Ki te Taumata o Pae Ora Waikato DHB Maori Health Plan 2016 ... · Ki te Taumata o Pae Ora ... LMC discharge 5. ... and 2.7 times as high for Māori as for non-Māori in Waikato during

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Waikato District Health Board Māori Health Plan

Ki te Taumata o Pae Ora 2016-2017

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KiteTaumataoPaeOra“TowardsthesummitorpinnacleofPaeOra”

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TABLE OF CONTENTS TABLEOFCONTENTS................................................................................................................3

ACKNOWLEDGEMENTS............................................................................................................4

FORWARDFROMACTINGEXECUTIVEDIRECTORMĀORIHEALTH...........................................5

SUMMARYOFINDICATORS......................................................................................................6

POPULATIONPROFILE..............................................................................................................8

OurPopulation..................................................................................................................8

HealthProfile....................................................................................................................9

MĀORIHEALTHPRIORITIESANDINDICATORS.......................................................................12

TEPUNAORANGAHOLISTICPROJECTS/PROGRAMMESTOACHIEVEHEALTHTARGETS13

NATIONALPRIORITIESANDINDICATORS...............................................................................16

DataQuality....................................................................................................................16

AccesstoCare-PHOEnrolments....................................................................................17

AccesstoCare–AmbulatorySensitiveHospitalisation(ASH)........................................20

ChildHealth(Breastfeeding)...........................................................................................22

CardiovascularDisease....................................................................................................25

CancerScreening(Cervical).............................................................................................26

CancerScreening(Breast)...............................................................................................28

Smoking...........................................................................................................................30

Immunisation(1).............................................................................................................32

Immunisation(2).............................................................................................................34

OralHealth......................................................................................................................37

MentalHealth.................................................................................................................39

RheumaticFever..............................................................................................................41

SuddenUnexpectedDeathinInfancy(SUDI)...................................................................43

LOCALPRIORITIESANDINDICATORS......................................................................................47

1. SupportingWhānauOraProviderCollectivesandWhānauOraCollectivePlan.....47

2. Workforce................................................................................................................54

3. VirtualCare..............................................................................................................54

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ACKNOWLEDGEMENTS

Ka hoki, anoo, ki te timatanga koorero e kiia ana, he honore, he korooria ki te Atua; kia tau, tonu, oona manaakitanga maha ki runga i a Kiingi Tuheitia me toona Whare Ariki, nui tonu. He maungarongo ki te whenua; he whakaaro pai ki ngaa taangata katoa!

Ka whai iho nei he timatanga tuhononga o te mahere rautaki Māori o te Rohe Hauora o Waikato ki raro i te maru o ’Whānau Ora’; me te mihi ki ngaa manukura o teenaa iwi, o teenaa iwi me maataawaka o te rohe nei, kua whakaaengia, ka whakawhanakehia teenei tuhononga; hei tautokona te tirohanga whakamua, te anga whakamua o ’Whānau Ora’.Kia ara poutama, tonu, te kaupapa o ’Whānau Ora’, hei oranga ake mo te iwi nui tonu!

Waikato District Health Board (DHB) wishes to thank and acknowledge the members of our Iwi Māori Council and Kaunihera Kaumātua, our Māori communities, and the Waikato DHB Board who participated in the development of Waikato DHB’s Māori Health Plan 2016-2017. In particular Waikato DHB wish to give special thanks to the people of Hauraki, Ngāti Maniapoto, Ngāti Raukawa, Waikato, Ngāti Tuwharetoa, Whanganui and all other iwi (Ngā Maata Waka) living within the Waikato DHB rohe.

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Ti

FOREWORD FROM ACTING EXECUTIVE DIRECTOR MĀORI HEALTH

TePunaOranga,theMāoriHealthService,oftheWaikatoDistrictHealthBoard,isgoingthroughaperiodofchange.Aspartofthatchange,wearerefreshingthewayweplantoimproveMāorihealthoutcomesintheWaikatoregion.Thenewplanningformatwillbepredicatedonavisionof“happy,healthyandwealthyMāori.”ItwillincludeatwentyyearoutlookstatementbasedonwhereweexpectMāorihealthtobein2026ifwearetobeintentionalaboutachievingourvision.ItwillincludeafiveyearMāoriHealthPlanwhichwillidentifyandarticulatethekeyelementsrequiredtoimproveMāorihealthinthisregion.Finally,itwillincludeatwelvemonthbusinessplanthatwillidentifywhereTePunaOrangawillfocusitsresourcesasittransitionstothenewplanningregime.

ThiswillbeacollaborativearrangementbetweenTePunaOrangaMāoriHealthServiceandtheIwiMāoriCounciloftheWaikatoDHB.

WeexpecttohavethenewplanningformatcompletedandforwardedtoyoubytheendofAugust2016.Inthemeantime,wesubmitthisMāoriHealthPlantosatisfythecompliancerequirementsoftheMinistryofHealth.

MillieBerryman

ActingExecutiveDirectorMāoriHealthTePunaOrangaMāoriHealthServiceWaikatoDistrictHealthBoard

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SUMMARY OF INDICATORS

National

Priorities Indicators

Baseline 2014/2015 unless otherwise stated

Māori Other

Target for Māori

Data Quality 1. Ethnicity data accuracy Primary Care Ethnicity Data Audit Toolkit Implemented

Access to care 2. Percentage of Māori enrolled in PHOs 91.95%1 95% 100%

Access to care

3. Ambulatory sensitive hospitalisation (ASH)

0-4 yrs

45-64 yrs

9,088

7,956

7,956

4,154

7,936 or less

5,650 or less 2

Child health3

4. Exclusive or fully breastfed at LMC discharge

5. Exclusive or fully breastfed at 3 months

6. Receiving breast milk at 6 months

6 weeks 3 months 6 months

60%

43%

50%

Total:

66%

54%

60%

75%

60%

65%

Cardiovascular disease and diabetes

7. Percentage of ‘eligible Māori men in the PHO aged 35-44 years’ who have had a CVD risk recorded within the past five years

84%4 89.3%5 90%

Cancer

8. Breast screening rate

60.1% 68.1% 70%

9. Cervical screening rate

60% 80% 80%

Smoking 10. Percentage of pregnant Māori women who

are smoke free at two weeks postnatal 60% Total population

WDHB-

82%6 95%

Immunisation 11. Percentage of infants fully immunised by 8 months of age 88%

Total population WDHB-

91%7

95%

1DataretrievedfromTrendlyforperiodQ1toQ42015

2ASHdatasourcedfromNSFLwebsiteforperiod12monthstoMarch2016

3MinistryofHealth:2016.IndicatorsfortheWellChildTamarikiOraQualityImprovementFramework:September2015.Wellington:MinistryofHealth



6DatasourcedfromMinistryofHealth.2015.IndicatorsfortheWellChild/TamarikiOraQualityImprovementFrameworkMarch2015.Wellington:MinistryofHealth.Timeperiod:birthsbetween1Januaryand30June2014.

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National

Priorities Indicators

Baseline 2014/2015 unless otherwise stated

Māori Other

Target for Māori

12. 75% of the eligible population (>65 years) are immunised against influenza annually

55.25% 56% 75%

Rheumatic Fever

13. A two-thirds reduction from baseline in the number and rate of hospitalisations for acute rheumatic fever

2013/2014:

4.8 per 100,000

2014/2015:

3.6 per 100, 000

Rate: 1.2 per 100,000

Please note this is a target for the total population

Sudden Unexpected Death in Infancy

14. National SUDI target - 0.4 SUDI deaths per 1,000 live births

2010-2014:

1.48/1,000 live

2010-2014:

.18/1,000 live

0.4 /1,000 live Māori births

Sudden Unexpected Death in Infancy

15. All caregivers of Māori infants are provided with SUDI prevention information at Well Child Tamariki Ora Core Contact 1

2014:

39.2% of Māori

caregivers received

SUDI info at Core

Contact 1

2014:

59.9% of non-Māori

caregivers received

SUDI info at Core Contact

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70% of caregivers of Māori infants are provided

with SUDI prevention

information at WCTO Core

Contact 1

Mental Health

16. Mental Health Act: section 29 community treatment order comparing Māori rates with other (per 100,000)

July 2012 to June 2013:

384

July 2012 to June 2013:

301

N/A

Oral Health

17. Percentage of Māori preschool tamariki are enrolled in the community oral health service

Not able to be reported

Not able to be reported 95%

Local Priorities Supporting Whānau Ora Provider Collectives and Whānau Ora Collective Plan

18. Strengthen the relationship that the Waikato DHB has with its local Whānau Ora collective

Workforce 19. A workforce that is reflective and responsive to

the needs of Māori

Virtual Care 20. Increased delivery of health services to the large

rural population closer to home.

7DatasourcedfromMinistryofHealth.2015.IndicatorsfortheWellChild/TamarikiOraQualityImprovementFrameworkMarch2015.Wellington:MinistryofHealth.Timeperiod:October2014toDecember2014.

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POPULATION PROFILE WaikatoDHBPopulationWaikatoDHBservesapopulationof400,820andcovers21,220squarekilometres.ItstretchesfromnorthernCoromandeltoMtRuapehuinthesouth,RaglanonthewestcoasttoWaihiontheeastcoast.

