The Well Child Tamariki Ora programme is outdated and inequitable, a review has found, and will likely change to a whānau-led model that pairs families with a nurse of kaiāwhina.
Photo: RNZ / Samuel Rillstone
The programme, which began with Royal New Zealand Plunket in 1907, provides health and development screening for children and advice for parents from birth to five years of age, and is delivered by Whānau Āwhina Plunket and more than 60 other predominantly Māori and Pacific non-government organisations.
Some 87 percent of babies born in New Zealand last year were enrolled with the programme, but rates for Māori, Pacific, and whānau living in high deprivation areas were lower.
Associate Minister of Health Dr Ayesha Verrall announced the review findings at Takapūwāhia marae in Porirua this morning saying the programme, while developed with good intent, needed more consistency in referring tamariki to specialist services.
"A shift to a more responsive, integrated, and evidence-based approach is needed to fully support tamariki who are Māori or Pacific, are living with disabilities, are in state care, and/or have high needs," she said.
"New Zealand's population has changed significantly, and this programme has not kept pace with the needs of whānau including the impact of poverty, drug use, mental health challenges, housing and family situations. It needs better integration with other health, maternity, social and early learning services."
The review highlighted six areas as needing change in the short or long term:
- Models of care
- Funding and commissioning
- Governance
- Quality, monitoring and evaluation
- Information and technology
- Workforce
Verrall said two pilots of a model of care pairing whānau with a nurse or kaiāwhina who was backed by a team that could offer mental health, social, education and specialist health services were well under way in Lakes DHB and Counties Manukau, and would inform the redesign.
A third trial was set to begin in Tairāwhiti later this year.
The marae is the home of Porirua's Ora Toa Community Health Unit, which has been providing Well Child Tamariki Ora services for 21 years, and contributed to the Ministry of Health review carried out as part of the Child Youth and Wellbeing Strategy 2019.
"There has been this evolution of more and more Māori and Pacific providers coming in but they haven't been strengthened in a way to really meet their population's needs, so I see it as a continuation of, say, 25 years of change," Verrall said.
"There are certainly disparities in who even enters the system and then who gets referred for services and that is not right."
Verrall said designing services that work for different families' needs was a key element of the government's planned reforms to the health and disability system, and the programme had to be designed, delivered and resourced differently to achieve equity.
"That work must respond to the science around the first 1000 days of life, which shows strong evidence that investing in whānau during pregnancy and a baby's early years can make the biggest difference to lifelong wellbeing."
She said meaningful partnerships with Māori must be embedded throughout the governance, design, delivery and monitoring of the programme.
She said the redesign was expected to take three years, and costs would not be known until the new model had been developed.
"Our first step is to work with Māori health organisations to develop better models of delivering the service and then we'll have to take costings from there."
Asked if Plunket would be replaced, she said it "has an awful lot to give" but the government wanted to go through the process of seeing what the new provision of services would look like.
"Our concern is to strengthen existing organisations through making sure that we recognise what is valuable about those smaller Māori and Pacific non-governmental organisations ... we don't have a concern about the number of organisations but we want to know that they're backed up well."
