Agenda
Meeting name:
Te Manawa Taki Regional Integration Team (kanohi ki te kanohi)
Location:
Waiora CBD, 87 Alexandra Street, Hamilton CBD, Waikato
RIT Attendees:
Regional Wayfinder Nicola Ehau (Co-Chair); Regional Pacific Health Director; Vincent Tuioti;
Interim Regional Lead Service Improvement and Innovation Sarah Davey;  Regional Director
Hospital & Specialist Services Chris Lowry and Regional Director National Public Health Service
Nat White.
Attendees:
Interim Regional Communications and Engagement Lead Te Manawa Taki Nick Wilson; Interim
Regional Lead Data and Digital Te Manawa Taki Garry Johnstone; Group Manager Regional
System Integration Lisa Gestro; Senior Adviser Te Manawa Taki Ricky Bel ; Interim Director Te
Manawa Taki West Makarita Tangitu-Joseph and Group Manager Office of the Regional
Wayfinder Te Manawa Taki Mike Agnew.
Apologies:
Regional Director Te Aka Whai Ora Stewart Ngatai (Co-Chair)
Date:
Monday 30 October 2023
Time:
10:00am – 04:30pm
Chairperson:
Nicola Ehau
Minutes by:  Crystal Langton-Garde
Time
Details
Attachments/Notes  Who
9:50
Assemble at
Al
• Kotahitanga Meeting Room (Ground Floor), Waiora
CBD, 87 Alexandra Street, Hamilton CBD, Waikato
10:00
Whakawhanaungatanga
Al
Standing items
10:30
• Health & Safety
Nicola Ehau
10:45
• System Pressures
Nicola Ehau
23.09.28 - Winter
Pressures Minister W
11:00
• Immunisations
Kaitlin
Greenway/
20231026
Rochel e
under the Official Information Act 1982
Immunisation Month
West/May
Pritchard
20231024
Reimagining the fut
20230809WhanauV
oiceRapidAssessmen
Released
20230918
Immunisation Indica
11:30
• Planned Care
Chris Lowry
New items

Meeting Agenda
11:45
SESSION 1: Purpose and Function on a Page
Sarah Davey
RIT Purpose and
Functions on a page
12:15
Kai (Working Lunch)
12:30
SESSION 2: Risk Capture Session
Guy Hobson
RIT Risk
1982
Survey.docx
SESSION 3: Waikato-based
Act
1:15
• Pacific Health
Vincent Tuioti/
Rachel Karalus
- K’aute Pasifika
2:00
• Commissioning
Nicola Ehau/Lisa
Gestro
- Regional Health & Wellbeing Plan
2:45
• Te Aka Whai Ora
Marama
Tauranga
- Toi Ora System of Care
Information
3:15
• Break
3:30
• National Public Health Service
Natasha White/
Pania Te Haate/
- NPHS Waikato team
Hinemoerangi
Ngatai Tangirua
Official
Discussion
4:15
Final Terms of Reference
Nicola Ehau
the
Final RIT TOR
20231023.docx
Fol ow up hui with IMPBs & Locality prototypes – two
Nicola Ehau
sessions under
- 14 November at 1pm – 3pm and 3:30pm –
4:30pm
IMPB quarterly meetings (Face to face)
Nicola Ehau
- Expected to start in December
o What date is most convenient for
everyone?
Released
RIT visit to Lakes
Nicola Ehau
- Placeholder: Thursday, 16 November
4:25
Wrap up
Nicola Ehau
4:30
Whakamutunga
Waikato - Regional Integration Team Agenda v2.docx
Page 2 of 2

Winter Preparedness Initiatives Implementation Update
As at 28 September 2023
Directorate
Initiative
Duration
Status
Delivery Plan Milestones
Comment
lead
d
C
kl
ch
v
lan
A
CM
id
gtn
Tau
h
In
Other areas/other actions
N
M
W
C
Clinical Telehealth to
As of  18 September 2023 there have been:
support Rural Māori and
26,135 calls made to the seasonal pressures telehealth service.
Pacific General Practices
Nov 2022-Sept
Commissioning
National initiative
Contract in place.
Of these:
and general practices with
2023
- Approximately 5,708 have required consultations.
at least 50% Māori, Pacific
- Doctor consults continue to increase and  have doubled week on week from August.
or quintile 5.
Whakarongorau pilot will be extended till end of October 2023.
For the Auckland region – Emergency Consult and St John clinical telehealth pilot:
Since the start of the calendar year there have been
-  1,419 referrals into the service
Clinical Telehealth to
-  77.01% non-transfer rate to ED. (A total of 1,093 patients )
Nov 2022-Sept
Wgtn region and Wairarapa (WFA) have other
support ambulance
Commissioning
Contract in place.
2023
existing arrangements
frontline Paramedics.
For the rest of the country excluding Auckland and Wellington - St John and Whakarongorau
Aotearoa pilot:
Since the start of the calendar year there have been
- 1,658 referrals into the service
- 60.44% non-transfer rate to ED. (A total of 1,002  patients).
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A start-up workshop with Ngati Porou Oranga is scheduled for Wednesday 27 September.  The
aim of the workshop is to identify conditions to be monitored, and how the lead partner will
Tairawhiti contract (in place). Tai Tokerau,
identify whānau to participate in the RPM pilot.  Once whānau are identified, Te What Ora will
Wharekauri provider contracts, 30 June 2023. All
Remote patient monitoring  Commissioning &  May 2023 to June
x1 Te Tai Tokerau, x2 Tairawhiti, x1
work with each whānau to match them with RPM devices.
providers implementing, from 15 August 2023.
prototype
Data & Digital
2025
Wharekauri (Chatham Islands).
Note: original timeframes were contracts signed  Hoa O Te Ora O Wharekauri have appointed a kaiāwhina to lead the Chatham Islands pilot.  The
30 May, sites operational 30 June.
RPM team will  work with the kaiāwhina over coming weeks to arrange meetings with
participating whānau.
Act
As of 31 August:
Consultations: 98,824.
- Total: 13% Maori, 15% Pacific, 72% Other
Pharmac approval (in place). Sector engagement,
Pharmacies to treat minor
Priority regions
- Adults (14+yrs)  30%  / Under 14yrs - 70%    (10% Maori, 90% non Maori and Pacific)
Commissioning
30 May 2023. Service start in new areas, June
ailments
June - Sept 2023
Conditions: 57% pain and fever, 28% skin conditions
2023.
Pharmaceutical dispenses: 91,048
This service is due to cease as of end of September as planned.
Service is operational in all districts. Data collection and collation is in progress and will be
Community radiology
Priority regions
Contracts in place, 30 May 2023
included in evaluation of winter preparedness initiatives.
Commissioning
services
June - Sept 2023
Services start, from June 2023
This service is due to cease as of end of September as planned.
Contracts in place for early localities and
Comprehensive primary
May 2023 - June
Local tailoring to finalise the Comprehensive Primary Care Teams is progressing in the locality
Commissioning
Plus other locations.
targeted Kaiawhina, 30 June. Phase 2
care teams
2025
prototypes as part of phase 1 and phase 2 planning continues.
commences, from 1 July
Provisional analytics for phase 1 shows an uplift of activity for all priority areas. However, all of
Phase I one-off regional uplift acute POAC,
Primary Options for Acute
May 2023 - June
phase 1 allocation has not been utilised in all regions, therefore phase 1 uplift activity will be
Commissioning
Also Waitemata, Hutt and Waikato
service start 30 May. Implement Phase 2, from 1
Care
2024
extended into Q2 for some. All regions are planning phase 2 wider application of uplift activity
Oct 2023.
accross whole regions including focus on three priority pathways.
Information
National working group formed and scoping document is being developed.   Intention to form an
Advisory Group with both internal and external members.
More accessible Urgent
Priority regions:
Maintain current capacity (in place). Primary
Commissioning
Range of extensions in these areas
(A&M) care
May 2023
Care Resilience Tool introduced, from June 2023  Primary Care Resilience Tool:  an automatic notification alerting the wider primary care sector
of any urgent care clinic closures is enabled in the Northern Region. Other regions will come on
board in rolling starts as providers sign up to the Tool and build this function into their systems.
Pathways & virtual
Pathways: Middlemore, Tauranga, Lakes,
Daily ARC Bed Vacancy Reporting:  reporting is in place.  Work continues to transfer this
Pathways also in Taranaki, Hawkes Bay,
advice, select
Wellington, Hutt Valley, Nelson-Marlborough,
information to the Primary Care Resilience Tool.
Commissioning &
Whanganui, West Coast, and South
Initiatives to support ARC
regions. Daily
Southern, Q1 23/24; Waikato, 30 June 2023.
Complex Care Initiative: Various initiatives are in development, depending on local needs of
H&SS
Canterbury (in place) and Lakes, Waikato,
vacancy report,
Daily ARC bed vacancy reporting starts, 30 June
districts, to expedite discharge from hospital to ARC.
Hutt and Nelson-Marlborough (impl)
national.
2023
Pathways in place in Tauranga, Lakes, Waikato.
Removal of interNASC transfer process in Metro
Needs assessments
Carer support subsidy changes live since 1 July.
Priority regions:
Auckland, 30 May 2023.
Official
appropriate and do not
Commissioning
All districts, with priority to Auckland.
Use of the SAT tool has been promoted nationally.
June 2023
Increased use of POAC, 30 May 2023.
delay patients
Removal of interNASC transfer process in Metro Auckland is complete.
Promote use of SAT tool, ongoing.
Primary Care Resilience Tool pilot with HCSS Northern region is currently undertaking testing,
Home support workers reimbursement
Home support workers funded flu vaccination
due to finish in early October.  This will inform subsequent national rollout.
contribution, in place from May.
Community Allied Health
Priority regions:
is a national initiative.
Community rapid response services in place as part of BAU.
Commissioning
PCRT piloted with HCSS, August 2023.
Rapid Response Services
June 2023
DIVERT tool is being promoted as part of assessments.
Note: PCRT timeframe revised from June to
PCRT piloted in Auckland with HCSS.
Vaccination reimbursement is in place.  Total claims and corresponding coverage will be
the  August (as advised 12 July weekly update).     available in late October.
Te Tai Tokerau, 31 July 2023; Waikato, 30 June
2023; Taranaki, 30 June 2023; Lakes, 31 May
In place in several
Also in place Waitemata,  Whanganui and
2023; MidCentral, Q1 23/24; Wairarapa; Q1
districts, others
West Coast; being expanded in Waikato,
HSS national office is working with Te Tai Tokerau and Bay of Plenty to progress services in
23/24; Hawkes Bay, Q1 23/24; Nelson
Hospital in the Home
H&SS
expanding or
Wairarapa; and impl Lakes, Hawkes Bay,
those districts.
Marlborough, Q1 23/24; South Canterbury. 30
implementing May-
Nelson-Marlborough, Taranaki and South
May 2023
July 2023.
Canterbury.
Note: Te Tai Tokerau, Lakes & South Canterbury
timeframes were revised to 31 July.
Additional ED fields added in large hospitals (and
Rapid National Data
New ED fields are now in place and data is being being provided by all districts.
SI&I
In place (July 2022)
National initiative
others as feasible), June 2023.  Additional
Automation Project
Radiology fields have been deferred to later in the year.
under
Radiology fields, Q1.
National and Regional Escalation Models in
Review, refresh and communicate district
In place;
Regional and National
all areas.
escalation plans (triggers and threshold), 30 May.
H&SS
enhancements
Plans in place.
Escalation Pathways
PCRT implemented in priority areas, from June
ongoing
2023
In place select
Auckland, 31 July 2023; Waitemata, 31 July 2023;
Mental health support to
Further implementation work also in
In place.
H&SS
districts, others
South Canterbury, 31 May 2023; Southern, Q1
EDs
Waitemata, South Canterbury.
implementing.
2023.
Maintaining planned care
All regions have plans in development or in
Response plans in place in all districts (for review
H&SS
May 2023 onwards
Plans in place.
capacity
place.
and refresh on an ongoing basis), 30 May 2023
Bivalent COVID-19
NPHS
March 2023
National initiative
Underway
656,295  COVID-19 Boosters administered (between 1 April – 19 September 2023)
boosters
Influenza vaccination
NPHS
April 2023
National initiative
Underway
1,249,420 Influenza vaccinations administered (between 1 April – 19 September 2023)
campaign
Released
Concomitant vaccines for  NPHS
February 2023
National initiative
Underway
487,787 Childhood Immunisations administered (between 1 January – 17 September 2023)
children
International nurse and
Workforce
In place (November
National initiative
Underway
Reported separately.
other recruitment
Taskforce
2022)
Earn and learn
Workforce
Existing hospitals:
Model for wider rollout has been reviewed with DoNs and final changes are being made.  Next
programmes for health
Also in Waitematā, Waikato, Tairāwhiti.
Underway
Taskforce
in place
steps will be review from Regional Directors and other key SMEs, then PSA and NZNO.
care assistants
All districts have finished their targeted campaigns for staff influenza vaccinations.  Staff can still
Staff influenza vaccinations NPHS & P&C
April 2023
National initiative
Underway
access vaccinations via their local Occupational Health teams.
Right Care Right Time
Communications focusing on winter continue across a range of channels, including televison,
Comms
May 2023
National initiative
Communications rolled out, from late May
Communications Campaign
radio and internet including social media.
COVID-19-specific
surveillance, response, and  NPHS
Ongoing
National initiative
Underway
Reported separately.
services

Te Manawa Taki Immunisation Monthly Report
To:
Regional Integration Team
From:
Te Manawa Taki Immunisation Collaborative
Subject:
Immunisation Delivery Monthly Update
Date:
October 2023

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Purpose
This monthly report provides an update to the Regional Integration Team on the following:
Act
•  Immunisation indicators for Te Manawa Taki.
•  Delivery of activities in the Immunisation Work Plan 23/24.
•  Risks and issues associated with either achieving 90% delivery rates and/or delivering
activities in the Immunisation Work Plan.
•  Progress on the Reimagining the Future State Immunisation Project.
Immunisation Indicators for Te Manawa Taki
Currently measurable indicators:
Information
90% of tamariki Māori are fully immunised at 8-months
•  Regional rate: 59.1% of tamariki Māori are fully immunised at 8-months (53% BOP,
60.4% Lakes, 61.7% Tairāwhiti, 63% Taranaki, 60.6% Waikato)

90% of Pasifika tamariki are ful y immunised at 8-months
•  Regional rate: 80% of Pasifika tamariki are fully immunised at 8-months (75% BOP,
Official
75% Lakes, 100% Tairāwhiti, 60% Taranaki, 83.9% Waikato)

90% of tamariki Māori are fully immunised at 24-months
the
•  Regional rate: 64.9% of tamariki Māori are fully immunised at 24-months (60.7%
BOP, 67.6% Lakes, 64.5% Tairāwhiti, 73.8% Taranaki, 64.6% Waikato)

90% of Pasifika tamariki are ful y immunised at 24-months
•  Regional rate: 69.2% of Pasifika tamariki are fully immunised at 24-months (75%
under
BOP, 58.8% Lakes, 75% Tairāwhiti, 100% Taranaki, 67.2% Waikato)


Released

Figures 1&2: Te Manawa Taki immunisation reporting trends for 8-month and 24-month indicators
(July - September 2023, all eligible vaccines excluding rotavirus)1

Percentage of tamariki Māori fully-immunised at
8-months and 24-months
90%
85%
80%
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75%
70%
65%
Act
60%
55%
50%
July
August
September
8 months
24 months

Percentage of Pasifika tamariki ful y-immunised
at 8-months and 24-months Information
90%
85%
80%
75%
70%
Official
65%
60%
55%
the
50%
July
August
September
8 months
24 months

under

Immunisation Work Plan 23/24
Regional
In the last month a lead for progressing the development of activities and actions related to
immunisation delivery for tāngata whaikaha has been identified. Our SRO from Taranaki, Rachel
Court, volunteered to lead this work and will be identifying others across the region to develop
activities for incorporation into the Work plan, building on the initial thinking undertaken as part of
Released
the disability and capability workshop.
More recently, across the region teams have been developing plans for the incorporation of Public
Health Nurses into delivery of childhood immunisations. Weekly updates are being provided to NPHS

leadership on the implementation of this request. Our update from last week is provided as
Appendix one (below).
Taranaki
All activities for Taranaki are on track and progressing. A particular focus in the last month has been
the development of relationships with ECEs/kohanga reo for the purposes of delivering
immunisation education and clinics for all whānau in those spaces.
Waikato
Waikato activities are all on track. In the last month a number of comprehensive campaigns for
priority populations have occurred. A large amount of support is being provided across the
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immunisation landscape with training and relationship building. Hospital based immunisations are
being improved with pre-calling being extended to all outpatient clinics with tamariki attendance.
Regular immunisation clinics are happening in all birthing facilities and the team continues to attend
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Hapuu Waananga across the district.
Hauora a Toi
Awaiting an update for October.
Lakes
Within the last month a new SRO for immunisations has been getting up to speed with activities
outlined in the work plan and how these are progressing. As part of the request to utilise Public
Health Nurses, the team has been working closely with the Hauora Māori Relationship Lead for
Information
Lakes, to discuss the review and strengthening of a local operational group. The team have
undertaken work around improving immunisation delivery in hospital-based settings, as well as
identifying additional staff who are fully authorised vaccinators and can support with immunisation
delivery.
Tairāwhiti
Official
Awaiting an update for October.
Risks and Issues
the
No update for risks and issues.
Reimagining the Future State Immunisation Project
The draft project report is provided as Appendix two (attached separately) for the RIT’s
under
consideration. This was shared earlier in the week with the following review team previously agreed
in the project brief:
Reviewers
Te Aka Whai Ora  Megan Tunks, Ricky Bell, Dillon Te Kani
Pacific Health
Tamati Peni
GMs Planning and Chloe Mercer, Tim Slow, Lisa Gestro, Ariana Roberts
Funding

Released
Feedback received wil  be updated to the RIT on Monday. The project team would like approval from
the RIT to share the report with al  internal and external stakeholders that contributed to the
project, this list is included in the report as Appendix 4. Once all feedback is received, the final report
will be provided to the RIT for sign off, along with proposed changes to the Immunisation Workplan
to support implementation of the recommendations, at its meeting on 27 November.

