal and tailored interventions will be required to achieve equity. Activities must be specific, time-bound, and evidence-based and therefore most likely to increase the baseline rate towards the target. There should be a clear intervention logic outlining how the activities listed will lead to improved health outcomes for Māori and achieve equity
  4. clear statements about how the DHB will monitor (monitoring processes) progress throughout the year, such as quarterly review of performance data.
  5. All indicators must be measured, monitored and reported by Māori and total population for the DHB/PHO.
  1. Summary of the DHB/PHO Māori population and their health needs in the district

Instruction: This section should describe the DHB/PHO Māori population and their health needs. This section should be no more than four pages in length and summarise key features of the DHB’s Māori population such as: population size, growth, age distribution health service utilisation, and the leading causes of avoidable hospitalisation and mortality. PHO performance programme data should be used.

  1. National indicators

Instructions: National indicators include Health targets, DHB and PHO performance measures that link to the leading causes of mortality and morbidity for Māori. These targets and indicators will be agreed on as part of the annual planning process. DHB performance on the national indicators in the MHP is reported through the existing quarterly non-financial reporting database mechanism.

The reporting frequency for the national indicators is directed by the reporting schedule for performance measures and Health targets so that no new reporting burden is created.

Data for national indicators that are not Health targets or Performance Measures will be provided by the Ministry.

National Indicator Table

Note: Current baseline and target information must be provided for each indicator.

Indicator / Key information / Specific Guidance
Ethnicity Data Quality / Definition / Accuracy of ethnicity reporting in PHO registers as measured by Primary Care Ethnicity Data Audit Toolkit (EDAT).
Data Source / DHBs who are implementing the Primary Care EDAT can submit their data from this initiative and provide appropriate comment on how they are improving the quality of their ethnicity data.
Specific Criteria / DHBs who have implemented the EDAT describe their ongoing quality improvement activities.
DHBs implementing the EDAT outline activities to support the implementation of the Primary Care EDAT
DHBs not yet implementing EDAT should provide detailed explanation of how they are monitoring and improving the quality of their PHO ethnicity data.
Rationale: High quality ethnicity data has been an ongoing concern for the health and disability sector in New Zealand. While ethnicity data has been collected for a number of years, there have been variable levels of data completeness and quality. Collecting accurate ethnicity data in accordance with the Ethnicity Data Collection Protocols will improve the quality of ethnicity health data.[3]
Access to Care (PHO Enrolments) / Definition / Percentage of Māori enrolled in PHOs
Target / 100%
Data Source / Primary Health Organisation Enrolment Collection
Specific Criteria / Refer to DHB Criteria (Section III) of this template.
Rationale: PHO enrolment is the first step in ensuring all population groups have equitable access to primary health care services and is therefore a critical enabler first point of contact health care. Differential access to and utilisation of healthcare services plays an important role in health inequities, and for this reason it is important to focus on enrolment rates for Māori and Pacific populations.
Access to Care (ASH)
The Ministry has recently confirmed the definition and use of ASH data to ensure that it remains a meaningful measure of system performance. An update can be found on the NSFL website. / Definition / Ambulatory Sensitive Hospitalisation (ASH) rates per 100,000 for the age groups of 0–4 and 45–64 years.
Target / DHB-specific based on current equity gap for Māori.
Refer to ‘System Integration SI1: Ambulatory sensitive hospitalisations (ASH)’on page 88 of the 2016/17 DHB non-financial monitoring framework and performance measuresdocument for further information.
Note: Targets to be confirmed/worked through with each DHB before March 2016.
Data Source / National Minimum Dataset
Specific
Criteria / Please outline your DHBs highest incident local ASH conditions and their underlying factors/causes. Please be sure to highlight the equity differences between population groups i.e. Māori.
Please identify activities that aim to improve these ASH conditions with a focus on improving health equity for Māori. The activities can be a mix of condition-specific actions to improve care (for those conditions which account for large numbers of ASH events), and activities that more broadly impact equitable access/utilisation of healthcare services, and access to the social determinants of health.
Monitoring the processes and utilisation of services by ethnicity will also ensure these activities have been tailored for the most effective prevention of ASH conditions specific to each DHB and priority population group. Please outline how you plan to do this for Māori and by when.
Please note that ASH conditions and preventative activity may differ between each DHB due to a mix of demographic/environmental/system influences. It is the expectation that the highest incident ASH conditions should have similar focus in regard to preventative activity and actions within the primary care and community setting.
Linkages
For 2016/17 reduced asthma admission rates for Māori children is an indicator to support Whānau Ora. The performance of this indicator is also reported in System Integration S15: Delivery of Whānau Ora of the Annual Plan. It requires a heightened focus to achieve accelerated progress towards Whānau Ora and health equity, as agreed by the Whānau Ora Partnership Group.
Rationale: ASH is a proxy measure for avoidable hospitalisations, and unmet healthcare need in a community based setting. There are significant differences in ASH rates for different population groups and a key focus on activities to reduce ASH must address the current inequities
Child Health (Breastfeeding) / Definition / Exclusive or fully breastfed at LMC discharge (4-6 weeks)
Exclusive or fully breastfed at 3 months
Receiving breast milk at 6 months
Target / 75% exclusive or fully breastfed at LMC discharge
60% exclusive or fully breastfed at 3 months
65% receiving breast milk at 6 months
Data Source / Indicators for the WCTO Quality Improvement Framework.
The data sources are Lead Maternity Carer claims in the National Maternity Collection and Plunket. Data from DHB primary maternity providers and Tamariki Ora providers will be included from 2015.
Specific Criteria / Please state the current breastfeeding baselines and the change in breastfeeding rates since last year’s plan. The MHP should reflect the current performance and the improvements that are required for the DHB to achieve the target(s) for Māori.
Include and outline information that demonstrates a clear commitment to improved breastfeeding rates among Māori women. Activities need to be specific to ensure that infants are exclusively or fully breastfed at 3 months.
Examples of information that you could include in this section are:
  • How will the DHB ensure that Māori whānau continue to have access to appropriate breastfeeding advice and support after they are discharged from their LMC?
  • How will the DHB support breastfeeding services that are coordinated and delivered with a community development focus?
  • How will the DHB link breastfeeding activities to the childhood obesity activities stated in its Annual Plan?
  • How will the DHB assess the success of its breastfeeding measures for Māori whānau over time?
  • Outline a clear commitment that the DHB's results for Māori will be equal to or greater than those achieved within the total population for this indicator.