TheWaikatoDHBdistricttakesinthecityofHamiltonandtownssuchasThames,Huntly,Cambridge,TeAwamutu,Matamata,Morrinsville,Ngaruawahia,TeKuiti,TokoroaandTaumarunui,coveringsixIwigroups.WaikatoDHBpopulationbreakdownispresentedinthefollowingtable.AgeGroup Ethnicity

Māori Pacific Other Total00–24 47,850 5,700 86,950 140,50025–44 21,940 3,200 72,280 97,42045–64 16,680 2,120 80,940 99,74065–74 3,690 500 32,010 36,20075+ 1,640 280 25,040 26,960Total 91,800 11,800 297,220 400,820

Thelargeruralpopulationpresentsdiversechallengesinservicedeliveryandaccessinghealthservices.Significantpointsofinterestinclude:

• ThepopulationisexpectedtoincreaseinWaikatobutataslowerratethantherestofNewZealand

• WearemoreruralthanNewZealandasawhole• Wehaveapopulationthatisgettingproportionatelyolder(the65plusagegroupis

projectedtoincreaseby52percentbetween2011/12and2025/2026)• Thepopulationofchildrenandyoungpeopleispredicatedtodeclineby2026• WehaveaMāoripopulationwhichisgrowingataslightlyfasterratethanother

populationgroupsandisestimatedtobe23.3percentby2026

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• WehaveapopulationofPacificpeoplewhomakeupanestimated2.5percentofourpopulation

• AhigherpercentageofpeopleinourDHBliveinareasoflowsocio-economicstatuscomparedtotheNewZealandaverage(24.10percentliveinareasclassifiedasquintilefiveormostdeprived,comparedtoanationalaverageof20percent)

• Ruapehu,WaitomoandSouthWaikatoterritoriallocalauthoritieshavethehighestproportionofpeoplelivinginareasoflowsocio-economicstatus

• Inequalitiesinhealthtendtobehighestforpeoplelivinginareasidentifiedasquintilefourandfiveandthesepeoplearelikelytoexperiencelowerlifeexpectancyandhigherratesofchronicconditions

• HighnumbersoftheMāoripopulationinourdistrictliveinareasidentifiedasquintilefourandfive

HealthProfileUnderstandingourhealthprofileplaysanimportantpartinourplanninganddecisionmakingprocesses.KeypointsofinterestintermsofthehealthprofileoftheWaikatoDHBpopulationare8:

• In2012–2014,lifeexpectancyatbirthforMāoriintheWaikatoRegionwas76.5yearsforfemales(7.5yearslowerthanfornon-Māorifemales)and72.2yearsformales(8.1yearslowerthanfornon-Māori).

• Theall-causemortalityrateforWaikatoMāoriwastwiceashighasthenon-Māorirateduring2008–2012.

• Injurymortalitywas85%higherforMāorithanfornon-MāoriinWaikato.Maleshadhigherratesofdeathfrominjurythanfemales.

• Potentiallyavoidablemortalityandmortalityamenabletohealthcarewere2.6timesand2.7timesashighforMāoriasfornon-MāoriinWaikatoduring2007–2011.

• Theall-causerateofhospitaladmissionswas16percenthigherforMāorithanfornon-Māoriduring2011–2013.

• Almost5,200Māorihospitaladmissionsperyearwerepotentiallyavoidable,withtherate38percenthigherforMāorithanfornon-Māori.Theambulatorysensitivehospitalisationratewas75percenthigher.

• Therateofhospitalisationduetoinjurywas19%higherforMāorithanfornon-Māori.Maleshadhigherratesofadmissionthanfemales.

• ThemostcommoncausesofinjuryresultinginhospitalisationsamongMāoriwerefalls,exposuretomechanicalforces,andcomplicationsofmedicalandsurgicalcare,transportaccidents,andassault.

8InformationinthissectionhasbeensourcedfromRobsonB,PurdieG,SimmondsS,WaaA,BrownleeG,RamekaR.2015.WaikatoDistrictHealthBoardMāoriHealthProfile2015.Wellington:TeRōpūRangahauHauoraaEruPōmare

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• Ratesofhospitaladmissionforinjurycausedbyassaultwereover5timesashighforMāorifemalesasfornon-Māorifemalesand2.4timesashighforMāorimalesasfornon-Māorimales.Maleshadhigherratesthanfemales.

• Comparedtonon-Māori,cancerincidencewasalmost50%higherforMāorifemaleswhilecancermortalitywasclosetotwiceashigh.ForMāorimales,cancerincidencewassimilartothatofnon-Māori,whilecancermortalitywastwo-thirdshigher.

• BreastscreeningcoverageofMāoriwomenaged45–69yearswas55%comparedto68%ofnon-Māoriwomenattheendof2014

• CervicalscreeningcoverageofMāoriwomenaged25–69yearswas60%over3yearsand75%overfiveyears(comparedto78%and91%ofnon-Māorirespectively).

• Breast,lung,colorectal,uterineandcervicalcancerswerethemostcommonlyregisteredamongWaikatoMāoriwomen.

• Therateoflungcancerwas4timestheratefornon-Māori,aswasthemortalityrate.Breastcancerincidenceandmortalityrateswerebothtwo-thirdshigherforMāorithanfornon-Māori.

• ColorectalregistrationandmortalityratesweresimilarforMāoriandnon-Māori.• Stomachcancerwasthefourthleadingcauseofcancerdeathwith4timesthe

mortalityrateofnon-Māori.• During2011–2013Māoriwithdiabeteswerenearly4timesaslikelyasnon-Māorito

havealowerlimbamputated.• Māoriadultsaged25yearswere82%morelikelythannon-Māoritobehospitalised

forcirculatorysystemdiseases(includingheartdiseaseandstroke)in2011–2013.• WaikatoMāoriwere28%morelikelythannon-Māoritobeadmittedwithacute

coronarysyndrome,43%morelikelytohaveangiography.• Heartfailureadmissionrateswere5timesashighforMāoriasfornon-Māori.• StrokeadmissionratesweretwiceashighforMāoriasfornon-Māori,aswererates

ofadmissionforhypertensivedisease.• Chronicrheumaticheartdiseaseadmissionswerealmost6timesascommonfor

Māoriasfornon-Māori,whileheartvalvereplacementrateswerejustovertwiceashigh.

• BySeptember2014,66%ofMāorigirlsaged17yearsand64%ofthoseaged14yearshadcompletedallthreedosesofthehumanpapillomavirus(HPV)immunisation.CoveragewashigherforMāorithanfornon-Māori.

• Ratesofhospitalisationforseriousinjuryfromself-harmweresimilarforMāoriandnon-Māoriamongthoseaged15–24yearsduring2011–2013butoverathirdhigherforMāorithanfornon-Māoriatages25–44years.

• Māoriaged45yearsandoverwere3.8timesaslikelyasnon-Māoritobeadmittedtohospitalforchronicobstructivepulmonarydisease(COPD).

• Asthmahospitalisationrateswere2to3timesashighforMāorithanfornon-Māoriineachagegroup.

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• Onaverage,2,180Māoriinfantswerebornperyearduring2009–2013,40%ofalllivebirthsintheDHB.SevenpercentofMāoriand6%ofnon-Māoribabieshadlowbirthweight.

• In2013,two-thirdsofWaikatoMāorichildrenaged5yearsandone-thirdofnon-Māorichildrenhadcaries.

• AtYear8ofschool,almostthreeinfiveMāorichildrenandjustovertwoinfivenon-Māorichildrenhadcaries.

• Māorichildrenunder15yearsweretwo-fifthsmorelikelythannon-Māoritobehospitalisedfortoothandgumdisease.

• Māoriwerefour-fifthsmorelikelyasnon-Māoritobeadmittedtohospitalforamentaldisorderduring2011–2013.Schizophreniatypedisorderswerethemostcommondisorders,followedbymooddisorders.

TheIwigroupswithinWaikatoDHBdistrict:

The principal tribal Iwi groups that reside within the Waikato DHB district also affiliate to Tainui waka : • Hauraki • Ngāti Maniapoto • Ngāti Raukawa • Waikato

Ngāti Tuwharetoa and Whanganui iwi groups also reside within Waikato DHB district. A significant proportion of Māori living within the Waikato DHB district affiliate to Iwi outside the district and collectively they are known as Maata Waka.

Figure 2: Map of Te Rohe o Tainui

Mokau ki runga

Tamaki ki raro

Mangatoatoa ki waenganui

Pare Hauraki

Pare Waikato

Te Kaokaoroa o Patetere

Te hokinga mai ki te Nehenehenui

Mokau above

Tamaki below

Mangatoatoa in the middle

The lands of Hauraki

The lands of Waikato

The lands Maniapoto and Raukawa

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MĀORI HEALTH PRIORITIES AND INDICATORS ThefollowingsectionsofKiteTaumataoPaeOra2016-2017detailMāorihealthprioritiesandalignedindicatorsthathavebeenselectedatthenationalandlocallevel.

ThefirstcomponentfocusesonTePunaOrangaspecificactivitiesthataligntomorethanoneindicator;thisistoavoidrepeatsthroughoutthedocument.

Thesecondcomponentfocusesonprioritiesandthealignedindicatorssummarisedwiththefollowingheadings:

• Whyisthisapriority?• Objective• Actionstodeliverimprovedperformance • Measure • Reporting

Monitoring and Reporting

TheindicatorsandperformanceexpectationsidentifiedinKiteTaumataoPaeOra2016-2017aremonitoredregularly.WeprovideasixmonthlynarrativereporttotheSeniorManagementandBoardonourperformanceagainstalltheindicatorsinthisplan.SignificantreportsareprovidedanddiscussedinBoardmeetingsandthereportsareavailabletothepublicaspartoftherelevantBoardagendaavailableonourwebsite.

TheIwiMāoriCouncilandtheKauniheraKaumātuareceivetheannualnarrativereportswithanadditionalannualWaikatoDHBMāoriHealthMeasuresOmnibus.