Appendix One:
Te Manawa Taki Update: Public Health Nurses Supporting
Immunisations
To:
National Director, NPHS
From:
Interim Regional Immunisation Lead, Te Manawa Taki, NPHS
CC:
Regional Director Te Manawa Taki, NPHS
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Subject:
Public Health Nurses Supporting Immunisation Delivery
Date:
20 October 2023

Act
Description of Teams:
The following table outlines the total Public Health Nurse FTE in each local area and any other
resource not sitting within current Te Whatu Ora immunisation delivery teams that is available to
support.
Team
PHN’s
Other resource available
Tairāwhiti
4.8 FTE
1 FTE Kaiawhina
Hauora a Toi  21.9 FTE

Information
Lakes
11.9 FTE
0.5 FTE Vaccinating Health Worker
0.6 FTE Community Health Worker
Waikato
28.6 FTE
~21 FTE Whanau Navigators
Taranaki
14 FTE

Total
81.2 FTE

Official
Note that within these totals not all are fully authorised vaccinators, and some may need to continue
with other critical BAU.
the
Immediate priorities and planned activities:
•  The focus of conversations across the region with local teams has been how to utilise public
health nurses to support the mahi of Hauora Māori Partners and Pacific Providers in a way
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that puts whanau at the centre and our partners as the lead. All local immunisation leads,
alongside Te Aka Whai Ora Hauora Māori Relationship leads, are progressing these
conversations urgently and wil  provide further updates next week.
•  Initial plans include the immediate ‘scale up’ of existing outreach and opportunistic
immunisation delivery (clinics, pop ups, mobile delivery, home visits) including increased
flexibility for afterhours service provision where possible, the potential for expanded
delivery in schools and early childhood settings, as well as new collaborations with Plunket,
LMC’s, WCTO etc.
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•  All teams have identified urgent training needs for their Public Health Nurses including
training in cultural safety and clinical training to authorise delivery for tamariki aged 0-2
years.

o  Clinical training: Teams are identifying what can be immediately supported locally.
We plan to extend training opportunities to Hauora Māori Partners and Pacific
providers and then coordinate opportunities regional y.
o  Cultural safety training: Discussions are in place with cultural experts to formulate a
101 attitudes, self-awareness and bias training. This will be supported by in house
whare learning with a Hauora Māori Partner to support cultural intelligence uplift
and clinical uplift in a whare wananga style.
•  Al  teams have identified that a national y led partnership with Education, that included
communications being received locally would assist greatly in the development and
strengthening of those relationships. This is being progressed through the National
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Immunisation Programme.
•  Regional Communications resource has been identified (within existing COVID-funded
immunisation resource based in HSS, BoP) and will be working with local teams to develop
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collateral to help ensure communities are aware of increased immunisation services and
opportunities in their areas.
Coordination:
•  An Interim Regional Immunisation Lead has been appointed and is working closely with the
Te Aka Whai Ora Regional Immunisation Lead, local SRO’s (or their equivalents), Hauora
Māori Relationship Leads (Te Aka Whai Ora) and Public Health Nurse Managers.
•  In Te Manawa Taki, delivery of the Regional Immunisation Workplan is coordinated via the
Information
Regional Immunisation Collaborative group, which is cochaired by NPHS and Te Aka Whai
Ora Regional Directors or their delegates.
•  The Reimagining the Future State Immunisation project is also nearing completion so across
the region we are ensuring PHN activities align with key recommendations that have
emerged from stakeholder feedback, in order to ensure the increased immunisation
resource is contributing to an equitable and sustainable system moving forward.
Official
•  Once planned activities for the PHN’s have been confirmed, they wil  be incorporated into
the regional workplan for monitoring.
the
Te Manawa Taki Immunisation Rates:

Childhood immunisation coverage at 30 Sept 2023
Ethnicity
Age
Tairāwhiti  Taranaki  Lakes
Hauora a Toi  Waikato
8 months
61.20%
61.70%
60.10%
52.80%  60.90%
under
Māori
24
months
64.50%
73.80%
67.30%
60.70%  64.60%
8 months
100.00%
60.00%
75.00%
75.00%  85.50%
Pacific
24
months
75.00%  100.00%
61.10%
75.00%  67.20%
8 months
100.00%
90.00%
93.80%
96.90%  91.10%
Asian
24
months
100.00%
81.80%
86.50%
94.70%  88.70%
Released 8 months  81.40%  82.30%  88.20%  82.30%  82.80%
Other
24
months
71.40%
85.80%
80.80%
82.70%  82.40%

Eligible population (0-62 months as 29/07/23)

Tairāwhiti Taranaki
Lakes
Hauora a Toi Waikato
Total
Māori
2318
2440
4327
6395
10163
25643
Asian
158
597
830
1946
4572
8103
Other
1182
5112
2774
8614
14617
32299
Pacific
Peoples
107
155
260
462
1247
2231
Total
3765
8304
8191
17417
30599
68276

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Information
Official
the
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Released

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Information
REIMAGINING THE FUTURE ST
Official ATE
IMMUNISATION PROJECT
the Te Manawa Taki
Report of Findings and Recommendations
October 2023
under
Released

Executive summary

There is an urgent need to invest in and reimagine the immunisation system across Te Manawa Taki.
Immunisation rates in Te Manawa Taki are concerningly low and inequitably distributed, leaving
communities and whanau vulnerable to the harms of vaccine preventable diseases and outbreaks.
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The gaps in immunisation coverage and immunisation inequities have grown across Te Manawa Taki
over the last few years. This has occurred for a range of reasons, and despite the hard work of many
committed people. Importantly, there are a range of impacts from the COVID-19 pandemic, including
Act
greater levels of immunisation misinformation and a legacy of mistrust and caution from some
communities and whānau due to the vaccine mandates.

The health reforms and notably the creation of Te Aka Whai Ora, and the National Public Health
Service with its newly held accountability for immunisation, provide a unique opportunity to drive
improvements and achieve equitable outcomes across the immunisation system.

This report sets out a picture for a reorganised and cohesive regional immunisation system. The vision
is to create a system that delivers positive experiences, access and outcomes for Māori, Pacific and
tāngata whaikaha and ensures that trust and partnership is woven into contracting, funding, and
service design to allow Hauora Māori Partners and Pacific providers to serve and support the
communities in which they work.

Information
The guiding principles for this report include the principles of Te Tiriti o Waitangi and Pae Ora: Options,
Partnership, Equity, Active Protection, Tino rangatiratanga (self-determination). It is also informed by
the design features for primary and community healthcare within the reformed health system, as
outlined by the cabinet paper Achieving pae ora through primary and community healthcare.

This report presents the findings of a range of activities that were undertaken to understand the
current issues and challenges with the immunisation system across Te Manawa Taki, and the
aspirations and solutions to improve the system. These activities were: a review of relevant literature
Official
and reports, mapping of the current landscape of immunisation services and contracts across the
region, a review of ‘whanau voice’ on immunisation service access and experience, engagement with
Hauora Maori partners and Pacific providers and other sector experts across Te Manawa Taki and
finally, workshopping ideas and recommendations with contributors across the health sector.
the

This work has highlighted the many strengths and the resourcefulness of the workforce right across
the immunisation system, from commissioners and coordinators through to outreach staff who go the
extra mile to build relationships and trust with whānau. It has also highlighted the need for stronger
governance and accountability across the region, clear lines for escalation and responsibility, an
investment in workforce, the need for greater coordination, access to data and information and finally
more investment in culturally safe and accessible service delivery.
under

Critically, immunisation sits within a complex landscape of multiple delivery points, many providers
and in the context of misinformation and eroded trust. There is no quick fix. This report proposes a
suite of activities to reorganise and improve the Te Manawa Taki immunisation system. Achieving the
vision of this work will require a sustained investment and focus on immunisation.

Released

Glossary of Terms and Abbreviations
AIR – Aotearoa Immunisation Register
HSS – Hospital and Specialist Services
IMAC – Immunisation Advisory Centre
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LMC – Lead Maternity Carer
PHN – Public Health Nurse
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PHO – Primary Health Organisation
PPD – Pay Per Dose
NIP – National Immunisation Programme
NIR – National Immunisation Register
NPHS – National Public Health Service
RIT – Regional Integration Team
SBIP – School Based Immunisation Programme
SRO – Senior Responsible Officer
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WCTO – Well Child Tamariki Ora
VHW – Vaccinating Health Worker

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Purpose
The purpose of this report is to present the findings of a range of activities that were undertaken to
understand the current issues and chal enges with the immunisation system across Te Manawa Taki,
aspirations and solutions to improve the system, and to present recommendations and next steps for
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an immunisation system that is sustainable into the future.

The specific objectives of this project are to:
1)  Map and review current infrastructure and approaches to the delivery of immunisations across Te
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Manawa Taki, including provider and community context, whānau voice and aspirations.
2)  Identify areas for potential improvement as well as regional efficiencies and collaboration that
could be both implemented immediately and in the coming years for more equitable service
delivery.
3)  Propose a sustainable model, coming out of COVID-19 and aligned with our system reform.
Vision and Guiding principles
The vision for this work is to design a sustainable and equitable immunisation system that ensures all
communities across Te Manawa Taki are protected from Vaccine Preventable Diseases (VPDs).
Building on learnings from COVID-19, and empowering Hauora Māori Partners and Pacific providers
to best serve their communities, the vision is for a highly collaborative partnership approach that will
ensure equitable access to immunisation education and delivery  for  Māori,  Pacific,  and  tāngata
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whaikaha (1).

The guiding principles for this project include the principles of Te Tiriti o Waitangi and Pae Ora:
•  Options
•  Partnership
•  Equity
•  Active Protection
•  Tino rangatiratanga (self-determination) (2).
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This work is also informed by the design features for primary and community healthcare within the
reformed health system, as outlined by the cabinet paper Achieving pae ora through primary and
community healthcare. These features are:
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•  Comprehensive
•  Accessible
•  Continuous
•  Coordinated
•  Individual and whānau centred,
•  Fit for purpose
•  Continually improving (3). under
Background
Immunisation coverage that is both adequately high, and equitable, has been a challenge for the New
Zealand health system for many years. The COVID-19 pandemic exacerbated  many challenges for
immunisation services, including diverting resources and vaccinating workforce away from childhood
immunisations (4). Despite the chal enges, there were also many positive developments during this
time. This includes newly created capacity and capability, such as non-regulated vaccinating health
workers, an increase in iwi-led solutions, and an explicit national focus on creating accessible services
for under-served populations.
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Immunisation services and  coverage  have also been impacted by substantial change to the New
Zealand health system. In 2022, the Pae Ora (Healthy Futures) Act legislated the transformation of
publicly funded health services within Aotearoa, and led to the creation of Health New Zealand (Te
Whatu Ora) and the Māori Health Authority (Te Aka Whai Ora). The Pae Ora Act includes greater
recognition of the crown’s obligation to uphold te Tiriti o Waitangi, and achieve equitable outcomes
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for Māori. Specifically, it outlines the responsibilities under Article 2 to uphold Tino Rangatiratanga
and support Māori-leadership and Article 3, the responsibility of the Crown to deliver equitable health
outcomes.

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With the health reforms underway, the impacts of COVID-19 lessening and ongoing immunisation
inequities, there is both  an  urgent  need, and an  opportunity to take stock and strengthen the
coordination, governance and deliver of immunisation services to achieve Pae Ora.

The following sections outline the current state of immunisation coverage and inequities across Te
Manawa Taki, and the wider context of work and strategic alignment into which this project fits.

Immunisation coverage
Childhood immunisation rates have continued to decline national y since 2018,  with the decline
accelerating since the start of the COVID-19 pandemic in early 2020 (4). In addition, inequities have
worsened with tamariki Māori and Pacific tamariki less likely to be fully vaccinated at any time point,
compared to Pākehā/NZ European or Asian tamariki (2).
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Of the four Te Whatu Ora regions, Te Manawa Taki has the lowest percentage of fully immunised
tamariki at all milestone ages up to, and including, 5 years. (5, 6). Current childhood immunisation
rates in Te Manawa Taki at 24 months are 74.4% (Māori 62.1%, Pacific 79.1%, European 80.2%, Asian
92.0%, and Other 79.1%) (5). Of the four regions, Te Manawa Taki also has the largest equity gap for
Maori at this milestone, with a 19.9% difference in immunisation coverage at 24 months between
tamariki Māori and non-Māori tamariki (all figures as of 30 June 2023) (5). More detail regarding
immunisation coverage by local area and equity gaps is shown in the Immunisation Service Mapping
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section below.

Tāngata  whaikaha are another  priority group for improving immunisation access, coverage and
experience.  There is limited data on the immunisation coverage for tāngata whaikaha across the
the
immunisation system. However, tāngata whaikaha are known to have poorer access to health services,
and poorer health outcomes on a range of measures (4). Improving the immunisation system to meet
the needs of tāngata whaikaha is a priority of this work, and nationally (4).

National work
In December 2022,  the National Immunisation Taskforce Report outlined initial priorities for the
National Immunisation Programme (NIP) in Aotearoa (4). Although immunisations occur across the
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life  course, the  Taskforce recognised that childhood immunisations are one of the most effective
interventions against preventable diseases that can otherwise result in a high incidence of morbidity
and/or fatality (4). Therefore, the Taskforce prioritised the following groups: tamariki Māori, Pacific
tamariki, tamariki with disabilities, and hapū māmā (pregnant mothers) (4).

The recommendations focus on achieving on-time and rapid catch up of under-vaccinated tamariki
Māori and Pacific, and embedding an immunisation programme that achieves on-time vaccination of
the whole population to target levels of 95% fully vaccinated (4). The Report also advises on actions
to be taken locally, regionally, and nationally to achieve key targets for the Aotearoa childhood
vaccination schedule, seasonal influenza, and COVID-19 vaccination programmes.
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The National Immunisation Taskforce are  working on an implementation plan for the 54 Report
recommendations, under the following ten key priority areas:

1. Expansion of the vaccinator workforce
2. Authorisation of childhood vaccinators
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3. Antenatal immunisations
4. Enrolment into health services from birth
5. Proactive outreach immunisation services
6. Catch-up immunisations
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7. Funding for providers that is long-term and sustainable
8. Governance, technical advice, and service coverage oversight
9. Development of new provider and consumer-facing resources for immunisations
10. Quality and standards for providers delivering immunisations to tamariki in New Zealand

Notably, in 2023 Manatu Hauora also released a suite of strategies focused on improving the health
of New Zealanders across the board, and specific population groups who are historically under served.
The relationship between these strategies and immunisation system design is outlined in Appendix 1.

Regional work
To progress work at a regional level, in July 2023, Te Manawa Taki Immunisation Collaborative (the
‘Collaborative’) developed a Regional Immunisation Work Plan for 2023/24. The purpose of this joint
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plan between Te Whatu Ora and Te Aka Whai Ora was to outline activities local teams already have
underway and plan to continue, or those they intend to start within the 23/24 financial year. The focus
for activities was to provide immediate resource and support across the region to lift immunisation
rates  among  Māori,  Pacific,  and  Tāngata  whaikaha  pepi,  tamariki,  and  hapu  māmā  (using the
Prioritisation Matrix (4)).

In addition to the Plan, Immunisation Indicators for Te Manawa Taki were agreed to as part of a wider
monitoring framework for Te Manawa Taki.  These are outlined in detail in Appendix 2,  and are
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referred to in the Recommendations for the Future State section below.

