Te Mana Ähua Ake o Waikaremoana The Absolute Uniqueness of Waikaremoana Strategic Wellness Plan
2009 - 2013
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Contents CONTENTS ........................................................................................................................... 2 FOREWORD ......................................................................................................................... 3 VISION .................................................................................................................................. 4
Mission ............................................................................................................................ 5 Values.............................................................................................................................. 5 Whanau Ora in Waikaremoana ...................................................................................... 7 Service Delivery Interface .............................................................................................. 8 Community Stakeholder Interface ................................................................................ 8 Te Mana Ahua Ake o Waikaremoana .......................................................................... 10 He Korowai Oranga ...................................................................................................... 12 Tu Mai – Maori Health Strategy ................................................................................... 13 Whanau Ora Taskforce ................................................................................................ 14 Kahungunu Hikoi Whenua ........................................................................................... 16 Action Plan ................................................................................................................... 19 2.1 Developing Whanau, Hapu and Iwi .................................................................... 20 2.2 Maori Participation .............................................................................................. 21 2.3 Effective Health and Disability Services ........................................................... 22 2.5 Effective Leadership ........................................................................................... 26 2.6 Increasing Maori Capacity .................................................................................. 27 2.7 Sharing Information ............................................................................................ 28 PERFORMANCE MEASURES ............................................................................................ 29
3.1 3.2
Health Outcomes ................................................................................................. 29 Building Maori capacity and capability in the health sector ........................... 32
REFERENCES .................................................................................................................... 33 APPENDICES ..................................................................................................................... 34 APPENDIX 1 ....................................................................................................................... 35 APPENDIX 2 ....................................................................................................................... 36 APPENDIX 3 ....................................................................................................................... 37 APPENDIX 4 ....................................................................................................................... 38 APPENDIX 5 ....................................................................................................................... 41 APPENDIX 6 ....................................................................................................................... 46 APPENDIX 7 ....................................................................................................................... 47 APPENDIX 8 ....................................................................................................................... 48 APPENDIX 9 ....................................................................................................................... 50
KHW Communications Plan ........................................................................................ 52
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Foreword E nga iwi, e nga reo, tena koutou i roto i nga tini aitua e pa ana ki a tatou, mai o mua. Na ratou i whakatakoto tenei kaupapa, ko te Hauora, a, ma tatou e tohe, kia ora ai nga mokopuna e whai ake nei. No reira tena koutou, tena koutou, tena koutou katoa. It‟s with pleasure that we introduce Te Mana Ahua Ake o Waikaremoana Wellbeing Plan that will guide Nga Kaitiaki Hauora o Waikaremoana (NKOHW) towards improving the health of Maori whanau in its district. This plan replaces the existing Strategic and Business plans and sets in place a five-year strategy for gradual change, and supports alternative approaches to the way health services are delivered to meet community needs. NKHOW acknowledges that to make a difference to the health status of Maori requires action from many more participants than those who receive health funding. This plan articulates the first steps towards working with all of those participants. It will not be an easy task. It will require contributions from multiple stakeholders, working together in a coordinated and collaborative manner. Our task is now to ensure that the strategies and actions set out in this strategy are implemented.
Roha Lake Chairman Celia Waiwai Trustee
Aileen Himona Manager
Dr Rangimarie Turuki Pere Kaumatua
Maria Whakatiki Waiwai Trustee/ Kaumatua (Deceased)
Hilda Amaru Trustee
Vern Winitana Trustee
Acknowledgements We would like to acknowledge all of those people who contributed to the writing of this plan. (There is a list of all participants in appendix 6).
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Vision “Ko te mana hauora, ko te mana tangata the health of the people is the strength of the people”
Vision Our vision is that the Trust walks the journey with each individual and whanau in the Waikaremoana community assisting with their Hauora needs as required. The journey of our whanau is represented by the outer circle while the Trust is represented by the inner circle supporting our community from the inside. In each stage of life the Trust plays an important role facilitating and supporting the Hauora needs of our community. Our Vision: The Trust walks with each and every Waikaremoana whanau and individual in the journey of their lives and this walk commences in pre-birth and continues after death. The journey never ends for the Trust who will always support the people of Waikaremoana.
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Mission The Trust recognises that health and wellness in Waikaremoana is a product of Hauora Services and Social Services and the mission statement for the organisation must reflect this dual role the Trust must undertake to provide healthcare: To provide the best possible health and support services to the Waikaremoana whanau and surrounding areas to ensure that their health, social, economic and whanau needs are met.
Values The Trust acknowledges its values as:
Working with individuals within the community to achieve and sustain optimal health, which includes access to good housing To recognise ethnic and cultural diversity with particular regard to Maori To acknowledge Te Tiriti and to actively develop strategies to address Maori issues by increasing knowledge and skills To acknowledge the current models of practice as the guideline for public health promotion activities To be a good employer and provide positive leadership through valuing people and their skills To empower respect and support individuals right of choice To promote Tikanga Maori and values associated with whanau and Hapu of the area To always provide the highest quality service we can
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Executive Summary The establishment of the Tohunga Suppression Act in 1907 constrained the way in which Maori responded to the health needs of whanau and furthermore caused an assimilation that resulted in the development of mainstream models of care being imposed upon Maori. The one-size fits all approach was not effective and slowly but surely Maori health and wellbeing was on the decline. Over the last twenty years from 1987 there has been a steer to revisit Maori models of health practised within mainstream. It has been acknowledged that Maori community leaders could effectively engage their communities delivering key health messages. In 1987 there were only four Maori health providers in the country and no recognised Maori models of care in mainstream practice. The development in Maori health nationally over the last twenty years has seen positive change with now over 240 Maori providers in existence. Nga Kaitiaki Hauora O Waikaremoana Trust was established in 1994 and has provided health and social services to the Waikaremoana community ever since. NKHOW has experienced rapid change under the various funding regimes of successive governments, firstly the Central Regional Health Authority, the Health Funding Authority and now Hawke‟s Bay District Health Board. This has seen the initial contract of Whanau Ora evolve to Mobile Primary Nursing and now to Whanau Support services. Despite the many changes in the sector, one thing has remained constant, and that has been NKHOW‟s ability to deliver quality health and social services to the Waikaremoana community. HBDHB has initiated Kahungunu Hikoi Whenua in an effort to reduce the incidence of chronic disease in our communities. We support this kaupapa, and have included intiatives in the plan that will encourage whanau to develop and maintain healthy lifestyles. The National government elected in 2008 is looking to move the health sector into a new era. The focus has changed from that of population health and primary care to reducing waiting times and improving performance to reduce costs. The focus is moving from a quality service delivery model to more of a quantity model where provider scale and it‟s ability to deliver volumes will be key competencies in this current health environment. This model is not suited to isolated rural communities like Waikaremoana, where a personalised Whanau Ora approach is needed. New government strategy documents are supporting the development of “integrated family health centres” in an effort to encourage collaboration across services to improve patient outcomes. NKHOW has been implementing a Whanau Ora approach to its heatlh delivery for the past 15 years and has strong links to its community. NKHOW knows its community intimately and will continue to deliver effective services to them in the future, In addition to this NKHOW has developed strong relationships with a range of health and social service providers in the Wairoa and greater Hawke‟s Bay area. This experience and extensive relationship network will ensure NKHOW is at the leading edge of health delivery now and well into the future. Change can be unsettling however. The development of this strategy will help NKHOW to plan necessary actions that will help the Whanau in Waikaremoana have confidence in their future as they move forward together.
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Strategic Context Treaty of Waitangi New Zealand is culturally and ethnically diverse, broadly comprising Maori and non-Maori Treaty partners. The Treaty of Waitangi is the founding document of New Zealand. It‟s signing in 1840 provided for settlement of New Zealand by non-Maori. It provides a framework of rights and responsibilities, and also articulates a relationship between Maori and the Crown. A report by Te Puni Kokiri1 states that existing inequalities between Maori and non-Maori may be partly attributed to historical events experienced by the Maori population, such as asset loss, land alienation and rapid urbanisation. The report also noted: The Treaty of Waitangi was signed to protect the interests of Maori and it is certainly not in the interests of Maori to be disadvantaged in any measure of social or economic well being. It is therefore appropriate that action to achieve Whanau Ora in health in Waikaremoana is taken within a Treaty of Waitangi framework.
Whanau Ora in Waikaremoana NKHOW has delivered services to the Waikaremoana community over the past 15 years based on the following values: 1. WHANAUNGATANGA: Bonding together as a Whanau/ community to achieve a common goal. To remember that we are all Rangatira (Esteemed people) who need to celebrate both the differences and similarities that we have. 2. TE HINENGARO: Working on a conscious level to deal with the pain in a holistic creative way and to explain the full meanings of abbreviations, terminology etc. 3. TE WHATUMANAWA: Using sensory perception, including intuitive intelligence, those “first gut feelings” to deal with planning for the “present” and the “future”. 4. TE AOTUROA, TE AO KIKOKIKO: Catering for the physical and material needs of people, by ensuring that the Health & Social Services are accessible and welcoming, that no individual or family is left bereft. 5. TE WAIRUA: Working together with a positive spirit and applying the principal of neutrality to deal with challenges.