Ourperformanceagainsttheindicatorsinthisplanisoneofthetoolsusedbytheorganisation(throughtheIwiMāoriCouncil,KauniheraKaumātua,theBoardandSeniorManagement)toidentifyissuesandinformdecision-makingtoimproveperformance.

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TE PUNA ORANGA HOLISTIC PROJECTS/PROGRAMMES TO ACHIEVE HEALTH TARGETS

ThefollowingactivitiesdemonstrateaholisticapproachtomeetingtheNationalIndicators.

AstheyarereferredtooftenthroughouttheWaikatoDHBMāoriHealthPlanasummaryofeachprojectandwhichindicatorstheyaligntoisprovidedbelow.Moredetailonhowtheseactivitieswillimpactonachievingequityisdetailedwithintheplanningdocument.

Whatarewegoingtodo? Measure

1.Attempttocontactcaregiversofallpēpi,tamariki,andrangatahiadmittedintoWaikatohospitalwithrheumaticfever.

Monthlyreports

2. Workwithwhānautopreventreadmissionintohospitalbecauseofrheumaticfever

3. Workwithwhānautopreventotherpēpi,tamarikiandrangatahifromdevelopingrheumaticfever

4.TePunaOrangawillprovidetheMinistryofHealthwithmonthlyreportsontheprogressoftheimplementationofWhareOra

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1.ThenHartiHauora(HH)TamarikiAssessmenttoolreferralpathwayisevaluatedreviewedandimplementedinWaikatoHospital.

Reportannually

2.ImplementationoftheHartiHauoraTamarikiAssessmenttoolinatleast3othersettingswithinWaikatoandMidlandregion.

Reportannually

3.Developandimplement2xHHassessmenttoolstargetingspecificagesandgender

Developmentandimplementationof2xHHbasedassessmenttools

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1. ReviewandalignKaitiakiandKaitakawaengaculturalassessmenttooltoalignwithMāoriHealthindicators.

Assessmenttoolrealigned

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NATIONAL PRIORITIES AND INDICATORS

DataQualityWhyisthisapriority?

CollectingaccurateethnicitydatainaccordancewiththeEthnicityDataCollectionProtocolswillimprovethequalityofethnicityhealthdata.

BaselineMeasure

Māori AwaitingbaselinedatafromJune2016resultsofEDAT

Non-Māori AwaitingbaselinedatafromJune2016resultsofEDAT

Objective Actionstodeliverimprovedperformance Measure Reporting

EthnicityDataQuality

IdentifyandcreateasetofKPI’sthatwillbeusedindifferentsettingswithinthehospitaltocollectqualitydataethnicity.

CreateKPI’sthatcanbeauditedthroughouttheyeartoensurequalitydataiscaptured

Annualreporting

WaikatoDHBwillcontinuetoworkwithourlocalPHOsinordertoimproveandmaintainthequalityofethnicitydatasubmittedtonationalcollections

Sixmonthly

TheMidlandHealthNetworks(MHN)willauditagainstitsethnicitydataviaitsqualityassuranceprogramme.TheMHNwillprovideinformationonthecomparisonbetweenPHOenrolmentandCensusfigures(refertoPHOenrolmentsectionofthisplan)

100%ofHaurakiPHO’spracticeswithintheWaikatoDHBdistrictwillunder-taketheMinistryofHealth’sEthnicityDataAudit(by30thofJune2017)

100%ofNationalHauoraCoalitionpracticeswithintheWaikatoDHBdistrictwillunder-taketheMinistryofHealth’sEthnicityDataAudit(by30thJune2017)

Target

Awaitingbaselineinformationbeforeatargetcanbeestablished

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AccesstoCare-PHOEnrolments Whyisthisapriority?

PHOenrolmentisthefirststepinensuringallpopulationgroupshaveequitableaccesstoprimaryhealthcareservicesandisthereforeacriticalenablerfirstpointofcontacthealthcare.Differentialaccesstoandutilisationofhealthcareservicesplaysanimportantroleinhealthinequities,andforthisreasonitisimportanttofocusonenrolmentratesforMāori.

BaselineMeasure

Māori 91.95%

Non-Māori 95%

Objective Actionstodeliverimproved

performanceMeasure Reporting

IncreaseinthepercentageofMāorienrolledinaPHO

HartiHauora(HH)TamarikiAssessmenttoolreferralpathwayisevaluatedreviewedandimplementedinWaikatoHospital,withaspecificaccesstocarereferralpathway.

HHTamarikiAssessmentToolisevaluated,reviewedandimplementedbyDecember2016.

PublishevaluationfindingsinAcademicJournalbyDecember2016.

6monthlyreporting

ImplementationoftheHHTamarikiAssessmenttoolwithaspecificaccesstocarereferralpathwayinatleast3othersettingswithinWaikatoandthewiderMidlandregion,toincreasewhanauenrolmentthatmayhavebeenmissedinothersettings.

HHTamarikiAssessmentToolispilotedinatleast1settingattheendofeachofthefollowingquarters-

Q1-Firstsetting

Q2-Secondsetting

Q3-Thirdsetting

6monthlyreporting

Target

100%

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Objective Actionstodeliverimprovedperformance

Measure Reporting

Design,developandimplementassessmenttoolsbasedontheHHTamarikiAssessmentToolspecificallytargetingKaumatua,Kuia,wāhineandtāne,withaspecificaccesstocarereferralpathway.

ToolspecificallydevelopedtotargetKaumatua,Kuia,wāhineandtānebyDecember2016

6monthlyreport

ReviewandimplementKaitiakiandKaitakawaengaculturalassessmenttoincludeaspecificaccesstocarereferralpathway.

CulturalassessmentreviewedandimplementedbyDecember2016

6monthlyreport

NationalHauoraCoalitionwillcontinuetosupportarangeofPrimaryHealthOrganisationbasedinitiativestoimproveMāoriengagementwithprimarycare,includingcommunityeventsandtheuseofcommunityworkersandnavigatorstosupportMāoritoconnectwithgeneralpractice

WaikatoDHBwillmonitorPHOenrolmentsbyprovidingacomparisonoftheenrolledpopulationwithinourthreelocalPHO’srelativetoCensusdatathatrelatestotheWaikatoDHBdistrictbythefollowingdates-

FirstdatasetbyJune2016

SeconddatasetbyDecember2016

ThirddatasetbyJune2017

WaikatoDHBwillmonitorPHOenrolmentsbyethnicityonaquarterlybasis.

MidlandsHealthNetworkviaitslocalityplanningworkisalwaysactivelycomparingvariousviewsofthepopulationtoensurethatweareachievingthehighestpossiblecoverageaspossible.Inareaswhereitappearstherearegapsthenwewillundertakelocaldrivesandalwaysadviseparentsaccessingcaretoenlistwitharegularprovider




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Measure Reporting



HaurakiPHOwillworktoincreaseMāorienrolmentsinitsPHO,viaamediacampaignandmarketing,includingpromotionatcommunityevents,andthroughpromotingenrolmentinprimarycarethroughtheHaurakiWhānauOraAlliance,whichconnectstomanywhānauataserviceprovisionlevel






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AccesstoCare–AmbulatorySensitiveHospitalisation(ASH)Whyisthisapriority?

ASHisaproxymeasureforavoidablehospitalisations,andunmethealthcareneedinacommunitybasedsetting.TherearesignificantdifferencesinASHratesfordifferentpopulationgroupsandakeyfocusonactivitiestoreduceASHmustaddressthecurrentinequities.

TotalWDHBpopulation

BaselineMeasure

0-4years 9088

45-64years 7956


Measure Reporting

Fewerpeopleareadmittedtohospitalforavoidableconditions

During2016/17WaikatoDHBfurtherdevelopandstrengthenthework-streamaroundimprovingambulatorysensitiveadmissionsrates.Thiswillcontinuetobeajointprimaryandsecondarycarepieceofwork.

Workwithprimarycarealliancepartnerstoreduceambulatorysensitiveadmissions.

AmbulatorySensitiveHospitalisationsratesper100,000fortheagegroups0-4and45-64yearsareattained.

Forbothagegroups0-4and45-64years:

NarrativeandquantitativereportagainstallASHinitiativesbyquarter4reportingperiod2017.

UntilthatreportiscompletedquarterlyreportswilltrackeachASHinitiativebyhealthpriorityandethniccomparisonofutilisationofservices.

Continuesharingambulatorysensitiveadmissioninformationwithourprimarycarealliancepartners(toaiddecision-makingfrom1July2016to30June2017)

Datasharingprocesscontinues

Topfiveambulatorysensitiveadmissionareastobeconsideredforprioritisationbymapofmedicinegovernancegroup.AninitiativeviatheMAPofMedicinewilllooktoimprovereferralpathwaysbetweenprimarycareandsecondarycareinregardstoASHhealthpriorityareas.(CompletedJune2016)

AreasforWaikatoDHBdistrictforwardedtomapofmedicinegovernancegroupforconsiderationbyquarterone

Target

0-4years-<7956

45-64years<5836

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Measure Reporting

EnsurethattheMAPofMedicinehasastrongequityfocusintegratedintoitsapproachinordertosupportachievinghealthequityforMāori(July2016).ThiswillincludethedevelopmentofnodeswithintheMAPofMedicinethatlinkhealthprofessionalstoservicesthataddressdeterminantsofMāoriASHratessuchasincome,housing,foodsecurity,socialservicesandpreventativehealthservices.