During the development of the Plan, it became clear that each local area across Te Manawa Taki were
working differently in terms of the size and make-up of local immunisation teams, levels of investment
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into planned and opportunistic outreach immunisation services (OIS), and varied coordination of those
services. Potential opportunities for regional efficiencies and more collaborative ways of working were
also identified.

With many of the local teams and OIS contracts Covid-19 funded (and funding signal ed to end June
2024), there was an urgent need to review the immunisation system across Te Manawa Taki and
propose a future state that is sustainable into the future and demonstrates a commitment to Te Tiriti,
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achieving equity and the aims of Te Pae Tata. This work is captured in the ‘Reimagining the future
state’ immunisation project, which was endorsed by the Regional Integration Team (RIT) to progress
from August – October 2023.

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Out of scope and current unknowns
The following aspects of the immunisation system are outside of the scope of this report and its
recommendations:
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1.
The contracting arrangements and delivery of immunisations in primary care
2.
The restructure of the National Immunisation Programme
3.
The current reviews that are underway for:
a.
Immunisation clinical quality training and support functions (currently provided by
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IMAC)
b.
School Based Immunisation Programmes
c.
Outreach Immunisation services
4.
The Kahu Taurima workstreams
5.
The impacts and functionality of the Aotearoa Immunisation Register (AIR) and Whaihua portals
which are under development
6.
Care in the Community Hubs
Approach
To arrive at a set of recommendations for a reimagined immunisation system we have taken the
following steps:
1.  Literature and Document review
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This work has been guided by a range of evaluations and literature on immunisation systems and
service design. In addition to literature reviewed for the whānau voice document, the fol owing
papers have also influenced this work:
-  National Immunisation Taskforce Report (4)
-  Achieving Pae Ora Through Primary and Community Healthcare (cabinet paper) (3)
-  Lakes DHB Outreach Immunisation Service Review (7)
-  Summary Report Health Equity Assessment: Childhood Immunisation in Taranaki (8)
-  Kōmiromiro: Shared experiences of the Te Tai Tokerau, Tāmaki Makaurau and Waikato COVID-
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19 Māori and Pacific response teams (9)
-  Te Waipounami Review of Covid19 Immunisation and Care in the Community (10)
2.  Immunisation Service Mapping
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The project team conducted a review of the current baseline level of investment in immunisation
coordinator/s  and NIR administration  teams within each local area, along with planned and
opportunistic OIS contracting arrangements.  It also included mapping of the current contract
relationship holders, including collaboration between primary care providers, Te Aka Whai Ora,
Te Whatu Ora, Manatū Hauora, schools, and community organizations.
To identify variability and under-served areas, the size and funding of baseline  immunisation
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services across Te Manawa Taki were compared with the size and location of priority populations
within the region  (Māori  and  Pacific  tamariki  aged  0-5 years,  noting there is no  current  data
available for tāngata whaikaha).

3.  Whānau voice
The second part of the project was a rapid assessment of ‘whānau voice’ using recent New Zealand
literature and evaluations that captured qualitative data on the experience and views of people
accessing the immunisation system in Aotearoa New Zealand. This approach was taken due to
time constraints and to maximise  the existing contribution of whānau who have shared their
energy and views on the Aotearoa immunisation system. This review can be found in the Whānau
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voice document (Appendix 3). It highlights current issues and barriers as well as aspirations and
solutions proposed by whānau.
This document was circulated with all the Hauora Māori partners and Pacific providers who were
engaged with as part of the project, along with local immunisation teams and primary care. The
purpose of this was to ‘sense-check’ whether the findings from the literature review also aligned
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with what was being heard on the ground from communities. Additions were made as needed to
ensure the document reflects the content of conversations with providers who work directly with
whānau across Te Manawa Taki.

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4.  Provider and Professional views
Engagements with immunisation providers were  organised through local immunisation leads
(Senior Responsible Officers for immunisation, or equivalent). Being the key relationship holders
between Te Whatu Ora and local providers, local leads emailed out information about the project
and the Whānau voice document to all immunisation service providers within their local area,
inviting them to meet face to face with the project team to provide feedback. This included Hāuora
Māori partners, Pacific providers, primary care, Te Whatu Ora immunisation teams, Community
Hubs,  public health services,  pharmacy, and in some cases Well Child Tamariki Ora (WCTO)
providers and midwives. Where they had established relationships, Hauora Māori Relationship
leads (Te Aka Whai Ora) also supported engagements with Hauora Māori partners.

The project team also engaged with the New Zealand College of Midwives (NZCOM), Plunket,
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School Based Health Services, National Disability Leads, and attended the Disability Capability
Workshop.

Face to face meetings  with most providers of immunisation services across Te Manawa Taki
occurred from September – October 2023, prioritising meetings with Hauora Māori partners and
Pacific providers. The purpose was to gain an understanding of what is currently working well,
issues and barriers, as well as opportunities and aspirations for a future immunisation system that
is equitable and ensures al  communities are supported to protect their whānau from vaccine
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preventable diseases.
As a guide for discussions, the following areas were highlighted:
-  What is working wel  and/or not so wel  in the current immunisation system
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-  Ideas and opportunities for new ways of working
-  Your current role, capacity and any desire for this to change
-  Commissioning approaches, including whether current contracts are limiting your ability
to best serve the community
-  Areas of relationships such as governance, support/administration, and/or information
sharing
-  Workforce development/training
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-  Any data/digital solutions that would enable you to work more effectively
-  How communications (both internal and external) could be better supported
-  Any functions that could be regionalised for efficiency

Appendix 4 includes a list of the stakeholders who were engaged with over the course of the
engagement phase of this project.
5.  Collaboration across the Health System
After completing engagements with immunisation providers, the project team presented initial
findings and recommendations to the commissioning leads across Te Whatu Ora and Te Aka Whai
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Ora, as well as the National Immunisation Programme. Some of the recommendations discussed
are already being progressed by different parts of the health system, and these have been
highlighted in the Recommendations for the Future State section below.

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link to page 20
Findings

Immunisation Service Mapping
Childhood immunisations
Within Te Manawa Taki there are around 70,000 children aged 0-62 months. When looking at the
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distribution  of priority populations across the region,  the  highest  proportion  of  Māori  and  Pacific
tamariki aged 0-62 months are in Waikato, followed by Hauora a Toi.

Currently, Taranaki and Tairāwhiti have the highest immunisation coverage for tamariki Māori and
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Pacific tamariki across most milestone ages from 0-5 years.

Table 1. Estimated population aged 0-62 months, by local area across Te Manawa TakiError! Bookmark not
defined.

Tairāwhiti
Taranaki
Lakes
Hauora a Toi
Waikato
Total

Māori
2318
2440
4327
6395
10163
25643
Asian
158
597
830
1946
4572
8103

Other
1182
5112
2774
8614
14617
32299
Pacific Peoples
107
155
260
462
1247
2231

Total
3765
8304
8191
17417
30599
68276
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Table 2. Distribution of Māori and Pacific tamariki aged 0-62 months across Te Manawa Taki1

Tairāwhiti
Taranaki
Lakes
Hauora a Toi
Waikato
Māori
9%
10%
17%
25%
40%
Pacific Peoples
5%
7%
12%
21%
56%

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Figure 1. Māori childhood immunisation coverage by local area across Te Manawa Taki (June 2023)

Childhood Immunisation Coverage for Māori
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30 June 2023
100.00%
90.00%
80.00%
70.00%
60.00%
50.00%
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40.00%
30.00%
20.00%
10.00%
0.00%
Tāirawhiti
Taranaki
Lakes
Hauora a Toi
Waikato
8 months
24 months
5 years


1 The information was accessed via Qlik Cloud and represents the total count of individuals ages between 0
months and 64 months on the 29 July 2023.
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Figure 2. Pacific childhood immunisation coverage by local area across Te Manawa Taki (June 2023)

Childhood Immunisation Coverage for Pacific
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30 June 2023
100.00%
90.00%
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80.00%
70.00%
60.00%
50.00%
40.00%
30.00%
20.00%
10.00%
0.00%
Tāirawhiti
Taranaki
Lakes
Hauora a Toi
Waikato
8 months
24 months
5 years

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Across Te Manawa Taki, the majority of childhood immunisations are delivered via registered nurses
employed in general practice. In addition, local areas have a National Immunisation Register (NIR)
team, Immunisation Coordinator/s, a School Based Immunisation Programme (SBIP), and an Outreach
Immunisation Service (OIS). The role of these teams is to support primary care and other providers to
engage with and deliver immunisations to tamariki who are either unable to be reached by their
general practice or are not enrolled with a general practice.

Prior to COVID-19,  the investment in immunisation services was relatively stable. NIR and
Official
Immunisation Coordination were funded through Crown Funded Agreements following a population-
based funding approach. Outreach Immunisation Services (OIS) were funded from baseline resulting
in small variation across the region.

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Current Landscape
COVID-19 investment has resulted in large disruption to the immunisation landscape:
•  Senior Responsible Officer’s for immunisations (SRO’s, or equivalent) were established in each
local area to coordinate the rollout of the COVID-19 vaccination programme.
•  Service delivery teams were set up or expanded within hospital and specialist services (HSS)
or Commissioning to support with vaccination delivery.
•  New immunisation providers were brought on board, including Hauora Māori partners and
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Pacific providers to deliver COVID-19 and flu vaccinations, and there was an increase in the
number and type of vaccinations being offered through pharmacies.
•  Non-clinical staff were enabled to deliver COVID-19 vaccinations under supervision  as
Vaccinating Health Workers (VHWs).  The VHW  role  has now been expanded to include
delivery of influenza and MMR vaccinations to anyone aged 5 years and over.
•  Although not discussed in detail in this report, Care in the Community Hubs were  also
established to provide wrap around support to whānau while isolating.

The response to COVID-19 varied across the region. Of note, Waikato developed the WHIRI Hapori
model  as  a locally designed pro-equity response  that  is  whānau  centred,  manaaki-led and locally
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delivered.  This response brought together Care in the Community, vaccinations and testing, and
worked closely with iwi to establish a Community Hub Network (WHIRI Ihopū) across Waikato. WHIRI
Ihopū provide wrap around services to whānau, including support with health literacy, prevention and
promotion, and use  Whānau  Hauora  Assessments  (WHA)  to  link  whānau  with  health services,
government and NGO support. Waikato have established a Waikato Immunisations Network for all of
the immunisation providers and other stakeholders to regularly come together for coordination and
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support.

Hauora a Toi established a COVID-19 Immunisation Directorate within HSS, bringing together the SRO,
NIR team, vaccinators,  kaiāwhina,  communications,  and  data  support  to  provide  leadership  and
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coordination  to the wider immunisation programme.  Although not formally an Immunisation
Directorate,  Taranaki,  Lakes  and  Tairāwhiti  also  have  SRO positions, vaccinators  and  kaiāwhina
working closely with the NIR teams and immunisation coordinators to support with the vaccination
rollout.

As the focus on COVID-19  has lessened,  these services have transitioned to focus on childhood
immunisations. In Waikato and Hauora a Toi there remains a relatively large service delivery team in
HSS or Commissioning. In Lakes, Taranaki and Tairāwhiti, there has been significant down scaling of
HSS immunisation services, and a loss of commissioning staff to support these services.

A number of Hauora Māori partners and Pacific providers continue to deliver immunisations within
the community, and can often reach  whānau not engaged with primary  care.  Although COVID-19
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funding covers the cost for COVID-19 and flu vaccinations, not all partners and providers can claim
back costs for delivering childhood immunisations, and many are currently doing this out of good wil .
Childhood immunisations are being offered in places and spaces that work for whānau, often outside
of work hours, and at drive through events and Hauora days. Many partners and providers are also
offering childhood immunisations as part of their WCTO service, again often without funding to cover
administration costs. Lack of data to be able to pivot services also continues to be a limiting factor.

Other changes to the landscape include the Kahu Taurima workstreams (both Te Aka Whai Ora and Te
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Whatu Ora) which offer potential for investment in wrap around services for first 2,000 days. This
investment is still being worked through locally but is likely to have a positive impact on childhood
immunisation services.

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There are also significant changes underway as part of the health system reform, including the
establishment of Iwi  Māori  Partnership  Boards  (IMPBs)  and localities. IMPBs  will  ensure  Māori
governance in the determination of health priorities for iwi and Māori across localities (11). With
localities ensuring that health services are organised in a way that makes sense to the geographic
communities they service (11). For immunisations, IMPBs will play a significant role in making sure
services are designed to meet the local context in each locality, and therefore, recommendations from
this project wil  need to be agreed by the IMPBs across Te Manawa Taki and locally tailored.
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School-Based Immunisation Services
The School-Based Immunisation Programme (SBIP) only occurs during term time and delivers Boostrix
and HPV to around 14,690 children age 11-years  requiring school-based immunisations across Te
Manawa Taki.

Across the region the public health nurses (PHNs)  employed into HSS deliver school-based
immunisations. Boards of trustees within schools are responsible for approving the Programme in
their school and it is important the service maintains a relationship with the Board. If the board does
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not approve the programme, parents are required to arrange an alternative to have their child
immunised (e.g. through their general practice).

PHNs typically visit the school in February and March each year to provide education and promotion
about Boostrix and HPV immunisations, before delivering vaccinations in each school from March
onwards. Delivery of the SBIP was impacted during COVID-19. In particular, the PHNs were unable to
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provide education and health promotion face to face with students, teachers and parents, and their
relationships with schools were impacted.

In general, managing the paper-based consent process and attendance are significant chal enges for
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school-based immunisation services, as well as the inability to status check in real time. A number of
PHN’s are also paying out of pocket for youth engagement activities (e.g. incentives for returning
consent forms).

Immunisation coordinators and NIR teams
Immunisation coordinators are usually registered nurses with at least 2 years post-graduate
experience and are an authorised vaccinator. The immunisation coordinator role includes supporting
workforce development and vaccinator accreditation, training and upskilling community providers on
immunisation and cold chain compliance and managing cold chain breaches. Over time, this workload
has increased with new vaccines  added to the schedule,  and workforce from different clinical
backgrounds (e.g. VHWs).

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The National Immunisation Register (NIR) supports users to find out what vaccines a child has been
given and provides information on population coverage. The NIR administrators work with providers
to ensure the information in NIR is good quality and generates reports identifying gaps in service
coverage. However, there have been challenges sharing patient level information with a wide range
of providers. In November 2023, the NIR will be transitioning over to the Aotearoa Immunisation
Register (AIR).  The capability of the  AIR and the impact it will have on the workload for NIR
administrators is currently unclear.

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In Te Manawa Taki all NIR and Immunisation coordination services are delivered through HSS. This
enables the teams to access a wider range of data sets to reach whānau; however, it can reduce their
connection with primary care and community providers.

the
Variation occurs in the size of these teams relative to the size of priority populations, and the type of
activity being delivered. Of note, Taranaki have a relatively large team relative to the distribution of
Māori children, while Lakes and Tairāwhiti have relatively small teams. There is potential for these
teams to share best practice across the region, and workload if needed.

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Table 3: Size of NIR and Immunisation coordinator teams relative to the distribution of Māori and
Pacific children across Te Manawa Taki

NIR
Distribution  Distribution  Comments
(FTE)  Immunisation
Coordinator
of
Māori  of Pacific
(FTE)
children
children
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Taranaki
2.5  1.8
9%
7%
Large team relative to the distribution  of
priority populations
Lakes
1
1
17%
12%
Smal  team relative to the distribution  of
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priority populations
Hauora a
Toi
3.5  4.1
25%
21%
Includes a child liaison function
Waikato
2
n/a
40%
56%
Unable to compare immunisation coordinator
FTE  as  Waikato  have a different approach to
training and cold chain
Tairāwhiti   1
1
9%
5%
Smal  team relative to the distribution  of
priority populations
Outreach Immunisation Services
Referral to OIS is available for children aged 0 – 6 (or 7) years and generally occurs once the child’s GP
has attempted to contact the whānau three times and the immunisation is overdue. This referral
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process is managed by the NIR team. In Hauora a Toi, a proactive referral pathway to OIS for Māori
and Pacific is being trialled.

Prior to COVID-19, OIS were funded from baseline resulting in variations between local areas on the
level of funding. In some local areas, OIS is being delivered through HSS, in others, contracts sit in the
community with  PHOs  and/or  Hauroa  Māori  partners.  Currently  no Pacific providers across Te
Manawa Taki hold formal OIS contracts.

