This is the text extract for Te Whaioranga Maori Responsiveness Strategy Action Plan - November 2007, browse documents here.

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2007-2012 November 2007

Te Whaioranga

Pharmaceutical Management Agency

Māori Responsiveness Strategy Action Plan

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“He hānore, he korōria he maungārongo ki te whenua, he whakaaro pai ki ngā tāngata katoa” Me mihi ki te hunga mate kua wehe ki te pō. Ki tō tātou kaumatua tuatahi a Rongo WiRepa, haere e Koro, otirā koutou ngā mate katoa, haere haere haere atu rā! Ki te hunga ora, ko te tümanako kia piki ai te ora ki runga i a tātou katoa. Mā te Atua koutou e manaaki.

Haere e whai i te waewae o Uenuku, kia ora ai te tangata

Go search for the footprints of Uenuku so that mankind may be nurtured

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Executive summary

Te Whaioranga, PHARMAC’s Māori Health Action plan, outlines PHARMAC’s contribution to improving Māori Health over the next 5 years. PHARMAC’s contribution is one part of a suite of health solutions within the wider NZ Health sector.

The primary goal of Te Whaioranga is to ensure that Māori have access to subsidised medicines and have the knowledge to use these medicines safely and appropriately.

The key Māori Health related objectives for PHARMAC over the next 5 years include: • Delivering cost effective programmes that enhance access to and use of pharmaceuticals by Māori; • Developing enhanced performance metrics to improve Māori Health; • Improving internal policy and process to consider the impact on Māori health of new pharmaceutical investments; • Producing quality ethnicity data analysis to focus campaigns to improve outcomes, efficiency and effectiveness; • Improving internal responsiveness to Māori health issues; • Increasing stakeholder relationships across the sector; • Improving relationships with Iwi / Hapü and Māori Health organisations.

Māori Responsiveness Strategy Action Plan

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Te Whaiora Te Wha

Introduction

PHARMAC has been concerned for some time that the benefits of subsidised medicines may not be reaching Māori at the same rates as other New Zealanders. The overall aim of Te Whaioranga – Māori Health Action Plan aligns with that of He Korowai Oranga1 - whānau ora; Māori families supported to achieve their maximum health and wellbeing through the safe and appropriate use of medicines. PHARMAC undertook fifteen consultation hui across New Zealand to discuss the issues of access to medicines. This provided the opportunity for whānau, Māori health providers, GPs, nurses and pharmacists to identify areas of need in relation to medicines. Many of the issues and ideas raised at these hui were incorporated into PHARMAC’s Māori Responsiveness Strategy MRS (2002).

Māori Responsiveness Strategy: A Summary

1. 2. 3. 4. 5. 6.

The 2002 Māori Responsiveness Strategy had six strategic goals:

Incorporate Māori strategic priorities. Improve human resources. Improve ethnicity data collection and analysis. Improve our performance in negotiating with suppliers and assessing new drug applications. Improve our performance in informing Māori about available subsidised medicines. Improve Māori representation and participation.

These goals have been updated taking into account the progress PHARMAC has made in relation to Māori Health. 1. 2. 3. 4. 5. 6.

The 2007 – 2012 goals build from the original 2002 goals, they are: Integrate Māori strategic priorities. Enhance internal PHARMAC capability in relation to Māori Health issues. Improve the quality of data analysis in relation to Māori Health. Prioritise Māori health priority areas in Funding and Procurement. Advance Optimal Use of Medicines for Māori. Ensure significant Māori representation and participation within PHARMAC.

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Māori Responsiveness Strategy Action Plan

1. MOH:He Korowai Oranga 2002

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The Māori Responsiveness Strategy provides the framework for establishing Te Whaioranga. The report “Implementing PHARMAC’s Māori Responsiveness Strategy (2006)” summarises several areas where PHARMAC could progress its approach to produce benefits for Māori. These include: - targeting resources at priority areas; improving the quality of information and processes upon which decisions are based; promoting awareness amongst Māori of subsidised medicines; monitoring utilisation of medicines; and PHARMAC continuing to develop and implement initiatives that support an ongoing commitment to Māori health outcomes.

Te Tiriti o Waitangi The Treaty of Waitangi

PHARMAC acknowledges2 the special relationship that exists between the Crown and Māori and recognises the articles of the Treaty of Waitangi expressed through the principles of Partnership, Protection and Participation. PHARMAC shall demonstrate its commitment to the Treaty of Waitangi through the following actions: Partnership – working together with Iwi, hapu, whānau, Māori communities and Māori organisations to develop strategies for Māori health gain through use of medicines. Protection – ensuring Māori enjoy the same access to medicines as non Māori to receive at least the same level of health whilst acknowledging and safeguarding Māori cultural concepts and values. Participation – involving and encouraging Māori participation at all levels within the health sector in planning, procurement, access and optimal use of medicines.

anga

Expectations of PHARMAC

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Te Whaioranga sets out the activities PHARMAC will undertake to achieve the strategic goals of the Māori Responsiveness Strategy over the next 5 years.