Asthma

ContinueimplementingWhareOra(WO)ahealthyhomesinitiativeswhichseektomakehomeswarmerdrierandhealthierandsaferbyinstallingarangeofproducts(floorandceilinginsulation,thermalcurtains,heatingdevices,dehumidifies,mouldkits,firealarmsanddraftstoppers)andreferontosocialsupportservices/WhānauOraifrequired.

Respiratoryinfections-pneumonia

ContinueimplementingWhareOra(WO)

RheumaticFever/HeartDisease

ImplementationofactionsidentifiedintheWaikatoDHB’sRheumaticFeverPreventionPlan2015-2016(refertoRheumaticFeversectionofthisplan)(quarterlyreportstotheMinistryofHealthonprogressagainstactionsandtargetsdetailedintheplanandareductionintheincidenceofRheumaticfeverratesisevidenced.

Complete400HealthyHomeAssessmentsintheWaikatodistrict(ByJune2017)

ContinuesuccessfulcrosssectorapproachwithstakeholdersinWhareOraprogramme(ongoing).

EnsurewhānauarereceivinginterventionassistancefromWhareOraprogrammewithin7weeksofbeingreferred.(ongoing)

Monthlyreporting

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ChildHealth(Breastfeeding)Whyisthisapriority?

Breastfeedingprovidesinfantswithnutritionalneedsandbuildsimmunityforthefirstsixmonthsoflife,toprovideprotectionagainstarangeofconditions.Breastfeedingalsoprovidesbenefitsintermsofbondingbetweenmamaandpēpiandcansupportbetterhealthoutcomes.Researchshowsthatchildrenwhoareexclusivelybreastfedforaround6monthsarelesslikelytosufferfromchildhoodillnessessuchasrespiratorytractinfections,gastroenteritisandotitismedia.Breastfeedingbenefitsthehealthofmamaandpēpi,aswellasreducingtheriskofSUDI,asthmaandchildhoodobesity.Nationally,breastfeedingratesforMāoriinfantsstartataslightlylowerrateasthetotalpopulation,anddropoffmorequicklythanthetotalpopulationatthe3and6monthtimepoints.Breastfeedingisanimportantareaoffocusbecausethereissignificantroomforimprovement,andbreastfeedinghaswide-reachingbenefitsandpotentiallyresultsinreducedcostforfamilies.

BaselineMeasure

Māori ExclusiveorfullybreastfedatLMCdischarge(4-6weeks)

66%

Exclusiveorfullybreastfedat3months

43%

Receivingbreastmilkat6months 50%

Non-Māori ExclusiveorfullybreastfedatLMCdischarge(4-6weeks)

73%

Exclusiveorfullybreastfedat3months

60%

Receivingbreastmilkat6months 64%

Target

6weeks-75%

3months-60%

6months-65%

23


Measure Reporting

IncreasetheproportionofMāoriinfantsthatarebreastfed(fullyandexclusivelyat6weeks,and3months)

(exclusively,fullyandpartiallybreastfedat6months)

Promoteandtrainkaimahithatworkwith,orintendtoworkwithhapῡMāori,onhowtousethenewlydevelopedHapūWanangaCurriculum(KaupapaMāoriPregnancyandParentingcurriculum)fortheMidlandregionthatpromotes,empowersandencouragesbreastfeeding.

2xtrainingsessionsthroughoutMidlandregionbyJune2017

6monthlyreport

PromotebreastfeedingtoMāoriwhānau/communitiesbyholdingLatchOnandWorldBreastfeedingweekactivities,raisingawarenessoftheimportanceofbreastfeedingandtoassistwithMāoriuptake.WaikatoDHBwillencourageMāoriwāhinetoparticipateinmediaandothereventsheldbyMāoriprovidersandPHO’s.

Akeyobjectiveofallpromotionactivitieswillbetohighlighttheimportanceofbreastfeedinginbuildingimmunityagainstarangeofinfectiousdiseasesandcombatingchildhoodobesityanddiabetes

ParticipationinLatchOnandWorldBreastfeedingEventsduringAugust2016

Annualreport

WaikatoDHBwillpromotetheuseoftheMidlandbreastfeedingapp.

Ongoing 6monthlyreport

WaikatoDHBBreastfeedingChampionwillcontinuetoprovideworkshop/sontheimportanceofpromotingbreastfeedingtoPHOstaffwithintheWaikatoDHBdistrict

1workshopbyDecember2016

Annualreportt

WaikatoDHBand/orTePunaOranga,activeinvolvementintheBreastfeedingActionCoalitionKirikiriroa(B.A.C.K.)rooputodiscussactivitiesthatwillincreasethenumberofMāoribreastfeeding,supportedthe

Attendance80%ofscheduledmeetingsbetweenJune2016-July2017

6monthlyreport

24


Measure Reporting

developmentofthecontentoftheapp.Theappwillbepromotedviaprimarycare,healthpromotionandthroughourHapῡWanangaclassesandHapῡWanangapost-natalclasses.

MidlandMaternityActionGroupiscommittedtoincreasingbreastfeedingratesintheMidlandDHB’s.

DevelopaMidlandBreastfeedingFrameworktoinformandprioritisebreastfeedinginitiativesintheMidlandregion.

Q1-Q42016/17

MidlandBreastfeedingApp–BreastFedNZ

Midlandbreastfeedingfriendlyaccreditedspacesadded

WCTOandpregnancyandparentingserviceprovidersadded

IssuesandbarrierstobreastfeedingidentifiedinfocusgroupsofMidlandbreastfeedingframeworkareaddressed,whereapplicable

Evaluationofeffectivenessanduptake.Contentisreviewedagainsttopicsofsmokefreepregnancies,safesleeping,mentalhealthmessages,alcoholanddrugs,maternalnutrition,immunisation,etc.

IncreasedvisibilityofMāoribreastfeedingwomen,partnerandwhānausupportinapp,website,andresources

12monthmark:September2016

Implementthe‘MidlandUseofDonorBreastmilkProtocol’

Q22016/17

25

CardiovascularDiseaseWhyisthisapriority?

Theburdenofcardiovasculardisease(heartandstroke)isgreatestamongtheMāoripopulation,andmortalityismorethantwiceashighcomparedtonon-Māori.CVDriskassessmentsareanimportanttooltoenableearlyidentificationandmanagementofpeopleatriskofheartdiseaseanddiabetes.FastaccesstotreatmentforheartrelatedattacksisessentialtoachievehealthequityandimprovehealthoutcomesforMāori.

BaselineMeasure

Māori 84%

Non-Māori 89.3%


Measure Reporting

IncreasethepercentageoftheeligibleMāoripopulationwhohavehadtheirCVDriskassessedwithinthepast5yearsanddecreasethenumberoftertiarycardiacinterventionsperformed

Design,developandimplementassessmenttoolsbasedontheHHTamarikiAssessmentToolspecificallytargetingKaumatuatoincludeaspecificCVDriskassessmentreferralpathway.

ToolspecificallydevelopedforKaumatuaandKuiabyDecember2016

6monthlyreport

ReviewandimplementKaitiakiandKaitakawaengaculturalassessmenttoincludeaspecificCVDriskassessmentreferralpathway.


6monthlyreport

Target

90%

26

CancerScreening(Cervical)Whyisthisapriority?

In2012,Māoriwomenweretwiceaslikelyasnon-Māoritodevelopcervicalcancer,and2.3morelikelytodiefromit.Regularcervicalscreeningdetectsearlycellchangesthatwould,overtime,leadtocancerifnottreated.Nationally,cervicalscreeningcoverageforMāoriis62.2%,comparedtocoverageinEuropean/Otherpopulationswithcoverageat82.2%.ImprovingscreeningcoverageandmonitoringofthetimelinessandexperienceofcolposcopyforMāoriwomenisthereforeanimportantactivity.

BaselineMeasure

Māori 60%

Non-Māori 80%


Measure Reporting

RaiseourMāoricervicalscreeningratestomatchorbetternationaltargetrequirements

WiththeestablishmentoftheProjectBoard,communicationbetweentheDHBandthethreePHOstodeterminehowbestlimitedfundingcansupportMāori(andPacificIsland)womentoparticipateincervicalscreeningthroughimplementingprojectswillcontinue.

Holdmonthlyregionalcervicalscreeningcollaborationmeetingsandannualsmeartakerupdatefocusedonimprovingqualityandincreasingcoverage.

Monthlymeetingsandannualsmeartakerupdateoccur

ContinuetoprovidecervicalsmearsatnocosttoalleligibleMāoriwomenlivinginWaikatoDHB.OfferPHOsadditionalfundingforoutofhourssmeartakingonafeeforservicebasis.

IncreaseincervicalscreeningratesbyPHO

Quarterlyreport

Undertakeapilotproject(betweenJune2016toDecember2016)toidentifyandoffercervicalsmearteststoinpatientsandoutpatientswithinWDHB

Keymeasurements:

-Numberofwomenoverdueforscreen

-Thenumberofwomenofferedcervicalscreen

-Thenumberofwomenscreened

Reportatconclusionofpilotprogramme

WaikatoDHBwillworkwiththenewsupporttoscreeningservicesprovidertocreateanactionplanthatwillfocusonincreasingthe

Keyactivitieswithmeasurableoutputs

Annualreport

Target

80%

27


Measure Reporting

numberofeligibleMāoriwāhinewhohavehadacervicalscreeningeventinthepast36monthsandtoensurethatMāoriwomenaresupportedtoattendcolposcopyappointments.

28

CancerScreening(Breast)Whyisthisapriority?

Historically,Māoriwomenhavesignificantlyhigherincidenceandmortalityfrombreastcancercomparedtonon-Māori.InequitiesinaccesstoscreeningservicesneedtobeaddressedtoensureMāoriwomenexperiencethebenefitsofearlydetectionofbreastcancer.