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There has been a significant increase in demand for OIS since 2020 with no change to baseline funding.
Taranaki, Waikato, and Hauora a Toi have reported a two- to three-fold increase in referrals. Where
possible, COVID-19 service delivery teams in HSS and Commissioning have been supporting OIS
providers with vaccinating staff to reduce the waitlist, but this is not sustainable post June 2024.
the
It is likely that the level of funding required will  need to increase  across the region,  and for  the
distribution of funding  to  better  reflect the size and location of priority populations and rurality;
however, the addition of COVID-19 funding and staff makes the analysis challenging.

Current baseline funding for OIS services:
Taranaki: $148,865.00 bulk funded to Haoura Māori providers. These contracts have transferred to
Te Aka Whai Ora.
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Lakes: $185,000 bulk funded to a PHO for Taupo/Tūrangi and a small HSS service for Rotorua (0.8 RN
and 0.8 Kaiāwhina).
Hauora a Toi: $296,800 bulk funded contracts to PHOs. These contracts are under review.
Waikato: $720,496 bulk funded contracts to PHOs.
Tairāwhiti: Small HSS Service, bulk funded for three days per week (0.6 RN and 1.0 kaiāwhina).

OIS  funding excludes the Fee for  Service  (FFS)  being paid to general practice and pharmacy for
delivering immunisations. The current FFS rates for general practice and pharmacy are $36.05 for the
first vaccine given to an Eligible Service User, and $20.52 for the second vaccine, if more than one
vaccine is given on a single day.
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Leadership and coordination of immunisation services
Regional and local leadership and coordination of immunisation services is an important function to
pull together the various parts of the immunisation system. Even more so now that there are a number
of new immunisation providers and contracting arrangements. Prior to COVID-19, the leadership and
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coordination of immunisation services within each local area was led by the Portfolio Manager for
child and maternal health within Planning and Funding. During COVID-19, local SROs were established
to support with the large-scale vaccination rollout and  onboarding of many new immunisation
providers. However, as these COVID-19 funded services have pivoted to childhood immunisations, the
local SRO role has also moved to support with coordinating childhood immunisation services.
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The level of collaboration  between primary care providers, Te Aka Whai Ora and Te Whatu Ora
providers varies across the region. Waikato hold the Waikato Immunisation Network and have regular
cluster meetings with providers. Taranaki and Lakes hold fortnightly stakeholder meetings among
providers to discuss childhood immunisations, although Lakes are reviewing this currently.  While
Hauora a Toi and Tairāwhiti are developing their stakeholder relationships.

There are no local areas that regularly, formally connect with community organisations such as Te
Rōpū Wāhine Māori Toko i te Ora (Māori Women's Welfare League), or community midwives/Lead
Maternity Carer’s (LMCs) on immunisation. The involvement of local public health services also varies
across the region. The Medical Officers of Health sign off vaccinator authorisations, and in some cases
support with education sessions for vaccinators, complete standing orders for providers, and attend
Information
local steering groups or provider networks.

Most local areas have relationships with local schools and kura through the SBIP, but not al  regularly
connect in with early childhood education centres (ECE) and kōhanga reo. WHIRI Hapori (Waikato)
have recently run a pilot programme delivering immunisations to tamariki and the wider whānau
during drop off and pick up times at ECEs and kōhanga reo with success. They are looking to upscale
this initiative, and there is potential to roll it out across the region.

Official
Despite local public health services across Te Manawa Taki being minimally involved in immunisation
services prior to COVID-19, the National Public Health Service (NPHS) National Director has specified
that regional leadership, accountability, and coordination of immunisations services will now sit with
the NPHS Regional Directors. A national review is also underway considering where PHN teams should
the
sit within the system, with one option being a move to the NPHS. Both of these developments have
been factored into the recommendations in this report.

under

Released

Whānau voice
Below are the aspirations and solutions proposed by whānau for the immunisation system, grouped
under key themes. Refer to Appendix 3 for the full Whānau voice document.

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Cost
Availability and accessibility
•  All staff across the system recognise their role
•  A system in which enrolment/engagement with
in creating spaces for whānau to feel welcome
primary care is not a prerequisite for access to
accessing services (this includes administrative
immunisation services
Act
staff and clinical staff)
•  Services  that  bring  whānau  to  them,  and  take
•  Under-served communities are prioritised for
services to whānau when/as required
services that have fewer costs to the whānau
•  Services that provide flexible options for
(travel and time costs)
location, hours, days
o  e.g. pop-up clinics to provide delivery of
immunisations at kohanga reo as
whānau bring children into the service,
or before pick-up times
o  e.g. delivery of antenatal and neonatal
immunisations from Lead Maternity
carers or Well Child Tamariki Ora
providers who have an established
Impact of the Covid-19 pandemic,
relationship with the whānau
Information
vaccination rol  out and associated mandates
•  All  whānau  receive  pre-call and re-call
•  Whānau are provided with clear and evidence
information that supports timely immunisation
based information
•  Services that see immunisation as an
•  There is space to ask questions without
opportunity for engagement and not just a
judgement, and clear explanations are
transaction
provided
•  Communication via a range of methods works
•  Whānau  are  treated  with  empathy  and
best – including texts, calls, emails, social media
respect, and continue to be supported even
posts, etc
Official
when they choose not to immunise

the
Relevance to the need or perceived need of whānau and communities
•  Services that recognise whānau are ‘kaitiaki for their tamariki’
•  A workforce that has more Māori and Pacific practitioners and vaccinators
•  Messaging, information packs and media campaigns designed for and by Māori or Pacific whānau, including
in te reo Māori, other Pacific languages and other modalities such as video
o  Careful choice of messengers
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o  No guilt or fear-based messaging
•  All whānau receive appropriate and timely pre-calls/re-calls for immunisation
o  Communication is via a range of methods works best – including texts, calls, emails, social media
posts etc
•  Whānau questions are welcomed and are respected with time and clear, honest answers
Released

Manaakitanga and Cultural safety
•  Enough time for whanaungatanga
•  Immunisation services that welcome whānau and make it easy to attend and/or access services because
there is manaaki, time and care
•  Whānau feel genuinely valued and cared for, the interaction is not just about the vaccination
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•  Services that include and provide for all whānau health and wellbeing needs
•  Immunisation services that prioritise a positive experience for whānau
•  Providers who do more than just vaccinate – providers that see and respond to whānau needs and act as
connectors to other services.
Act
•  Vaccinators  that  understand  the  needs  of  whānau  with  disabled children and have both time for
specialised appointments, and can access expert support when required (e.g. play therapists)
•  Adults with disabilities can easily access outreach services for immunisations for themselves and their
dependents
•  Services that bring whānau to them, and when required take services to whānau
•  Healthcare workers that have time to talk, answer questions and build relationships
•  Feedback is listened to, services are responsive, and whānau have a way to shape the design and delivery
of services
•  Relationships are maintained, even when whānau choose not to immunise
•  Services that demonstrate that they value Māori culture and language (or Pacific cultures and languages)
through the physical environment, staff, language, resources, processes, acceptance of rongoa etc
•  Staff across all providers have good pronunciation of te reo Māori and understand tikanga
o  Names are pronounced with care and respect
Information
•  Vaccinators respect the process of gaining informed consent and shared decision making
•  Disabled people are involved in decision making for their own health

Provider and Professional Views
During the engagement phase, a number of high-level themes  came through  from providers and
professionals that were consistent across the region, and many aligned with findings in the Taskforce
Official
Report and Lakes DHB OIS review  (4, 7).  It also became clear that the current system creates
unnecessary barriers for providers and limits their ability to reach and best serve whānau. System gaps
were also identified, including a lack of:

the
-  Clear leadership and coordination
-  Workforce development
-  Communications and health promotion
-  Meaningful reporting on services
-  Data and digital support.

There was also a wealth of information shared by partners and providers about how immunisation
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services could be better delivered within their local area. Including specifics around contracting and
solutions proposed about how to coordinate and collaborate locally. Although not reflected in this
report, that local information will be used to progress some of the recommendations below and will
be shared by the project team where relevant.

The following sections outline high-level themes from  the discussions held with immunisation
providers, contract managers and other sector experts across Te Manawa Taki. Noting that this list is
not exhaustive, and although many themes were shared by multiple providers, they may  not  be
applicable to all.

Released

General Immunisation Delivery
•  Immunisations  should  be  part  of  a  wider  wrap  around  service  for  whānau  -  a  whānau  ora
approach. Everything preventative should be a priority but so should health education and literacy
– making whanau confident with their own health.
•  Immunisation education and delivery needs to be provided by the ‘right faces’ in the ‘right spaces’.
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Ideally by Māori and Pacific staff from the same community, in a wellness setting.
•  All immunisation providers should have an after-hours  component to their delivery, including
Primary Care.
•  A number of Hauora Māori partners and Pacific providers describe ‘intentionally offering services
Act
differently’. They’ve continued with lessons learnt from Covid-19, provide options and deliver
wherever it makes sense for whānau.
•  Access to primary care is currently a significant issue for whānau:
-  If they’re able to be enrol ed there is still often a significant wait for appointments
-  A large number of practices have closed books
-  In some cases, if people return from prison, they’re unenrolled from practices
-  There are other large access barriers such as debt, requirement for birth certifications or
‘judgements’ that mean a significant number of whanau can’t safely access primary care.

Antenatal Immunisations
•  Midwives have trusted relationships with hapū māmā and should be able to deliver antenatal
immunisations and ideally babies six-week immunisations.
•  Currently midwives are not adequately funded to provide these services and would have no way
Information
to claim back administration costs.

Outreach Immunisation Services
•  Currently, some tamariki are referred to OIS, are immunised, and then referred back to primary
care for subsequent immunisations. If primary care are unable to immunise again, another referral
is sent to OIS. This results in a ‘cycle of referrals’, with tamariki being consistently overdue for
immunisations. Whānau should have the choice about whether to be referred back to general
practice or stay with OIS.
Official
•  OIS needs to be available outside of business hours and would be best suited to sit within Hauora
Māori partners and Pacific providers, who already have relationships with priority communities.
•  The number of recent changes to the immunisation schedule, in particular the addition of Bexsero
has been extremely challenging. Bexsero requires an 8-week gap between doses and
the
incorporating that into a ‘catch up’ programme, including ensuring access to paracetamol is
difficult.

School Based Immunisation Programme
•  The SBIPs rely on paper-based consent and recording processes. Most nursing teams have little to
no technology to support delivery and on occasion this results in children receiving additional
vaccine, as the child and/or parent forgets if they have received it between the time of consent
under
and its delivery at school. The SBIP should be supported with an electronic consent process, the
ability to status check on site if needed, and recording of immunisation delivery electronically in
real time.
•  Al  SBIPs should be adequately funded to offer appropriate and engaging education and related
activities that support the building of trust between students and nurses.
•  During the Covid-19 response delivery of SBIP’s was stopped. This, as well as mandates, has
impacted relationships between SBIP and schools. Some school boards are not allowing the SBIP
into the school, and others there is very low support, which corresponds with low rates of consent
return/general uptake of the programme.

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Workforce and System Support
•  The immunisation landscape locally and regionally needs oranga governance3, support and
oversight.
•  The kaiāwhina workforce is currently undervalued by the system and needs to have a consistently
recognised place within the immunisation landscape, including career pathways. This workforce
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is often the ‘pou’ for the whanau and the system needs to value them accordingly.
•  Whanau voice needs to lead system improvement and innovation.
•  Data access is a significant barrier that undermines programme effectiveness. Providers would like
to be able to access timely, reliable data in real time.

Act
Commissioning and Funding
•  Contracts and reporting requirements should recognise and value all of the work that Hauora
Māori  partners  and  Pacific  providers  do,  not  just  the number of  immunisations given (e.g.
contracts that recognise relationship building, health promotion and education, and connecting
whānau in with other health and non-health services).
•  Hauora  Māori  partners  and  Pacific  providers  would  prefer  to  deliver more childhood
immunisations, either through formal OIS contracts or at a minimum have the ability to claim back
administration costs for opportunistic immunisations.
•  The  system should provide,  for  any  potential  opportunistic providers, funding for onboarding
costs as well as the ability to claim back administration costs. This would  include sole nurse
operators, WCTO/Plunket, LMCs etc.
•  Short term contracts are limiting their ability to recruit and retain staff. Long-term, sustainable
Information
contracts are required to properly build an immunisation programme.
•  Contracts for childhood immunisations shouldn’t be siloed. Any interaction with whānau is an
opportunity to provide all of whānau vaccinations as well as whānau ora wrap around care.
•  Currently a number of Registered Nurses are employed within Te Whatu Ora immunisation teams
and work in or alongside partners and providers to deliver immunisations. Feedback received is
that partners and providers would prefer to be appropriately resourced to hire their own staff. It
was noted that in some instances utilising Te Whatu Ora nurses created problems within team
cultures due to different contracting arrangements and ways of working.
Official
•  Throughout and since the Covid-19 response demand for OIS has increased significantly with little
to no increase in baseline funding.

Aspirations for the future immunisation system
the
Based on the findings from whanau voice and discussion with providers and sector experts, the
following aspirations for the future system have been identified:

Antenatal Immunisations
Education for the whole whānau about immunisations begins during the antenatal period.
under
Māmā and pēpi enrolment into primary care starts during the antenatal period.
Hapū māmā are able to receive their antenatal immunisations without an appointment, and outside
of business hours in a place that works for them.
Messages are delivered by those with a trusted relationship and are part of a wider conversation
around wel ness and protection, with parents being guardians or kaitiaki of their pēpi.
Māmā and pēpi experience wrap around and coordinated care with a clear handover from LMC to
primary care and WCTO provider.

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Whole of whānau immunisations
Immunisations are provided as part of a wider wrap around service for whānau by trusted faces and
in spaces they feel comfortable - a whānau ora approach covering the full lifespan.
Whānau are empowered with information about how to protect their pēpi and wider whānau,
1982
including information about the immunisation schedule, when immunisations are due, and where
they can walk in or book in for immunisations.
Whānau have options outside of primary care, including immunisation delivery in a wellness setting
by their WCTO provider, Hauora Māori partner or Pacific provider, ECE’s, kohanga reo and outside
Act
of business hours (including evenings and weekends).
All interactions with the health system are culturally safe, accessible, and provide an opportunity
for education and delivery of immunisations.
Relationships with providers are maintained even when whānau choose not to vaccinate.
Outreach immunisation services are coordinated locally and are mobile and proactive when
needed.

Leadership and coordination
There are clear lines of leadership, accountability, and coordination of immunisation services.
Immunisation coordinators and NIR teams can share best practice and support across the region as
Information
needed.
Co-governance2 structures for immunisations are in place at both local and regional levels.
All immunisation service partners and providers have access to Oranga governance3 and oversight.

Workforce development
Official
The workforce reflects the communities they are serving, with an increase in the number (and
proportion) of kaimahi Māori and Pacific kaimahi.
Kaimahi working in the community are as valued as their secondary care colleagues.
Workforce development and training opportunities include reception and administration staff and
the
non-regulated health workers
Vaccinators are supported to develop a range of skills and can provide more than immunisations
during interactions with whānau (e.g. blood pressure checks, blood tests, support with bowel and
cervical or HPV screening, etc).
Vaccinator training is culturally safe for staff attending.
under
Clinical assessment is not a limiting step for sign-off of fully authorised vaccinators, and Hauora
Māori partners and Pacific providers are able to sign off their own vaccinators.

Communications and health promotion

2 Co-governance refers to a shared governance arrangement - with representatives of tāngata whenua on one
side, and representatives of tāngata tiriti on the other, operationalised by co-chairing, each side having equal
voting rights at the decision-making table for better outcomes for Māori.
3 Oranga or ‘wellness’ governance refers to governance that includes the wider determinants of health, not just
clinical governance.
Released

Increase in public facing communications and awareness regarding immunisations.
Messaging, information packs and media campaigns designed for and by Māori and Pacific whānau,
including in te reo Māori, other Pacific languages and other modalities such as video. With careful
choice of messengers, and no guilt or fear-based messaging.
1982
National communications and collateral are adapted to the local context.
Staff providing education and delivery of immunisations are comfortable and confident discussing
the benefits and risks of immunisations and answering questions from whānau, and know where to
access accurate information or to seek advice.
Act

Meaningful reporting on services and Data and Digital support
Reporting systems capture engagement with whānau (including linking with other health and non-
health services), and whānau experience of services - not just the number of immunisations given.
All Hauora Māori partners and Pacific providers have access to timely and usable information on
immunisation gaps including patient level information, and the ability to status check in real time.
Data is up to date and reliable, and provided in a format that is easy to understand and useful.

