Primary health nurse practitioner ROSEMARY MINTO argues why nurses and health planners and providers should sit up and take more notice of Whānau Ora – a home-grown model she believes could help overcome health inequities in New Zealand.
“You can’t solve the problem with the same thinking that caused it” – Einstein.
As the election looms, I always find myself pondering the various political parties’ election promises about health and wonder who will come up with the best solutions for our inequities, inequalities, and other social ills that currently prevail.
Very recently, I was able to participate in Whānau Ora practitioner training. It made me reflect as to why New Zealand health care system planners, funders, and providers seem to be on the eternal search for the ultimate in “models of care” when we have such an all-encompassing solution already in the system.
I suspect the main challenge to acceptance to the programme lies in the statement made by a reporter in 2012, which described Whānau Ora as a “government welfare policy”. It is so much more than that. One researcher has described Whānau Ora as being “at once a philosophy, a model of practice, and an outcome” (Boulton see below).
This model of care has a workforce development training framework with core competencies that are also aspirational outcomes for whānau. The outcomes framework is beautifully simplistic and makes absolute sense for both providers and whānau. They include that whānau are:
- Economically secure – e.g. financial literacy;
- Knowledgeable – e.g. engaged in education;
- Nurturers, self-managing, and living healthy lives – e.g. improved parenting literacy to eradicate domestic violence, caring for their wellness as well as illness;
- Culturally secure, and;
- Finally, that whānau are growing leaders for themselves and their community.
Personally, these outcomes inspire me much more than many I have read over the past decade! Whānau Ora, with its domains and competencies, resonates strongly with a nursing philosophy of care and lends itself magnificently to the current health system direction towards integration, and to solve the challenges of inequity and health disparities, as the authors intended.
It is home-grown and firmly embedded in the Māori world view rather than an imported perspective. Because of this grounding, Whānau Ora demands of the practitioner that their personal values and actions reflect those of the world-view that are at its heart.
Whānau Ora is intended to not only transform whānau but also organisations and communities. If we consider the social returns in this investment, it may translate into a navigator ensuring a mother being able to access healthcare so she can continue to work and care for her children, or a child receiving educational assistance and staying at school, which may have been impossible without interagency collaboration or an unemployed father being assisted in gaining a heavy traffic licence to gain employment.
These seem simple outcomes, but with far-reaching repercussions, and when people have been in survival mode for so long, having barriers removed so they can have the space and hope to set and achieve life goals is indeed transformational.
I am heartened that this model has so far been given time to develop these frameworks and supporting structures, including the most recent change to funding through the commissioning agencies. Any positive transformational change takes time, and it has been many a long year since any changes in health have been given time to develop without demanding quantitative outcome results. Usually change is only sustained as long as the current governmental term, and outcomes are measured in outputs rather than the social outcomes measured here.
As Tariana Turia has said: “Whānau Ora is not a race – it is just as important to find joy in the journey.” So, lets all care about Whānau Ora and not allow it to be reduced to another ad hoc add-on or scorned “project” due to ignorance or misunderstanding.
Boulton et al (2013). Whänau- centred health and social service delivery in New Zealand-the challenges to, and opportunities for, innovation. http://www.journal.mai.ac.nz/sites/default/files/Vol%202%20%281%29%20024%20Boulton.pdf