BaselineMeasure

Māori 60.1%

Non-Māori 68.1%


Measure Reporting

RaiseourMāoribreastscreeningratestomatchorbetternationaltargetrequirements

WiththeestablishmentoftheProjectBoard,communicationbetweentheDHBandthethreePHOstodeterminehowbestlimitedfundingcansupportMāori(andPacificIsland)womentoparticipateinbreastscreeningthroughimplementingprojectswillcontinue.

Holdmonthlyregionalbreastscreeningcollaborationmeetingsandannualbreastscreeningupdatefocusedonimprovingqualityandincreasingcoverage.

Quarterlyreport

WDHBwillcontinuetocontactwomenwhohavenotbeenscreenedorareunderscreenedidentifiedbyBreastScreenMidland(BSM)viadatamatchingorasnon-responders.

Maintainanuptodatedatabaseofwomenwhohavenotbeenscreenedorunderscreened

MonthlyreporttoBSM

PromotebreastscreeningtoMāoriwomeninHamiltoninparticular,i.e.MAMAgrammonthofMay.

MAMAgrameventMay2017 Quarterlyreport

BSMwilllead,implementandevaluatetheactivitiesoutlinedintheBreastScreenMidlands(BSM)regionalplan.

ImplementationandevaluationofactivitiesoutlinedintheBSMregionalplanfollowthetimelinesprovided

Quarterlyreport

Undertakeapilotproject(betweenJune2016toDecember2016)toidentifyandoffermammogramtoeligibleinpatientsandoutpatientswithinWDHB

Keymeasurements:

-Numberofwomenoverdueforscreen

-Thenumberofwomenofferedmammogram

-Thenumberofwomenscreened

Reportatconclusionofpilotprogramme

Target

70%

29


Measure Reporting

SupportcollaborativeworkingrelationshipsbetweenprovidersacrossthebreastscreeningpathwayviatheregionalbreastscreeninghuiheldtwiceayearandtheBSMcoordinatorwhomeetswithkeystakeholdersonamoreregularbasis.

Attend2xhuiayear 6monthlyreport

WaikatoDHBwillcontinuetoworkwiththeUniversityofAucklandtoexplorereasonsforlowersurvivalforMāoriwomenwithbreastcancerandtodevelopandinterventiontosupportMāoriwomenwithbreastcancertohavelongersurvival.

Anacademicpublication 6monthlyprogressreport

ImplementotherinitiativesasagreedbetweenTePunaOrangaandBSMmanagersthatwillenhancetheparticipationofMāoriwāhineinBSM–TheimprovementinMāoriBSMcoverageasoutlinedintheBSMplanand/ortheWaikatoDHBMāoriHealthplan,withspecificreferencetoincreasingcoverageinHamilton,Tokoroa,MorrinsvilleandKihikihi/TeAwamutu(townswherethereisasignificantvolumeofMāoriwāhineandtheBSMmobileisvisitinginthisperiod).ThereiscurrentlyaServiceLevelAgreementbeingdraftedbetweenBSMandTePunaOrangawhichwillincludeactivities.

Measureswillbedeterminedaspereachinitiativeimplemented.

Quarterlyreports

30

SmokingWhyisthisapriority?

HapuMāoriwahinehaveveryhighsmokingprevalence(threetimeshigherthanthenationalprevalence).Smokingduringpregnancyincreasestheriskforpregnancycomplicationsandtobaccosmokeharmsbabiesbeforeandaftertheyareborn.

BaselineMeasure

Māori 60%

TotalWDHBpopulation

82%


Smokingcessation:PercentageofpregnantMāoriwomenwhoaresmokefreeattwoweekspostnatal

Promoteandtrainkaimahithatworkwith,orintendtoworkwithhapῡMāori,onhowtousethenewlydevelopedHapῡWanangaCurriculum(KaupapaMāoriPregnancyandParentingcurriculum)fortheMidlandregionthatpromotes,empowersandencouragesmamatobesmokefree.

2xtrainingsessionswithinMidlandregionbyJune2017

6monthlyreport

ContinuetodeliverHapῡWanangaclassestargetingyoungMāorimama,withaspecificfocusonbeingsmokefree.Provideareferralpathwayformamaandwhānautobesmokefree.

12classesbyJune2017 6monthlyreport

HapῡWanangaPost-natalclasseswillmeasurethepreviousandcurrentsmokingstatusandprovideareferralpathwayifneeded.

2xclassesbyJune2017

6monthlyreport

Target

95%

31


Design,developandimplementassessmenttoolsbasedontheHHTamarikiAssessmentToolspecificallytargetingwāhinetoincludeaspecificsmokefreereferralpathway.

ToolspecificallydevelopedforwāhinebyDecember2016

6monthlyreport

ReviewandimplementKaitiakiandKaitakawaengaculturalassessmenttoincludeaspecificsmokefreereferralpathwayforhapῡmama.


6monthlyreport

32

Immunisation(1)Whyisthisapriority?

“Immunisationisthemosteffectivewaytoactivelyprotectyourchildfrompreventablediseases,rangingfromwhoopingcoughtomeningitisandmeasles”(ImmunisationAdvisoryCentre,2013).AlthoughimmunisationratesarehighthereisstillalargehealthequitygapbetweenMāoriandnon-Māori.InitiativesneedtotargetMāoripēpiinordertoachievehealthequity.

BaselineMeasure

Māori 88%

TotalWDHBpopulation

91%


Measure Reporting

Raisethepercentageofourpēpifullyimmunisedby8monthsofage

ImplementationoftheHHTamarikiAssessmenttoolwithaspecificimmunisationforpēpireferralpathwayinatleast3othersettingswithinWaikatoandthewiderMidlandregion,toincreasewhanauenrolmentthatmayhavebeenmissedinothersettings.


Q1-Firstsetting

Q2-Secondsetting

Q3-Thirdsetting

6monthlyreportonHH

ReviewandimplementKaitiakiandKaitakawaengaculturalassessmenttoincludeaspecificimmunisationforpēpireferralpathway.


6monthlyreport

HapῡWanangaclasseswillcontinuetoreviewfeedbackfromparticipantstopromotediscussiononimmunisationforpēpi.

Ongoinginfutureclasses

6monthlyreport

HapῡWanangaPost-natalclasseswillmeasurethenumberofeligiblepēpiandwhethertheyhavebeenfullyimmunised.Areferralpathwaywillbeofferedtowhānau.

FirstclasscompletedbyDecember2016

SecondclasscompletedbyJune2017

6monthlyreport

Target

95%

33


Measure Reporting

MaintainourUnderFivesImmunisationSteeringGroup

Quarterly

Actionstosupportincreasingchildren'simmunisationrates(fortwoyearsandfiveyears)to95percent:

- Include,monitorandincreasethefour-year-oldmilestoneaspartoftheimmunisationalliancesteeringgroupoutputs.

Quarterly

34

Immunisation(2)Whyisthisapriority?

In2014Māorihadthesecondhighestrateofinfluenzaconfirmedhospitalisation,49.2per100,000.The65yearsandoveragegroupalsohavethehighestratesofinfluenzaadmissionstoICU.A75percentinfluenzavaccinationrateisrequiredtoprovidethebestprotectionforthisagegroupandinparticularforMāori.IfweareabletoincreaseimmunisationratesforMāoriwewillseeasignificantreductioninoverallinfluenzacases

BaselineMeasure

Māori 55.25%

Non-Māori 56%


Measure Reporting

IncreasethepercentageofKaumātuaandKuia(65yearsandover)seasonalinfluenzaimmunisation

ContinuetoworkwithlocalMāoriprovideronKaumātuaprogrammestopromoteandprovideaccesstoout-reachfluvaccinationservicestoMāoriwithintheWaikatoDHBdistrict.ImplementationofprojectinMarch2016tocoincidewiththebeginningofthe2016fluimmunisationseason(MauriorakingāKaumātua)andwillcontinuethroughtoSeptember2016.

WorkingwithMāoriproviderswillensurethatimmunisationischampionedonawidefrontratherthanjustthroughGPservicesormoremainstreamservices.

TePunaOrangawillreportonthenumberKaumatuaandKuiaimmunisedataprogrammeoreventTePunaOrangawasapartnerat.

Quarterlyreport.

ContinuetospreadthehealthmarketingcampaignthatpromotesthebenefitsofimmunisationandidentifieswhereKaumātua65yrs+cangetfreeimmunisation(campaignimplementedinMarch2016ledbyTeTumuakiAnaruThompsonandhiswife).

EnsurethatKaumātua65yrs+canaccessfreeinfluenzaimmunisationfromnotonlyGP’sbutalsoPharmaciestoensureawiderrangeofservicescanprovideimmunisation

Numberofeventsand/ordisplaysthemarketingcampaigntookplace.

Providealistofparticipatingpharmaciesandotherservicesthathavefreeinfluenzaimmunisationfor65yearsandover.

Target

75%

35


Measure Reporting

inamoretimelyandefficientmanner.

Design,developandimplementanassessmenttoolbasedontheHHTamarikiAssessmentToolspecificallytargetingKaumatuaandKuiawithaspecificseasonalinfluenzareferralpathwayforthe2017influenzaseason.

ToolspecificallydevelopedforKaumatuaandKuiabyDecember2016

6monthlyreport

ReviewandimplementKaitiakiandKaitakawaengaculturalassessmenttoincludeaspecificseasonalinfluenzareferralpathway.


