Roles en la creación multimedial

care

Although Māori health providers have delivered primary care services for over 20 years, comprehensive information about the overall services and cancer-specific services they provide is limited. Indeed, there is no central database of Māori health providers and little publicly-available information on the work that is carried out. The first nationwide postal survey canvassing the cancer services of all Māori health providers was undertaken in 2011 (Slater et al, 2016). The study found that Māori health providers deliver a wide range of programmes including cancer prevention services focussed on health promotion, advocacy, information and support. A major finding of the study was the importance of trust and long- term relationships with a focus on families rather than individual-based care. The way that Māori health providers engage with and deliver services to whānau is described in more detail in the whānau ora section of this chapter. Māori health providers’ local knowledge and whanaungatanga (importance of relationships

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and networks) within their communities meant that they were able to facilitate access for patients into mainstream health care. Māori health providers identified financial hardship, transport difficulties, and lack of information as the greatest barriers to cancer care, and considered that culturally safe care by mainstream providers would improve cancer service provision overall (ibid).

As primary health care providers, Māori health providers have been shown to offer on-going support throughout all parts of the cancer journey including

screening, diagnosis and treatment (Cormack et al, 2005; Maniapoto & Gribben, 2003; McLeod et al, 2011; Slater et al, 2016; Thomson, Crengle & Lawrenson, 2009; Walker et al, 2008). The work that Māori health providers do with, and for, whānau in their communities may include the provision of medical care but also encompasses emotional support and appropriate practical and logistical support for the whole whānau (Slater et al, 2013). Such support includes assistance with applying for medical certificates or completion of benefit entitlement forms.

Māori health providers have also shown innovation in their approaches to cancer care. One study for example, reported an increase in Māori breast screening participation rates in their GP population from 45% to 97% (Thomson et al, 2009). The authors documented their community knowledge and practical steps taken to encourage women to attend screening. The providers addressed barriers to participation in screening through improved information, phoning women to confirm appointments, helping with transport, and co-ordinating appointments for women from the same household. The authors suggest that these strategies can also be used by mainstream organisations to improve screening participation by Māori (ibid).

Not all Māori receive their primary care from a Māori health provider organisation. Indeed, most Māori access mainstream services (Cunningham, 2008). The

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reasons for this are varied. First, mainstream primary health care providers far outnumber Māori health providers and are therefore more easily accessible throughout all areas of Aotearoa. Second, mainstream health providers have been established for much longer than Māori health providers, and have access to more resources, including a larger proportion of government funding through the PHO system contracting services (Matheson, 2013), even though patients cared for by Māori health providers would meet the definition of ‘high needs’ (Ellison-Loschmann et al, 2015; Ministry of Health, 2014f).

In addition, as described at the beginning of this chapter, Māori are not a

homogenous group. Reflecting the diversity found within all ethnic groups, Māori have different preferences and needs and not all choose to access Māori health providers. Despite this, Durie has noted that during periods of vulnerability such as illness, cultural heritage continues to shape ideas, attitudes and reactions (Durie, 1977).

Studies have shown that access to health services is increased when people have faith in the health system (Cormack et al, 2005; Ellison-Loschmann & Pearce, 2006; Lovell, et al, 2007). Part of that faith rests in the different people who make up the health workforce and just as people universally feel more comfortable with someone of their own ethnicity, Indigenous people too, feel welcomed when there are other Indigenous people represented in health services (Ratima, Brown & Garrett, 2008; Shahid, Finn & Thompson, 2009).

There is agreement in the literature that the current Māori health workforce is stretched very thinly (Huria et al, 2014; Minister & Associate Minister of Health, 2002; Ministry of Health, 2006; Ratima et al, 2008). For example the burnout effect of few Māori staff expected to be the ‘go to’ Māori for the cultural questions of all staff, and the added workload of caring for every Māori patient on the ward

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is described in a recent study exploring the experiences of Māori nurses (Huria et al, 2014).

The Ministry of Health also agrees that the Māori health workforce must increase (Ministry of Health, 2006). The need for greater Māori participation and effective service delivery are evident in He Korowai Oranga (Minister and Associate Minister of Health, 2002). Raranga Tupuake, the Ministry of Health’s Māori Health Workforce Development Plan (Ministry of Health, 2006) sets out to grow the Māori health and disability workforce, to expand the expertise of the

workforce and to enable equitable access for Māori into training opportunities.

The previous sections have explored the importance of the pathways through cancer care, co-ordination of care between cancer care providers, and the role of Māori health providers in each of these. Equally important in addressing Māori cancer care needs is good cancer control and cancer policy, which will be outlined in the next section.