Rationale: Research shows that children who are exclusively breastfed for around 6 months are less likely to suffer from childhood illnesses such as respiratory tract infections, gastroenteritis and otitis media. Breastfeeding benefits the health of mother and baby, as well as reducing the risk of SUDI, asthma and childhood obesity. Nationally, breastfeeding rates for Māori infants start at a similar (although slightly lower) rate as the total population, but drop off more quickly than the total population at the 3 and 6 month time points. Breastfeeding is an important area of focus because there is significant room for improvement, and breastfeeding has wide-reaching benefits and potentially results in reduced cost for families.
Cancer Screening
(Cervical) / Definition / Cervical screening: percentage of women (Statistics NZ Census projection adjusted for prevalence of hysterectomies) aged 25–69 years who have had a cervical screening event in the past 36 months.
Target / 80% coverage for Māori women
Data Source / National Cervical Screening Register data, available from the NSU website, published quarterly. NCSP coverage data is published approximately one month following the end of the quarter.
Specific Criteria / Outline information and activities that will support Māori women to participate in cervical screening. This should include information on the following 5 areas:
  • identify women who have not been screened or are under screened (not screened in the last five years)
  • promote cervical screening to Māori women
  • support primary care (including PHOs) to successfully invite and recall Māori women to cervical screening
  • improve the timeliness and experience of colposcopy for Māori women
  • support collaborative working relationships between providers across the cervical screening pathway.
All activities should be ‘SMART’ i.e. be specific, measurable, achievable, realistic, and have a timeframe. Performance indicators are needed to help the DHB to identify how they will know these activities have been successful.
Rationale: In 2012, Māori women were twice as likely as non-Māori to develop cervical cancer, and 2.3 more likely to die from it. Regular cervical screening detects early cell changes that would, over time, lead to cancer if not treated. Nationally, cervical screening coverage for Māori is 62.2%, compared to coverage in European/Other populations with coverage at 82.2%. Improving screening coverage in Māori women is therefore an important activity to improve this equity gap.
Cancer Screening
(Breast) / Definition / Breast screening: 70 percent of eligible women, aged 50 to 69 will have a BSA mammogram every two years.
Target / 70% coverage for Māori women aged 50 to 69
Data Source / Breast Screen Aotearoa data available from BSA Lead Providers or from the National Screening Unit.
*For baseline coverage rates the dates of the period reported on should be included.
Specific Criteria / Outline information and activities to support Māori women to participate in breast screening. This should include information on activities that:
  • identify women who have not been screened or are under screened
  • promote breast screening to Māori women
  • work with primary care (including PHOs) to ensure data matching with BSA Lead Providers.
  • participate in the regional planning process with BreastScreen Aotearoa providers and the Independent Service Providers.
Activities should have an evidence base which shows they are effective at increasing breast screening coverage.
All activities should be ‘SMART’ i.e. be specific, measurable, achievable, realistic, and have a time frame. Performance indicators are needed to help the DHB to identify they will know these activities have been successful.
While the majority (15) of DHBs are not contracted by the Ministry of Health to provide breast screening services directly it is expected that all DHBs will have linkages to breast screening activities through regional coordination, managed by the 8 Breast Screen Aotearoa lead providers.
Rationale: Historically, Māori women have significantly higher incidence and mortality from breast cancer compared to non-Māori. Inequities in access to screening services need to be addressed to ensure Māori women experience the benefits of early detection of breast cancer.
Tobacco / Definition / Smoking cessation: Percentage of pregnant Māori women who are smoke free at two weeks postnatal.
Target / 95%
This target is reported by ethnicity and the expectation is that all DHBs achieve the 95% target for Māori.
Data Source / Indicator 19 of the WCTO Quality Improvement Framework.
Please refer to the link below to learn more about this indicator and assess your DHB’s current performance against this target.

Specific Criteria / State your DHB’s current baseline. The MHP plan should reflect the current performance and the improvements that is required for the DHB to achieve the 95 percent target for Māori.
Include and outline information that demonstrates a clear commitment to reduce smoking rates among pregnant Māori women.
Examples of information that you could include in this section are:
  1. How will the DHB ensure that the pregnant Māori women continue to have access to appropriate cessation services after delivery and remain smoke free?
  2. How will the DHB support the whanau of pregnant Māori women to remain smoke free?
  3. How will the DHB support its staff in delivering the above activities? For example what training and resources will the DHB provide for DHB employed midwives to ensure that they are capable of providing smoking cessation advice to all pregnant Māori women?
  4. How will the DHB assess the success of its cessation measures for pregnant Māori women over time?
  5. Outline a clear commitment that the DHB's results for Māori will be equal to or greater than those achieved within the total population for this indicator.
  6. Outline examples of how the DHB is engaging with the local stop smoking services in their area.