6monthlyreport

TheMidlandHealthNetwork(MHN),NationalHauoraCoalition(NHC)andtheHaurakiPHOwillprovideinformationandvaccinateKaumātua65yrs+acrosstheWaikatoDHBdistrict

WaikatoDHBandTePunaOrangawilldevelopabusinesscaseforanon-siteHartiHauoraHubwhichwillconducthealthpromotionandopportunisticscreeningandimmunisationofMāori.Oneoftheservicesprovidedwillincludeopportunisticimmunisationagainstinfluenza.Thebusinesscasewillbedevelopedby1stJuly2015

TheMidlandHealthNetwork,HaurakiPHOandtheNationalHauoraCoalitionPHOwillallcollaborateindevelopmentofannualPHO/DHBInfluenzastrategy(completedby30thJune2016)

WaikatoDHBwillcollectandmonitorthehealthsectorsperformanceforMāori/highneed65yrs+onamonthlybasisfromGP’sPharmacistsandprimarycareasa

Successwillbemonitoredthroughthecompletionoftaskswithinspecifiedtimeframesandevidenceofanimprovingtrendand/orattainmentoftheseasonalinfluenzaimmunisationtarget.

36


Measure Reporting

whole(from1stJuly2015to30thJune2016

37

OralHealthWhyisthisapriority?

NationallyasatDecember2014,76%ofallpre-schoolersand64%ofMāoripre-schoolerswereenrolledintheCommunityOralHealthServices(COHS).TheinequitybetweenMāoriandnon-MāorienrolmentsissignificantthereforetheneedformoreMāoritargetedinitiativesandprogrammesiscrucial.


Measure Reporting

IncreasethenumberofMāoripre-schoolchildrenenrolledintheCommunityOralHealthService

DentalConditions

WaikatoDHBwillworktopromoteearlyenrolmentinChildOralHealthServicesandworktopromoteOralHealthwithwhānau.

OralHealthInformationwill

WiththeimplementationoftheNationalChildHealthInformationplatform(NCHIP)intocommunityoralhealthservicesenrolmentfrombirthwillbeusedforenrolmentforCommunityOralHealthandloggingoforalhealthmilestonesinadditiontodatamatching

OralHealthCo-ordinationandHealthPromotion

CommunityOralHealthwillpromoteoralhealthforpre-schoolerswithaparticularfocusonMāoriWhānau.

NCHIPwillbeusedtorecordenrolment

Quarterly

HartiHauora(HH)TamarikiAssessmenttoolreferralpathwayisevaluatedreviewedandimplementedinWaikatoHospital,withaspecificCOHSreferral


PublishevaluationfindingsinAcademicJournalby

Target

95%

38


Measure Reporting

pathway.

December2016.

6monthlyreportingonHH

ImplementationoftheHHTamarikiAssessmenttoolwithaspecificCOHSreferralpathwayinatleast3othersettingswithinWaikatoandthewiderMidlandregion,toincreasewhānauenrolmentthatmayhavebeenmissedinothersettings.


Q1-Firstsetting

Q2-Secondsetting

Q3-Thirdsetting

6monthlyreportonHH

39

MentalHealthWhyisthisapriority?

NewZealandhasveryhighratesofcompulsionofpatientsundertheMentalHealthAct,comparedwithsimilarjurisdictions.Māoriarenearlythreetimesaslikelyasnon-Māoritobetreatedunderacommunitytreatmentorderwhichrepresentsasignificantdisparity.

BaselineMeasure

Māori 384

Non-Māori 301


Measure Reporting

ImprovementalhealthandaddictionoutcomesforMāoriwithinHealthWaikatoservices

TheestablishmentoftheworkinggrouptoimproveMentalHealthandAddictionoutcomesforMāoriwithinHealthWaikatoserviceswillcontinuetomeetandplanactivitiesthatwillimpactpositivelyonreducingsection29ratesforMāori.

Improvingtrendinthereductionofsection29CommunityTreatmentordersevidenced.

Quarterlyreporting

Target

N/A

40


Measure Reporting

TheworkinggrouphasdevelopedasetofindicatorstomonitorperformanceofHealthWaikatoservicesforMāoripatients.

MonitorthepercentageofMāoriwhohaveanacuteadmissionwithin28daysfordischargefromtheinpatientunitascomparewithotherethnicities

PercentageofMāoriinadultinpatientbedsplacedinseclusionandthenumberofhoursMāoriareinseclusionascomparedtootherethnicities

PercentageofMāoriwhoarefollowedupbyCommunityMentalHealthTeamwithin7daysofdischargefrominpatientunit.Measureifthecontacthasbeentelephoneorfacetoface.

PercentageofMāoriwithcurrenttreatment/recoveryplansinplaceascomparedwithotherpopulationgroups.

Aspecificmethodologyhasbeenchosentoprovideanalysisofandmonitorperformanceagainstindicators.Providemonthlyreportsofresults.

WhilsttherearesignificantconcernsabouttheuseandsenseofthisKPI,theDirectorofClinicalServicesforHealthWaikatowill:

•activelyencouragejudicioususesoftheMHA,asclinicalneedsdictate.

•encourageallResponsibleClinicianstoreviewtheiruseofIndefiniteCTorders

ProgressreportedquarterlyinPP26-–MentalHealthandAddictionsServiceDevelopmentPlan

41

RheumaticFeverWhyisthisapriority?

RheumaticfeverisaseriousbutpreventableillnessthatmainlyaffectsMāoriandPacificchildrenandyoungpeopleaged4to19years.ReducingrheumaticfeverwillcontributetoachievingequityofhealthforMāori.

TotalWDHBpopulation

BaselineMeasure

2013/2014 4.8per100,000

2014/2015 3.6per100,000


Measure Reporting

Reductioninthenumberandrateofhospitalisationsforacuterheumaticfever

ImplementationofactionsidentifiedintheRheumaticFever2015refreshedpreventionplan.

ActionswillbemeasuredspecifictotheactionsnotedintheWaikatoDHB’sRheumaticFeverPreventionPlan

Quarterly

WhareOrahealthyhomesinitiativewillbepromotedandimplementedthroughouttheWaikatoregionforeligiblewhanau.

400healthyhomesassessmentscompletedfromJune2016-2017

Monthlyreporting

EnsurethatallcasesofacuteandrecurrentacuterheumaticfeverarenotifiedwithcompletecaseinformationtotheMedicalOfficerofHealthwithinsevendaysofhospitaladmission.

Annual

Ensurepatientswithahistoryofrheumaticfeverreceivemonthlyantibioticsnotmorethan5daysaftertheirduedate.

Undertakeanannualauditofrheumaticfeversecondaryprophylaxiscoverageforchildrenaged0-15years,youthaged15-24years,andadultsaged25+years.

Identifyandfollow-upknownriskfactorsandsystemfailurepointsincasesofrecurrentrheumaticfever.

Follow-uponanyissuesidentifiedbythe2015/16auditofrecurrenthospitalisationsofacuterheumaticfeverandunexpectedrheumaticheartdisease.

Target

1.2per100,000

42


Measure Reporting

Confirmationandexceptionreportagainsttheactionstodeliverimprovedperformance

PleasealsoseetheWaikatoDHB’sRefreshedRheumaticfeverpreventionplan-

http://www.waikatodhb.health.nz/assets/public-health-advice/public-health-topics/rheumatic-fever/The-Waikato-DHB-refreshed-2015-Rheumatic-Fever-prevention-plan.pdf

The-Waikato-DHB-refreshed-2015-Rheumatic-Fever-prevention-plan.pdf

43

SuddenUnexpectedDeathinInfancy(SUDI)Whyisthisapriority?

ThetargetforSUDIwillbeloweredfrom0.5to0.4SUDIper1,000livebirths.ThetargethasbeenloweredtomatchthereducedrateofSUDIamongnon-Māoriinfants(0.38SUDIper1,000livebirthsduring2010-2014).YetthereisstillasignificantdifferenceinSUDIratesbetweenMāoriandnon-MāorifamilieslivinginWaikatoDHB.

Thetargetfor‘CaregiversprovidedwithSUDIinformationatWellChildTamarikiOraCoreContact1’isloweredfromallcaregiversto70%ofcaregivers.Thetargethasbeenchangedfromafinaltargettoaninterimtarget.Theinterimtargetisslightlyhigherthanlevelsofcurrentserviceprovisiontonon-Māori(62.6%)duetothehigherSUDIratesofMāori.

BaselineMeasure

Māori SUDIrateper100,000live

birthsbetween2010-2014

1.48per100,000live births

%ofcaregivers

providedwithSUDI

preventioninformationatWellChild

TamarikiOraCoreContact1

39.2%

Non-Māori SUDIrateper100,000live

births

.18per100,000livebirths

%ofcaregivers

providedwithSUDI

preventioninformationatWellChild

TamarikiOraCoreContact1

59.9%

Target

0.4SUDIdeathsper1000Māorilivebirths

IncreaseenrolmentandconsequentaccesstoWellChildTamarikiOraCore

Contact1of70%caregiversofMāoriinfantstoenabletimelyprovisionofSUDIpreventioninformation

44


ReductioninMāoriratesforsuddenunexpecteddeathinInfancy(SUDI)

PartnershipwithWhakawhetuNationalSUDIPreventionforMāoritoprovideworkforcedevelopmentplanforpreventiontrainingtohealthworkersandotherkaimahi

CreateplanbyendofQ2incollaborationwith‘calltoactiondiscussiondocument’(actionpointbelow)

Annualreport

WaikatoDHBwill:

PromotetheservicesofWellChildTamarikiOraprovidersandtimelyenrolment(4-6weeks)duringpregnancyandpost-natalperiod

WorkwithLMC’s,Maternityfacilities,NCHIPandtheChildHealthCoordinationServicetoensurethatthereistimelyenrolmentintoWCTOservices

EnsurethatWCTOprovidersbuildgoodrelationshipswithLMC’sandmaternityfacilitiestoensurereferralstoWCTOaredoneinatimelymanner.

