That was one of the conclusions when Dr Esther Willing from the University of Auckland investigated implementation of the immunisation health target for two year olds within the New Zealand health system.
“Although vertical accountability focused attention on immunisation and elevated it as a priority on local policy agendas, what was interesting about the health target experience was the way that it was implemented at the local level – horizontally through network coordination,” says Dr Willing who now works for Te Kupenga Hauora Māori – a group within the University of Auckland that co-ordinates teaching on Māori health.
“Network coordination allowed the District Health Boards studied, to take a universal systems approach towards improving immunisation coverage in their region,” she says. “This increased immunisation coverage for all children, including Māori children, in a way that previous policy attempts had failed to achieve.”
Her research contributed to the understanding of health targets by highlighting a number of lessons from the immunisation health target experience.
Persistent immunisation inequities between Māori and non-Māori children were highlighted as a challenge for immunisation policy in New Zealand for almost twenty-three years, she says.
“Even when rates of immunisation coverage increased in New Zealand the level of inequity between Māori and non-Māori children remained the same,” she says
Dr Willing set out to understand how local health organisations responded to the health target and what they did to improve immunisation coverage and address immunisation inequities between Maori and non-Maori children in their regions.
Her research explored how DHBs (using case studies on Auckland, Hawkes Bay, Waikato and Bay of Plenty DHBs), implemented the immunisation health target and what they did to improve immunisation coverage at the local level.
She wanted to know;
- How effective is a health target as a policy mechanism for improving immunisation coverage?
- How was the immunisation health target implemented at the local level in New Zealand?
- How did DHBs address immunisation inequities between Māori and non-Māori children?
Understanding the implementation process within the four case study sites allowed Esther to consider how effective the immunisation health target was as a policy mechanism for improving immunisation coverage within the New Zealand health system.
She says the introduction of a health target for immunisation in 2007 acted as a catalyst for change within the New Zealand health system.
“Immunisation coverage for children at two years of age increased significantly over the course of the health target experience and persistent immunisation inequities between Māori and non-Maori children were reduced, and in some DHBs, eliminated”, says Dr Willing.
Health targets have been used internationally to stimulate change and improve performance within specific areas of a health system, she says.
While some countries have a long history of using health targets, their use within the New Zealand health system is relatively recent.
“Previous research on health targets has shown that they can be an effective policy mechanism for improving accountability and focusing attention on priority areas,” she says. “But critics of health targets have argued that they can create dysfunctional consequences within a health system that can have a negative impact on performance.”
Dr Esther Willing will be giving a Tōmaiora Seminar presentation on this topic on Tuesday 20th October, (12:30 pm at the School of Population Health, Tāmaki Innovation Campus, University of Auckland.)
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