Information
Official
the
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Recommendations for the Future State
A number of actions need to be taken in order to achieve the aspirations outlined above for an
immunisation system that is sustainable into the future and demonstrates a commitment to Te Tiriti,
achieving equity and the aims of Te Pae Tata. Considering the project objectives, guiding principles,
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feedback and aspirations outlined above, the following key recommendations have emerged:

•  To increase options and accessibility for whānau, it is recommended that a greater number of
immunisations providers  are  contracted  and/or  funded to deliver both adult and childhood
Act
immunisations. This includes LMCs, WCTO providers, Hauora Māori  partners,  and  Pacific
providers.
•  Given tamariki Māori and Pacific tamariki have higher rates of missed primary vaccination (4, 7),
and the importance of having the ‘right faces’ in the ‘right spaces’, it is recommended that all OIS
contracts are shifted to Hauora Māori partners and Pacific providers, supported by the fol owing:
-  Realigning OIS contracts to planned and opportunistic services
-  Providing contracts that are long-term, sustainable and holistic (ideally 3-5 years with right of
renewal)
-  Professional development pathways to support and grow the Māori and Pacific clinical and
non-clinical workforce
-  Access to timely and usable immunisation data
•  To enable tino rangatiratanga, it is recommended that education packages and communications
are developed for both providers and whānau, so that whānau are empowered with information
Information
about the benefits and risks of immunisations, when immunisations are due, and where they can
access services to make an informed choice.
•  To ensure all communications and services are accessible, it is recommended that an
immunisation strategy is co-designed with tāngata whaikaha to deliver equitable immunisation
outcomes and experiences for disabled people and their dependents.
•  For regional efficiency and collaboration, it is recommended that Immunisation coordinators and
NIR teams begin working collectively, alongside NPHS and across the region, to share best practice,
innovation, and workload when needed.
Official
•  Acknowledging that immunisations will continue to sit right across the health system, there will
need to be continued collaboration across/between, Te Aka Whai Ora and Te Whatu Ora
Commissioning teams, Pacific Health, HSS, and the NPHS. A  regional immunisation lead4  is
recommended to support with collaboration across the system and regional coordination of the
the
immunisation programme.
•  To provide stability in the system and local coordination of services, it is recommended that there
is a permanent local immunisation lead5 in each local area. There would be efficiency gained by
the  local  leads  being in the same part of the system as the regional immunisation lead,
Immunisation coordinators and NIR teams. Feedback received was that to align with regional
accountability for immunisations, these roles would be best placed within NPHS.
under

4 It is proposed that the regional immunisation role would be responsible for regionally coordinating
the immunisation programme, co-chairing the regional immunisation group, and information sharing
between the local leads, RIT  and National Immunisation Programme.  Note:  an interim regional
immunisation lead has recently been appointed within the NPHS.
5 It is proposed that the local immunisation lead would be responsible for coordinating planned and
opportunistic immunisation services at a local level, reporting on local activities in the Work Plan,
information sharing between the regional immunisation group and local providers, co-chairing the
local operational forum, and be a key local point of contact for the regional immunisation group.

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•  To enable partnership across the system, it is recommended that a co-governance2 structure is
established for both local and regional immunisation groups.  This is discussed in more detail
below.

Proposed Regional and Local Immunisation Groups
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Regional and local immunisation  groups  would be  responsible for ensuring the immunisation
programme is fit for purpose, coordinated and continually improving.

It is recommended that, where these don’t exist, local operational groups are established and co-
Act
chaired by the local immunisation lead and a representative elected by local Hauora Māori partners.
Membership and size of operational groups would be determined locally and may change as localities
are established,  to reflect a locality approach to services. The purpose of these groups are to
coordinate planned and opportunistic immunisation services locally, deliver on local activities in the
Work Plan, problem solve operationally, and escalate risks and issues as needed to the regional
immunisation group (via the local lead). Membership could include: Hauora Māori partners, Pacific
providers, primary care, pharmacy, midwives, WCTO providers, PHNs, immunisation coordinators, NIR
team, Medical Officer of Health, health promoters, communications.

The current regional immunisation group (‘Immunisation Collaborative’) to remain in place, but
membership reviewed to ensure it allows for collaboration across the system and is fit for purpose.
The purpose of this group is to provide operational leadership and direction for the regional
immunisation system. This includes monitoring progress against the Work Plan and immunisation
Information
indicators, problem solving and escalating risks and issues as needed to the RIT and National
Immunisation Programme. Regional monitoring of the immunisation system wil  be equity focused,
including equity-based indicators, and decision-making that directs resource to areas of greatest need.
The RIT would provide overall governance at a regional level. National governance structures are still
under development and how these will interact with regional and local immunisation groups in future
is still unclear.

It is recommended that information flow, reporting and escalation of issues occurs from providers to
Official
the local operational group, from the local operational group to the regional immunisation group via
the local immunisation leads, and from the regional group to the national team and RIT via the regional
immunisation lead (and vice versa).

the
Figure 3: Proposed regional and local immunisation groups and lines of communication
under

Released

Specific Recommendations and Next Steps
A number of more specific recommendations were identified by the project team to work towards
achieving the immunisation system aspirations. In some cases, these recommendations are already
being progressed by other parts of the health system (e.g. Kahu Taurima workstreams, NIP taskforce
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workstreams, and others). Where known, specifics about what is being progressed and by whom have
been outlined below.
Progressing some of the recommendations will require a phased approach. These are captured under
Suggested next steps, with Phase 1 and Phase 2 actions. Phase 1 actions are those already underway,
Act
or are able to be progressed in the short-medium term and are significant enablers. Phase 2 actions
are those that are either, reliant on Phase 1 actions in order to progress, or are not significant enablers
and therefore not prioritised.  Although suggested next steps  and actions  are outlined below,
ultimately these wil  need to be determined by those responsible.

To align with system aspirations, the recommendations and actions are grouped under the same
headings:
•  Antenatal Immunisations
•  Whole of Whānau Immunisations
•  Leadership and Coordination
•  Workforce Development
•  Communications and Health Promotion
•  Meaningful Reporting on Services and Data and Digital Support
Information

Official
the
under
Released

link to page 35
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Antenatal Immunisations
Recommendations
Responsible
Suggested next steps

Act

Phase 1
Phase 2
Enable Lead Maternity Carer’s (LMCs) to

provide vaccinations
•  When Te Whatu Ora is acting as  HSS
HSS maternity teams in each local area to
the lead maternity carer there are
determine.
robust processes in place to
ensure antenatal vaccinations are
offered
•  Mixed model contracting
NIP  (NPHS)  and  The NIP are working with Kahu Taurima to
approach with retainer and pay  Kahu Taurima develop  a  Pay Per Dose (PPD) funding
per dose,  and  funding to cover  Commissioning  arrangement and an onboarding package as  Information
time  LMCs  spend  attending  workstream
the first step for both LMC’s and Plunket.
training, education courses and
Approximate timeframe – by June 2024.
operational groups

Explore options for funding to cover
attending local immunisation operational
groups.6
•  Support access  to cold chain,  NPHS
Regional  immunisation  lead to lead the  When PPD funding arrangements are in
either set up within their clinic
following process:
place, support access to cold chain (and
Official
rooms or partnered with a cold
1)  Identify LMCs who would like to provide  immunisation ordering, etc) for all LMC’s.
chain provider close by (e.g. local
antenatal immunisations, even without  Prioritising  Māori  and  Pacific  midwives,
pharmacy or general practice)
PPD funding arrangements, or would like  and those located in areas with high Māori
the
to be partnered with a vaccinator. This  and Pacific populations.
could be supported through the NZ
College of Midwives regional meetings.
2)  Through the Immunisation Collaborative,
identify staff in local teams who could
support coordinating access to cold chain
under

6 Consider extending this model to others who currently serve priority groups that are not funded by health (e.g. disability providers, iwi/hapū representatives, Māori Womens
Welfare league, etc).

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1982
for LMCs
and/or coordinating
vaccinators.
Act
Antenatal Education

•  Education packages are provided  TBD
Working with IMAC, explore whether
to  LMCs  to ensure they feel
education packages  could be supported by
comfortable and confident
NPHS staff.
delivering and discussing
immunisations with whānau
•  Midwives are supported by NPHS  NPHS
As above.

staff to deliver immunisation
education  during  hapū  wānanga
and antenatal classes
Improved System Integration  and

Information
Engagement with Primary Care
•  20-week scan is an opportunity to  Kahu Taurima  Kahu Taurima to determine.

encourage antenatal
Commissioning
immunisations  and  direct  hapū  workstream
Regional communications resource could be
māmā  to  an  immunisation
used to support with providing information to
provider, e.g. local pharmacy
hapū māmā attending 20-week scans.
•  All outpatient antenatal clinics  HSS
HSS to develop a process where this is not
include education and delivery of
already in place. Suggest starting with
Official
antenatal immunisations.
antenatal clinics and paediatric outpatient
Also recommend having
clinics, followed by  paediatric  inpatient
processes in place to offer
wards,  and  B4school checks as a starting
the
opportunistic immunisations to all
point.
attending HSS services, including
outpatients, ED, and inpatients.
•  Improve  timely  notification of  NPHS and Data  The NIP are working with Manatū Hauora to  Explore how this information could be
pregnancy and birth to primary  and Digital
establish a database of pregnant people with  linked to notify primary care, Hauora Māori
care, Hauora Māori partners and
the aim of linking this to  antenatal  partners and Pacific providers.
Pacific providers
immunisation data. Timeframe - ??
under
Commented [KG1]: Check with Rob

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1982
•  Funded third trimester GP visit for  Kahu Taurima  Kahu Taurima are already  exploring this
Māori,  Pacific,  and  tāngata  Commissioning  option. Timeframe - ??
Act  Commented [KG2]: Check with Sarah Nash/Nicky Nelson.
whaikaha (self-identified). The workstream
visit could be with a practice nurse
and  include a discussion about
immunisations (antenatal and
childhood), delivery of antenatal
immunisation, whānau enrolment
(if not already enrolled), and start
the newborn enrolment process,
with pre-call scheduled for 6-
week immunisations.
Information
•  Funded postnatal in person Kahu Taurima  Kahu Taurima are already  exploring this
handover between LMC, WCTO,  Commissioning  option. Timeframe - ??
Commented [KG3]: Check with Sarah Nash/Nicky Nelson.
and general practice (for  Māori,  workstream
Pacific,  and  tāngata  whaikaha),
ideally in a wellness setting

Official
Whole of whānau immunisations
Recommendations
Responsible
Suggested next steps

Phase 1
Phase 2
the
Supporting Primary Care

•  Streamline the newborn
NIP (NPHS), HSS  The NIP are working on an enhanced
enrolment process.
and Commissioning  newborn enrolment system that wil  link
Including, notification to OIS (or
with HSS data to identify newborns and
alternative contact within the
ideally also pick up pēpi who have fallen
system) when a newborn  b-
off b-code enrolments (i.e, did not
code enrolment doesn’t
become fully enrolled by 3-months). This
under
convert to fully enrolled by 12-
wil  support with data but won’t change
weeks.
the enrolment process. Timeframe - ??

Commented [KG4]: Check with Rob

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1982

Suggest HSS and Commissioning work
Act
with primary care (including

receptionists/admin staff) to streamline
the enrolment process. Suggestions:

o  Information provided by HSS to

primary care includes parental

details (so that the practice can

accept newborns of enrolled  o  The ability to check eligibility for full
patients)
enrolment via a national database instead
o  Automatic  full  enrolment  for  pēpi
of relying on birth certificates.
whose parents are already enrolled  o  Providing birth certificates for free.
with the practice, and a 6-week check
Information
booked
•  Prioritise enrolment in PHO for  Living Well
Living Well Commissioning team to  Once a database has been established
Māori, Pacific and tāngata whaikaha  Commissioning
determine,  but this could be supported  identifying pregnant people, suggest support
team
by  a  kaiāwhina  contacting  whānau  of  enrolling with a PHO starts during the
tamariki unenrol ed on the NIR/AIR to  antenatal period.
support enrolment for the whole
whānau, discuss immunisations, and
options  for  where  whānau  can  access
Official
immunisation services.  A funded first
visit could support enrolment with
primary care.
•  A coordinated precall/recall system  NPHS and Data and
Investigate the potential for a coordinated
the
so that all whānau receive precalls  Digital
precall/recall system  for scheduling  of all
and recalls for immunisations via a
immunisations (not just those overdue).
range of communication methods,
including information about where
they can book or walk in
•  Develop a regional approach to  Living Well
Living Well Commissioning team to
under
resolving practice debt for priority  Commissioning
determine.
populations
team

Released

link to page 39
1982
•  Develop an environment that is  Commissioning
Suggest that training  and education
culturally safe and encouraging of
starts with receptionist staff within
Act
immunisations.  E.g robust anti-
general practice.
racism systems,  cultural safety
training, education about the
importance of immunisations, and
training around what is and isn’t
required for childhood
immunisations to be delivered, e.g.
not required to be enrol ed with the
practice.

Information
Outreach Immunisation Services7

•  Realign contracts to planned and  Commissioning
Commissioning to determine best
opportunistic services and ensure
approach.
contracts include coordination,
promotion and relationship
building, and an expectation of
service provision outside of
business hours.
Official
•  Shift OIS service delivery to Hauora  Te Aka Whai Ora  Suggest Te Aka Whai Ora  and Pacific  Review the distribution of current OIS resource
Māori  partners  and  Pacific  Commissioning
Health lead the following:
across the region and potentially redistribute
providers, supported by contracts  team, Pacific
1)  Identify providers who are already  to better reflect the size and location of priority
that are long-term, sustainable and  Health, NPHS
set up to provide an outreach  communities, taking into consideration
the
holistic (ideally 3-5 years with right
service, and would like to.
rurality.
of renewal). Contracts should also
2)  Identify providers who want to
allow for outbreak response.
provide outreach in future but
require additional support.
under

7 Note: The NIP are undertaking an outreach review of al  outreach services (including OIS and the SBIP). This wil  be completed early 2024. However, the NIP recommend
progressing with recommendations in this report and not waiting for the review to be completed.

Released

1982
3)  Prioritise providers located in areas
where there are currently gaps in
Act
service delivery and/or low
immunisation  coverage  for  Māori
and Pacific.
4)  Start shifting OIS contracts out to
Hauora  Māori  partners  and  Pacific
providers but with a transition phase.
Transition funding required to cover
set  up  costs  for  Hauora  Māori
partners and Pacific providers while
current OIS continues.

Information
NPHS could support with coordinating
training days and clinical sign off for staff
to become fully-authorised vaccinators.
•  Create a process to bring online  Commissioning and  Suggest a similar process outlined above
more opportunistic vaccination NPHS
to Enable Lead Maternity Carer’s (LMC’s)
services and maintain a relationship
to provide vaccinations.  Including,
with opportunistic service providers
contracting arrangements, access to cold
e.g.  tāngata  whaikaha  service  and
chain, etc.
Official
mental health service, WCTO, LMCs,

B4school checks
Relationship and local coordination with
opportunistic immunisation providers
would be maintained through the local
the
immunisation lead, and where relevant,
attending local operational groups.
•  All partners and providers have  NIP and Data and  The AIR rollout is underway and will allow  Once AIR rol out is complete, check in with
access to immunisation data and  Digital
for status checking in real time. Need to  partners and providers to identify what else
can status check in real time
ensure all partners and providers have  could be better supported in terms of data
access to AIR.
access.
under

Released

link to page 41
1982
NIP are working on live GIS mapping of
immunisation coverage that can be used
Act
by providers. In the meantime, access to
the National Childhood Immunisation
Dashboard could be supported through
screen sharing at local operational
groups, or screen shots of the dashboard
being sent to partners/providers if they
would find this helpful. Local leads to
support as needed.
Hospital and Specialist Services

•  Increase vaccination rate amongst  HSS
HSS to determine.

Te Whatu Ora employed clinical
Information
staff
•  Enforce robust anti-racism systems  HSS
HSS to determine. Suggest training starts
including compulsory Te Tiriti
with PHNs given their involvement in
training for all staff and racism
B4school checks and the SBIP.
reporting mechanism –  wider
system and deliberate action.
Starting with staff regularly
delivering immunisations.
Official
School-Based Immunisation

Programme8
•  Update processes to enable catch  HSS and NPHS
This needs further exploration, but could
up immunisations as part of the
involve  partnering  with  Hauora  Māori
the
SBIP.
partners and Pacific providers to provide

catch-up immunisations while PHNs are
completing the SBIP. Potential for: whole
of  whānau  immunisations  at  the  same
time;  providing  catch  up  immunisations
across all year  groups;  and  at  ECE’s  or
under

8 Note: The NIP have completed a review of the SBIP, pending report in the next month which may assist with next steps.

Released

1982
kohanga reo where these are associated
with a school.
Act

Not all PHN’s are authorised to deliver
the ful  suite of childhood immunisations
(e.g. six weeks to two years). NPHS could
support with providing additional
training and coordinating clinical sign off
(along  with  staff  from  Hauora  Māori
partners and Pacific providers).
•  Consent process is digitalised, NPHS
NIP are working on a digital solution for  The NIP are also looking to incorporate the
straightforward and easy for
the consent process. Timeframe – aiming  school based patient management systems
whānau
for Term 3 or 4, 2024.
into the AIR (noting these weren’t included in
Information

the minimum viable product for AIR).

