Background
In 2020, the Northern Regional Alliance identified paediatric ORL as a vulnerable service requiring an equity focused Planned Care recovery programme. It was found that ORL services are subject to multiple systemic vulnerabilities causing inequities in access to secondary care assessment, treatment and outcomes, leading to delays to appointments and treatment. Notably, tamariki Māori and Pasifika children are disproportionately impacted by these inequities and variations, as evidenced in the rates of grommet insertion. The impacts of these inequities are not only limited to negative health outcomes such as multiple ear infections and acute hospitalisations, but also have repercussions for children’s learning and quality of life. Te Toka Tumai Starship Child Health) was established in 2022 to deliver the Ministry of Health endorsed ‘Paediatric ORL Pathway Redesign for Equity Project’ for the Northern Region. A key priority is to design services that consider the health, social and economic impacts to the child and their whānau, aiga or kāinga when navigating the ORL planned care pathways.
Methods
Key informant interviews with Māori (n=8) and Pasifika (n=4) families were conducted by Wai Rangahau, a Māori research unit at Te Whānau o Waipareira Trust in Auckland to explore and report on Māori and Pasifika experiences and perspectives of ORL services in the Northern Region. The research was co-designed with Te Toka Tumai and based on high levels of trust in each other’s kaupapa, capabilities and accountability to the voices that were gathered. The research was guided by kaupapa Māori methodology and principles. As a philosophical and conceptual approach to research, kaupapa Māori is about realising the “affirmation and legitimation of being Māori” (Pihama, Cram & Walker, 2002, p.30).
Findings
The overall theme is that Paediatric ORL services in the Northland are harmful to Māori and Pasifika families. This is underpinned by two sub themes, System Barriers, and Structural Barriers. Together these show that the ORL pathway of care in the Northern region of Aotearoa is driven by a number of complex and clinical systems that are out of touch with the realities of whānau, āiga and kāinga.