Abstract: As the populations of Western, so-called “firstworld” countries grow; so too do the pressures for the funding, purchasing, and provision of high-quality health care for their citizens. The drive to purchase and monitor outcomes, as opposed to simply accounting for outputs, has grown in strength in New Zealand and elsewhere, as a means of ensuring greater accountability for spending and ensuring every dollar invested in health care has some positive, downstream impact.
This paper, based on a small qualitative research study, explores a specific model of purchasing for outcomes, namely the Te Pou Matakana (TPM) model of Whānau Ora commissioning. We explore how commissioning as a particular model for purchasing services has fared in terms of delivering for Whānau Ora. The paper provides a brief history of Māori health provider development, as a means of establishing the roots of the TPM commissioning approach. We then explore in greater detail the commissioning approach unique to this case study site before presenting the study itself, our data collection methods, results, and analysis of those results. The paper concludes that in the New Zealand context, commissioning as a purchasing model has benefited from alignment with Whānau Ora principles, to the extent that an Indigenous model of commissioning is apparent in the TPM commissioning approach.

Abstract: New Zealand's mental health performance and monitoring framework is a complex and evolving one. Its initial development occurred at a time when it was taken for granted that mainstream understandings of health and mainstream systems of service delivery would not only be appropriate for all New Zealanders, but would also service the needs of all New Zealanders. Latterly however there has been an acknowledgement that a wholly different understanding of health and health care has existed in this country; the worldview understood and shared by tangata whenua. This thesis uses a theoretical framework devised specifically for this research to investigate the experience of Maori mental health providers as they contract to provide mental health services for the Crown; to ascertain whether maori mental health providers deliver outside of their contracts; and to examine the role multiple accountablities play in contracting. The theoretical framework, the “Maori research paradigm net” is inclusive of both the kaupapa Maori and Maori centred approaches, moving beyond the traditional dichotomy that frames Maori health research and allowing the researcher the freedom to select and use the best and most appropriate research tools from both traditional social science research practices, and from Maori culture and tikanga, to answer the research question posed. The thesis concludes that Maori mental health providers deliver mental health services at the interface between two philosphical viewpoints or worldviews: that of the Maori community in which they are located and to whom they provide servies; and that of the funder, from whom they obtain resources to enable them to deliver services. As a consequence of working at the interface, Maori providers regularly and routinely work outside the scope of their contracts to deliver mental health services which are aligned with those values and norms enshrined in Maori culture. To adequately acknowledge and validate the beneficial extra-contractual provision which occurs as a result of delivering mental health services at the interface, and prevent less desiable provision, a more responsive contracting environment and a performace measurement framework, which integrates both worldviews and which takes account of the multiple accountabilities that Maori providers manage, is required.

Abstract: Ngā Kairaranga Oranga – The Weavers of Health and Wellbeing is a theory about the health and wellbeing of Māori women. Health data about Māori women indicate that their health status is less than that of the non-Māori population despite the right to experience equality in health outcomes. Māori women’s health and wellbeing influences the nature of their health outcomes, varies across their lifetime. ‘What is happening for Māori women, their health and interactions with ‘mainstream’ health services?’ is the question that guided the research with Māori women. A grounded theory informed by a Māori centred approach was developed that utilised Mason Durie’s Māori-centred concepts of mana Māori (control), whakapiki tangata (enablement) and whakatuia (integration), and integrated Glaserian grounded theory to guide the collection and analysis of the data. Twenty-three women who identified as Māori within the Te Arawa rohe, and who were between the ages of 18 and 80 years were formally interviewed as either a group, pairs or individuals, with a further 15 informally interviewed during the process of theoretical sampling. Semi-structured interviews and field notes were used to collect the data, and the processes of constant comparative analysis, theoretical sampling and saturation were used to generate a middle-range substantive Māori centred grounded theory. Three core categories were identified relating to the health and wellbeing of Māori women: (a) Mana Māori, which describes what is important for their health and wellbeing; (b) The Way It Is, which outlines the resigned acceptance they have of their reality and life circumstances, and the barriers and challenges that are encountered; and (c) Engaging with Health Services, which describes what they require from ‘mainstream’ health services to improve the access and use of these services. The basic social psychological process of ‘weaving health and wellbeing’ integrates these core categories. The interpretations Māori women have of health and wellbeing, and health-related actions are explained by the theory generated. This substantive grounded theory provides a model to guide the education and practice of health care providers working within ‘mainstream’ health services.