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Progress Towards Closing Social and Economical Gaps Between Maori and Non Maori. Te Puni Kokiri 2000
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6. TE MAURI: To ensure that each member of the team resonates in a way that is appropriate for her or him, so that the life force of the team waxes strong for both the individual and the collective. 7. TE MANA, AHUA AKE: Enabling the individual to stand in her or his own power, by respecting the absolute uniqueness of each individual in the team, so that a balance is kept between individual and group endeavour. 8. HA, TAONGA TUKUIHO: Respecting the cultural traditions and protocols of each individual in the team, with particular regard for the two signatories of the Treaty of Waitangi. Ensuring that both Treaty Partners stand up with equal mana. Te Wheke is the model that works for whanau in Waikaremoana for the following reasons:
It is based on nga tikanga o nga atua me nga tipuna. It is holistic in its approach. Multiple services need to „wrap around‟ the needs of whanau ensuring that each factor that impacts whanau (both structural and individual factors) are addressed. Key services that impact on whanau will work together collaboratively and resource services adequately to ensure whanau receive the highest quality service. The interface with whanau is to be „culturally sound‟. Services must reflect the values and aspirations of whanau. Despite a high number of services that contribute/ fund services, provider interfaces with whanau remain few and are familiar. Services are targeted and delivered seamlessly
Te Wheke will be implemented on two levels to achieve whanau ora: Service Delivery Interface At the service delivery level, NKHOW staff will be support whanau needs and aspirations on an individual and whanau basis. Identifying whanau needs and aspirations and working alongside them in developing and achieving goals and solutions. Whanau support workers are the key interface with whanau and will have tools available to provide timely solutions to whanau. Community Stakeholder Interface Where needs of whanau are outside of the scope & expertise of whanau support workers, they will draw on a network of local and regional stakeholders to ensure appropriate services are available to whanau in a timely manner. Again whanau support workers will be a key resource for whanau in mobilising this extensive provider network. It will be critical to ensure whanau support workers have key contact information and other resources available to them so that these opportunities are also available to whanau.
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Figure 1 – Te Wheke Whanau Ora Model in Waikaremoana
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Nga Kaitiaki Hauora o Waikaremoana Nga Kaitiaki Hauora o Waikaremoana Trustee's and staff prides itself in “going the extra mile” for whanau. Although contracted by HBHDB to provide Whanau Support and Health promotion services, NKHOW often has to be creative to ensure needs outside of contracted services are met. Although capacity of staff is often stretched to the limit, staff often go “above and beyond” the call of duty to ensure whanau receive the appropriate care. E.g. supporting whanau to attend GP, specialist and hospital consultations (Wairoa and Hawke's Bay hospitals). Often this is with whanau who live outside the Waikaremoana District. In order for NKHOW to offer effective support to whanau, relationships have been developed with numerous stakeholders. These include Kahungunu Executive, Rongomaiwahine, Manaaki House, Ngati Pahuwera Hauora, WINZ, budget advisors, Housing NZ, Plunket, NZ Police, Department of Justice, Victim Support, Cancer Society, HB Renal unit, Wairoa PHO, HBDHB, Wairoa Hospital, Public Health nurses, Funeral Directors, and Wairoa Community Centre among others . Refferals are given to and taken from these stakeholders on a regular basis. NKHOW has always put the needs of whanau first. It has recently completed negotiations with HBDHB to change its contract service specifications to better align with the needs of whanau. This has included the provision of a mirimiri service as part of the whanau support service specification (this is a first for HBDHB). In addition to providing effective health services, NKHOW has been at the forefront of community development in Waikaremoana. An example of this is the development of the Waikaremoana District Housing response Plan in 2006. This document outlined the housing needs and priorities for whanau in the district. The result of this project was the retrofitting of 27 homes in the Waikaremoana District. This project was a huge success and an excellent example of whanau ora in action.
Te Mana Ahua Ake o Waikaremoana Te Mana Ahua Ake o Waikaremoana Wellbeing Plan acknowledges that there is a wonderful opportunity to influence and ensure our whanau enjoy a healthy quality of life in Waikaremoana and surrounding Districts. The Plan articulates the need to move away from a deficit model towards a strength based model where partnerships with whanau, hapu and other community organisations will be critical. Te Mana Ahua Ake o Waikaremoana Plan acknowleges the need for effective Health promotion and Health prevention services working together to fight the onset of chronic longterm conditions amongst our whanau2. Although HBDHB has asked to focus only on the Health promotion (KHW), this plan looks at a holistic approach to health and wellbeing including access to effective primary and secondary health services. To influence complex and often chronic conditions we will need to take a broader view of the social context within which they arise, then using this understanding to mobilise community networks and agencies to support self care. This requires a view of „people not patients‟, challenging primary and secondary care to identify in different circumstances, which is the most important focus of activity: the individual patient, the whanau or other parts of their social network. For example, Te Wheke model of care that requires that we meet the needs of whanau across the determinants of health (i.e. tikanga Maori, housing, income, health, education etc.) Therefore, The Plan acknowledges this expertise and experience developed over the past decade by community providers and other key stakeholders and provides pathways to further develop and implement these frameworks. 2
Mason Durie, Nga Kahui Pou, Launching Maori Futures, 2003
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He Korowai Oranga He Korowai Oranga was launched in 2002 and sets the direction for Maori Health action out to 2010. Te Overall aim of He Korowai Oranga is whanau ora: Maori families supported to achieve their maximum health and well-being. This requires an approach that recognises and builds on the integral strengths and assets of whanau. Whanau, which may comprise kuia, koroua, pakeke, rangatahi and tamariki, is recognised as the foundation of Maori society. As a principle source of strength, support, security and identity, whanau plays a central role in the well being of Maori, individually and collectively.
Developing hapu, whanau and iwi Working collaboratively with whanau, hapu, iwi and Maori communities to identify what is needed to encourage health as well as to prevent and treat disease. This includes supporting whanau development and participation in Te Ao Maori and to improve Maori health and well-being. Maori Participation Active participation by Maori at all levels of the health and disability sector in decision making and planning, and in the development and delivery of health and disability services.
Effective Health and Disability Services Ensuring whanau receive timely, high-quality effective and culturally appropriate health and disability services to achieve whanau ora. A range of evidence suggests that the design, configuration and method of delivery of health services affect their accessibility and effectiveness for different groups of people. There are opportunities to further explore and develop new models of service delivery that improve access, reduce barriers and improve health outcome for Maori.
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Historically Maori have lacked access to both preventative and treatment services in particular primary health care services, relying on hospital care when their illnesses become pressing. Article three of the Treaty of Waitangi guarantees Maori the same citizen rights as all British subjects. Equity in health services means that those with poorest health should be accessing health services the most. It also means equal quality of care for all. NKHOW will work towards Maori enjoying the same level of wellbeing, health outcomes, and provision of health service as non-Maori, i.e. access and quality of care. Working Across Sectors A whole-of-community approach is critical to ensuring whanau ora in Waikaremoana so that the community is better able to take control of the circumstances affecting them and to improving the health and wellbeing of whanau. For whanau to participate fully in New Zealand society, co-ordinated and effective service development across all sectors must be in place to ensure equitable access to resources and services. Effective Leadership Maori are under-represented in the health and disability workforce in almost every area, holding back both Maori provider development and improvements in mainstream delivery to Maori. Developing critical mass of leadership (clinical and non-clinical) in communities will ensure that health gains for Maori will be achieved. Increasing Maori Capacity Maori Providers are key players in improving access to, and effectiveness and appropriateness of, health and disability services for whanau. The effectiveness of health and disability services at delivering successful outcomes depends to a large extent on the effectiveness of the workforce. The health system is labour-intensive, involving people who are providing a range of services to whanau. Developing the Maori health workforce and Maori health providers is an important way to augment efforts to make mainstream services more accessible and responsive to Maori.
Sharing Information If communities and the health sector are to work together, it is important to build knowledge and develop ways of collating and sharing reliable information. New models of service delivery will increasingly require shared information platforms between primary and secondary care and between other government agencies. Collaborating with the various agencies to develop socioeconomic and health indicators will be critical in monitoring progress towards reducing inequalities in health.
Tu Mai – Maori Health Strategy Tu Mai was launched in 2007 and sets the direction for Maori Health action in Hawke‟s Bay out to 2012. Te Overall aim of Tu Mai is whanau ora, within a kaupapa Maori framework. Tu Mai acknowledges that traditional Maori frameworks are critical to achieving Whanau Ora. By supporting aspirations of whanau, hapu and iwi, health and disability services are better positioned to meet the health needs of Whanau. This whakaaro moves from “doing to” to “doing with”, or where Pat Sneddon articulates; “When rangatiratanga and kawanatanga are aligned full citizenship is realised and outcomes for all are enhanced” (Tu Mai, 2007).
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One of the key themes in Tu Mai, is the development of a population/ community heatlh approach to Whanau Ora which supports communities to develop their own models of care. This has led to the development of Kahungunu Hikoi Whenua, which really aligns both rangatiratanga and kawanatanga to improve community outcomes and will be a key enabler in achieving Whanau Ora in Waikaremoana. Many of the actions and initiatives for this strategy have resulted from the consultation process initiated from Kahungunu Hikoi Whenua.
Whanau Ora Taskforce In April 2010, The Hon Tariana Turia (Minister for the Community and Voluntary Sector), released a report on Whanau Ora, Report on the Taskforce of Whanau-Centered Initiatives. The report is important in that it will guide Government policy around the delivery of health and social (Whanau Ora) services in the future. NKHOW needs to be mindful of how this could impact on delivering a Te Wheke Whanau Ora Model for its community. NKHOW must look for opportunities within changes in the health sector
The Whanau Ora Taskforce has developed a set of seven principles underpinning Whanau Ora, which underpin whanau-centred service delivery. The principles are shown in the diagram above: nga kaupapa tuku iho; whanau opportunity; best whanau outcomes; coherent service delivery; whanau integrity; effective resourcing; and competent and innovative provision. Nga- Kaupapa Tuku Iho: the ways in which Maori values, beliefs, obligations and responsibilities are available to guide whanau in their day-to-day lives. Whanau Opportunity: all whanau will have chances in life that will enable them to reach new heights, do the best for their people, engage with their communities and foster a strong sense of Whanaungatanga – connectedness. Best Whanau Outcomes: the success of Whanau Ora interventions is measured by increases in whanau capacities to undertake those functions that are necessary for healthy living, and shared contributions to the wellbeing of the whanau as a whole, as well as the wellbeing of whanau members.