WorkwithkeymaternitypeopleandWellChildTamarikiOraproviderswithWCTOQualityManagertodevelopacontinuityofCarepathway

WorkwithWCTOproviderstoensureSUDIinformationisincludedintheircore1check

Increaseinthenumberofcore1checksby31Dec2016

CompletedbyQuarter12016/2017

Annualreport

6monthlyreport

Q1report16/17

AsaresultoftheTamaitiHuiMay2016aCalltoActiondiscussiondocumentspecificforWaikatoregionaddressingantenataleducationandcare,andpostnatalcarewillbeproducedtoaddressSUDIriskfactors.InputfromWhakawhetu,TePunaOranga,WDHB,WaikatoCYMRC,maternitystakeholders,WCTOgovernancegroup,andPHOwillbeincluded.

Documentwillhaveanumberofactions-

1. CollaborativeapproachtoSUDIprevention

2. Specificactivities,initiatives,projectstoassistcommonvision

3. SupportforhealthservicestoimplementSUDIpreventionfactors,i.e.safesleeppolicies

4. Improvecommunicationbetweenprovidersandhealthandsocialservices

Annualreport

45


5. Improvedaccessforwhanau,hapῡmama,andcommunitytohealthresources/healthcare

Businesscaseforsustainablefunding

Reviewandamendifnecessary‘SafeInfantSleeping–Birthto1Year’policyusedwithinWaikatohospital

RenewalofpolicybyendofQ3

Annualreport

TePunaOrangamembershipontheWaikatoChildandYouthMortalityReviewCommitteetoproviderecommendationstoNationalCYMRCwhocaninfluencepolicyataNationallevel.

Attendanceatminimumof90%ofmeetingsthroughouttheyear

6monthlyreporting

WaikatoDHBwillinvestinpēpi-pods,mini-pod,wahakuraandcotsforatriskwhānau.

Purchaseaminimumof400safesleepdevices.

SafeSleepmessagesandpracticesaredistributedwithpēpipodsandwahakuratohighneedswhānauresidingwithintheWaikatoDHBregion

Minimumof400pēpi-podsandwahakuradistributedJune2016toJune2017.

QuarterlyreportfromChangeforourChildren

Thenumberofpēpi-podsandwahakuradistributedtowhānaudata,loadedontoChangeforourChildrendatabase

WaikatoDHBwillpromoteSafeSleepmessagesandtheWaikatopēpi-podsandwahakuraprogrammeatcommunityeventswithspecificemphasisonsafesleepday.

Participationinatleast1eventduringsafesleepday

Annualreport

Promoteandtrainkaimahithatworkwith,orintendtoworkwithhapūMāori,onhowtousethenewlydevelopedHapūWanangaCurriculum(KaupapaMāoriPregnancyandParentingcurriculum)fortheMidlandregionthatpromotesSUDIpreventionmessagesandsolutionsforwhānau.

2xtrainingsessionsthroughoutMidlandregionbyJune2017

6monthlyreport

46


HartiHauora(HH)TamarikiAssessmenttoolreferralpathwayisevaluatedreviewedandimplementedinWaikatoHospital,withaspecificSUDIpreventionreferralpathway.ThepathwaymayrequireaccesstoasafesleepdeviceorreferraltoservicesthatsupportSUDIprevention,i.e.WellChildTamarikiOraenrolment,immunisationforpēpi,smokefreepathwayorbreastfeedingsupport.


PublishevaluationfindingsinAcademicJournalbyDecember2016.

6monthlyreportingonHH

ImplementationoftheHHTamarikiAssessmenttoolwithaspecificSUDIpreventionreferralpathwayinatleast3othersettingswithinWaikatoandthewiderMidlandregion,toincreasewhanauenrolmentthatmayhavebeenmissedinothersettings.ThepathwaymayrequireaccesstoasafesleepdeviceorreferraltoservicesthatsupportSUDIprevention,i.e.WellChildTamarikiOraenrolment,immunisationforpēpi,smokefreepathwayorbreastfeedingsupport.


Q1-Firstsetting

Q2-Secondsetting

Q3-Thirdsetting

6monthlyreportonHH

ReviewandimplementKaitiakiandKaitakawaengaculturalassessmenttoincludeaspecificSUDIpreventionreferralpathway.ThepathwaymayrequireaccesstoasafesleepdeviceorreferraltoservicesthatsupportSUDIprevention,i.e.WellChildTamarikiOraenrolment,immunisationforpēpi,smokefreepathwayorbreastfeedingsupport.


6monthlyreport

WhareOraassessmenttoolwillbereviewedtoincludeaspecificreferralpathwayforSUDIpreventiontoensureasafesleepdeviceforpēpiisavailable,suchasapēpi-podorwahakura.

WhareOraassessmenttoolisreviewedtoincludeaspecificsafesleepdevicereferralpathwaybyDecember2016.

Monthlyreporting.

47

LOCAL PRIORITIES AND INDICATORS

1. SupportingWhānauOraProviderCollectivesandWhānauOraCollectivePlan

WiththedisestablishmentoftheWaikatoRegionalLeadershipGroupforWhānauOraandthe

movetowardstheCommissioningAgencyTePouMatakanatheshapeofWhānauOraonour

local landscape has shifted significantly. Currently the Waikato DHB district has only one

WhānauOracollectivewithinitsdistrictwhichisfundedbyTePouMatakanatheWhanauOra

CommissioningagencyfortheNorthIslandandthatisTeNgira.

Te Ngira comprises of membership from Wāhi Whanui, Raukura Hauora, Nga Miro and Te

Kohao Health. Formerly these providers had aligned themselves to Te Koiora our Northern

CollectiveandtotheNationalUrbanMaoriAuthority(NUMA).

AsawayforwardtheWaikatoDHBhascommittedtodeveloping“TePoutamaoWhanauOra”anaction

planwithTeNgiratostrengthentheimplementationofWhanauOrawithintheWaikatoDHBdistrict.

“TePoutamaoWhanauOraActionPlan2016”will define jointwork and support fromWaikatoDHB

towardsTeNgiraandWhanauOraasaformalprogrammewithintheWaikatoDHBdistrict.Keyareasof

focuswillfocusonthreekeyareas:

1. Mahitahi-toworkasoneincollaboration

2. Kaitiakitanga-IwiguardianshipinrelationtoWhanauOra

3. Puawai–tosupportWhanauOracapacitydevelopment

Actionsagainsttheabovethreestrategicdirectionsaredetailedinthefollowingactiontables.

WorkingwiththeWhānauOraPartnershipgroupiscrucialtoimprovingthehealthofMāoriinWaikato.TheactivityinthefollowingactionplancannotbeachievedwithoutcollaborationbetweenWhānauOraproviders,TePunaOranga(MāoriHealthService)andWaikatoDHB.

InNovember2015,theWhānauOraPartnershipGroupagreedtoasetofindicatorstosupportWhānauOra,includingfivekeyareasforthehealthsectorthatcontributetoWhānauOratoachieveacceleratedprogresstowardshealthequityforMāoriandPacific,andWhānauOrainthenextfouryears.Theindicatorsare:

• Mentalhealth(reducedrateofMāoricommittedtocompulsorytreatmentrelativetonon-Māori);

• Tobacco(95percentofallpregnantMāoriwomensmokefreeattwoweekspost-natal);• Asthma(reducedasthmaandwheezeadmissionratesforMāorichildren(ambulatory

sensitivehospitalisations0-4years));• Oralhealth(increaseinthenumberofchildrenwhoarecariesfreeatage5);

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• Obesity(byDecember2017,95percentofobeseMāorichildrenidentifiedinB4SchoolCheckprogrammewillbeofferedareferraltoahealthprofessionalforclinicalassessmentandfamilybasednutrition,activityandlifestyleinterventions).


TosupportthecapabilityandcapacityofWhānauOrawithintheWaikatoDHBdistrict

TheWaikatoDHBhascommittedtodeveloping“TePoutamaoWhānauOra”anactionplanwithTeNgirathroughoutthe2016-2017periodtostrengthentheimplementationofWhānauOrawithintheWaikatoDHBdistrict.

“TePoutamaoWhānauOraActionPlan2016”willdefinejointwokandsupportfromWaikatoDHBtowardsTeNgiraandWhānauOraasaformalprogrammewithintheWaikatoDHBdistrict.Keyareasoffocuswillfocusonthreekeystrategicdirections:(1)Mahitahi-toworkasoneinthespiritofco-operation.Keyareasoffocusinclude:

-progressingintegratedcontracts

-identifyhowWaikatoDHBcangivesupportto

TeNgiracollectiveimpactproject

-sharingofinformationandexpertisetosupport

WhānauOraprogrammewithintheWaikato

district

-secondmentstosupportWhānauOra,

-mediaandcommunicationsplantopromote

WhānauOradevelopmentsandsuccessesinthe

Waikatodistrict,

-promotionasappropriatetowhanauonhow

toaccesswhānaudirectfunding/support,

-formalisationofprocessestoensurethatthe

WhānauOracollectivescanparticipatein

WaikatoDHBAnnualPlanningandMāoriHealth

Plandevelopment,

-completionofastocktakeofhowothersectors

areprogressingWhānauOrawithaviewto

identifyopportunitiestocollaborate.

