Case Study

The inequalities between the health status of Pacific and non-Pacific peoples result from poor access to services and/or inappropriate service delivery. Recent Ministry sponsored research about the contribution of health care to health gains is showing that, in contrast to other population groups, Pacific peoples have benefited least.  

The development of the Etu Pasifika Integrated service began in 2017. This service was co-created with the Pacific community in Christchurch, Canterbury District Health Board and Pasifika Futures the Whanau Ora Commissioning Agency for Pacific Families. The service was informed by a review of the outcomes and socioeconomic indicators for Pacific families in the region, supported by consultation with over 1100 families as part of the design of the Pacific Whanau Ora Outcomes. 

The Etu Pasifika service is Pacific family focussed, family driven and seeks to achieve a Pacific well- being framework that pacific people have designed.

This co-design and resulting service mirrors international good practice on integrated health services for indigenous and minority ethnic communities including the Nuka System of Care, from the South-Central Foundation in Anchorage, Alaska16. It builds on 20 years of experience by Pacific health and social service providers in New Zealand and is strongly anchored in Pacific cultural contexts and contemporary realities.

Urgent Response Teams provide urgent service to Pacific families immediately in need of support. This includes social, medical or mental health assistance to maintain health and wellness within the Pacific community. The UR Team’s focus is to work with Pacific families to develop a Support Plan within 12 hours from initial contact/referral. The responsibilities of the UR Team include:

• Respond to same day, walk in service (unplanned)
• Urgent Outreach visits
• Matua support
• Responding to disease outbreaks (measles)
• Social emergency requiring intervention ie urgent housing needs
• Mental health emergency
• Emergency Department admissions/ discharges
• Integrated safety response 

Navigators enable family capability development through family plans and goals, critical guiding tools to coordinate care around family aspirations, alongside dedicated budgets and investment into families to achieve their goals. 

Successful commissioning in a Pacific context relies on ensuring that commissioning decisions and priorities are delivered in a strengths-based manner and are informed and driven by:

• evidence
• Pacific family’s aspirations
• strong partnerships with communities and partners

This requires the commissioning agency to operate from a strong base of principles which guides the relationship with partners.

This approach includes:

• contracting on an outcome’s basis
• reporting on outcomes, anchored in Pacific methodologies and supported by a Pacific outcomes framework
• funding in advance, long term contract (4 years)
• investment in training and support
• quarterly collaboratives to discuss performance and opportunities and investment in capability development.

In-house tools (MAST Tool) that holistically measure needs and strengths, family by family, are critical to monitoring how well families are progressing and when enablement support is required. Regular feedback from families through surveys and talanoa is a critical part of ensuring high quality service and performance improvement. Methodologies are supported by quarterly collaboratives that discuss performance and opportunities and investment in capability development.

Etu Pasifika is an integrated general practice clinic and Whānau Ora service. Its healthcare and social workers provide a holistic approach to health care. Its staff speak a range of Pacific languages, including Samoan, Tongan, Fijian, Niuean and Tokelauan.

Medical clinic

GP services. Community-based, primary health care. This includes diagnosis, management and treatment of health conditions.
Nursing services. Primary care nursing support, patient interventions and treatment within the clinic. From time to time it includes services in people’s homes.
Child & adolescent health. Health assessments and support services for children and their families. This includes antenatal, birth to five years, and five to sixteen years.
Mothers and pēpē. Support for new mothers through pregnancy and with babies under 2.
Mental health. Support for individuals and families to maintain their mental health and wellbeing.

Social services

Whānau Ora. Improving and strengthening the wellbeing of families. It does this through advocacy and access to health, education, economic and social services.
Matua Support. Weekly activities including health and wellbeing services for Pacific elders.
Mana Ake. Early intervention mental health programme in schools.
Support to quit smoking. Face-to-face support for those wanting to quit.

Etu Pasifika have implemented an Integrated model where doctors, nurses, Whānau Ora navigators, team members all work together with individual families, to find solutions to any issues (health, social etc). Their navigators go out to the communities for home visitations (which is a point of difference to other mainstream services).

Etu Pasifika, General Manager, Amanaki Misa said his team are constantly on the ground seven days per week, engaging with families so, they have a great relationship with their community and are aware of their needs.

“We know the community, and the families have relationships with us so, they are telling us what they need now and the support they will need post Covid-19,” he said.

“We are working hard to make sure our response to family needs is timely, and we have a record of that so, we are the best vehicle to deliver support to our Pacific families here.”