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Coherent Service Delivery: recognises a unified type of intervention so that distinctions between services provided by health, welfare, education and housing, for example, are not allowed to overshadow wider whanau needs. Whanau Integrity: acknowledges whanau accountability, whanau innovation and whanau dignity. This principle assumes that a code of responsibility is present in all whanau, though it may sometimes be masked by events or circumstances that propel whanau into survival mode or trigger a defensive reaction. Effective Resourcing: underlines two important aspects of services to whanau. First, the level of resourcing should match the size of the task – whanau-centred approaches may initially be time intensive. Second, resourcing should be tied to results. Effective resourcing means allocating resources in order to attain the best results and an intervention plan should include a set of indicators that can measure successful outcomes. Competent and Innovative Provision: recognises a need for skilled practitioners who are able to go beyond crisis intervention to build skills and strategies that will contribute to whanau empowerment and positive outcomes. On the basis of Taskforce members‟ experience and expertise, and the available evidence, the Taskforce has identified five key elements of effective whanau-centred services: whanau, hapu and iwi leadership; whanau action and engagement; whanau-centred design and delivery of services; active and responsive government; and funding. Whanau, Hapu- and Iwi Leadership Whanau, hapu and iwi have critical and distinct roles to play in facilitating Whanau Ora. These roles, relationships and responsibilities are based on whakapapa connections and lie largely outside government interventions. Supporting natural leaders within whanau is critical to the success of Whanau Ora. …it should not be a structure that oppresses; it has to be underpinned by principles. Whanau Action and Engagement Whanau strengths are acknowledged and endorsed. Whanau ownership of solutions and actions is encouraged. Partnerships between whanau and providers are the norm. Whanau have opportunities to extend their own resources and expertise, while also addressing the needs of individual members. Whanau-Centred Design and Delivery of Services Services are designed and delivered in a way that places whanau at the centre of service provision. Services build on the strengths and capabilities already present in whanau. Services and whanau interventions are underpinned by a focus on building whanau capability so that they are able to prevent crises, manage problems and invest in their future. Active and Responsive Government Government agencies should be responsive and flexible enough to align with and support whanau, hapu and iwi aspirations. Government should invest in whanau aspirations. Funding Funding arrangements should be consistent with a wha¯nau-centred approach to service delivery. The focus should be on a relational approach to contracting between providers and government agencies which focuses on best outcomes for whanau.
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Kahungunu Hikoi Whenua Kahungunu Hikoi Whenua is unique in that the programme addresses issues around Nutrition (Healthy Eating), Physical Activity (Healthy Action) and tobacco use at a population level across three DHB boundaries that make up the Ngati Kahungunu Iwi rohe. Kahungunu Hikoi Whenua utilises a Kaupapa Maori Community Development approach that focuses on key settings where Whanau – live, learn, work and play. This approach recognises the need for Maori to develop approaches and initiatives which are appropriate for Maori. This involves working in and with Whanau and communities toward social change in order to prevent disease and improve health outcomes through partnership processes with Whanau and community stakeholders. KHW is about:
Increasing opportunities for Whanau to participate in Physical Activity, Nutrition and Smoke free initiatives within their own communities. Influencing environments so they are supportive of Whanau making healthy choices Whanau and communities taking ownership of their own health and wellbeing and developing solution oriented initiatives Building communities through whanaungatanga and kotahitanga Haputanga and cultural revitalisation Kahungunu Hikoi Whenua is about us doing it for us
Waikaremoana Hikoi Whenua Various hui were undertaken with the community to inform whanau of Kahungunu Hikoi Whenua and its objectives. We then had hui to ascertain the needs and aspirations of whanau pertaining to this kaupapa. Questions posed to whanau were: What do you want? What makes you strong? Who do you trust? Answers to these questions would invariably help to develop healthy initiatives that would make a positive impact on the whanau and hit home to the values of whanau. If the initiatives are not aligned to the values and aspitations of whanau then it is pointless. We also need to ensure that those who engage with whanau are trusted. The answers were: What do you want? Healthy whanau Wellbeing for future generations Educated whanau (mokopuna, tamariki, pakeke and kaumatua) What makes you strong? Whanaungatanga (support from family) Security and stability (job, house, pay the bills) Personal identity (marae, whakapapa, haputanga) Traditional values (Te Reo me ona Tikanga, Kawa) Knowledge and experiences (Te Wheke) Who do you trust? Kaumatua and pakeke Hauora staff Marae committees
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Rural fire force Kura and Kohanga reo Manawhenua Trusts
Strengths Te Wheke was developed by our tipuna and promoted by one of our kuia, Dr Rangimarie Turuki Rose Pere. It is based on nga tikanga o nga atua me nga tipuna and is holistic in its approach. Key services that impact on whanau will work together collaboratively NKHOW intimately knows its community and they have credibility with whanau This then led to a stocktake hui to identify the range of activities currently undertaken by community stakeholders. This helped to identify areas of existing strength, capacity and focus. It was useful to ensure that duplication of effort would be minimised, gaps and needs identified and solitions developed.
Community Stakeholders
Activities undertaken (red text denotes linkages with KHW kaupapa)
Nga Kaitiaki Hauora o Waikaremoana
Health, Advocacy, Whanau support, Housing (Retro fit, Repairs, Rentals), Transport, Sports team, Rugby, netball, golf, touch, tennis, Kaumatua support, Mirimiri, Ist response unit. Holiday programmes, TAPS, Renal unit, Links with other hauora, Rongoa
Hinekura Marae
Karakia, Tangi/Hui/wananga, Civil defense meeting place,TAPS,Catering Kawa & tikanga, Kapa Haka
Waimako Marae
Karakia, Tangi/Hui/wananga, Civil defense meeting place,TAPS,Catering Kawa & tikanga, Kapa Haka, Rongoa Hauwai
Waikaremoana Kohanga Reo
Te reo me ona tikanga, Fruit in schools, Garden, Recycling/ zero waste, Kapa haka, Manu korero, Sports Teams
Te Kura o Waikaremoana Education of Tamariki, Te reo me ona tikanga, Gardens, korikori tinana, Manu korero Te Pikinga Aio
Waka Ama, Sports, tennis, golf, Social services, Whanau support, Gardens
Lake Waikaremoana Hapu Restoration Trust
Gardens, kiwi enclosure, sustainable recycling, conservation, planting native rakau, Hapu Development
Te Whenua Toopu Trust, Treaty Claims, Mana whenua rights, Hapu Development Panekire Tribal Trust, Te Heitakoha 2B, Te Kopani 36, 37 Trust Whakamarino Lodge
Tourism, Catering, Accommodation
Genesis Power
Gymnasium, employment
Identified GAPS & opportunities
Weekly community night – increasing opportunities for whanau to meet together regularly, to work and play. Activities could include, healthy cooking, crafts, workshops etc. As an isolated area, whanau ora would improve with increased opportunities for whanau to engage and socialise.
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Kaumatua story nights - Increasing opportunities for intergeneration knowledge to be passed on. Kaumatua to tell younger generations how things were done in their time (gardening, food gathering etc.) Good opportunity for kaumatua to socialise with community networks. Mentoring groups for young mums (wahine purotu)/ young men (tane purotu) - There is an opportunity to better support younger generations in basic life skills such as healthy cooking, gardening, traditional food gathering, bush safety, raising children, breastfeeding etc. This would provide opportunities for rangatahi to learn from the older people and receive needed support from whanau. Community Gym (equipped with weights etc.) - having a central location dedicated to health promotion was seen as important. A central place where whanau can go to socialise while at the same time getting fit. Community Tennis Club – Encouraging physical activity through whanau tennis matches. Making use of existing facilities (Tuai tennis courts) and encouraging whanau to play the game. Look to play other areas such as Raupunga, Frasertown and Mahia in an annual competition.
Weaknesses and Threats/ Risks Limited Health promotion capacity - In addition to our hauora staff we will need to identify local health promotion champions who can help to support the kaupapa. We feel that having a Community Gym and other initiatives will help to bring whanau “out of the woodwork” that might be interested in further developing health promotion skills. We will be looking to HBDHB for support in this area also. Coordination/ Promotion of events and initiatives - NKHOW will need to ensure events and initiatives are coordinated to ensure best use of resources. This is likely to put additional pressure on NKHOW administration and resources. NKHOW will link into KHW social marketing tools and resources as much as possible. Evaluation and monitoring of outcome measures - NKHOW will need to work closely with HBDHB and others to develop evaluation measures and outcome tools. This is a challenge for all providers. We will utilize HBDHB Maori Health outcome measures as a benchmark for measuring improvement. Sustainability of Funding - Sustainability of funding for KHW is uncertain, hence why this plan incorporates all parts of whanau ora in Waikaremoana. We will utilize resources from every part of Te Wheke to support Whanau ora. If funding is available, kei te pai, if not, we will be resourceful and creative in achieving our vision. From this planning exercise the community developed a range of initiatives that would support the health and wellbeing of whanau over the next 2 years. The initiatives are outlined in the action 2.3.1 of the Action Plan. KHW Implementation Plan Details are contained in Appendix xx
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Action Plan “E hara taku toa i te taki tahi, engari ko taku toa, he taki tini Our success is dependent on collective not individual efforts” There are 7 Goals identified in this document. Each of these goals has been taken from He Korowai Oranga and Tu Mai where they are identified as action pathways and key drivers. It is important that The Plan is consistent with and supports national and regional strategy. Below each strategy the is a commentary describing the rationale behind each strategy. Within each strategy are a number of objectives that build toward the strategy and the specific actions that will be implemented. NKHOW acknowledges that key partnerships with other agencies and organisations will be critical to ensuring these actions and objectives are achieved. Action results will help to monitor our progress against the strategies and actions and ensure accountability is maintained. Progress on the plan correlates with the Maori Health Outcomes framework which is reported to the HBDHB Maori Relationship Board every six months. Each of the actions will be measured against one or more indicators of DHB performance that correlate with the Maori Health Monitoring Framework. All objectives will have a time frame within which the work must be completed.
