Abstract
Tāpiri Mai- An indigenous model of care
Matakana and Mōtītī Islands in Tauranga, New Zealand, are home to predominantly Māori (Indigenous) communities with a combined population of 400. One island is quintile 5, which represents 20% of the most deprived data zones, the second island is outside of territorial authority and does not have a deprivation value.
The transformative journey to enhance access to wellbeing and healthcare started in 2020, where at a community meeting, facilitated by the Western Bay of Plenty Primary Health Organisation (WBOPPHO), the community shared their healthcare challenges and aspirations. Through authentic engagement, 1000 cups of tea, employing co-design principles, a collaborative effort involving local iwi (tribes), healthcare providers, government agencies, and emergency services was cultivated.
Recognising the need for a holistic approach, stakeholders began the journey to address barriers. Telehealth emerged as a priority, prompting the development of video consultation equipment, workflow optimisation, and digital proficiency. It was important to find a system to enable primary and secondary care consultations. One of the desired outcomes of the project design was a sustainably reduced carbon footprint. From the onset of the project, it was clear this would be a socially led rather than a technically led initiative.
A unique and valued tripartite relationship was established to deliver Tāpiri Mai: Western Bay of Plenty Primary Health Organisation (WBOPPHO) ,Te Awanui Hauora (Matakana Island Health Provider) and Mōtītī Island Hauora (Mōtītī Island Health Provider), as well as Ngāti Kahu Hauora (Very Low-Cost Access-VLCA- General Practice). Technical and strategic expertise from our local Te Whatu Ora is a valued key partner. Te Whatu Ora is the primary publicly funded healthcare system of New Zealand.
At community meetings we were there to listen, confirm what they thought they heard, listen more and it was the start of developing enduring and meaningful relationships. Conversations with the communities are ongoing to inform the design and decisions. Relationships are critical to success. – our motto is “It’s not just about relationships it’s all about relationships” Notably, an indigenous model of care, Tāpiri Mai, was codesigned with the community, underpinned by sustainable objectives.
The proposed long-term outcomes are improved access to care, strengthened community-provider relationships, increased autonomy in managing individual and family wellbeing and health, and access to services resulting in a fairer and more equitable health system. The opportunity to optimize the service by integrating a focus on the broader determinants of health is beginning to take shape.
The success of distance healthcare initiatives hinges on authentic community engagement, tailored co-design strategies, working at a pace the communities set and transparent communication. Moving forward, commitment to quality improvement, expanded partnerships, robust monitoring frameworks, and respect for Māori data sovereignty are essential.
This journey signifies a shift in healthcare delivery, advocating for inclusivity, fairness, and equity. As we continue to share insights and champion bold decision-making, this journey unfolds alongside our island communities and stakeholders, demonstrating a commitment to transformative change.