Quarterlyreportcompleteddetailingprogressagainstinitiativesandactivitiesin“TePoutamaoWhanauOraActionPlan”2016-2017,90%ofactionsandoutcomesdetailedinplanattained.

Quarterlyreporting

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(2)Kaitiakitanga-Iwiguardianship,Keyareasoffocusinclude:

-establishmentofprocessesthatsupport’ourIwi

RelationshipBoardIwiMaoriCouncilto

effectivelymonitorandevaluateWhānauOra

withintheWaikatoDHBdistrict

-ensurethatsuccessstories,keytrendsandthe

performanceofWhānauOraimplementationin-

theWaikatoDHBdistrictispresented2xper

yearbyTePouMatakanatoIwiMaoriCouncil.

(3)Puawai–tosupportWhānauOracapacity

development,keyareasoffocusinclude:

-progressingintegratedcontracts,

-identificationoffundingshortfallsthatimpede

WhānauOrarolloutintheWaikatoinclusiveof

serviceprovisiongapsinHauraki,Raukawaand

Maniapoto.

-workforcedevelopment/trainingfor

WhānauOrakaimahi,explorationofthe

feasibilityofhowresearchcandemonstrate

thevalueaddedbyWhanauOra.

Quarterlyreportcompleteddetailedprogressagainstinitiativesandactivitiesin”TePoutamaoWhānauOraActionPlan”2016-2017,90%ofactionsandoutcomesareattained.

Quarterlyreporting

StrengthentherelationshipthattheWaikatoDHBhaswithitslocalWhānauOracollective

WaikatoDHBwillactivelypromoteWhānauOracollectivesprogrammes,initiatives,projectsthatimprovethehealthofMāoriintheWaikatoregion.

Annualreport(quarter4)onactivityundertakentoprogresstheWhānauOraapproach

Quarterlyreporting

WaikatoDHBwillcollaboratewithWhānauOracollectivestomeetthenationalindicatorswithintheMāoriHealthPlan.

Activecollaborationandengagementinatleast3projectsthroughouttheWaikatoregionwithWhānauOraCollectivesbetweenJune2016-June2017

Quarterlyreporting

TePunaOrangawillactivelyconnectwhānauandcommunitieswithWhānauOraCollectivesservices.E.g.OneofthereferralpathwaysusedinHapῡWanangaclassesinHamiltonforCommunityOralHealthServicesincludeRaukuraHauoraOTainui.

Referralpathwaysforassessmenttools(HH,KaitiakiandKaitakawaenga),andprogrammessuchasHapῡWanangawillbereviewedand

Quarterlyreporting

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monitored6monthly

MentalhealthandAddictions

WorkinggrouptoimproveMentalHealthandAddictionoutcomesforMāoriwithinHealthWaikatoservicesestablishedandindicatorsidentified.

Improvingtrendinthereductionofsection29CommunityTreatmentordersevidenced.

MonitorthepercentageofMāoriwhohaveanacuteadmissionwithin28daysfordischargefromtheinpatientunitascomparewithotherethnicities.

PercentageofMāoriinadultinpatientbedsplacedinseclusionandthenumberofhoursMāoriareinseclusionascomparedtootherethnicities

PercentageofMāoriwhoarefollowedupbyCommunityMentalHealthTeamwithinsevendaysofdischargefrominpatientunit.Measureifthecontacthasbeentelephoneorfacetoface.

PercentageofMāoriwithcurrenttreatment/recoveryplansinplaceascomparedwithotherpopulationgroups.

Quarterly

Tobaccocontrol Trainkaimahithatworkwith,orintendtoworkwithhapūMāori,onhowtousethenewlydevelopedHapūWanangaCurriculum(KaupapaMāoriPregnancyandParentingcurriculum)fortheMidlandregionthatpromotes,empowersandencouragesmama.

2xtrainingsessionsthroughoutMidlandregion

Quarter4

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WaikatoDHBiscommittedtoaheightenedfocusinthisareatoachieveacceleratedprogresstowardsWhānauOraandhealthequity.ThroughTePunaOranga(MāoriHealth

Design,developandimplementassessmenttoolsbasedontheHHTamarikiAssessmentToolspecificallytargetingwāhinetoincludeasmokefreereferralpathway.

Toolspecificallydevelopedforwāhine

Quarter2

ReviewandimplementKaitiakiandKaitakawaengaculturalassessmenttoincludeaspecificsmokefreereferralpathwayforhapῡmama.

Culturalassessmentreviewedandimplemented

Quarter2

Asthma ContinueimplementingWhareOrahealthyhomesinitiativeseekingtomakehomeswarmer,drier,healthiersaferandreferontosocialsupportservices/WhānauOraifrequired.

Complete400HealthyHomeAssessmentsintheWaikatoDHBdistrict

Quarter4

Oralhealth HartiHauoraTamarikiAssessmenttoolwillincludeanoralhealthenrolmentassessmentandreferralpathwayofallchildrenadmittedandscreenedusingtheHartiHauoratool.

IncreasedenrolmentofMāoritamarikiandPacificchildrenwithCommunityOralHealthService

Quarter3

HartiHauoraTamarikiAssessmenttoolreferralpathwayisevaluatedreviewedandimplementedinWaikatoHospital,withaspecificCommunityOralHealthServicereferralpathway.

ImplementationoftheHartiHauoraTamarikiAssessmenttoolwithaspecificCommunityOralHealthServicereferralpathwayinatleastthreeothersettingswithinWaikatoandthewiderMidlandregion,toincreasewhānauenrolmentthatmayhavebeenmissedinothersettings.

HartiHauoraTamarikiAssessmentToolisevaluated,reviewedandimplemented

AssessmentToolispilotedinatleast1settingperquarter

Quarter2

Quarters1,2,3

Obesity HartiHauoraTamarikiAssessmenttoolwillincludeabodymassindexassessmentandreferralpathway

Toolincludesabodymassindexassessmentandreferralpathwayofallchildrenadmittedandscreened

Quarter4

Partnership WaikatoDHBactivelyengageandcollaboratewiththeWhānauOraCommissioningAgenciesinitspriorityprogrammeplanninginitiatives

AnnualreportonactivityundertakentoprogresstheWhānauOraapproach.

Quarter4

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Service)wearerunninganumberofholisticprojects/programmestoachievetargetedimprovements.Theseprojects/programmeswillimpactonanumberofdifferenthealthindicators.Thefollowingtableprovidesasummaryoftheseholisticprojects/programmes.

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2. WorkforceObjective Actionstodeliverimprovedperformance Measure Reporting

AworkforcethatisreflectiveandresponsivetotheneedsofMāori

BiculturaleducationforWaikatoDHBstafftobuildculturalcompetency

E-learningBiculturalEducationTrainingandEthnicityDataCollectiontrainingdevelopedandimplementedbyWaikatoDHB

AllnewandexistingstaffwhohavenotcompletedTreatyofWaitangitrainingareenrolledontotheonlineTreatyofWaitangiandhealthcaree-course

AllstaffworkingdirectlywithMāoripatients,whānauand/orcommunityaresupportedtoattendTeAraTotika(TOWworkshop)

ContinuetopromoteHauoraMāoriTrainingFundtokaimahiworkingintheunregulatedhealthanddisabilitysectorwithintheWaikatoregion.

Gateway-exposureofMāoristudentstohealth(year12/13)(April2017)

ContinuetoworkwithHumanResourcestosupportgatewayplacementsatWaikatohospitalforMāoristudentsinterestedinahealthcareer

Annualreport(quarter4)onproportionofstaffinselectedcategoriesinMidlandDHB’swhoareMāoriwithsignificanttrendsidentified

Quarterly

3. VirtualCareObjective Actionstodeliverimproved

performanceMeasure Reporting

SystemIntegration

Healthneedsassessmenttoolsusedintheareasofchildhealthandmentalhealthandaddictions.

Updatereportidentifyingprogressmadeduringthequarteragainsttheactionstodeliverimprovedperformance.Thereportwillinclude:

WhethertheDHBisontrackmeetingeachdeliverablebytheendofquarter4,includingcommentonspecificactionsdeliveredinthequarter

Wheredeliverablesarenotontrackthereportmustincludemitigationstrategiesandnew

Quarterly

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Measure Reporting

timeframesfordelivery

Wherequantitativemeasuresarereported–Reportsmustincludebaseline,targetandquarterlyperformanceprogress

PharmacyActionPlan

Developandimplementmedicinesadherenceandoptimisationservicesofhighquality(thePharmacyCouncilofNewZealand’sMedicinesManagementCompetenceFrameworkandtheNationalPharmacistServicesFrameworkaregoodreferencesindevelopingtheseservices)thatmustincludetargetedvolumesforeachservicebyyearend

Developandimplementanefficientmedicinessupplychain

Commissionservicestobestmeettheidentifieddemand.

Updatereportidentifyingprogressmadeduringthequarteragainsttheactionstodeliverimprovedperformance.Thereportwillinclude:

WhethertheDHBisontrackmeetingeachdeliverablebytheendofquarter4,includingcommentonspecificactionsdeliveredinthequarter

Wheredeliverablesarenotontrackthereportmustincludemitigationstrategiesandnewtimeframesfordelivery

Wherequantitativemeasuresarereported–Reportsmustincludebaseline,targetandquarterlyperformanceprogress

Quarterly

Documents

Ki te Taumata o Pae Ora Waikato DHB Maori Health Plan 2016 ... · Ki te Taumata o Pae Ora ... LMC discharge 5. ... and 2.7 times as high for Māori as for non-Māori in Waikato during