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2.1
Developing Whanau, Hapu and Iwi
Working collaboratively with whanau, hapu, iwi and Maori communities to identify what is needed to encourage health as well as to prevent and treat disease. (Bold – denotes lead responsibility) Specific actions
Partners
2.1.1 Whanau, hapu, and Maori communities are supported to achieve their own aspirations for whanau ora.
Objective
Community organisations are clear about strength and weaknesses. Each to focus on areas of strength and interests. Acknowledged boundaries and limitations.
NKHOW Whenua Toopu Panekire Heio Tahoka – Te Kopani
Everyone works on own roles (understanding own boundaries and working together when needed)
Results
2010/11
Time
2.1.2 Kaupapa Maori models of Wellness are developed.
Highlighting Te Wheke model of care as the example of Whanau Ora for small rural communities where there are high health and social needs.
NKHOW Te Pikinga Social Services
An application is lodged to MoH to access Health Innovation funding over the next 3 years
2009/10
2.1.3 Improve Maori participation in health research.
Partnerships are developed with health research group(s) to improve Maori health and inequalities intelligence
HBDHB Nga Kairauhii NKHOW
DHB Indicator
A pilot is developed which incorporates Te Wheke Whanau Ora model implementation.
Research tools are available to support future planning. Will also indicated where and if health outcomes are improved for Waikaremoana.
2011/12
Local iwi/Maori are engaged and participate in DHB decision making and the development of strategy and plans for Maori health gain (HK01-01)
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2.2
Maori Participation
Active participation by Maori at all levels of the health and disability sector in decision making and planning, and in the development and delivery of health and disability services. Objective
Specific actions
Partners
2.2.1 Maori have effective input into service planning, design, implementation and evaluation of health services.
Whanau are consulted and engaged in the development of health & disability services in Waikaremoana
NKHOW Whenua Toopu Panekire Heio Tahoka – Te Kopani Hinekura Waimako Kura Kohanga
DHB Indicator
Measures Community consultation process is implemented
Time 2009/10
Waikaremoana Community Strategy is developed that articulates the aspirations of whanau Whanau Ora model developed and implemented
Local iwi/Maori are engaged and participate in DHB decision making and the development of strategy and plans for Maori health gain (HK01-01)
21
2.3
Effective Health and Disability Services
Ensuring whanau receive timely, high-quality effective and culturally appropriate health and disability services to improve whanau ora. Objective 2.3.1 Kahungunu Hikoi Whenua community initiatives are planned and implemented.
Specific actions Te Kura o Waikaremoana School Gardens and food preparation/ preserving Wahine Purotu – mentoring for young mums (healthy cooking, breastfeeding, wananga, homemaking activities) Tane Purotu – mentoring for young men/ boys (traditional kai gathering, Ngahere, moana, bush and water safety etc.) Waikaremoana Tennis club – improved participation by rangatahi and pakeke in tennis. Competitions with other marae/ clubs.
Partners KHW Education KHW Evaluation KHW Marae NKHOW Health promotion Breastfeed ing KHW Marae NKHOW Health promotion NKHOW Health promotion
Te Kohanga Reo o Waikaremoana – increasing daily physical activity for tamairiki. Continue Maara kai and healthy eating.
KHW Education KHW Evaluation
Community Gym – exercise, weights, line dancing, aerobics, tai che etc.
NKHOW Health promotion
Hapu Restoration Trust– Community Gardens, sustainable recycling Te Pikinga – Nga Waka o Waikaremoana (lake/ waka physical activity)
KHW Marae NKHOW Health promotion NKHOW Health promotion
22
Measures
Time
Improved access to vegetables and fresh fruit Increased knowledge of gardening techniques
2009/10
Increased physical acitivity increased knowledge of healthy eating/ cooking increase socialisation/ whanaungatanga increase cultural knowledge
2010/11
Increased physical acitivity increased knowledge of healthy eating/ cooking increase socialisation/ whanaungatanga increase cultural knowledge
2010/11
Increased physical acitivity increase socialisation/ whanaungatanga Increased physical acitivity increased knowledge of healthy eating/ cooking increase socialisation/ whanaungatanga increase cultural knowledge Increased physical acitivity increase socialisation/ whanaungatanga increased knowledge of healthy eating/ cooking increase socialisation/ whanaungatanga increase cultural knowledge Increased physical acitivity increase socialisation/ whanaungatanga
2009/10
2009/10
2010/11
2009/10
2010/11
Objective
Specific actions
Partners
Measures
Time
NKHOW Toopu Whenua Panekire Heio Tahoka – Te Kopani Hinekura Waimako Kura Kohanga
The Community Strategy is reflected in all strategic/ business plans
2010
Effective prevention and screening services are available to whanau
NKHOW NGOs Wairoa PHO
Improving referral services between NKHOW and GP services to reduce DNA's. There is no reason of DNA's in Waikaremoana if Hauora staff are informed early.
2010
Appropriate for Maori by Maori smoking cessation /auahi kore services accessed.
NKHOW NGOs Wairoa PHO
Reduction in the prevalence of smoking
2012
2.3.4 Maori will receive accessible, appropriate and effective primary health care services
NKHOW NGOs Wairoa PHO
Wairoa Health Plan reflects Waikaremoana community aspirations.
2.3.2 Planning of health and disability services is robust and equitable
Community aspirations are articulated in Hauora business and service plans
Work with Wairoa PHO and other Wairoa providers in the understanding of NKHOW values (Te Wheke) Ensure the needs of Waikaremoana is articulated in the Wairoa Health Plan.
Improved relationships with GP services. Making these services whanau friendly (e.g. AP payments available for overdue accounts)
Work with Wairoa PHO to ensure SIA funded services are making a difference to Waikaremoana Whanau.
Improved communication between GP and NKHOW
2010 2010/11
2009/10
2009/10
Work with Wairoa PHO to support a low fees environment. Supporting whanau to access the Wairoa School Dental Clinic
Wairoa School Dental services to reflect the needs of the community/ whanau
23
2011/12
Objective 2.3.5 Maori will receive accessible, appropriate and effective chronic disease management services
Specific actions Better communications with GPs around whanau with Long Term Conditions (referral processes) to ensure appropriate support
Partners NKHOW NGOs Wairoa PHO
Develop a relationship with Wairoa Hospital Midwives to support our young mothers and their pepi.
Measures Discharge plans are monitored and followed up on.
Time 2011/12
Whanau referrals to NKHOW are implemented Appointments kept as referred by specialists. Midwives attending scheduled visits to Waikaremoana. Where this is not possible, NKHOW is informed so that support continues. Improved Breastfeeding education to young mothers.
2.3.6 Maori will receive accessible, appropriate and effective Mental Health services
Kaupapa Maori Mental Health & Addiction services are delivered in a way that is responsive to the needs of Whanau.
DHB Indicators
NKHOW NGOs Wairoa PHO
Culturally responsive, quality mental health and addiction services are accessible to whanau
2010
Increase the number of Maori whom have had a absolute CVD risk recorded in last 5 yrs (IDP POP-02) Increase the number of Maori persons where CVD risk >= 15% where statins have been prescribed in the past year (IDP POP-02) Increase the number of Maori who have suffered Acute Coronary Syndrome who attend a cardiac rehabilitation outpatient programme. (IDP POP-02) Increase the proportion of projected Maori diagnosed with diabetes who have a free annual diabetes review to 90 % by 2012. (IDP POP-01) Increased number of Maori on the register who have had a retinal screen in the last 2 years to 90 % by 2012 (IDP POP-01) Increase the rate of Maori diabetic whom have good management HBA1c <= 8 to 80 % by 2012 (IDP POP-01) Reduce the proportion of year 10 students who smoke daily in low decile schools (ASH SURVEY-01) Increase the % 5 Maori year olds caries free (IDP POP-05) Decrease the Mean number of DMF teeth of Maori children at year 8 (IDP POP- 04) Increase the Maori adolescent oral health utilisation rates (IDP POP- 11) Reduce the disparity in the Ambulatory sensitive Hospitalisation rates for Maori 64-74 years with Non Maori (IDP POP-09) Increase the access rates to secondary mental health services for Maori 0-19 years to at least 2 % of the population (IDP POP-06) Improving Mainstream Effectiveness (HK0-03)
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2.4
Working Across Sectors
A whole-of-community approach is critical to ensuring whanau and communities are better able to take control of the circumstances affecting them and to improving the health and well-being of whanau. Objective
Specific actions
2.4.1 NKHOW continue a cross sectoral approach to addressing social determinants of health impacting on the health status of Maori
Develop Te Wheke Whanau Ora service delivery model. Cross-sectoral approaches to planning are implemented. NKHOW will work with others in the development of Integrated Family Health centres. Support and facilitate inter sectoral activities at provider level particularly around: Housing Education Employment
DHB Indicator
Partners NKHOW Social Services HNZ TPK NKII TLAs Kura Marae Mana Whenua Trusts
Measures Cross-sectoral initiatives such as the healthy homes project are implemented and evaluated. Continue services if evidence supports it.