•  Immunisation data is up to date and  NPHS
Await findings from the SBIP review.

staff can status check in real time.
This would require technology so
that PHN’s have access to the AIR
while at schools. E.g. laptops and
internet.
Official
•  Increased number of kaimahi Māori  NPHS
NPHS  to  identify  kaimahi  Māori  and
and Pacific kaimahi are involved in
Pacific kaimahi that could partner with
both education and delivery
the PHNs to support the SBIP.
the
Tāngata whaikaha

Co-design  actions  with  tāngata  NPHS
A lead from the Immunisation
whaikaha to deliver equitable
Collaborative has been identified to take
immunisation outcomes and
this work forward, building on learnings
experiences for disabled people and
from the Disability Capability workshop.
their dependents
under

Released

link to page 30
1982

Act
Leadership and Coordination
Recommendations
Responsible
Suggested next steps

Phase 1
Phase 2
Coordination

•  Immunisation coordinators and NIR  HSS
Start bringing the immunisation
teams begin working col ectively
coordinators and NIR teams together
across the region to share best
across the region. This could be facilitated
practice and innovation.
by the regional immunisation group.
•  Where possible, leadership,  Commissioning,
Suggest identifying or establishing in Te  Consider the best place for leadership,
accountability, and coordination  HSS and NPHS
Whatu Ora, a permanent local accountability and coordination roles to sit
structures/roles are made
immunisation lead within each local area,  within the system, ideal y within the same
permanent (e.g. regional and local
and a permanent regional immunisation  business unit (e.g. regional and local
Information
immunisation leads), and sit within
lead to support with regional immunisation leads, Immunisation
the same business unit of Te Whatu
coordination. Note: An interim regional  coordinators, and NIR teams)
Ora.
immunisation lead has already been
appointed within the NPHS.
•  Contracts specify the need for Commissioning
This may already be in place in the service
collaboration and coordination
links clause of contracts.
Commented [KG5]: Check with commissioning leads
between community providers and
Official
partners.
•  Hauora  Māori  partners  and  Pacific  Te Aka Whai Ora  Te Aka Whai Ora and Pacific Health to
providers  delivering immunisation  and Pacific Health  determine.
services  have access to Oranga

the
governance3 and oversight.
As OIS contracts move out to Hauora
Māori partners and Pacific providers, this
process could involve ensuring Oranga
governance and oversight is in place (in
some cases, partnering with other
providers who can provide that support,
under
or a local collective of providers).
Local and Regional Groups

Released

1982
•  Local operational groups are Te Aka Whai Ora
Local immunisation leads to work closely  As localities are established, review local
established, co-chaired by the local
with Te Aka Whai Ora and the Hauora  operational group size and makeup. It may
Act
immunisation lead and a
Māori Relationship Leads to progress this  also be appropriate for operational groups to
representative elected by local
action. In some cases local operational  expand to include more than just
Hauora Māori partners.
groups are already in place, and may just  immunisations, e.g. other prevention services
need to be reviewed to ensure they are fit  such as screening, etc. This would reduce
for purpose.
siloing of services, and interactions with
providers.
•  Regional immunisation group NPHS
Review current membership and Terms of  As above, it may be appropriate for this group
(currently the Immunisation
Reference.
to expand to include other prevention services
Collaborative)
membership
is
(not just immunisations).
reviewed.
Communication

  Information
•  There are clear communication NPHS
Establish a process for ensuring
channels within and between Te Aka
information flows as agreed (including
Whai Ora and Te Whatu Ora that
between national, regional and local
ensures local relationships are
groups as outlined above under Proposed
appropriately maintained.
Regional and Local Immunisation Groups).

Workforce development
Official
Recommendations
Responsible
Suggested next steps

Phase 1
Phase 2
•  Pay parity between primary and secondary care
Te Aka Whai Ora  Commissioning to determine.

and Te Whatu Ora the
Commissioning
•  Professional development pathways are in place  Te Aka Whai Ora  Te Aka Whai Ora Commissioning and
for kaimahi Māori and Pacific kaimahi (for clinical  Commissioning  an  Pacific Health to determine.
and non-clinical staff, regulated and unregulated)  Pacific Health.
•  Hauora  Māori  partners  and  Pacific  providers  are  Te Aka Whai Ora  Te Aka Whai Ora Commissioning and
supported with workforce pipeline planning.
Commissioning an Pacific Health to determine.
under
Pacific Health.

Released

1982
•  Vaccinator training is delivered as part of a  NPHS  and Te Aka  NIP already progressing this with Te  There is also a  review
Kaupapa Māori immunisation education package,  Whai Ora
Aka Whai Ora.
underway of the immunisation
Act
with Kaupapa Māori educators.
An EOI process is underway to broaden  clinical quality training and
access to training,  to ensure  a  more  support functions (currently
equitable training service is  being  provided by IMAC). The
provided,  including  Kaupapa  Māori  findings  are due June 2024,
education packages.  The intention  is  with new contractual
that it is in place from 1 March 2024.  arrangements in place from
Ideally training offered in a range of  Jan 2025.
ways - virtually and in person.
•  Kaupapa  Māori  Nurse  Educator  positions  are  NPHS  and Te Aka  This is built into the  EOI process
established and recruited to, to support the  Whai Ora
outlined above.
vaccinator workforce across Te Manawa Taki
Information
•  The process for clinical sign-off of authorised  NPHS
Regional immunisation lead to work  If clinical sign off isn’t limited
vaccinators is reviewed, including whether this
with the NIP and IMAC to determine  to immunisation coordinators,
needs to be an immunisation coordinator
whether  clinical sign off needs to be  identify staff in each local area
done by an immunisation coordinator.  who can perform clinical sign
If not, identify process to upskill  off and partner with providers
vaccinators  in  Hauora  Māori  partners  that don’t.
and Pacific providers so they can
clinically sign off their own staff.
Official
•  Review the title ‘Immunisation  Coordinator’ and  TBC

propose a new name that better reflects the
current function of technical expertise and support
the

Communications and Health Promotion
Recommendations
Responsible
Suggested next steps

Phase 1
Phase 2
•  Local health promotion teams support LMCs,  NPHS
Identify staff within NPHS that could
under
WCTO providers, the School Based Immunisation
support with this.

Released

1982
Programme,  and  hapū  wānanga  and  antenatal
Then, working with LMCs, PHNs and
classes with immunisation education.
WCTO  providers, develop a plan in
Act
each local area around how NPHS staff
could best support. This may be
facilitated through local operational
groups  and/or the current planning
around reprioritising the PHN
workforce
to childhood
immunisations.
•  Establish a regional communications resource that  NPHS
Suggest identifying or establishing a
can  work closely with wider to Te Whatu Ora
permanent  regional communications
communications teams as well as  support  local
resource for immunisations.
partners and providers to adapt national
Information
messaging.  Feedback  would also be provided  to
the national team about what communications
would be useful for local communities.
•  Develop a regional communications strategy that  NPHS

Using the resource identified
ensures all communities across Te Manawa Taki
above, develop a regional
are empowered with information about how to
communications strategy,
protect their whānau from VPDs.
working closely with Te Aka
Whai Ora, Pacific Health, Hauora
Official  Māori  partners  and  Pacific
providers.  Ensure that the
strategy considers accessibility,
in  particular  for  tāngata
the
whaikaha.

Meaningful Reporting on Services and Data and Digital Support
Recommendations
Responsible
Suggested next steps

Phase 1
Phase 2
Meaningful Reporting on Services

under

Released

1982
•  Regional reporting systems established for NPHS and Data  Regional immunisation lead to work  Work  towards data and digital
immunisation priorities and governance.
and Digital
with Data and Digital to ensure, where  solutions that allow all
Act
possible, indicators for Te Manawa  indicators to be measured and
Taki are captured in the national  tracked over time, including
dashboard.
those  for  hapū  māmā  and

tāngata whaikaha.
For those indicators not currently
measurable, interim solutions to be
identified.
•  Pathways developed to col ect qualitative NPHS,
To be determined.

information  on  whānau  voice  and  experience  of  Commissioning
the immunisation system to support continuous  and  Data and
improvement,  including  experiences  of  tāngata  Digital
Information
whaikaha and access barriers/enablers.
Data and Digital Support

•  Data Sharing Agreements completed for all Hauora  NPHS (NIP)
NIP currently working on this–  to be
Māori partners and Pacific providers
completed in October 2023.
•  Access to the National Childhood Immunisation  NPHS (NIP)
See above under Outreach
Dashboard given to all Hauora Māori partners and
Immunisation Services  -  Al  partners
Pacific providers  to provide an overview of
and providers have access to
Official
immunisation coverage within their local area by
immunisation data and can status
SA2 level
check in real time.
•  Successful rollout of AIR and Whaihua with priority  NPHS (NIP)
NIP currently supporting with this.

the
to  Hauora  Māori  partners  and  Pacific  providers
(this includes the ability to status check in real
time)

under

Released

Monitoring and Immunisation Indicators
The regional immunisation group will be responsible for the overall monitoring and reporting of the
immunisation system across Te Manawa Taki. Summarised below are the Immunisation Indicators
that have been agreed to by the Regional Integration Team, and many of these align with the
recommendations above. The indicators are covered in more detail in Appendix 2, including
1982
identifying those that are currently measurable and those that are under development.

Service indicators:
•  The number of Hauora Māori providers funded to deliver immunisations.
Act
•  The number of authorised childhood vaccinators in Te Manawa Taki.
•  The number of authorised childhood vaccinators in Te Manawa Taki who are Māori or who
are Pacific.
•  The percentage of authorised vaccinators in Te Manawa Taki that have completed a Kaupapa
Māori immunisation education package.
•  The number of Kaupapa Māori Nurse Educators across the Te Manawa Taki region.
Enrolment indicators:
•  The percentage of Māori newborns and Pacific newborns fully enrolled with a primary care
provider by 12 weeks of age.
Immunisation Coverage indicators:
•  The percentage of Māori, Pacific, and disabled hapū māmā immunised against pertussis.
•  The percentage of Māori, Pacific, and disabled hapū māmā immunised against influenza.
•  The percentage of tamariki Māori, Pacific tamariki, and disabled tamariki, who met the 8-
Information
month age milestone within the three-month reporting period and are fully immunised.
•  The percentage of tamariki Māori, Pacific tamariki, and disabled tamariki, who met the 24-
month age milestone within the three-month reporting period and are fully immunised.
•  The  percentage  of  tamariki  Māori, Pacific tamariki, and disabled tamariki who are fully
immunised up to the four-year milestone.
•  The percentage of Māori children, Pacific children, and disabled children immunised against
HPV by school year cohorts.
•  The percentage of Māori and Pacific aged 55 years and older who are immunised against
Official
seasonal influenza.

Ongoing Immunisation System Quality Improvement and Innovation
the
Quality improvement is a key feature of successful health services. The establishment of new
operational and governance groups, monitoring and reporting systems are all instrumental for driving
quality improvement across the system. Additionally, establishing mechanisms to hear and
incorporate whānau voice and experiences will be critical for ensuring that immunisation services are
in fact meeting the needs of whānau and communities.

The newly established System Innovation and Improvement directorate within Te Whatu Ora present
under
an opportunity for collaboration, particularly in regard to progressing improvements to service
delivery and design, especially within hospital and outpatient settings.
Opportunities for Investment
Given a number of the recommendations are being progressed by various parts of the health system,
high level costings have not been provided. However,  it is recommended that any resourcing for
immunisations should be focussed on building a sustainable system and support with progressing the
recommendations above.

Released

Some initial areas for investment identified by the project team include:

Workforce
•  Funding to cover LMCs attending local immunisation operational groups. This would enable
LMCs to be involved in progressing recommendations locally, including linking LMCs with the
1982
team supporting cold chain access, identifying barriers and opportunities to support LMCs
delivering vaccinations, etc.
•  Training costs to support upskilling staff to become fully authorised vaccinators (Hauora Māori
partners, Pacific providers, WCTO providers, LMCs, and PHNs).

Act
Service Delivery
•  Funding to cover set up costs for Hauora Māori partners, Pacific providers, WCTO providers
and LMCs  to deliver planned and opportunistic immunisation services.  This funding could
cover cold chain set up (including fridges, chilly bins, etc), staff training and education, and
data and digital systems.
•  Transition funding for moving OIS to Hauora Māori partners and Pacific providers. For a period
of time, this will include funding staff FTE so that partners and providers can recruit into roles
and develop their immunisation programme, while current OIS programmes continue. Noting
that when contracts are provided for OIS, these should be long-term and sustainable.
•  Given the increase in referral numbers to OIS during and post-COVID, an increase in baseline
funding may need to be worked through in more detail. However, this will depend on the
impact of moving current OIS provision out to  community  partners and providers  and
Information
increasing the number of services providing opportunistic immunisations. It is recommended
that regardless, the distribution of current OIS resource across the region is reviewed and
potentially redistributed to better reflect the size and location of priority communities, taking
into consideration rurality.

Data and Digital
•  Several partners and providers articulated data and digital solutions as part of their ‘blue skies’
thinking. However, given the number of changes underway with AIR and Whaihua, and data
Official
sharing agreements, it is unclear at this stage what, if anything will be needed into the future.
Any data and digital solutions would need to be scoped and budgeted separately.

the
under
Released

References
1.
Te Whatu Ora - Health New Zealand, Te Aka Whai Ora - Māori Health Authority. Te Pae Tata -
Interim New Zealand Health Plan 2022 [Internet]. 2022 [Available from:
https://www.tewhatuora.govt.nz/whats-happening/what-to-expect/nz-health-plan/summary-of-
priorities-in-te-pae-
1982
tata/#:~:text=Summary%20of%20priorities%20in%20Te%20Pae%20Tata%201,Te%20Pae%20Tata%2
0Summary%20of%20Priorities%20%28English%29%20.
2.
Ministry  of  Health.  Te  Tiriti  o  Waitangi:  Ministry  of  Health,;  2020  [cited  2023  October].
Available from: https://www.health.govt.nz/our-work/populations/maori-health/te-tiriti-o-waitangi.
Act
3.
Minister of Health. Cabinet paper: Achieving pae ora through primary and community
healthcare [Internet]. Ministry
of
Health,;
2023
[Available
from:
https://www.health.govt.nz/system/files/documents/information-
release/cabinet_material_achieving_pae_ora_through_primary_care_redacted_for_pr.pdf.
4.
Te Whatu Ora -  Health New Zealand. Initial Priorities for the National Immunisation
Programme in Aotearoa 2022 [cited 5 May 2023. Available from:
https://www.tewhatuora.govt.nz/publications/initial-priorities-for-the-national-immunisation-
programme-in-aotearoa/.
5.
Te Whatu Ora -  Health New Zealand. Immunisation Coverage [Internet]. New Zealand
Government,; 2023 [updated 4 October 2023. Available from: https://www.tewhatuora.govt.nz/for-
the-health-sector/vaccine-information/immunisation-coverage/.
6.
Childhood Immunisation dashboard [Internet]. NPHS Intel igence -  Reporting & Analytics,
Manatu Hauora -  Ministry of Health. 2023 [cited 20 May 2023]. Available from:
Information
https://mohgovtnz.sharepoint.com/sites/CVIPDataAnalytics/SitePages/Children-
immunisation.aspx?xsdata=MDV8MDF8fDg3NzJhNTdhNzlhMzQ0MDU3ZGQ3MDhkYjUyOTI0MDQ5f
DIzY2VjNzI0NmQyMDRiZDE5ZmU5ZGM0NDQ3ZWRkMWZhfDB8MHw2MzgxOTQ1NjAzMDAzMTgxNj
d8VW5rbm93bnxWR1ZoYlhOVFpXTjFjbWwwZVZObGNuWnBZMlY4ZXlKV0lqb2lNQzR3TGpBd01EQWl
MQ0pRSWpvaVYybHVNeklpTENKQlRpSTZJazkwYUdWeUlpd2lWMVFpT2pFeGZRPT18MXxNVFk0TXpn
MU9USXlPRFkzTmpzeE5qZ3pPRFU1TWpJNE5qYzJPekU1T20xbFpYUnBibWRmVG5wS2FFOVhVWHBh
YWxWMFQwUkZlVTFwTURCTmJVVTBURmRKTTFsVVJYUk9iVXBxVG1wRmVFNTZaR3ROYlZsM1FIUm9
jbVZoWkM1Mk1nPT18ZjMyMGM4Mjg2YjQ2NDcxNDdkZDcwOGRiNTI5MjQwNDl8YzIwNzFkOWQxOT
Official
M3NDBjOWE4N2M1MTM1OTFkYzU3Zjg%3D&sdata=QzA2Z1B1citaRjY0ZW1Nc3lib3libTRzU1JKaVpid
nBJTUJGblkzWEpZcz0%3D&ovuser=23cec724-6d20-4bd1-9fe9-
dc4447edd1fa%2CKaitlin.Greenway%40health.govt.nz&OR=Teams-
HL&CT=1683859275773&clickparams=eyJBcHBOYW1lIjoiVGVhbXMtRGVza3RvcCIsIkFwcFZlcnNpb24i
the
OiIyNy8yMzA0MDIwMjcwNSIsIkhhc0ZlZGVyYXRlZFVzZXIiOnRydWV9.
7.
Everitt S, Stevenson S. Lakes DHB Outreach Immunisation Service Review. 2021.
8.
Pollard E, Young M. Summary Report Health Equity Assessment: Childhood Immunisation in
Taranaki. Taranaki District Health Board; 2017.
9.
Matheson K. Kōmiromiro: Shared experiences of the Te Tai Tokerau, Tāmaki Makaurau and
Waikato COVID-19 Māori and Pacific response teams and recommendations for the future operating
model of the National Public Health Service.; 2023.
under
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Clendon J. Te Waipounami Review of Covid19 Immunisation and Care in the Community. Te
Whatu Ora; 2023.
11.
Te Aka Whai Ora -  Māori  Health  Authority.  Iwi-Māori  partnership  boards  [Internet].  New
Zealand  Government;  2023  [Available  from:  https://www.teakawhaiora.nz/our-work/iwi-maori-
partnership-boards/.

