Connect
MJA
MJA

Strengthening Māori participation in the New Zealand health and disability workforce

Mihi M Ratima, Rachel M Brown, Nick K G Garrett, Erena I Wikaire, Renei M Ngawati, Clive S Aspin and Utiku K Potaka
Med J Aust 2007; 186 (10): 541-543. || doi: 10.5694/j.1326-5377.2007.tb01034.x
Published online: 21 May 2007
Māori participation in the health workforce

In the 1996 and 2001 censuses, Māori made up about 15% of the New Zealand population, but less than 10% of the workforce employed in health and community service.1 According to the Health Workforce Advisory Committee 2002 stocktake of the New Zealand health and disability workforce,2 the proportion of Māori within the health and disability workforce groups is below 7% (with the exception of social workers at 18%). In many health occupational groups or specialist areas, Māori are either not represented or are vastly under-represented. Further, Māori tend to be clustered in areas that require lower levels of formal qualifications, such as health field service workers (13.2% of service workers are Māori). Māori account for nearly 13.8% of the health “technicians and associate professionals” occupational groups, and about 5.7% of the health “professional” occupational groups, with levels of 2% or lower in about half of the “professional” groups. In terms of retention in the workforce, where workforce data enable measurement, it appears that there are generally moderate levels of Māori retention (60%–80%) across health professions.3

Māori medical practitioners provide an example of progress. In the 2001 census, Māori medical practitioners accounted for 2.6% of the medical workforce (consistent with findings of the New Zealand Health Information Service workforce survey 2001–02). More recent statistics show that the number of registered Māori medical practitioners has increased; however, the proportion of the workforce remained stable through to 2004. Māori are under-represented in all medical practitioner employment categories, particularly for specialists (1.9% in 2004–05) and medical officers (1.6% in 2004–05). Examination of data on active Māori doctors by employment type (eg, anaesthesia, dermatology, pathology) showed many areas in which no Māori were reported as working or where there were fewer than four Māori.

The number of Māori students completing medical studies during 2001–2003 remained stable, but enrolments over the period increased by about 20%. Nevertheless, substantial additional growth in Māori student enrolments and completions is required to facilitate representative participation of Māori.3

Progress across occupational categories is varied, and this may reflect differences in the level of commitment to Māori health workforce development across professions, including training institutions and professional bodies. Nevertheless, Māori enrolments are increasing in some health courses, especially medicine, which indicates that activities to increase Māori participation in the health workforce are having a positive effect.

Te Rau Matatini

Te Rau Matatini is a national Māori mental health workforce development organisation funded by the Ministry of Health.6 Te Rau Matatini contributes to Māori mental health workforce policy development, increasing the capacity and capability of the Māori mental health workforce, and promoting career opportunities in mental health among Māori.

Te Rau Matatini projects have included developing clinical placement guidelines for Māori tertiary students7 and working with educational providers to better ensure that programs align with the needs of the Māori mental health workforce.8 The key strength of Te Rau Matatini is that, although it focuses on Māori mental health workforce development, it has a broad mandate in the sense that it operates at a number of levels (eg, structural, systems, organisational) and with a range of stakeholders.

Vision 20:20

Vision 20:209 is a University of Auckland Faculty of Medical and Health Sciences initiative to increase the number of Māori health professionals (some aspects of the program also target Pacific students). The program has three components: the Māori and Pacific Admissions Scheme (MAPAS); Hikitia Te Ora (Certificate in Health Sciences); and the Whakapiki Ake Project.

MAPAS was established to increase the number of Māori and Pacific students enrolled within the faculty’s health programs and graduating as health professionals. Eligible Māori and Pacific candidates undergo an interview process, including cultural components and opportunities for extended family input, to determine their most appropriate academic pathway within the faculty. The following support is offered to students who choose the MAPAS entry pathway:

Hikitia te Ora is a 1-year foundation program that is designed to enable Māori and Pacific school leavers or alternative entry applicants to make a supported transition from secondary school or their community or workplace to university. The certificate course supports development of study skills. Successful students receive a university entrance equivalent qualification and are encouraged to apply for entry into a range of tertiary health field programs.