Time 2010/11
Local iwi/Maori are engaged and participate in DHB decision making and the development of strategy and plans for Maori health gain (HK01-01)
25
2.5
Effective Leadership
In order to build healthy Whanau we need to develop leadership capacity across all areas of the community, including Marae, health and social contexts. Objective
Specific actions
2.5.1 Nurture existing governance boards
Identify opportunities for community boards to utilise shared governance training: e.g. -Te Manu Whakahiato training for Maori board members
Boards MRB
Partners
All Board members will have participated in Maori Governance training.
Measures
2010/11
2.5.2 Partnerships are developed with key stakeholders to identify and nurture future leadership
Mentoring programmes are developed and supported.
Kura Local Employers MSD NKHOW
Supporting Wairoa College (Cactus Programme) and Wairoa District Council programmes
2010/11
Tane & Wahine Purotu mentoring programmes focus on development of leadership qualities with tamariki/ rangatahi. Leadership potential is identified early and supported. DHB Indicator
Increase the capacity of Maori provider workforce (HK02-02) Improving Mainstream Effectiveness (HK0-03)
26
Time
2.6
Increasing Maori Capacity
The effectiveness of health and disability services at delivering successful outcomes depends to a large extent on the effectiveness of the workforce and the available capacity of Maori to deliver. Objective 2.6.1 The Maori workforce is supported and strengthened.
Specific actions Strategies to attract/ retain Maori clinical expertise are developed and implemented as articulated in Turuki Maori Workforce Plan
Partners
Measures
HBDHB EIT NGOs PHOs HPC
Clear consultation with Maori providers and communities is evident.
Time 2010/11
Hauora Staff are competent in their areas of specialty
Work with Hauora Provider Council (HPC) to develop a model that will best build provider workforce capacity
2.6.2 Building stronger relationships with local employers to develop career pathways for rangatahi.
Investigate career pathway pilot opportunities with key agencies, utilising local resources and meeting local needs e.g. Utilising community max scheme to develop employment opportunities.
Kura Local Employers MSD NKHOW
Develop a local employers/ business network to dicuss these issues.
2.6.3 Develop smart strategies to maintain ISO9000 accreditation
Work with other Hauora/ organisations to leverage skills, resources and reduce compliance costs of ISO9000.
NGOs Auditors NKHOW
Develop standardised auditing tools, processes and policies that are easily duplicated and maintained.
DHB Indicator
2010/11
Pilot identified and implemented.
2010
Increase the capacity of Maori provider workforce (HK02-02) The DHB will set targets to increase funding for Maori health and disabilities initiatives (HK0-04)
27
2.7
Sharing Information
If communities and the health sector are to work together, it is important to build knowledge and develop ways of collating and sharing reliable information. Objective Kahungunu Hikoi Whenua messages are clear and help to promote community KHW kaupapa and initiatives Health needs assessment data is available for Waikaremoana
Specific actions
Partners
Measures
Time
Work with KHW social marketing team to ensure marketing and advertising material will connect with Waikaremoana community
HBDHB KHW marketing team NKHOW
Clear messages that connect with Whanau are promoted to the community.
2009/10
Work with HBDHB information staff to source appropriate health needs data i.e. Hospital admissions, Diabetics, cardiac, renal for Waikaremoana whanau.
NKHOW HBDHB
Waikaremoana Health needs assessment is completed and used in all service plans
2009/10
improved health reporting requirements and feedback. Medtech better reflects community provider reporting needs
DHB Indicator
Improving Mainstream Effectiveness (HK0-03)
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Performance Measures Performance Outcomes for Waikaremoana 1. Continued improvement connecting with marae, hapu and iwi (including Te reo me ona tikanga) 2. Continued improvement in Waikaremoana health status (see Maori Health Monitoring Framework) 3. Continued improvement connecting with te Ao Wairua (Hahi and Te Ao Maori) 4. Continued improvement accessing primary and secondary care 5. Continued improvement participating in healthy kai and physical activity opportunities 6. Continued Improvement accessing education and employment opportunities 7. Continued improvement accessing warm, safe and secure housing 8. Continued improvement accessing social services and family benefit entitlements
Maori Health Outcome Monitoring Framework The following health outcomes framework is measured and monitored by HBDHB. Although it only measures health and not other social determinants, it helps to provide a baseline of outcome information to support Whanau Ora. In addition to these indicators, we will be working with the KHW evaluation team to develop qualitative indicators to monitor progress.
3.1
Health Outcomes
Action Area Chronic disease: Cardiovascular Diabetes Cancer Chronic Respiratory Disease
Protective Factors Indicators
Service coverage Indicators
Increase the % of Maori adults eating 3 servings vegetables and 2 servings fruit (NZHS- QX)
Increase the number of Maori whom have had a absolute CVD risk recorded in last 5 yrs (IDP POP-02)
Increase the % adults engaging in at least 2.5 hrs physical activity per week (NZHS- QX)
Increase the number of Maori persons where CVD risk >= 15% where statins have been prescribed in the past year (IDP POP02)
Reduce the prevalence of obesity in Maori 15 + (NZHS- QX) Increase the number of marae implementing healthy active / health promoting environment
30 % increase the number of Maori who have suffered Acute Coronary Syndrome who attend a cardiac rehabilitation outpatient programme by 2012. (IDP POP-02) Increase the proportion
29
Health outcomes Reduce the disparity in Ischemic heart disease mortality rate between Maori and non Maori Reduce Maori Standardised discharge rates for Ischemic heart disease, Acute Myocardial Infarction, stroke (over 55 yrs)
Reduce rate of diabetes related lower limb amputation in Maori population Reduce the rate vitrectomy in Maori with diabetes Reduce the Maori age standardised cancer mortality rate, all cause, breast, lung, colorectal,
Action Area
Protective Factors Indicators Reduce the smoking prevalence amongst Maori. (Health target)
Service coverage Indicators of projected Maori diagnosed with diabetes who have a free annual diabetes review to 80 % by 2012. (IDP POP-01)
Health outcomes prostate
Increased number of Maori on the register who have had a retinal screen in the last 2 years to 85 % by 2012 (IDP POP-01) Increase the rate of Maori diabetic whom have good management HBA1c <= 8 to 75 % by 2012 (IDP POP-01) Reduce the Maori DNA rates to Cardiology and Respiratory, specialty clinics by 30 %. (HBI-01) Improving Mainstream Effectiveness (HK003)
Action Area Women s Health
Protective Factors Indicators
Service coverage Indicators 25 % increase in the 3 yr cervical screening coverage rates for Maori women 20-69 by 2012 (NSU SC-1) 25 % increase in the 2 yr breast screening coverage for Maori women 45-69 by 2012 (NSU BS -1) 30 % decrease in the Maori DNA rates for Gynaecology and Colposcopy Specialties Outpatient FSA (HBI-02)
30
Health outcomes
Reduce the disparity in cervical cancer rates between Maori and nonMaori women by 2012 Reduce the disparity in breast cancer mortality rate between Maori women and non-Maori women by 2012
Action Area Child and youth
Protective Factors Indicators
Service coverage Indicators
75 % of Maori women breastfeeding full or exclusively at 6 weeks and 27 % at 6 months
95 % of all Maori children immunised at age 2 years (IDP POP-08)
Reduce the disparity in the rate of low birth weight babies between Maori and Non Maori
95 % utilisation of well child minimum core contacts by Maori children at the age of 5 years
Increase the % of Maori children passing school entry hearing tests
30 % reduction in the %of Maori women who smoke in pregnancy Reduce the proportion of year 10 students who smoke daily (ASH SURVEY-01) Reduce the teenage pregnancy (13-17 yrs) rates for Maori by 2012.
Reduce the disparity in ambulatory sensitive hospitalisation rates for Maori under 5 yrs with non Maori (IDP POP-09)
Health outcomes
Increase the % 5 Maori year olds caries free (IDP POP-05) Decrease the Mean number of DMF teeth of Maori children at year 8 (IDP POP- 04)
Reduce the rate of repeat admissions for asthma
Reduce the Maori children hospitalisation rates for asthma.