Released

Appendix 1: New Zealand Health Strategies for Alignment
•
Protect, promote, and improve the health of all New Zealanders.
•
Achieve equity in health outcomes among New Zealand’s population groups, including by striving
Pae Ora (Healthy
to eliminate health disparities, in particular for Māori.
Futures) Act 2022
•
Build towards Pae Ora (healthy futures) for all New Zealanders
1982

•
Priority populations: Māori, Pacific and tāngata whaikaha
•
Implementing a population health approach
Te Pae Tata: Interim
Act
•
Place whānau at the heart of the system to improve equity and outcomes.
New Zealand Health
•
Implement a national y consistent system of data capture, analytics and intelligence that supports
Plan 2022
the use of health intelligence and insights to ensure equity of access and outcomes from all health

services across Aotearoa.

•
Children and families wil  be supported to have a healthy start to life.
•
The  health  system  will  work  in  partnership  with  Māori  in  the  leadership,  design,  delivery  and
The New Zealand
monitoring of services.
Health Strategy 2023
•
Action will be needed to ensure that people’s feedback and information on the experience of health

services are key indicators of success and underpin system monitoring and performance at all
levels.

Information
Pae  Tu:  The  Māori
•
Growing the Māori health workforce and sector to match community needs.
Health Strategy 2023
•
Ensuring accountability for system performance for Māori health

•
The health system grows and supports strong Pacific health leadership and a resilient health care
Te Mana Ola: The
workforce that reflects the population it serves.
Pacific Health Strategy
•
The health system better understands the needs and aspirations of Pacific peoples and
2023
communities and enables them to exercise authority over their health and wellbeing.
Official

•
Pacific peoples [wil ] have equitable immunisation and screening rates.

•
“The new system must require all NZ health providers, [. .] provide all health-related information
the
that is available to any other person in the requested accessible format …”
•
Embed self-determination of disabled people and their whānau as the foundation of a person and
Provisional Health of
whānau-centred health system.
Disabled People  •  Ensure the health system is designed by and accessible for disabled people and their whānau and
Strategy
provides models of care that suit their needs.
•
Increase the visibility of disabled people in health data, research and evidence as part of an active
learning system.
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•
Ensuring the availability of screening and immunisation in al  rural communities, with a focus on
children and women with caring commitments.
•
The higher amenable mortality rates for rural Māori and rural non-Māori, when compared to their
Rural Health Strategy
urban counterparts, suggests that there are additional challenges faced by rural communities.
•
We need to design and deliver health services in ways that work better for rural communities.
•
A wider range of service options are available in the home or in the community, including from
outreach options (such as mobile outpatients’ clinics and digital solutions).
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•
Continue work to join up care and create pregnancy and early years care pathways to improve
quality, safety, and equity of outcomes for al  pregnant women and people and their whānau into
Women’s Health
the first few years of their children’s lives.
Strategy
•
Ensure accessible, quality and cultural y safe antenatal and birthing care, including wrap-around
support, for wāhine hapū, and for wāhine Māori and whānau during the early years of a child’s life.
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Appendix 2: Indicators document
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Appendix 3: Whānau voice
Appendix 4: Contributors
There was a significant amount of engagement undertaken for the project, with the below
contributors giving of their time and expertise. The project team would like to thank everyone who
contributed, and acknowledge that although not all of the information captured could be outlined in
the report above, it wil  be used to progress with recommendations.

Project team:
Project Sponsors  Regional Directors NPHS and Te Aka Whai Ora (co-chairs  Te Manawa Taki
Information
Immunisation Collaborative)
Project Manager  Kaitlin Greenway (NPHS)
Project Team
Kaitlin Greenway (NPHS), May Pritchard (Te Aka Whai Ora), Rochelle West
(NPHS), Tipene Joseph (NIP), Sarah Le Leu (Commissioning), Julianna Lees
(NPHS), Kathy Rex (NPHS/Commissioning)
Local leads
Brent Gilbert-De Rios (BOP), Gina Burney (BOP), Ariana Roberts (Tairāwhiti),
Karin Norman (Lakes), Jessica James (Lakes), Janise Eketone (Waikato), Claire
Russell (Waikato), Rachel Court (Taranaki)
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Reviewers
Te Aka Whai Ora  Megan Tunks, Ricky Bel , Dillon Te Kani
Pacific Health
Tamati Peni
GMs Planning Chloe Mercer, Tim Slow, Lisa Gestro, Ariana Roberts
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and Funding

Regional and National Groups:
•  Te Whatu Ora Tāngata whaikaha national leads
•  Plunket
•  NZ College of Midwives
•  Waikato Regional Meeting for the NZCOM
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•  Ministry of Education School Based Health Services
•  National Immunisation Programme
•  Te Aka Whai Ora and Te Whatu Ora commissioning teams

Waikato:
•  Te Whatu Ora –  WHIRI Hapori,  Hospital and Specialist Services  (including Public Health
Nursing) and Waikato Public Health Service
•  Rauaawawa Kaumatua Charitable Trust School Based Health Services
•  Ethnic Health Hub
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•  K’aute Pasifika
•  Meeting at Nga Miro Health including representatives from:
-  Raukura Hauora o Tainui
-  Ngati Haua
-  Waahi Wanui Trust
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•  Te Kōhao Health
•  Tuuhono Hub
•  Pookekatia Hub
•  Matawhaanui Trust
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•  South Waikato Cluster – Raukawa Charitable Trust, South Waikato Pacific Community Trust
•  Te Toi Ora
•  Pinnacle PHO
•  Taumarunui Cluster – Kokiri trust, Public Health Nurses, Te Whare Taumarutanga
•  Meeting at Te Nehenehenui Trust including representatives from:
-  Ngāti Maniapoto Marae Pact Trust
-  Te Kuiti Medical Centre
-  Putiki Hub
-  Public Health Nursing Team Te Whatu Ora
-  Te Kuiti Hospital Te Whatu Ora
•  Te Korowai Hauora
•  Taumarunui Community Kokiri Trust
•  Hauraki PHO
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•  Te Ngakau a Kiwa

Taranaki:
•  Te Whatu Ora – Hospital and Specialist Services (including Covid-19 Immunisation Team and
Public Health Nursing) and Taranaki Public Health Service
•  Ngāti Ruanui
•  Tui Ora
•  Ngāruahine
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•  Taranaki Immunisation Steering Group with representatives from:
-  Pinnacle PHO
-  Community Pharmacy
-  Te Aka Whai Ora – Hauora Māori Relationship Lead Taranaki
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Tairāwhiti:
•  Te Whatu Ora – Hospital and Specialist Services (Well Child Team, including Public Health
Nursing), and Tairāwhiti Public Health Service
•  Meeting at Turanga Health including representatives from Ngati Porou Oranga and Pinnacle
PHO
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•  Three Rivers Medical Centre
•  Sean Shivnan (Pharmacist) – The Sunshine Pharmacy

Hauora a Toi:
•  Te Whatu Ora – Hospital and Specialist Services (Immunisation Directorate), and Toi Te Ora
Public Health Service
•  Te Puna Ora o Mataatua
•  Poutiri Trust
•  Waiariki Whānau Mentoring
•  Pacific Island Community Trust
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•  AvaNiu Pasifika
•  Ngāti Ranginui – Rangiora Health Hub
•  Tūwharetoa ki Kawerau Hauora

Lakes:
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•  Te Whatu Ora – Hospital and Specialist Services (including Public Health Nursing)
•  Manaaki Ora
•  Te Rūnanga o Ngāti Pikiao

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Information
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link to page 55

Reimagining the Future State of Immunisation for Te Manawa Taki
Rapid assessment of Whānau voice and service aspirations for Māori
and Pasifika whānau

August 2023

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Audience and Purpose
The intended audience of this report are the project leads for the immunisation system redesign and
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the wider group of colleagues involved. This report will be used to shape the design and priorities for
the regional immunisation system for Te Manawa Taki, to deliver on health equity and Te Tiriti o
Waitangi obligations.
This report has been commissioned to summarise the views of whānau and service users regarding
the immunisation system in Aotearoa, and specifically within the Te Manawa Taki region.
The purpose is to provide a concise assessment of the current issues, solutions and aspirations of
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Māori, Pasifika and tāngata whaikaha whānau within the Te Manawa Taki region.
For more in-depth analysis and background, the primary documents are available for review.
Methodology
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This report draws on a range of sources from across Aotearoa that have collected and collated
whānau voice on immunisation services.
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This paper pul s together the lessons from these documents into key themes for immunisation
service improvement and delivery of equitable outcomes. This information was presented back to
Hauora Māori partners and Pasifika immunisation providers from across Te Manawa Taki, as well as
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other immunisation service providers, to chal enge and test whether these issues and aspirations are
still current.
This methodology has been informed by the ‘Sprinting for Good Toolkit’1.
This methodology has been chosen for two reasons. Firstly, as an efficient use of time for this
project, and secon
Released dly due to the ethical imperative to listen to and use the contributions from
whānau who have already given of their time, energy and expertise.

1 Centre for Social Impact. (2020). SPRINTING FOR GOOD: USING CO-DESIGN TO COLLABORATE FOR SOCIAL IMPACT.
In Centre for Social Impact. Retrieved August 2, 2023, from https://www.centreforsocialimpact.org.nz
1

The main sources are:
•  The Immunisation Taskforce report (December 2022)
•  In Pursuit of Māori Health Equity: Evaluation of the Māori Influenza and Measles Vaccination
Programme (March 2022)
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•  HE HARAKEKE TŌNGAI NUI: CCDHB HVHDHB 2DHB CHILDHOOD IMMUNISATIONS REPORT
2022
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•  Māori Māmā views and experiences of vaccinating their pēpi and tamariki: A qualitative
Kaupapa Māori study. Report for Te Hiringa Hauora/Health Promotion Agency (2021)
•  Attitudes towards COVID-19 vaccination amongst Pasifika peoples (Colmar Brunton
Research, commissioned by Manatu Hauora 2021)
•  Relevant New Zealand literature focused on the experience, cultural safety and mechanisms
for achieving immunisation equity in Aotearoa (see bibliography)
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Findings
These reports highlight a range of issues with the way in which immunisation services are designed,
funded and delivered for whānau.
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These reports highlight that our current service design and delivery do not adequately prioritise
historically underserved communities who are known to have inequitable immunisation rates.
the
Whānau also bring many hopes and aspirations for the way in which services can be reimagined to
support whānau and tamariki to thrive, and to have positive experiences in their interactions with
health services.  under
The findings of the report are summarised in the following tables. There is some overlap between
these issues.
•  Cost
•  Availability and accessibility
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•  Manaakitanga and cultural safety
•  Relevance to the need or the perceived need of whānau and communities
•  Impact of the Covid-19 pandemic, vaccination rol  out and associated mandates
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Cost
Issues and Barriers  •  Primary care debt (for adult caregivers) is a significant disincentive (source of
shame) to accessing care for tamariki (this appears to predominantly be an issue
for patients accessing non-Hauora Maori or Pasifika services)
•  Financial and non-financial costs of accessing services (time off work, childcare,
transport costs – see accessibility)
Aspirations and
•  Al  staff across the system recognise their role in creating spaces for whānau to
Solutions
feel welcome accessing services (this includes administrative staff and clinical  1982
staff)
•  Under-served communities are prioritised for services that have fewer costs to
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the whānau (travel and time costs)

Availability and accessibility
Issues and Barriers  •  Primary care chal enges:
o  Limited capacity to enrol in primary care
o  Primary care not always aware of their obligation to enrol the infants of
existing patients
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o  Confusing and/or slow enrolment process into primary care services
•  Limited outreach services
•  Limited hours/locations for vaccination delivery (especial y for young children)
•  Rurality
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•  Lack of transport
•  Competing priorities, including work and school, housing transience, stress
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•  Lack of childcare and/or services that enable bringing other children
•  Inflexible hours for delivery
•  Immunisation services wil  address the needs of al  the members of the whānau,
not just the tamariki that have been referred to them
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Aspirations and
•  A system in which enrolment/engagement with primary care is not a
Solutions
prerequisite for access to immunisation services
•  Services that bring whānau to them, and take services to whānau when/as
required
•  Services that provide flexible options for location, hours, days.
o  e.g., pop-up clinics to provide delivery of immunisations at kohanga reo
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as whānau bring children into the service, or before pick-up times
o  e.g., delivery of antenatal and neonatal immunisations from Lead
Maternity carers or Wel  Child Tamariki Ora providers who have an
established relationship with the whānau
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•  All whānau receive pre-cal  and re-cal  information that supports timely
immunisation
•  Services that see immunisation as an opportunity for engagement and not just a
transaction
•  Communication via a range of methods works best – including texts, cal s,
emails, social media posts etc

Manaakitanga and Cultural safety
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Issues and Barriers
•  Few Māori and Pasifika vaccinators
•  Feeling ‘harassed’ by multiple services and that a decline for immunisation is
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not heard/acknowledged
•  Spaces that are not welcoming for whānau with other children
•  Services that do not accommodate whānau who have children with disabilities,
behavioural or sensory needs
•  A lack of manaaki and sense of welcome and care (see comments regarding
affordability)
•  Negative experiences with primary care staff or with unknown people cal ing to
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ask why a child is not vaccinated
•  Feeling judged as a neglectful parent for choosing to decline or delay
immunisations
•  Feeling rushed or coerced to get vaccinated – choice and autonomy is not
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respected
•  Feeling like you don’t fit in – the services feel ‘white, middle class, and clinical’
the
•  Siloed services that only focus on immunisation
Aspirations and
•  Enough time for whanaungatanga
Solutions
•  Immunisation services that welcome whānau and make it easy to attend
and/or access services because there is manaaki, time and care.
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•  Whānau feel genuinely valued and cared for, the interaction is not just about
the vaccination
•  Services that include and provide for all whānau health and wel being needs
•  Immunisation services that prioritise a positive experience for whānau
•  Providers who do more than just vaccinate – providers that see and respond to
whānau needs and act as connectors to other services.
Released  •  Vaccinators that understand the needs of whānau with disabled children and
have both time for specialised appointments, and can access expert support
when required (e.g., play therapists)
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•  Adults with disabilities can easily access outreach services for immunisations
for themselves and their dependents
•  Services that bring whānau to them, and when required take services to
whānau
•  Healthcare workers that have time to talk, answer questions and build
relationships
•  Feedback is listened to, and services are responsive and, whānau have a way to
shape the design and delivery of services
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•  Relationships are maintained, even when whānau choose not to immunise
•  Services that demonstrate that they value Māori culture and language (or
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Pasifika cultures and languages) through the physical environment, staff,
language, resources, processes, acceptance of rongoa etc
•  Staff across all providers have good pronunciation of te reo Māori and
understand tikanga
o  Names are pronounced with care and respect
•  Vaccinators respect the process of gaining informed consent and shared
decision making
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o  Disabled people are involved in decision making for their own health

Relevance to the need or the perceived need of whānau and communities
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Issues and Barriers
•  Limited Māori and Pasifika health workforce and administrative staff
•  Limited Māori and Pasifika designed education resources for whānau to
the
recognise the need/relevance of immunisation
•  Whānau are not always receiving information regarding vaccination
requirements (i.e., pre-cal s and re-call messages are not always getting to
whānau in a timely manner)
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•  Unable to ask questions due time pressure or because they feel humiliated for
asking questions - “we are made to feel stupid”
Aspirations and
•  Services that recognise whānau are ‘kaitiaki for their tamariki’
Solutions
•  A workforce that has more Māori and Pasifika practitioners and vaccinators
•  Messaging, information packs and media campaigns designed for and by Māori
or Pasifika whānau, including in te reo Māori, other Pasifika languages and
Released  other modalities such as video
o  Careful choice of messengers
o  No guilt or fear-based messaging
•  All whānau receive appropriate and timely pre-cal s/re-cal s for immunisation
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o  Communication is via a range of methods works best – including texts,
cal s, emails, social media posts etc
•  Whānau questions are welcomed and are respected with time and clear,
honest answers

Impact of the Covid-19 pandemic, vaccination rol  out and associated mandates
Issues and Barriers
•  Feeling pressured
•  Vaccination status resulting in social exclusion
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•  Fear about immunisation side effects
•  Lack of trust in the Ministry of Health/Te Whatu Ora after feeling coerced
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•  Vaccination fatigue
Aspirations and
•  Whānau are provided with clear information, which includes the risks and
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benefits
•  There is space to ask questions without judgement, and clear explanations are
provided
•  Whānau are treated with empathy and respect, and continue to be supported
even when they choose not to immunise
Information

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Bibliography

Allen + Clarke. 2019. Improving New Zealand’s childhood immunisation rates: Evidence review. Wel ington:
Al en + Clarke.

