Part 5: Reporting on reducing Māori health disparities

Health sector: Results of the 2012/13 audits.

In this Part, we provide an update on our 2010/11 review19 of the quality of DHBs' reporting on how they are reducing Māori health disparities.

In our 2010/11 review, we found that a lack of information made it hard to gauge DHBs' progress in reducing disparities for Māori. Information was lacking about the size of the disparity for most DHBs' Māori populations, the initiatives that DHBs were taking to address disparities, and the measures and targets used to assess progress in reducing disparities.

We reviewed the 2012/13 annual reports of DHBs to re-assess this reporting. There has been a significant improvement in the 2012/13 reporting. We saw a notable increase in the number of Māori-specific performance indicators, and better linking of Māori health plans to performance reporting in the annual reports.

However, several DHBs still need to provide better information about the extent of disparities for their Māori population, the initiatives and programmes to reduce disparities, and the progress that has been made in reducing those disparities. This is important information for New Zealanders and should be clearly set out for readers of the DHBs' annual reports.

Requirement to reduce Māori health disparities

Under section 22(1)(e) and (f) of the New Zealand Public Health and Disability Act 2000, DHBs have a statutory objective to reduce (with a view to eliminating) health outcome disparities "by improving health outcomes for Māori and other population groups". DHBs are expected to prepare, and put into effect, services and programmes to do so.

The Ministry also requires each DHB to produce an annual Māori health plan, describing the DHB's efforts to improve Māori health in its district and reduce inequalities.20

The Ministry has a template for the Māori health plans that it regularly reviews. For 2012/13, the template required DHBs to report against a set of 15 indicators in nine health areas. Seven of these areas (access to care, maternal health, cardiovascular disease, diabetes, cancer, smoking, and immunisation) relate to health services, with some overlap with the National Health Targets, while two (workforce and data quality) relate to organisational capability. DHBs assess and report their performance against these plans directly to the Ministry.

We do not audit the Māori health plans. However, we do have a strong interest in the accountability of public entities. DHBs' annual reports play an important role in enabling public accountability for how effective DHBs are in reducing disparities.

Where the disparity in health status for Māori is significant, we expect to see measures and targets for Māori, with trend information showing progress, in the annual report of the DHB.

Our review

To assess the progress in the quality of DHB reporting since our review two years ago, we decided to review each DHB's 2012/13 annual report. We assessed how the DHB reported on:

  • the extent of the district's Māori health disparities, including Māori population and health status information;
  • initiatives that the DHB was taking to reduce disparities and to respond if it failed to achieve its targets for Māori; and
  • the effect of those initiatives on Māori health (that is, progress against the measures and targets, including trend data).

Extent of Māori health disparities

We expect DHBs to identify in their annual report any particular health disparities for their Māori population, to give an idea of the extent of the disparities (in terms of severity and areas of disparity), and to use this as a basis for planning services to meet the needs of Māori.

If Māori health disparities are a priority for a DHB, this should be clear in the annual report. Linking the DHB's Māori health plan (which contains detailed information on the population profile of the district, including the size and age distribution of the Māori population and the leading health issues affecting Māori) to the performance reporting in the annual report is an important way for the DHB to be publicly accountable about how it is reducing disparities for Māori.

What we found

There has been an improvement from 2010/11 in how well DHBs identify the extent of Māori health disparities, but there is room for further improvement.

In 2010/11, DHBs typically made a general statement (without describing particular health disparities or providing data) that Māori health was a priority. The relative importance of the issue for the district was not made clear, and typically the Māori health plan was not linked to the annual report.

In 2012/13:

  • seven DHBs (Auckland, Counties Manukau, Hawke's Bay, Northland, Waikato, Wairarapa, and Waitemata) reported the extent of the overall disparity in Māori health by reporting trends in the life expectancy rates for Māori people in their district compared to other population groups; and
  • a further six DHBs (Hutt Valley, Taranaki, Canterbury, South Canterbury, Southern, and West Coast) reported the results of specific disparities between Māori and non-Māori performance and how disparities are changing over time.

However, the amount of trend information for disparity areas varied widely between the DHBs, and more commentary is needed for graphs to explain the severity of, or change in, the disparities for Māori.

The DHBs' Māori health plans contain detailed information on the population profile of their district, including the size and age distribution of the Māori population and the leading health issues affecting Māori.