Reduce the Maori DNA rate for Paediatric specialties outpatients FSA by 50 % (HB1-03)
Reduce mortality rates for children 0-14 years
Improve the Maori adolescent oral health utilisation (IDP POP- 11)
Reduce the mortality rates for Maori youth 15-24 years. Reduce the incidence of injuries in the home 0-4 year olds. Falls , scalds, burns, poisonings, fractures and head injuries (IPS-01)
Increase the proportion Maori accessing exercise based falls prevention programmes
Older People
Increase the access rates for Maori to NASC
Mental Health
Reduce the prevalence of hazardous drinking and addictions (NZHS-QX)
Reduce the disparity in the Ambulatory sensitive Hospitalisation rates for Maori 64-74 years with Non Maori (IDP – POP-09) Increase the access rates to secondary mental health services for Maori 0-19 years to 2 % by 2012 (IDP POP- 06)
31
Reduce the disparity in the suicide mortality rate for Maori compared to nonMaori
Action Area
3.2
Protective Factors Indicators
Service coverage Indicators
Health outcomes
Building Maori capacity and capability in the health sector
Action areas Workforce
Provider level
Mainstream primary
Development of Maori health workforce and Maori health Providers (HKO-02)
DHB level Increase the Maori DHB Workforce (HKO-02)
Funding
The DHB will set targets to increase funding for Maori health and disabilities initiatives (HKO-04)
32
References Durie M. 1998. Whaiora: Maori health development. Auckland Oxford University Press Durie M. 2003. Nga Kahui Pou, Launching Maori Futures, Huia Publishers Hawke‟s Bay District Health Board (2005). An Indication of Hawke’s Bay Peoples’ Health. McElnay 2005. Hastings. Hawke‟s Bay District Health Board (2007). Tu Mai Maori Health Strategy 2007-2011. Hastings. Hawke‟s Bay District Health Board (2006). Strategic Plan 2006-2015, A Picture of Health. Hastings. Howden-Chapman P, Cram F. 1998. Social, Cultural and Economic Determinants of Health. Background paper to the National Health Committee of New Zealand. Wellington: National Advisory Committee on Health and Disability Howden-Chapman P, Tobias M. 2000. Social Inequalities in Health: New Zealand Medical Journal 113:301-2 Ministry of Health. 2001. He Korowai Oranga: Maori Health Strategy. Wellington. Ministry of Health. 2003. Healthy Eating Action. A Background. Wellington Ministry of Health. 2002b. Reducing Inequalities in Health. Wellington: Ministry of Health. NZ Child and Youth Epidemiology Service (2007). The Health Status of Children and Young People in Hawke’s Bay. Ngati Kahungunu Iwi Incorporated. 2007. - Te Ara Toiora o Ngati Kahungunu 2007-2026. Hastings Nga Kaitiaki o Waikaremoana (2008) Strategic Plan 2008 - 2011 Nga Kaitiaki o Waikaremoana (2008) Business Plan 2008 - 2009 Pere , Rangimarie Turuki (1991). Te Wheke, A celebration of infinite Wisdom Te Puni Kokiri 2000. Progress Towards Closing Social and Economical Gaps Between Maori and Non Maori. A report to the Minister of Maori Affairs. Wellington: Te Puni Kokiri. Woodward A, Kawachi I.1998. Why Should We Reduce Health Inequalities? Reasons for Acting on the Social, Cultural and Economic Factors that Cause Ill Health. Wellington: National Advisory Committee on Health and Disability.
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Appendices Appendix 1 – Glossary Of Māori Terms Appendix 2 – Glossary Of Terms Appendix 3 – Waikaremoana Demographics Appendix 4 – Hawke‟s Bay and Waikaremoana Māori Health Status Appendix 5 – Community Services Delivered to Waikaremoana and Districts Appendix 6 – List of Participants Appendix 7 – The creation of Lake Waikaremoana Appendix 8 – Explanation of the NKHOW Logo
34
APPENDIX 1 Glossary Of Māori Terms Hapū
subgroup of a large tribe, clan
Iwi
Tribe of people
Kaumātua
An elderly person who speaks on behalf of a family, sub tribe or tribe
Korowai
ornamental cloak (chiefly)
Koroua
elderly man/grandfather
Kuia
Eldery woman/ grandmother
oranga
Health and wellbeing
pakeke
grown-up or adult;
papakāinga
fortified place, village settlement, homelands
rangatahi
youth
tangata whenua
local people/people of the land
taura here
taura is rope and here is the binding. Taura here is used by a tribe to define its people who are living outside of their tribal boundary
mataawaka
Mata- a-waka defined as the face of many waka. Mataawaka is used by a tribe to define the people whoa re living inside of their tribal boundary and belong to another
tamaiti
a child
tamariki
children
tikanga
rule, plan, method; custom, habit; reason
tino rangatiratanga
"unqualified exercise" of chieftainship
utu
returning for anything; satisfaction, ransom, reward, price, reply
waka
canoe
whakapapa
genealogy
whānau
to be born, offspring, family group not necessarily of blood ties
Whakatātaka
to be turned, turning towards/away
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APPENDIX 2 Glossary Of Terms CVD DNA ED EIT EPMHRC HNZ HOP HPC IDP MoH MRB MSD NGO NKII NKHOW PHO TLA TPK WSM
Cardio Vascular Disease Did Not Attend Emergency Department Eastern Institute of Technology Eru Pomare Maori Health Research Centre Housing New Zealand Health of Older People Continuum Hauora Provider Council Indicator of District Health Board Performance Ministry of Health Maori Relationship Board Ministry of Social Development Non-Government Organisation Ngati Kahungunu Iwi Incorporated Nga Kaitiaki Hauora o Waikaremoana Primary Health Organisation Territorial Local Authority Te Puni Kokiri Wellington School of Medicine
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APPENDIX 3 Waikaremoana Demographics3
The recent 2006 census indicates the current Maori population of Waikaremoana is 309. 71.4% of this population is Maori and 28.6% non-Maori
The Wairoa district has the highest proportion of Maori of any local authority in the country at 56.6%. (see Table 1).
The largest iwi in Waikaremoana is Tuhoe followed by Ngati Kahugnunu.
33% of the Waikaremoana population are under 15 yrs old. 42% are aged between 15 and 65 years. 5% of the population are over 65.
In 2006 19.6% of the Waikaremoana population earned over $30,000 p.a. 80.4% of the population earned less than this. 49 whanau received a WINZ benefit (unemployment or domestic purposes)
In the Waikaremoana District 69% (66) of all households are one family households compared to 69.1% in NZ.
The average household size in Waikaremoana is 2.7 people, the same as the average household in NZ.
58% of Waikaremoana residents owned their own homes, with or without a mortgage.
In 2006 21% of the families in the Waikaremoana District were one-parent households, compared with the New Zealand average of 19%.
Couples with children make up 32% (30 families) of all families in the Waikaremoana District compare to the NZ average of 42.1%.
Couples with no children make up 17% of all families in the Waikaremoana District compared with 39% in NZ.
3
Current population figures are based on the 2006 census. Population projections are based on the 2001 census but will be updated when the information becomes available.
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APPENDIX 4 Hawke’s Bay and Chatham Islands Māori Health Status Table 1 Census 2006: Hawke‟s Bay DHB % Maori by Territorial Local Authority Territorial Local Authority Wairoa District Hastings District Napier City Central Hawke's Bay District Chatham Islands Territory
Total population 8481 70845 55365
Maori population 4,797 16,233 9,813
% Maori 56.6% 22.9% 17.7%
12963
2,694
20.8%
606
369
60.9%
Hawke's Bay
148242
33,906
22.9%
New Zealand
4027947
565,329
14.0%
Table 2.Census 2006: Hawke‟s Bay Maori Population split by urban/rural Number
%
Napier Zone Hastings Zone Independent Urban Community (Wairoa, Waipukurau and Waipawa) Rural Area with High Urban Influence Rural Area with Moderate Urban Influence Rural Area with Low Urban Influence Highly Rural/Remote Area Chatham islands
Urban/Rural group
9807 15099
28.9% 44.5%
3,981 537 510 2970 624 366
11.7% 1.6% 1.5% 8.8% 1.8% 1.1%
Total
33894
100.0%
5007
14.8%
% Rural (including chathams)
Table 3: 2006 Census: Tenure Holder, for the Census Usually Resident Population Count Aged 15 Years and Over Territorial Authority Description Central Hawke's Bay District Napier City Hastings District Wairoa District Chatham Islands Territory New Zealand Total
Total population Aged 15yrs & over 10,038 43,644 53,736 6,264 471 3,160,371
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Own or Partly Own Usual Residence No. 5,619 23,712 27,885 2,898 213 1,578,081
% 56% 54% 52% 46% 45% 50%
Map 1: 2001 Index of Deprivation - Hawke’s Bay
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Map 5: Deprivation & Ethnicity by Census area Unit – Wairoa
Table 3. 2006 Census: Hawke‟s Bay DHB Census Area Units with largest number of Maori
Territorial Local Census Area Unit Authority Largest number Napier
Hastings District
Wairoa District
Central Hawke's Bay District
Number
Census Area Unit Smallest number
Number
Maraenui Onekawa South Marewa Pirimai Tamatea North
1,836 1,446 1,104 648 594
Ahuriri Awatoto Poraiti
105 81 39
Flaxmere East Kingsley-Chatham Lochain Mayfair Raureka
1,809 1,569 1,455 1,164 1,083
Whanawhana Te Mata Hills Havelock Hills Woolwich
18 18 15 6
Wairoa Whakaki Mahia Raupunga
2,544 543 477 336
Tuai Maungataniwha
150 138
Waipukurau Waipawa Elsthorpe-Flemington Tikokino
984 453 384 357
Otane Porangahau
183 123
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APPENDIX 5 Community Services Delivered to Waikaremoana and Surrouding Districts Nga Kaitiaki Hauora o Waikaremoana Trust Ngā Kaitiaki Hauora o Waikaremoana Trust provides Whanau Support services focusing on the Maori population of Waikaremoana and its surrounding areas. However this is not an exclusive service and is accessed by both Maori and non-Maori. The provider is located in the remote and rural areas of Waikaremoana, north of Wairoa, and is the only provider of health services in this area. The community rely heavily on the services of the provider delivering Whanau Support services. Its vision to provide a holistic service that encompasses all ages and includes the whole whanau. Ngā Kaitiaki Hauora o Waikaremoana Trust provides health education and promotion services, assesses its clients‟ well-being, and refers them to healthcare specialists as required. Ngā Kaitiaki Hauora o Waikaremoana Trust Governance Board is comprised of four members who all have strong links with the Waikaremoana community. The skills of the Board include extensive experience on government boards in the health and education sectors, and a doctor who specialises in traditional and holistic healing. The Trust has sound business and financial management processes in place and has been an ISO accredited organisation since 2005. The provider has strong quality management systems in place and policy and procedure manuals are comprehensive. The provider works with whanau living in surrounding areas of Waikaremoana and in some instances Wairoa, and demonstrates an integrated approach to service delivery. Nga Kaitiaki Hauora o Waikaremoana Trust provides a service that is culturally appropriate and consumer focused. Te Pikinga AIO Inc. Society Te Pikinga, loosley translated from Maori to english means "upward and onward". The motto "Utua te kino ki te pai" (repay evil with goodness) is more than appropriate for these challenging times. Our grandparents generation believed in walking the path of peace, and had extreme difficulty dealing with the aftermath of the First World War, and likewise the second world war. Our forefathers were tillers of the soil, builders, social scientists and conservationalists. On November 20th 1929 when the Governer General of NZ, Sir Charles Fergusson and his wife lady Alice Fergusson came to open the Ruapani Power Station at Tuai, my Grandmother, Mihomiho Alice Caroline (Kare) Rangi Jackson, was asked to represent the people of Waikaremoana, both Maori and Pakeha, as a guide and to discuss the possibility of setting up an organisation that could best benefit the people of the district, with the Governer General and His wife. Although they came from other sides of the world, both women found that they had a great deal in common, particularly with regard to the importance of family, and a strong identity with ancestors and the transmission of important traditions. The "Te Pikinga Incorporated Society" was brought into being, and blessed in a way that was appropriate to both peoples.
