Improving Access to Primary Care for Maori and Pacific Peoples

Improving Access to Primary Care for Māori and Pacific Peoples
A literature review commissioned by the Health Funding Authority

Date of publication: December 2000

This document is a review of the most relevant literature on strategies that improve Māori and Pacific peoples’ access to primary health care services, commissioned by the former Health Funding Authority. It may help inform PHOs when planning services to improve access.

Executive summary
This report was commissioned by the Health Funding Authority to review the most relevant literature on strategies that improve Māori and Pacific peoples' access to primary health care services. Particular attention was to be paid to research and evidence based evaluation of strategies.

The Health Funding Authority commissioned a literature review from the Clearinghouse for Health Outcomes and Health Technology Assessment (NZHTA). From the references generated, those that appeared most relevant on the basis of their abstracts were retrieved for review in this report. While the search was of New Zealand and international databases, particular efforts were made to retrieve New Zealand research and evaluations. However, such material is rare, and where it is available, it has been given prominence in this report.

There are conceptual and methodological issues in measuring access to care and a range of measures have been used in different studies. Consensus is developing that traditional methods of measuring access, which focus on the ability to enter the system, must be supplemented by efforts to measure whether individuals have access to effective and appropriate health care. The need for culturally appropriate and high quality health services has been identified by both Māori and Pacific people as of prime importance.

In the past ten years New Zealand has seen significant changes in the governance, organisation and funding of primary health care services. While general practitioners are still significant providers of services, there is an increasing range of 'third sector' (neither government nor private) provision including partnerships between health providers and iwi, and between health providers and community groups. While rigorous evaluations of such projects are scarce, indications are that they are reducing barriers to care for target groups.

Delivering services away from traditional settings appears to be effective in engaging underserved populations with primary health care. In New Zealand marae-based services for Māori, and church-based services for Pacific people, have been well received by the communities in which they have been offered. Outcome evaluations of other community-based initiatives are scarce, but process evaluations suggest a high level of satisfaction with such services.

In addition to developing customised services for minority populations, the literature also discusses ways of enhancing existing services in order that they better meet the needs of traditionally underserved groups. Commentators endorse the need for mainstream services to develop an increased awareness of the culturally determined nature of behaviour; to recognise the impact of the power imbalances inherent between health professionals and patients; and to appreciate that attitudes to health, health promotion and treatment are culturally determined and may influence patients' responsiveness to health care advice.

Workforce development strategies figure in the literature as a key way to ensure that primary health care services are more accessible to minority groups. Such strategies include making available health care professionals of the same ethnicity as the client group, recruiting ethnic or bilingual lay health workers, and providing additional training for existing health workers.

Other strategies about which a small amount of material was retrieved include: home visiting services, language support, transport strategies, the use of technology, and multi-faceted strategies.

From its review of almost 100 of the more methodologically robust studies available, a British health research group identified some of the characteristics found more frequently amongst the programmes that have been shown to be effective. The more successful programmes:

are systematic and intensive approaches
are multifaceted
use a multidisciplinary approach, collaboration between agencies and/or between lay and professional groups
involve some face-to-face interaction
give thought to whether group or individual strategies are more appropriate to achieve their objectives
consider the setting within which the programme is to be delivered
have undertaken some prior needs assessment to inform intervention design
ensure interventions are culturally appropriate
recognise the importance of the 'agent delivering the intervention' - be it health professional, education professional, outreach worker, ethnic health worker, volunteer or peer educator
tailor support material for their purpose
recognise that information alone is often insufficient
use prompts or personal reminders to encourage people to use services or keep appointments.

Document availability
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