However, this information was generally not included in the annual report, with 11 DHBs not stating the percentage of their district's population represented by Māori. We consider that this information is essential in providing context to the reader as to the importance of the issue of Māori health disparities in the district.

Taranaki DHB provided a good example of alignment with its Māori health plan. It prepared a table that reports the results for Māori and non-Māori for each of the measures in its Māori health plan, with a column that states the disparity percentage as well as reporting on the DHB's progress towards the outcomes in the plan.

Initiatives to improve Māori health

We expect DHBs to report what they have done specifically to address the disparities that they have identified.

What we found

In the 2010/11 annual reports, descriptions of the initiatives to address disparities were general rather than specific. They were more focused on improving the participation of Māori in the health workforce than health services initiatives.

In 2012/13, 14 DHBs included some discussion in their annual report on initiatives to reduce disparities in Māori health, with the number of initiatives discussed varying widely.

DHBs still tended to be somewhat vague about the initiatives they implemented. Counties Manukau DHB is one exception. Its annual report provided good descriptions for a number of specific health service initiatives for Māori.

Reporting progress in reducing disparities

We expect DHBs to use measures and targets by which their performance in reducing those disparities can be measured, and to report against these in its annual report.

What we found

In the 2010/11 annual reports, half of the DHBs had five or fewer indicators about Māori in their statement of service performance.

By contrast, in the 2012/13 annual reports, three-quarters of the DHBs included 10 or more measures for measuring achievements for Māori in the statements of service performance.

For the seven areas in the Māori health plan related to health services (access to care, maternal health, cardiovascular disease, diabetes, cancer, smoking, and immunisation):

  • four DHBs reported results for all seven areas in their annual report; and
  • seven DHBs (including the four South Island DHBs, with relatively small Māori populations) reported results for fewer than five of the areas.

Eight DHBs (Capital and Coast, Hawkes Bay, Hutt Valley, MidCentral, Tairāwhiti, Wairarapa, Whanganui, and South Canterbury) reported that there is no longer a disparity for Māori in the immunisation national target, because Māori immunisation levels are now on a par with those of non-Māori.

Most DHBs had indicators of Māori achievement as well as the seven considered a focus for Māori health nationally. All DHBs apart from one had oral health indicators and 17 DHBs had mental health indicators.

Where there is a single target for the whole population, with the intended goal of equality in the long term, progress should, in our view, still be reported against milestones toward eliminating any existing disparities. Twelve DHBs reported trend information to show their results for the Māori health indicators, often separately reporting the Māori and non-Māori results on the same graph so the reader could see the size of the disparity and any changes in it over several years.

In our view, there is still room for improvement in reporting on the effectiveness of initiatives in reducing Māori health disparities. This is particularly so in setting targets and reporting trend information as the DHB moves toward achieving those targets.

More commentary with trend graphs would help readers better understand the results, and what the DHB intends to do to reduce any remaining disparities.

District health boards' partnership arrangements

Sixteen DHBs clearly reported in 2012/13 on the processes in place to allow Māori to take part in, and contribute to, strategies for improving Māori health. This is a slight improvement on 2010/11, when 14 DHBs reported this.

However, the amount of detail in the information varied widely. Some included only the statutorily required information. Other DHBs reported on their relationship with iwi partners and set out whether they had representatives on the board to contribute to the governance and development of the strategic direction for Māori.

Other population groups

As well as improving the health outcomes of Māori, the New Zealand Public Health and Disability Act also requires reporting on other population groups.

Eleven DHBs reported results of performance indicators for their districts' Pacific population. For the remaining DHBs, we confirmed that the size of their Pacific population was not large, at less than 4% of the district's total population.

Results from the DHBs' service reporting indicated that the Pacific population experience the same level of health disparities as Māori. However, very little was reported on the specific initiatives in place targeted at reducing inequalities for the Pacific population.

It is important that DHBs report on the extent of disparities in the health status of Māori and other population groups in their annual reports so that it is clear to Parliament and the public what disparities exist and what is being done to address them. This includes describing initiatives, with measures and targets to reduce disparities, and reporting on the effect of those initiatives, so that progress in reducing disparities can be assessed.

19: See Health sector: Results of the 2010/11 audits, Part 5.

20: The Ministry's requirement for Māori health plans is set out in the Operational Policy Framework. Clause 21.5 of SOC Min (10) 15/2 states that DHBs' annual plans are to include Māori health plans.

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