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Lake Waikaremoana Hapu Restoration Trust The trust was established so that tangata whenua could be represented in the kiwi recovery project. Operating out of Tuai Village an efficient system of predator eradication is executed by the trust on the Puketukutuku peninsula of Lake Waikaremoana. To ensure the survival of the kiwi, over 70 kilometres of the area have been secured with traps. The kiwi‟s biggest threats come in the form of rats, stoats, ferrets and dogs. The number of these predators has been greatly reduced thanks to the efforts of the trust. However a single stray dog can easily wipe out an entire population of kiwi with ease. With help from other agencies Lake Waikaremoana Hapu Restoration Trust will ensure the survival of our national icon for at least another generation, hopefully many more. Te Kura o Waikaremoana Te Kura O Waikaremoana is a Kura located in Kokako/Tuai district. Historically there were two kura in the area, namely Tuai and Kokako. These two kura were closed down by the Ministry and our new Kura was established and is now known as Te Kura O Waikaremoana. This merger took place over the last 4 years, with the erection of our new buildings finally being finished approximately 2 years ago. We are a decile 2 kura (having only just been upgraded from decile 1), with a roll of 52 students (roughly 50/50 gender mix). We cater for students from new entrant to Year 8. After leaving our kura, children either attend boarding school or attend the college in Wairoa, which means there is also a teenage age group within Tuai and the surrounding areas. The children who make up the student base for our kura come from a 96% Maori background. All Maori children at our kura are able to identify with one (or both) of our local marae and are able to whakapapa back to either Kahungunu, Tuhoe, or both. The area is part of Waikaremoana which in turn is part of Te Urewera. The main providers of employment are education sector, farming, Department of Conservation, Tourism, QRS, and Genesis Power Supply, with several power stations being contained within the area. We also have a Hauora in Tuai and a resident policeman (through the week). Social services are provided through what was once the old Tuai School building. Our local hapu run our local Hapu Restoration Trust which is involved in a kiwi restoration project, as well as trout and tuna counting. The most recent initiative of the Trust is being involved in establishing a recycling venture with the Wairoa District Council.
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Waikaremoana Te Kohanga Reo In the late 1970‟s the predictions for survival of Te Reo Mäori were very grim. The experts believed our language was soon to be extinct. In response to this prediction, our kaumatua gathered as many of their mokopuna and created a language nest where mokopuna would be totally immersed in Te Reo Mäori…and so .. our humble beginnings formed in the old Waimako wharekai in the early 1980s. Throughout New Zealand Maoridom had pulled together and created the concept of Te Kohanga Reo. On the 11th of October 1982 Waikaremoana officially adopted the concept of Te Kohanga Reo. The Kohanga Reo was a Whanau operation and without each other‟s support it wouldn‟t continue. Money didn‟t play a big part of Kohanga Reo, each Whanau brought a raurau. which continued for years to come. Te Iwa Wano, Kui Turipa, Motuorohi Winitana and Irene Hemopo were the first Kaiako. Unlike today everyone that went to Kohanga Reo at that time, were all fluent in Te Reo Mäori. It was run by Kuia and Koroua, so there wasn‟t just one Kaiako, there were many. By the late „80‟s early „90‟s our building was built and site chosen specifically between the kaumatua flats and wharenui so our tamariki and mokopuna would be nurtured forever within the realms of our Whanau, Kaumatua, Hapu and Iwi giving them a sense of belonging, an identity and pride in being Mäori! Today we have a role of 20 tamariki, and 7 full time kaimahi Lake Whakamarino Lodge Lake Whakamarino Lodge was built between 1925 and 1928 to house workers who built the hydro scheme that formed this beautiful lake. In 1995 the Lodge and grounds were returned by the Crown (NZ Government) to the original Maori iwi (tribe) Ngati Hinekura Te Whanaupani of Ngati Ruapani ki Waikaremoana. The Lodge provides moderately priced, comfortable accommodation in a picture postcard setting. Friendly old fashioned hospitality is one of it's charms. There is good access from the East by mainly sealed roads (via Frasertown or Wairoa) from Gisborne or Napier or from the north-west via unsealed gravel road from Rotorua and Murupara. Of course you are only minutes away by helicopter from Gisborne, Rotorua or Napier. Te Whanau o Rongomaiwahine Trust (Mahia) Te Whanau o Rongomaiwahine was incorporated under the Charitable Trusts Act in May 1988. The Board currently consists of nine elected Trustees. All appointments have been made under the terms prescribed in the Trust Deed. One of the Trustees is assigned the Hauora portfolio and responsibility for the health activities of the Trust. Te Whanau o Rongomaiwahine established Te Hauora o Te Wheke a Nuku (Rongomaiwahine) to deliver a range of health and social services to Maori and non-Maori in Mahia and the surrounding area. Services that Te Hauora delivers under their contracts with Hawke‟s Bay DHB, are namely Whanau Ora Services, Nga Oranga O Te Rae services and the day activity programme. The Hauora is based in the small rural community of Mahia and is situated in the township for easy access. The Hauora‟s Whanau Ora services are currently provided between the hours of 8am and 4:30pm Monday to Friday. Services are mobile and are provided in a range of settings including marae, schools, kohanga reo and private homes. Te Whanau o Rongomaiwahine‟s Nga Oranga o Te Rae
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(NOOTR) service provides Kaupapa Maori community support and care for Maori with ongoing mental health issues. Te Whanau o Rongomaiwahine provides a day activity / life skills programme two days a week for people with a diagnosed mental illness. The service is provided from a Marae complex in Mahia. Te Whanau o Rongomaiwahine employs a full time Manager, a Registered Nurse (Whanau Ora), an Enrolled Nurse / Community Health Worker (Whanau Ora), a Mental Health Support Worker (NOOTR) and a Mental Health Day Programme Co-ordinator (Day Programme). Te Whanau o Rongomaiwahine is an ISO accredited organisation since 2005. The provider has developed a comprehensive quality management system as part of the accreditation process. Te Whanau o Rongomaiwahine Trust has developed its Te Mana Ahua Ake o Waikaremoana Plan for the next five years and aligns with national and DHB priorities. Ngati Pahauwera Incorporated Society (Raupunga) Ngati Pahauwera is governed by a Committee of hapu representatives.These representatives are elected from the representative groups outlined in the Constitution, including the four marae within the Ngati Pahauwera district. The committee has formally delegated day-to-day management of the contracted services to the Hauora Management Committee. A comprehensive five-year Strategic Plan is currently in place. The Strategic Plan outlines the origins of the Society, the principles under which it operates, key risks associated with the provision of services and identifies goals and objectives to focus future direction of health services. Business and financial management aspects of services are managed by the Hauora Management Committee. Ngati Pahauwera delivers Whanau Ora services to the community in Raupunga and surrounding areas including Putere and Kotemaori. Services are delivered by a registered nurse and community health worker. While the Whanau Ora contract does not have any clinical outputs and requirements, the inclusion of a registered nurse on the team enables the service to provide cervical screening and immunisation services to the local community. Ngati Pahauwera is managed and operated by tangata whenua and has strong community support and ongoing support from kaumatua and kuia and their whanau. A comprehensive Maori health plan has been developed and implemented. The hauora has a strong focus on improving Maori health (particularly Ngati Pahauwera) and has completed in-depth needs analysis to identify gaps in healthcare in their community. Kahungunu Executive ki te Wairoa Charitable Trust (Wairoa) Kahungunu Executive ki te Wairoa Charitable Trust (“Kahungunu Executive”) provides a much-needed service to the Wairoa community. The organisation is governed by the full executive committee, which is elected by committees from 35 marae in Kahungunu, and by the management committee of six members elected from the full executive. Kahungunu Executive an ISO accredited organisation and has assisted other Wairoa Maori providers to become accredited since 2005. Kahungunu Executive has developed a strong quality and risk management system with policies and procedures for the operation and governance of the organisation. Kahungunu Executive delivers a service that is culturally safe with staff are professional and have a good understanding of how to deliver their respective services according to the quality standards and guidelines.