As a Crown Entity, PHARMAC has a responsibility for improving whānau ora and Māori health through its statutory functions. PHARMAC’s role in the health sector is to manage the national Pharmaceutical Schedule on behalf of all District Health Boards. As well as performing its statutory function, PHARMAC considers Government priorities as outlined in legislation and government strategies when setting strategy and determining actions. These include: New Zealand Public Health and Disability Act 2000 New Zealand Health Strategy New Zealand Disability Strategy He Korowai Oranga – Māori Health Strategy, 2002 New Zealand Primary Care Strategy, 2001 Whakatataka Tuarua – Ministry of Health

aioranga

Māori Responsiveness Strategy Action Plan

2. PHARMAC Operating Policies and Procedures 2006

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PHARMAC Vision, Mission and Values

The PHARMAC vision is Leading Edge Medicines Management, the Te Whaioranga goal in relation to the vision is;

Māori have the right to the right medicine, at the right time, for the right price and with the right information to understand how to use medicines.

PHARMAC Strategic Goals Te Whaioranga Goal Best health outcomes (“outcome mission”) Māori deserve and are entitled to the best health outcomes reasonably achievable through medicines. To be understood (“external mission”) Make a difference (“internal mission”) Our decisions and processes need to be understood by all, including Māori. PHARMAC recognises that to make a difference to Māori Health, it needs effective Māori representation and the goals of the Māori health action plan need to be incorporated into the work of all staff. Te Whaioranga Values There’s no need to wait – we know the problem, let’s get on with finding and implementing solutions. Te Āo Māori (the Māori world) is at the forefront of our heart and minds. We walk the talk. Where proposed solutions look like they are not working, we don’t waste time in stopping them and trying something else. To achieve our goals, we cannot do it alone. We must be grounded in Te Āo Māori and operate in Te Āo Pakeha.

PHARMAC Values Make it happen

Above the Line We Add Value

Unity

He iti te toki e rite ana ki te tangata

’A little adze can do as much work as a man’

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The ability of PHARMAC to deliver on its Māori Responsiveness Strategy requires a whole of PHARMAC approach. The initiatives identified within Te Whaioranga form the basis of a 5 year plan which will include an annual review. Continual consultation is essential to ensure the activities are focussed, successful and relevant. Regular performance measurement will ensure we are on task.

Te Whaioranga implementation plan

2007/2012 Te Whaioranga Initiative / Activity 1 Integrate Māori Strategic Priorities Māori Responsiveness Strategic Goal 1.1 PHARMAC policy development and review considers and includes the Māori Responsiveness Strategy. Status of activity In progress & developing Future activities include improved consideration of the Māori Responsiveness Strategy within policy. In progress and developing Future activity includes permanent resourcing of existing positions and the inclusion of the MRS within performance management & Career Advancement Plans. In progress.

1.2 Human Resource systems including recruitment / performance management and the Career Advancement Plan’s programme incorporate Māori Responsiveness Strategy specific requirements.

1.3 Strategic documents include and or reflect the aims and objectives of the Māori Responsiveness Strategy and Māori health priorities.

1.4 An annual Māori training and staff development plan In progress and developing. is supported through adequate resource. Future activity includes committed resource allocation and internal commitment to participate. 1.5 Operational and Pharmaceutical budgets reflect Māori Responsiveness Strategy priorities. 1.6 Strategic Communications – a Māori communication and consultation plan is developed and a review of existing relationships is conducted. 1.7 Government relationships – Regular engagement with government reporting on PHARMAC’s Māori Responsiveness Strategy, 1.8 PHARMAC website meets State Services Commission guidelines in relation to the use of Te Reo Māori. 1.9 A Māori health section is included on the PHARMAC website 1.10 An annual Matariki event. 1.11 Māori macrons / keyboard and dictionary made available to all staff. In progress and developing. Future activity includes improved process. New development.

New development. Future activity includes regular contact with officials. In progress and developing. New development New development (2007). New development

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Enhance Internal Capability 2.1 Improve and further develop the existing Māori stakeholder database. In progress and developing. Future activity includes improved methods of capture of stakeholder information. New development. Future activity includes systematic and improved process for integrated team work.

2.2 The Māori Health Team will work strategically and constructively across all teams to provide advice regarding Māori health issues or wider Iwi/Māori.

