FEATURE
working in collaboration:
referrals to Tamariki Ora Well Child services CLAIRE MACDONALD MIDWIFERY ADVISOR
The Well Child Tamariki Ora (WCTO) programme is a universally offered, publicly funded child health and whānau support programme. The programme delivery begins with midwives, who undertake the first four health assessments: at birth to 24 hours, within 48 hours, up to one week, and at 2-6 weeks. A WCTO provider follows on, with health assessments at 4-6 weeks, through to 2-3 years, and the programme is completed with the B4 School Check, at four years old. The GP team provides a six week check alongside immunisations. A national review of the WCTO programme was undertaken in 2020, with a report pending. The College had a representative on the Review Advisory Rōpū, the members of which all shared a clear desire: for the programme to support equitable health outcomes and meet Tiriti o Waitangi responsibilities by flexing to meet the needs of whānau, so that they are supported to thrive. While the programme redesign is yet to begin, there are some clearly
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identifiable actions for improvement, which will be as relevant and necessary in future as they are now. For midwives, these include information-sharing with whānau about all provider options, and ensuring timely referral to the WCTO provider of choice. Concepts like equity, access and te Tiritibased care are frequently discussed in the current health context, so what does this mean in practice when it comes to primary maternity and infant/child care services? The Ministry of Health’s definition of equity is: “In Aotearoa New Zealand, people have differences in health that are not only avoidable but unfair and unjust. Equity recognises different people with different levels of advantage require different approaches and resources to get equitable health outcomes.” It is estimated that health care is responsible for around 20-25% of health outcomes, while the social, environmental, cultural and commercial determinants of health contribute significantly more. Health services, including maternity, have
a responsibility to support optimal health outcomes wherever they can. Access, and related concepts like acceptability and engagement are about ensuring services are culturally safe, relevant, and available in locations and at times that work for whānau. In her presentation at the Perinatal and Maternal Mortality Review Committee’s 2021 webinar about Te Taitokerau-based antenatal education programme Ngā Wānanga o Hine Koopu, Raewyn Smith described the programme’s unique approach: “We don’t have DNAs [did not attend], we have DNIs [did not inspire]”. Viewing health care through this lens requires services to adapt to the needs of whānau, rather than using a one-size-fits-all approach that tends to be more focused on the needs of the service provider. Te Tiriti-based health care uses te Tiriti o Waitangi as the guiding framework for health services. Te Tiriti is the document that guarantees tangata whenua the same rights and protections as tauiwi, including equal health outcomes, and is the document that enabled tauiwi to settle and call Aotearoa home.