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Services provided include Tamariki Ora Services, Support Services for Mothers and their Pepi, Maori Disability Support Services, Whanau Ora (Maori Community Health), Dental Health Educator Services, School Health Services, Kaupapa Maori and Alcohol & Drug Services and a Kaumatua programme. Kahungunu Executive has a range of other sector contracts delivering education and social services to its population. This is the largest Maori provider between Wairoa and Napier and has a large geographical area to cover for most services it offers. This provider has suffered staff losses due to the pay jolt of District Health Board nurses and has worked innovatively to ensure staff numbers are attained to deliver against its contractual obligations. Manaaki House (Wairoa) Wairoa District Society on Alcohol and Drug Misuse was incorporated under the Incorporated Societies Act in October 1988. The Society has developed a Strategic Plan for the period 2002 – 2007, and progress towards meeting objectives are reported to its Board on a monthly basis. The committee provides oversight and monitoring of monthly activities but due to lack of personnel resources, all employees individually report to the chairperson and committee. These roles have a dual role in governance and management responsibilities. The administrator has overall responsibility for financial management which includes day to day financial functions. Wairoa District Society has documented financial and human resource policies and procedures. Community based alcohol and drug counselling and assessment services are provided primarily for adults but also include rangatahi and youth. The service also provides support for whanau of clients. The provider has well documented policies and procedures to support the referral process and clinical pathway for clients. The society has linkages with a number of local and regional service providers. The delivery of alcohol and drug counselling is based on Maori principles such as whanaungatanga and manaakitanga, which are intrinsic in developed policies, protocols and procedures. Support is provided to employees through training and access to kaumatua and other Maori services. Staff is professional and takes pride in their work and the services they provide to the local community. All staff has appropriate qualifications and experience. The society has well documented policies and procedures for managing safety and risks, infection control, hygiene management and abuse and neglect. The organisation was accredited through ISO in May 2005.
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APPENDIX 6 Participants Nina Buxton Kuha Marae
Roha Lake Nga Kaitiki Hauora o Waikaremoana
Aileen Himona Nga Kaitiaki Hauora o Waikaremoana
Maria Waiwai Nga Kaitiaki Hauora o Waikaremoana
Geraldine Waiwai Nga Kaitiaki Hauora o Waikaremoana
Huia Brown Rongomaiwahine
Rob White Pauline Waiwai Lake Waikaremoana Hapu Restoration Trust Whakamarino Lodge Atiria Pouwhare TKR O Waikaremoana
Tuakana August HBDHB
Pare Eparaima Waikaremoana School
Amber Logan Riley Kahungunu Hikoi Whenua
Rose Pere Te Pikinga Aio
Bayden Barber Nga Kairauhii
Judith Morice Waikaremoana School
Beverley Te Huia Choices Clinic
Lisa Waiwai Lake Waikaremoana Hapu Restoration Trust Paul Paku Social Services Arana Waiwai Kuha Marae Desiree Winitana Kuha Marae Jennifer Takuta Moses Waikaremoana Commuinity
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APPENDIX 7 The Creation of Lake Waikaremoana A great chief Maahu Tapoa Nui and his Whanau lived near a tapu spring. At this time there was no great lake, but below Panekire lay a deep valley where streams met an ancient river. One day Maahu instructed his children to fetch him some drinking water. However two of the children, Haumapuhia and Te Rangi – did not go as instructed, and those that did, took water from the sacred spring instead of the one designated for everyday use. Upon discovering that the water was from the tapu spring, Maahu turned the offending children into stone. Maahu then turned to Haumapuhia who was again asked to fetch some water, but once again she ignored her father‟s request. Maahu was so incensed with his daughter‟s disobedience that he seized Haumapuhia and thrust her head under the spring waters. In a desperate attempt to escape she cried out to the gods, who headed her pleas, turning her human form into a taniwha. Thrashing the earth, she twisted her way out of Maahu‟s grasp. Haumapuhia then endeavoured to break out to the east; in attempting this she formed the inlet known as Te Whanga nui – a – Parua. Unsuccessful in that attempt, she turned to the south and tried to escape near present day Onepoto and reach the sea. Although finding her way successfully underground to the Waikaretaheke river, when she surfaced the sun had risen and the rays falling upon her caused her to be transformed into rock. The rock that is Haumapuhia, lies in the Waikaretakehe river but has since been buried by a landslide.
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APPENDIX 8 Explanation of the NKHOW Logo
Hinekura: The vision of the Hau-o-ra commenced. Hau-o-ra: First koru symbolises the beginning of the Hau-o-ra's journey. Hau-o-ra is the twin sister to Wai-o-ra. Wai-o-ra: Symbolises pre-birth. Inside the womb, Wai-o-ra, is the life of the baby. Wai-ora = the living waters Mokopuna (Infant):Beginning of life. Infant stage of the Hauora's journey. Rangatahi (teenage): Beginning of our Rangatahi (teenage) journey. Symbolises their bond as they grow together. Matua (parents): These koru's symbolise the family bond shared between parents and their children. Kete:
Shows the strong bond between the parents and their children. 48
Tikanga
(teachings), Guidance and Faith. Kaumatua: Double koru designed to depict the opening of a book of knowledge. The key to the book is the Kaumatua. They pass all the tikanga down to our parents. It is from the past knowledge that guides us forward into the future. 1. Io – wisdom 2. Iro – knowledge 3. Iho – truth 4. Ipo – love 5. Iri – hope 6. Ira – joy 7. Ipu - caring 8. Ina – patience 9. Ita – faith 10. Ia – charity 11. Ira – energy 12. AIo - peace All of the above is Mauri – Ora. Mauri Ora is the mother of the female twins. Female Twins: Wai – Ora – Physical/ Spiritual Hau – Ora – Spiritual/ Physical Whakairo (carvings): The whakairo (carvings) facing down represent the teachings of life. The whakairo (carvings) facing up prepare you for the next journey. The Star: The center of the star represents the Mau-ri-o-ra (life essence) of Nga Kaitiaki Hauora o Waikaremoana. Te Wheke is represented by the eight pointed star. Whanaungatanga Te Hinengaro Te Aoturoa Te Whatumanawa Wairuatanga Nga Taonga Tukuiho Te Mana Ahua Ake Mauri
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APPENDIX 9 KHW Implementation Plan Goal Increase physical activity options for whanau
Objective Establish a community Gym at Tuai. Will serve as a central meeting place where health & exercise are promoted.
Steps Step1: Secure a venue for the GYM
Step 2: Purchase weights equipment
Step 3: Recruit whanau Gym volunteers Increase physical activity options for Rangatahi (tane)
Tane Purotu – Young Mens group
Step 1: Recruit Mentors Step2: Recruit young Men Step 3: Plan calendar of events Step 4: Implement Activities
Increase
Wahine Purotu
Step 1: Recruit
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Deliverable Secure Lease of old School for Hauora & Gym
Timeframe July 2010
Responsible Aileen Himona
Have weights and exercise equipment ready for use
July 2010
Geraldine Waiwai
Elite Fitness
Talk to whanau that could look after the Gym (Community Max) Talk to community and recruit volunteers/ Rangatahi
July 2010
Geraldine Waiwai
Whanau WINZ
April 2010
Roha Lake
Whanau Rangatahi Waikaremoana School Marae NKHOW
Plan activities that will increase traditional knowledge Implement Programmes Talk to
May 2010
Roha Lake, Geraldine Waiwai
June 2010 – June 2012 April 2010
Aileen Himona
Stakeholders Nga Mana Whenua Trusts TOW Commision
Whanau
Healthy eating and physical activity of young women
– young womens group.
Mentors (kuia/ pakeke) Step2: Recruit young Mums Step 3: Plan calendar of events
Increase physical activity of tamariki/ rangarahi
Step 4: Implement Activities Waikaremoana Step 1: Recruit Tennis Club tamariki Step 2: Acquire tennis gear Step 3: Start lessons Step 4: Challenge other areas
community and recruit young wahine/ kuia mentors
May 2010
Plan/ implement activities that will increase life skills
June 2010 – June 2012
Nancy Waiwai
Talk to community and recruit tamariki/coach mentors
October 2010
Acquire gear
October 2010
Commence lessons
November 2010
Geraldine Waiwai
Young mums Waikaremoana School Marae NKHOW
Whanau Young mums Waikaremoana School Marae NKHOW
Tane Purotu – Young tamariki/ rangatahi are selected by their pakeke to join this elite group where they are groomed as future leadership of Waikaremoana. Boys are mentored in a range of life skill activities such as food gathering (hunting in ngahere, fishing in lakes and rivers), basic bush survival skills, health & fitness, sport & recreation, service projects such as cleaning up the marae and urupa, traditional Maori haka and waiata, Nga whakapapa o Waikaremoana. Wahine Purotu – Young mums, wahine are selected by their pakeke to join this group where they are groomed and taught basic lifeskills. Activities include breast feeding education, Healthy cooking, budgeting, karanga and waiata tawhito, healthy exercise (Zumba), Mirimiri and Rongoa, Self care and beatification.
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KHW Communications Plan NKHOW will develop a communications plan to promote key KHW messages to whanau and stakeholders (see stakeholder table). Key messages will be:
KHW KHW KHW KHW KHW KHW
is a kaupapa Maori nutrition and physical activity based programme programmes will be delivered in the Waikaremoana and Tuai communities programmes will be fun and educative programmes will be based on and promote tikanga practices of nga tupuna programmes are free or gold coin donation Coordinator will facilitate the programme and will be responsible for the quality and delivery of the programmes
Key promotion methods will be:
Face to face hui Posters and pamphlets, T-shirts Community Newsletter
NKHOW will build on existing methods of promotion and communications, as the existing budget does not allow for the development of new resources. It will be important for NKHOW to utilise materials and resources made available by the wider KHW programme and social marketing campaign. A key example of this will be the KHW website and advertising materials that will support and reinforce our KHW key messages.
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