The Whakapiki Ake Project, which began in July 2003, facilitates secondary school student entry into Hikitia Te Ora, and aims to recruit 100 Māori students per year, half of whom would be channelled into the School of Medicine at the completion of the course, with the other half moving into various health programs. Generally, students gain access to the project through 31 schools with which formal relationships have been developed. The project provides information on health careers, facilitates opportunities for health field work experience, provides assistance with applications and course costs, and ensures access to learning and other support throughout the students’ study. Since the project was initiated, the number of Māori enrolling in Hikitia Te Ora has grown rapidly, with 24 students enrolled in 2003, and 49 enrolments in 2006.

Strengths of the Vision 20:20 program include:

Hauora Māori Scholarship program

The Hauora Māori Scholarship program10 is administered by the Ministry of Health. The program provides financial assistance to Māori students to support Māori health workforce development. It has been successful in facilitating Māori student entry into and completion of tertiary health-related studies, and in making a substantial contribution to the capacity and capability of the Māori workforce. Success factors include a history of governance-level champions, a clear intervention logic, targeting of Māori and an evidence-based rationale, consistency with government policy, an interdisciplinary and multilevel focus, and provision of financial support to address the barrier of affordability of tertiary education.

Future directions

Official statistics indicate that Māori health workforce recruitment and retention interventions are having a positive effect. There is much to be learnt from the key strengths and success factors of these interventions, and there are opportunities both to consolidate progress to date, and to build on it as a foundation for ongoing action to increase Māori participation in the health workforce. The initiatives described provide models for intervention that may be applied more widely, in particular Te Rau Puawai, Te Rau Matatini, and Vision 20:20.

Key success factors of the interventions have included:

The lessons learned from Māori health workforce development activities provide a strong basis for ongoing action to address inequities in Māori health workforce participation, and are likely to be relevant to health workforce development approaches for other indigenous peoples.

  • Mihi M Ratima1
  • Rachel M Brown1
  • Nick K G Garrett1
  • Erena I Wikaire1
  • Renei M Ngawati2
  • Clive S Aspin3
  • Utiku K Potaka4

  • 1 Faculty of Health and Environmental Sciences, AUT University, Auckland, New Zealand.
  • 2 School of Population Health, University of Auckland, Auckland, New Zealand.
  • 3 Ngā Pae o te Māramatanga, University of Auckland, Auckland, New Zealand.
  • 4 Rātā-teitei Associates, Opotiki, New Zealand.


Correspondence: mihi.ratima@aut.ac.nz

Acknowledgements: 

Data used in this article were drawn from research funded through the Māori Health Joint Venture within the Health Research Council Partnership Programme. The Māori Health Joint Venture is a funding partnership between the Health Research Council of New Zealand and the New Zealand Ministry of Health, Māori Health Directorate.

Competing interests:

None identified.

  • 1. Statistics New Zealand. 2001 census of population and dwellings: Māori. Wellington: Statistics New Zealand, 2002.
  • 2. Health Workforce Advisory Committee. The New Zealand health workforce: a stocktake of issues and capacity 2001. Wellington: Health Workforce Advisory Committee, 2002.
  • 3. Ratima M, Brown R, Garrett N, et al. Rauringa raupa — recruitment and retention of Māori in the health and disability workforce. Auckland: AUT University, 2007.
  • 4. Nikora LW, Rua M, Duirs A, et al. Te Rau Puawai 2002–2004. An evaluation. Hamilton: University of Waikato, 2005.
  • 5. Koia M. Te Rau Puawai co-ordinator’s report semester 1, 2006. Palmerston North: Te Rau Puawai, 2006.
  • 6. Hirini P, Maxwell-Crawford K. Te Rau Matatini: Māori mental health workforce development. The proceedings of the Māori national graduates of psychology symposium. Palmerston North: Te Rau Matatini, 2002.
  • 7. Adsett S, Whiting C, Ihimaera W. Mataora. Auckland: David Bateman Ltd, 1996.
  • 8. Moko Business Associates. Career pathways and core competencies in Māori mental health nursing. Palmerston North: Te Rau Matatini, 2004.
  • 9. Gluckman P, Mantell CD. Vision 2020 proposal. Auckland: University of Auckland, 1997.
  • 10. Ratima M, Waetford C, MacDonald K, et al. Review of the Ministry of Health Hauora Māori Scholarship Programme. Auckland: AUT University, 2007.
  • 11. Health Research Council of New Zealand. Māori health research awards. Auckland: Health Research Council of New Zealand, 2004.

Author

remove_circle_outline Delete Author
add_circle_outline Add Author

Comment
Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Online responses are no longer available. Please refer to our instructions for authors page for more information.