2.3 PHARMAC will exhibit leadership externally regarding In progress and developing. Māori health issues with a focus on optimal use of Future activity includes information medicines by Māori. sharing with key external organisations. 2.4 Provide a forum for PHARMAC to incorporate specialist advice on Māori issues through access to Kaumatua & Māori Caucus members to strengthen PHARMAC business. 2.5 To access specialist advice from Kaumatua to ensure PHARMAC staff are culturally safe when engaging with Māori. In progress and developing. Future activity includes improved process to incorporate specialist cultural advice into PHARMAC business. New development Future activity includes an engagement process and cultural competency training.

2.6 Develop and implement the annual PHARMAC Māori In progress and developing. Staff Training and Development Plan.

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Improve the Quality of Data Analysis 3.1 Māori ethnicity research and analysis is prioritised and resourced internally. 3.2 Technology assessments (including cost utility analysis) consider Māori health status where relevant. 3.3 Regular reports provided in relation to Māori access to Hospital Exceptional Circumstances and Cancer Exceptional Circumstances. 3.4 Increased communication of data analysis to key stakeholders. In progress and developing. Future activity includes considering dedicated and allocated resource. In progress and developing. Future activity includes improving information sharing. New development. Future activity includes considering dedicated and allocated resource and growing internal capacity.

Te

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Prioritise Māori Health priority areas in Funding and Procurement 4.1 Prioritisation considers Māori health priority areas - Diabetes (and renal disease) - Respiratory disease (including Asthma, Chronic Obstructive Pulmonary Disease (COPD), Lung Disease) - Heart / Cardiovascular Disease (including management of cardiovascular risk – smoking cessation, raised blood pressure, thrombosis, dyslipidaemia, metabolic syndrome) - Mental Health - Cancer and Smoking Cessation - Arthritis and Gout - Tamariki Ora - Obesity 4.2 Kaumātua, Māori Caucus and the Māori Health team are used as internal consultants. In progress and developing. Future activity includes process development and improved data analysis.

New development. Future activity includes incorporating specialist cultural advice within decision support tools. In progress and developing. Future activity is incorporated with the development of the Māori stakeholder database.

4.3 PHARMAC consultation processes include the Māori Health Sector.

4.4 Where Māori have an increased prevalence or burden New development. of disease and an increased capacity to benefit from Future activity includes internal new pharmaceutical applications, consideration of process development. impact to Māori is taken into account.

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Advance optimal use of medicines for Māori 5.1 Conduct a workshop for the Māori health team about In progress and developing. EC access criteria. 5.2 Work with Māori health providers on Pharmaceutical Schedule training. 5.3 A specific clause is added to PHARMAC contracts regarding Māori responsiveness New development. Future activity is incorporated into current campaigns. New development. Future activity includes process of consultation with external parties and joint development of the clause to consider impact to Māori In progress and developing. Future activity includes increased stakeholder engagement with Iwi/ Māori organisations. In Progress

5.4 Access and Optimal Use campaigns in the Māori health priority areas will be specifically targeted at Māori. The campaigns will target populations groups and specific geographical areas where there is a high Māori population. 5.5 The He Rongoa Pai, He Oranga Whanau – Whanau Staying well with medicines training programme is delivered to Māori health providers throughout the country. The programme includes a Māori traditional healing - Rongoa Māori module. 5.6 The Māori resource framework is used for all campaigns where Māori have greater burden of disease

New development.

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Ensure significant Māori representation and participation 6.1 PTAC and sub-committees have Māori Health representatives 6.2 Appropriate Māori representation on all Technical Advisory Groups related to the Māori health priority areas In progress. Future activity includes development of identification and recruitment plan.

6.3 Provide high quality advice and papers to both Māori New development. Caucus and CAC. Future activity incorporates improved communications and relationship management.

Links to government and PHARMAC strategy

The Māori responsiveness strategy role within the MOH health outcomes framwork

Better health MRS SG 5 Focus on optimal use of and access to medicines Reduced inequalities MRS SG 1 Improving Primary Care sector delivery to Māori through the provision of information and increased knowledge of Te Ao Māori and the impact of racism in the health sector Better participation & independence MRS SG 6 Increased Māori participation in the internal functions of PHARMAC. Supporting selfdetermining health behaviour. Trust & security MRS SG 3 Improving cultural competency in the health sector. Recognition of the role that rongoā Māori has in Te Ao Māori

3. The PHARMAC Māori Caucus comprises Māori members of the PHARMAC Board, PTAC, Consumer Advisory Committee and Māori Health Team.

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Māori Responsiveness Strategy Action Plan

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Equity & access

Quality

Efficiency & value for money MRS SG 4 Reducing cost as a barrier to access. Prioritising Māori health.

Effectiveness

Intersectoral focus

MRS SG 1 / 5 Developing tools internally to identify disparity and to provide explicit solutions with the decision criteria. Increase Māori team advocacy skills. Implement a cultural safety programme for Māori staff.

