The purpose of this solutions paper is to inform and generate sector discussion about the urgent need to advance the smart and efficient use of the Māori Community Health Workforce. Hauora.com suggests that at present, this unique Workforce is not universally recognised and therefore its potential is underutilized. We also posit that the future of the Māori Community Health Workforce is unclear due to the lack of a cohesive and resourced approach for development and advancement.

Advancing the Smart and Efficient Use of New Zealand’s Maori Community Health Workforce

This situation needs to change in order to effectively mobilise what is effectively New Zealand’s largest Māori health workforce.The opportunity to effect change is now because emphasis is being placed on new sector configuration and funding opportunities linked to “transformational” change, for example, Minister Turia’s Whānau Ora Strategy (Durie et al, 2010), Minister Ryall’s Better Sooner More Convenient Policy (Ryall, 2009) and Minister Bennett’s Community Response Forums (MSD, 2010)..

Accordingly, this paper outlines the context and rationale for change by analyzing the role of a Community Health Worker, and in particular, a Māori Community Health Worker; why it is important to recognize the value and impact of this workforce; the current state of this workforce and ; the potential of transformational sector opportunities and Māori CHWs.We then summarise the five key barriers, that in our opinion, currently impede Māori CHW development and we present five POU or Solutions to mitigate these barriers.

The Barriers outlined in this paper are summarized as follows:

Barrier 1: Lack of a cohesive national approach leading to inconsistent recognition of the value and impact of Māori CHWs

Key Point there is no cohesive national approach to Māori CHW development and this has contributed to inconsistent recognition of the value and impact of Māori CHWs.

Barrier 2: Resource poor representational infrastructure

Key Point: the representational infrastructure for Māori CHWs is limited in terms of financial, legal, human and technological resources.

Barrier 3: Poor recruitment, role definition, retention and reward frameworks

Key Point: poor recruitment, role definition, retention and reward frameworks combine to affect the recognition of Māori CHWs and also creates powerful disincentives for Māori to enter into this high value career.

Barrier 4: A dearth of research and evaluation material.

Key Point: there is still a dearth of readily available published research and evaluation on Māori CHWs.

Barrier 5: Failure to recognise the extra duties and pressures linked to being a Māori CHW

Key point: Māori CHWs face unique expectations linked to their ethnicity and cultural beliefs.These ‘extra’ duties and pressures should be recognized as part of their dual mainstream and Māori expertise, skill base and commitment.

The 5 POU (Solutions) are summarized as follows:

POU 1: Recognition

Key Point: consistent and universal recognition of the value and impact of Māori CHWs is one of the key POU for advancing the smart and effective use of the Māori CHW.

POU 2: Representation

Key Point: a fully resourced and Māori CHW endorsed representational infrastructure is critical to ensuring Māori CHWs have the capacity to demonstrate leadership in terms of sector reform and to influence system design for the smarter use of Māori CHWs.

Key Point: recruitment and retention are two key parts of the gateway and pathway for the long term growth and sustainability of the Māori CHW workforce.Active investment in a cohesive and multi-sector stakeholder response, that connects activity and investment across a new and dedicated Te Ara Mahi (Work Pathway) for Māori CHWs will create more transparent options and choices for potential, new and existing Māori CHWs.The tension between the dual Academic and Matauranga Māori paradigms will be minimized leading to greater workforce satisfaction and CHW impact on outcomes.

POU 4: Role

Key Point: clear definition of the role of a Māori CHW will assist with recognition, recruitment, retention and smarter deployment.

POU 5: Research & Evaluation

Key Point: a targeted research and evaluation approach is needed for Māori CHWs. This can be linked into other developments but must have sufficient specificity to provide the evidence to support recognition, recruitment, retention and effective relationships.

Hauora.com suggest that if these POU are implemented in a cohesive manner, and if these solutions are endorsed and facilitated by Māori Community Health Worker leadership, this will create a comprehensive platform to rapidly advance this workforce and achieve unparalleled positive outcomes for families/whānau, communities and systems.Finally we note that this paper has been endorsed by Te Whiringa Trust which represents Māori CHWs nationally.