MAORI COMMUNITY HEALTH WORKERS

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MAORI COMMUNITY HEALTH WORKERS
December 2000 Riripeti Haretuku
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AIM

• To examine why and how Maori community health
  workers make a difference to the health of Maori
  communities and identify how the energy of this
  workforce can be harnessed.
• At a time when the notion of closing the gaps
  is being discussed it is critical that the
  opinions and insights of this health workforce be
  considered.

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METHODOLOGY
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There is a scarcity of written/ published data on
the work that Maori community health workers do
and the differences they make to the health of
Maori communities.
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Expectation of this Study

• That the experiences and practices of Maori
  health workers, often taken for granted by the
  workers and unrecognised by health planners are
  invaluable to the well being of Maori communities.

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RATIONALE - QUALITATIVE STUDY

• More acceptable to Maori
• Needed to explore issues in depth

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PARTICIPANT SELECTION

• Job Description
• Experience
• Personal Networks
• Opportunistic
• Referral

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PROFILE OF PARTICIPANTS

• Number of Participants Twelve (12)
• Gender Female Eleven (11)
• - Male One (1)
• Range of Experience - 6 months 15 years
• Te Reo Speakers Six (6) Urban (4) Rural (2)
• Urban Six (6)
• Rural Six (6)

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LOCATION OF PARTICIPANTS
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SIX MAIN THEMES TOPROMOTE DISCUSSION
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1. WHY DID YOU BECOME A MAORI COMMUNITY HEALTH
WORKER?

• It was important to explore the reasons why
  participants became Maori CHWs.
• Was it primarily for employment or because the
  work was meaningful or a combination of both?

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What was your educational experience?

• This allowed some general discussion around the
  participants learning experienes.
• This was asked to ascertain whether they believed
  a formal education was an important factor in
  their work.

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3. What are your general views about formal
qualifications?

• It is important to consider the attitudes of
  participants to formal qualifications to scope
  whether the idea of professionalising the service
  is a viable option for the future development of
  Maori CHWs.

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4. What do you not like about your work?

• Each participant was asked to consider the issues
  and then the possible resolutions.
• This was a difficult process.

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4. What things do you most enjoy about your work?

• This thought was posed so that participants could
  reflect on the reasons for staying in their
  current position.

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5. Where do you work and what are the health
issues you most commonly address?

• This theme was asked to compare the health issues
  in urban and rural areas and to capture an
  insiders perspective of the current health
  realities of Maori communities.

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6. How could your current situation be improved?

• The establishment of a national advocacy and
  support body for the Maori community health
  workforce

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Key Findings
What Do CHWs Do?
Support Clinicians Are expected to be
Multi-Skilled Are able to respond quickly, Crisis
Intervention Are catalysts for lifestyle
change Offer voluntary support Are effective
Health Promoters Are effective interpretors of
verbal/nonverbal
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Maori CHWs Values
Collective Responsibility Strong Sense of
Duty Strong sense of Whanaungatanga Common
Sense Approach Sense of Humour Honesty Trust
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Formal Qualifications vs. Practical Experiences
Doubt value of formal education CHW training
inappropriate/irrelevant Practical experience
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• E tipu, e rea, mo nga ra o tou ao
• Ko to ringa, ki nga rakau a te Pakeha, hei ara mo
  te tinana
• Ko to ngakau ki nga taonga a o tupuna Maori hei
  tikitiki mo to mahuna a
• Ko to wairua, ki te atua, nana nei nga mea katoa
• Grow up in the days ahead and learn the skills of
  the Pakeha in order to take care of your whanau.
  Hold fast to the treasures left by our Maori
  ancestors and keep those things close to their
  heart. Finally acknowledge to the spirit and God
  who is the creator of all things.

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The Value of a Pakeha Education

• All participants agreed to the value of an
  education but circumstances made that difficult
  eg
• I had to pay the mortgage
• I was sent away to be educated
• There were far more demanding things like working
  on the farm

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Community Health Worker Training

• Training is ad hoc, short term and specific to
  the organisation.
• Information Technology
• Communication Skills

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EMERGENT ISSUES
By Maori For Maori health services Maori
Politics Working in Mainstream Treaty of
Waitangi Te Reo Rural/Urban Services Pay measures
the worth of an employee Restructuring the Health
Sector Medical Status
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Maori people want to define health for
themselves identify and prioritise their own
health concerns be involved and take
responsibility for their health.(M. Durie,
Whaiora)
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Summary
Maori Community Health Workers
Do Not
Belong to a unified organisation Enjoy work
recognition Receive sufficient remuneration Have
a formal job description Have a formal line of
accountability Receive acknowledgement of prior
learning
Have Limited
Access to appropriate training Options for career
advancement
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Recommendations

• Ministry of Health sponsor a national Hui for
  MCHWs to discuss
• Current status in health sector
• Potential for career development
• National body established for MCHWs
• Establish Maori community health workforce
• MCHWs be given the opportunity to have
• Prior knowledge recognized
• Opportunity to gain formal qualifications
• Competency standards developed
• Recognize cultural expertise
• Training relevant to work environment