Strengthening public health contracting: findings of a follow-up nationwide survey from Aotearoa

In 2010 and 2015 nationwide surveys monitored government management of public health providers. These surveys found evidence of inconsistent management which disadvantaged Maori providers, consistent with institutional racism. In Dec 2019 to March 2020 a follow-up nationwide telephone survey was completed. Public health units, primary health organisations, Maori health providers and non-governmental organisations with public health contracts responded (72%). This paper focuses on the findings about (i) contracts, and (ii) relationships. Descriptive statistical analysis was applied to quantitative responses and explanatory and combinatory analyses informed by thematic analysis were applied to qualitative data. The 2019-.2020 quantitative data identified no statistically signficant variations. There was no evidence Maori provider experiences improved, but generic providers reported less favourable conditions. Qualitative data revealed providers remain dependent on individual managers and there was inconsistency across providers that could be addressed by transparent quality assurance. Maori providers were frustrated by contracting environments. They wanted to be recognised as Te Tiriti o Waitangi partners, with flexibility, certainty of investment (longer contracts), support (infrastructure investment) to be able to meet the high needs of their communities. This nationwide survey was completed prior to the current health reforms but implications are considered for the Maori Health Authority.

Automated summary

Nationwide surveys in 2010 and 2015 revealed inconsistent government management of public health providers, which disadvantaged Maori providers and indicated institutional racism. A follow-up telephone survey conducted from December 2019 to March 2020 included responses from public health units, primary health organizations, Maori health providers, and non-governmental organizations. The findings showed that Maori provider experiences did not improve, and generic providers reported less favorable conditions. Qualitative data highlighted the dependence on individual managers and inconsistency across providers. Maori providers expressed frustration with contracting environments and emphasized the need for recognition as Te Tiriti o Waitangi partners, flexibility, longer contracts, and support to meet community needs. The implications of this nationwide survey are considered for the Maori Health Authority.