Part 5 - Ministry of Health: Monitoring the progress of the Primary Health Care Strategy

Public entities' progress in implementing the Auditor-General's recommendations.

In 2001, the then Minister of Health launched the Primary Health Care Strategy (the Strategy). Primary health care covers a broad range of out-of-hospital health services supplied by private and public providers. The Strategy required significant changes to how primary health care was delivered and funded, such as introducing Primary Health Organisations (PHOs) and significant extra expenditure – increasing from about $226 million in 2002/03 to about $835 million in 2007/08. The Ministry of Health (the Ministry) is responsible for carrying out the Strategy, and for monitoring and reporting on its progress.

The scope of our performance audit

In October 2008, we published a report of our performance audit that assessed how well the Ministry was monitoring the progress towards achieving the high-level goals that are set out in the Strategy.

Our findings and recommendations

We found that the Ministry was actively collecting a large amount of information on the changes made and the effects of the Strategy's implementation. It had begun to report on performance and other indicators as the data had become available.

However, we were concerned that there were significant gaps in the Ministry's approach to collecting and reporting information about the Strategy. This meant that the Ministry was not in a position to report progress towards all of the Strategy's goals. The information that was available had not been brought together to give a concise overview of progress.

We recommended that the Ministry prepare a complete set of performance measures to monitor the Strategy's progress and report the results to the public in a plain English report. We also recommended that reports about PHOs' performance be published because these organisations are meant to be accountable to their enrolled populations.

We have previously reported on the Ministry's progress in responding to our recommendations in Performance audits from 2008: Follow-up report (April 2010).

The Ministry of Health's response to our findings and recommendations

The Ministry and district health boards have fully implemented our recommendation that they publish reports about PHOs' performance. This means that the PHOs and DHBs are now more accountable to the public and Parliament about the progress that is being made to improve the health of enrolled patients.

Five types of reports were published and these are publicly available.8 The reports were first published on 10 September 2010 (for the period ending 31 December 2009). The next set of reports was published in November 2010 and they will now be updated every six months. Some of the published reports contain comments from the PHOs and DHBs that explain the results. We found these helpful and consider that the public will also find them useful.9

Since our last report on the Ministry's response to our recommendations, it has become clear that changes in the way that primary health care is being approached mean that it is no longer useful for the Ministry to carry out our other recommendations. Nevertheless, the Ministry has accepted the intentions behind our recommendations and has considered them in monitoring the effectiveness of the Government's primary health care initiative, which is known as Better Sooner More Convenient.10 The Ministry is making an effort to clearly communicate the results of this and other health sector initiatives to the public.

We have discussed with the Ministry its plans to change, over time, some of its measures so that it will report on the effectiveness of primary health services from the patient's perspective and the health improvements that have been achieved. Currently, some of the measures focus more on the efficiency of the organisation providing the service. This information may still be collected and used by managers but may not be publicly reported. We support the Ministry's plans to work with the sector in making improvements in this area.

8: The reports were published on the website of District Health Boards New Zealand (DHBNZ) at The Ministry links to the reports on its website, These DHBs also provide a link to the reports from their websites – Auckland, Canterbury, Capital and Coast, Counties Manukau, Hawke's Bay, Northland, and Southern.

9: Generally, there were three types of comments – they highlighted any problems with data quality or reporting; discussed reasons why performance was below expectations and set out actions that were in progress, or were planned, to make improvements; or celebrated excellent results with comments, such as "detection [of diabetes] is great!" and "these results are particularly pleasing as both targets [for diabetes detection] were missed in the last performance period".

10: Information about the Better Sooner More Convenient initiative is available from the Ministry's website,, in the section about "Primary Health Care & PHOs". This approach is intended to specifically address previously slow progress in two areas – encouraging more multi-disciplinary teamwork and new service delivery models.

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