MRS SG 1 / 6 Māori people deserve only the best. High quality analysis, focus and decision making.

MRS SG 1/2/3/4/5/6 He Rongoā Pai – He Oranga Whanau.

MRS SG 1 / 6 PHARMAC works with DHBs to deliver on Māori health priority areas. Whole of Government approach working with MOH, MSD, TPK, NGOs. Representation on National Committee’s. Relationship with Te Tumu Whakarae.

Whānau Staying well with Medicines Being cognisant programme. Māori people of rural and are provided remote Monitoring the outcomes with quality populations. of PHARMAC information to decisions. self advocate for quality services. Prioritising high quality data analysis. Promoting Optimal Use of Medicines.

MRS SG = Māori Responsiveness Strategy Strategic Goal

Te Whai

Māori Responsiveness Strategy Action Plan

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Framework

VISION

OUTCOME SUCCESS

INTERNAL SUCCESS

EXTERNAL SUCCESS

VALUES

for success

PHARMAC framework for success

PHARMAC’s framework for success supports the Māori Responsiveness Strategy and Te Whaioranga ensuring a balanced outcome, external and internal focus.

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Māori Responsiveness Strategy Action Plan

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Outcome Success – “Best Health Outcomes” “Māori deserve and are entitled to the best health outcomes reasonably achievable through medicines within the amount of funding provided”. Strategy Define improved performance metrics Explanation PHARMAC is committed to improving Māori Health through optimal use of medicines. To achieve this we need to have a clear and concise picture of Māori health statistics in the defined Māori Health priority areas. Using this data we will measure the progress we are making towards positive Māori health outcomes and focus our campaigns to achieve results.

Pursue better budgeting PHARMAC budgeting process includes adequate resource and process to determine consideration of the Māori Responsiveness Strategy and the Māori optimal pharms budget Health Action Plan. Streamline the application and prioritisation process The ability to consider Māori health priorities during the application and prioritisation process is potentially important to ensuring that best health outcomes are achieved through use of medicines. An improved process for consideration of Māori Health priorities will be developed and implemented in consultation with the PHARMAC Analysis & Assessment and Funding & Procurement teams. The Māori Health Team will work across the whole of the organisation to provide assistance with integrating Māori health priorities between supply side (Analysis & Assessment, Funding & Procurement) and access/optimal use aspects (Access & Optimal Use). Optimal use of medicines by Māori is a key focus. Awareness raising and information sharing with Māori consumers, communities and their healthcare providers is vital to ensuring optimal use. Providing information and, subsequently, services in a culturally efficacious way is the key. PHARMAC will play a lead role in the development and implementation of national policy that will support positive Māori Health gains. Internally PHARMAC will promote a culture of responsiveness to Māori health issues in relation to medicine use.

Better integration of supply and Access & Optimal Use work Increased focus on optimal use of medicines

Increased contribution to policy considerations

External Success – “To Understand and to be Understood” “By people who prescribe, dispense, educate about and take medicines”. Strategy Stronger relationships across the medicines system Closer working relationships with DHB’s Increased communication and stakeholder engagement activity Improved communications capability Explanation Show leadership throughout the sector by building relationships for mutual win/win benefit. The Māori Health Manager will form close links with Te Tumu Whakarae (Māori General Managers from DHBs) through providing support, advice and analysis about Māori use of medicines by each DHB. A specific Iwi/Māori relationship management & communications plan is developed internally and led by the Māori Health Team.

Improve current communication channels to reach Māori consumers, communities and their healthcare providers. This will include using Māori communication networks and informal networks through a comprehensive and detailed database. It will also include PHARMAC’s wider communications to prescribers and the health sector to ensure these consistently incorporate impacts on and health gains for Māori.

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Internal Success – “Make a Difference” “We are committed to delivering, monitoring and measuring how we make a difference to Māori health outcomes”. Strategy Improved performance management process. Stronger capability management. Making PHARMAC an even greater place to work. Clarification of accountabilities and responsibilities. Explanation Our internal policy, process and practise will support the Māori Responsiveness Strategy. We will develop clear and achievable metrics to measure our performance across the whole of the organisation. Comprehensive whole of PHARMAC training will occur annually to encourage and nurture whole of organisation capability and responsiveness to Māori. We will support our Māori Caucus and staff by providing and encouraging use of Te Reo Māori and cultural practises. Encourage internal ownership of identified objectives through all PHARMAC teams to ensure implementation of the Māori Responsiveness Strategy.

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Pharmaceutical Management Agency Level 9, Cigna House, 40 Mercer Street, PO Box 10-254, Wellington 6143, New Zealand Phone: 64 4 460 4990 - Fax: 64 4 460 4995 - www.pharmac.govt.nz Freephone Information line (9am-5pm weekdays) 0800 66 00 50