Brown, S., Toki, L. & Clark, T. C. (2021). Māori Māmā views and experiences of vaccinating their pēpi and
tamariki: A qualitative Kaupapa Māori study. WotMatters Consulting contracted by NZ Work Research
Institute, Auckland NZ.
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Colmar Brunton Research. Attitudes Towards COVID-19 Vaccination Amongst Pasifika Peoples. Ministry of
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Health, 2021.

Gauld, N., Dumble, F., Petousis-Harris, H., & Grant, C. C. (2022). Mapping the maternal vaccination journey and
influencing factors for Māori women in Aotearoa New Zealand: a qualitative study. Journal of Primary Health
Care, 14(4), 352-362.

Gauld, N., Martin, S., Sinclair, O., Petousis-Harris, H., Dumble, F., & Grant, C. C. (2020). A qualitative study of
Information
views and experiences of women and health care professionals about free maternal vaccinations administered
at community pharmacies. Vaccines, 8(2), 152.

Immunisation Taskforce (2022). Initial Priorities for the National Immunisation Programme. Wel ington: Te
Whatu Ora.
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Ministry of Health. 2018. Whāia Te Ao Mārama 2018 to 2022: The Māori Disability Action Plan. Wel ington:
the
Ministry of Health.

MokoPuna Solutions Ltd (2022). He Harakeke Tōngai Nui CCDHB HVHDHB 2DHB Childhood Immunisations
Report 2022. Wel ington: MokoPuna Solutions Ltd.
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Nowlan M, Wil ing E, Turner N. Influences and policies that affect immunisation coverage-a summary review of
literature. N Z Med J. 2019 Aug 30;132(1501):79-88. PMID: 31465331.

Prickett, K. C., Habibi, H., & Carr, P. A. (2021). COVID-19 vaccine hesitancy and acceptance in a cohort of
diverse New Zealanders. The Lancet Regional Health–Western Pasifika, 14.
Released

Tafea, V., Mowat, R., & Cook, C. (2022). Understanding barriers to immunisation against vaccine-preventable
diseases in Pasifika people in New Zealand, Aotearoa: an integrative review. Journal of Primary Health Care,
14(2), 156-163.
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Wehipeihana, N., Sebire, K., Spee, K. & Oakden, J. (2022). In Pursuit of Māori Health Equity. Evaluation of the
Māori Influenza and Measles Vaccination Programme. Wel ington: Ministry of Health.

Young, A., Charania, N. A., Gauld, N., Norris, P., Turner, N., & Wil ing, E. (2023). Informing women about
maternal vaccination in Aotearoa New Zealand: Is it effective?. Midwifery, 120, 103636.

Horizon Omnibus (2023). Omnibus Rangatahi Research Presentation May 2023 - Current perceptions towards 1982
childhood immunisations. Te Whatu Ora.
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Information
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link to page 76 link to page 77

Appendix 2. New Zealand Health Strategies for Alignment ................................................................. 14
Appendix 3. Exclusions from Immunisation Indicators ......................................................................... 15

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Information
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2

Current context
Immunisation is a key public health initiative to reduce the harms from vaccine preventable diseases
(VPD). Te Manawa Taki currently has a significant and urgent need to improve immunisation rates
and deliver equitable outcomes for Māori and Pasifika communities and disabled people (tāngata
whaikaha). Current immunisations rates are not at the population target of 90% and are
considerably lower for Māori and Pasifika. Immunisation rates for disabled people are not known.
The proposed indicators in this report have been developed as part of a suite of activities which are 1982
designed to improve the immunisation coverage within Te Manawa Taki, achieve equitable
outcomes and build the relationships and infrastructure required for a sustainable immunisation
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system. The indicators in this report contribute to a wider monitoring framework for immunisations
in Te Manawa Taki. The Collaborative (‘Collab’) and local level operational teams will receive more
granular data.
Notably, there is a national dashboard under development by the National Immunisation
Programme (NIP), and concurrent development of immunisation indicators across other regions. It is
possible that the NIP dashboard may supersede and/or overlap with many of the proposed
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indicators in this document.
However, the proposed indicators will contribute to interim monitoring of immunisation across the
region. Additionally, they will help clarify the functionality that should be built into emerging
information systems and data collection.  Official
Limitations and challenges
the
Currently there are a range of chal enges to reporting timely and accurate immunisation indicators
for Te Manawa Taki (and nationally).
1.  Roles and responsibilities are changing across the health system.
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a.  The roles and responsibilities for immunisation are in a time of change within the health
system. Notably, the NPHS has a newly established intelligence directorate, including a
specific immunisation team.
b.  Further work needs to be done to clarify the roles for regional immunisation reporting,
for example:
•  NI
Released R coordinators and NIR administration teams
•  The intelligence directorate, specifically the immunisation team
•  The members and administrator of the Collab
•  The National Immunisation Programme
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link to page 66

2.  Immunisation Data Systems are changing.
a.  A comprehensive set of immunisation indicators requires information that is currently
held on a range of data sources: IMAC databases, commissioning services, National
Enrolment Services, National Immunisation Register/ Aotearoa Immunisation Register,
Whaihua Portal, Hospital and Health Services data.
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b.  Some of the proposed indicators are potentially reportable with current data collection
and data systems.
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c.  For other indicators, they are reportable, but only with a substantial amount of analyst
and/or administrative time. For example, newborn enrolment into primary care.
d.  New immunisation databases are currently under development. Notably Aotearoa
Immunisation Register (AIR) and the Whaihua Portal. However, the capabilities of these
systems are not yet clear. However, clearly defining preferred indicators will allow us to
advocate for the necessary functionality of these systems.

Information
3.  Population estimates for Māori and Pasifika underestimate the population size.
a.  Historically, population estimates have been less accurate for Māori and Pasifika,
including a substantial undercount for these populations in the 2018 census.1 Ethnicity
data needs to be interpreted with a clear understanding of the population
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denominators and their limitations.

the
4.  Data col ection for Pregnant People is limited.
a.  Hāpu māmā (antenatal) indicators are not currently available. Recording and data
collection for pregnant people in Aotearoa is limited and sits across multiple patient
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management and data systems.
b.  There is no specific recording of pregnancy immunisation in the NIR, and this capability
is not yet confirmed to be part of the new Aotearoa Immunisation Register (AIR).
c.  The ‘Aotearoa BadgerNet Perinatal Spine’ is under development. This wil  provide a
single record for pregnancy related care. In future, it may be possible to link this data to
immunisation records and therefore report on antenatal indicators.
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1 Lees J, Lee M, Winnard D (2021) Demographic Profile: 2018 Census, Population of Counties Manukau. Auckland: Counties
Manukau Health.
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link to page 67 link to page 67

d.  There are ‘work arounds’ for estimating hapū māmā vaccinations. However, the current
options provide very poor estimates for this indicator. Further work is required to see if
there are better ways to provide a proxy for this indicator, while longer-term solutions
are developed.

5.  Data collection for disabled people is not yet available.
a.  At present, disability status is not recorded on the NIR. Additionally, it is not recorded  1982
and linked to NHI. Consequently, there is no reportable immunisation data for disabled
people.2
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b.  Work is underway through the PPNHI (Patient Profile and National Health Index project)
to link disability status to NHI. However, it is unclear what the status of this project is,
and whether this information will be accessible for monitoring and governance
purposes.

6.  Whānau voice is not captured in the current monitoring.
a.  Whānau voice is necessary to gather information on the experiences, accessibility and
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cultural safety of the Te Manawa Taki immunisation system. However, there are
currently no established methods for routinely col ecting and reporting whānau
experience of immunisation system in Te Manawa Taki.
b.  Further work is required to clarify the information necessary for quality improvement,
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and the methods and intervals for information gathering. Consideration must also be
given to avoiding duplication across the health sector, and burden on communities and
the
whānau to participate.

7.  Intersectionality needs further consideration for immunisation reporting.
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a.  There is substantial evidence to show that health outcomes are influenced by a range of
social factors, and these intersect to compound disadvantage for some populations. For
example, tāngata whaikaha Māori on average, have poorer health outcomes than either
non-disabled Māori, or disabled people who are non-Māori.3

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2 Baker, G., King, P.T., Jones, B., Ingham, T. (2022) Hauora and Tāngata Whaikaha Māori: Advice to Te Aka Whai Ora on
meeting the health and wel being needs of Tāngata Whaikaha Māori in the first two years of its operations, Foundation for
Equity & Research NZ (FERNZ), Wel ington.
3 Ingham, T. R., Jones, B., Perry, M., King, P. T., Baker, G., Hickey, H., ... & Nikora, L. W. (2022). The multidimensional
impacts of inequities for Tāngata Whaikaha Māori (Indigenous Māori with lived experience of disability) in Aotearoa, New
Zealand. International Journal of Environmental Research and Public Health, 19(20), 13558.
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link to page 68

b.  The Provisional Health of Disabled People Strategy4 outlines the importance of increased
visibility of data on disabled people, and in particular, the breach of Te Tiriti of Waitangi
that is occuring by inadequate col ection of data on tāngata whaikaha Māori.
c.  Further work needs to be done to ensure immunisation reporting adequately captures
the outcomes and experiences of both, tāngata whaikaha Māori, and Tagata sa’ilimalo
(disabled Pasifika people and their whānau).
Strategic alignment
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The development of indicators, monitoring approaches has been created with the vision of Pae Ora,
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in mind. Additionally, this work has drawn on the Pae Ora Act, the recommendations outlined by the
Immunisation Taskforce, and key strategic documents for the National Public Health Service.

Notably, the priorities of the immunisation taskforce report (Appendix 1) include: expansion of the
vaccinator workforce, antenatal immunisations, enrolment into health services from birth and
‘governance, technical advice, and service coverage oversight’. The alignment between
immunisation improvement across Te Manawa Taki, the Pae Ora Act and strategies for Te Whatu
Information
Ora can be found in Appendix 1.
Data management
Immunisation data stewardship wil  be managed jointly by Te Aka Whai Ora, and the National Public
Official
Health Service (Te Whatu Ora). The data collection, analysis, and interpretation of immunisation
data wil  be undertaken based on the values outlined in this report, with the express purpose of
the
providing high quality and equitable immunisation services across Te Manawa Taki.
Immunisation monitoring framework.
The purpose of the indicators in this report are to support monitoring of the immunisation system
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within Te Manawa Taki and ensure accountability for a high-quality and equitable system. The
primary audience for these indicators is the Regional Integration Team and the Collab.
Immunisation indicators will contribute to an overall monitoring framework for immunisations
across Te Manawa Taki. The other components of this framework include:
Released
•  progress on the Regional Immunisation work plan 2023/24
•  the Regional Immunisation Production plans

4 Minister of Health. 2023. Provisional Health of Disabled People Strategy. Wel ington: Ministry of Health.
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•  risks and issues for escalation
Indicator purpose and approach
The indicators proposed in this document include both:
•  currently reportable indicators
•  indicators that are necessary for comprehensive monitoring but are not reportable with
current data collection and data management systems.
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The indicators have been designed based on a systems approach, taking into consideration key
structural elements, processes, and the outcomes required of the Te Manawa Taki immunisation
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system. Notably, these are designed around current delivery systems. For example, enrolment in
primary care may be less important for immunisation outcomes if there is a change in the way that
immunisation reminders are delivered and/or additional investment into outreach services.
These indicators have been developed to highlight immunisation outcomes for Māori and Pasifika
and disabled people. This is to align with the priority populations listed in Te Pae Tata and to ensure
that equitable immunisation is a priority for the immunisation system.
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Indicator criteria
Indicators must meet the following criteria:
1.  The indicator is clearly defined.  Official
2.  The indicator provides useful information for action.
3.  The data required for the indicator are accessible and timely.
the
4.  The data are of high quality.
Immunisation indicators and rationale
This section outlines the proposed immunisation system indicators and the rationale.
under
Currently (September 2023), only seven of 13 indicators can be reported using the current
immunisation data capture and information systems.
Noting, that this does not include any reporting for disabled people.
See Appendix 2 for specific exclusions to the indicators.
Released
7

Service indicators
The purpose of service indicators is to provide information on the funding and resources (e.g.,
workforce, contracts and resources) that enable services within the Te Manawa Taki immunisation
system.
Indicator 1: Hauora Māori Providers - Currently reportable
Description: The number of Hauora Māori providers funded to deliver immunisations.
Rationale: To support the growth of Hauora Māori providers and provide options and choice for 1982
Māori who wish to access immunisation via Hauora Māori providers.
Act
Desired outcome: Increased number of Hauora Māori providers delivering childhood immunisations.
Limitations and Chal enges: This indicator does not recognise whether funding is adequate and/or
equitable to meet the needs of whānau and communities.
Indicator 2: Authorised Vaccinator Workforce – Currently reportable
Description: The number of authorised childhood vaccinators in Te Manawa Taki.
Information
Rationale: A greater number of the healthcare workforce capable of delivering childhood
immunisations will contribute to improving access and equity outcomes.
Desired outcome: An increasing vaccinator workforce capable of delivering childhood
immunisations.
Official
Limitations and Chal enges: Not all authorised vaccinators will routinely deliver immunisations.
the

Indicator 3: Māori and Pasifika Authorised Vaccinator Workforce – Under development.
Description: The number of authorised childhood vaccinators in Te Manawa Taki who are Māori.
under
Description: The number of authorised childhood vaccinators in Te Manawa Taki who are Pasifika.
Rationale: An increased Māori and Pasifika vaccinator workforce will support the achievement of
equitable immunisation outcomes for Māori and Pasifika.
Desired outcome: An increased Māori vaccinator workforce and Pasifika vaccinator workforce that
reflects the local demographics at a minimum.
Released
Limitations and Chal enges: This data is available from IMAC and Medical Officer of Health records
but will take time and effort to collect and collate.

8

Indicator 4: Kaupapa Māori Immunisation Education Packages - Under development
Description: The percentage of authorised vaccinators in Te Manawa Taki that have completed a
Kaupapa Māori immunisation education package.
Rationale: This indicator supports the uptake of educational packages that support tikanga,
mātauranga Māori and contribute to achieving health equity.
Desired outcome: The development and delivery of Kaupapa Māori immunisation education
packages to all authorised vaccinators in Te Manawa Taki.
1982
Limitations and Chal enges: This programme of education has not yet been commissioned or
Act
developed.

Indicator 5: Kaupapa Māori Nurse Educator Positions - Under development
Description: The number of Kaupapa Māori Nurse Educators across the Te Manawa Taki region.
Rationale: Specialist kaupapa Māori nurse educators will support clinical and non-clinical staff to
implement tikanga, and best practice for achieving health equity in Te Manawa Taki.
Information
Desired outcome: Kaupapa Māori Nurse Educator positions are established and recruited to, to
support the vaccinator workforce across Te Manawa Taki.
Limitations and Chal enges: These positions have not yet been commissioned or developed, and
Official
there is not yet an agreed-on target number for these roles.

the
Enrolment indicators
The purpose of enrolment indicators is to provide information on the enrolment of tamariki into
primary care given that primary care is a critical partner for delivering immunisations.
under
Indicator 6: Māori and Pasifika newborns enrol ed in primary care - Under development.
Description: The percentage of Māori newborns ful y enrol ed with a primary care provider by 12
weeks of age.
Description: The percentage of Pasifika newborns ful y enrol ed with a primary care provider by 12
weeks of age.
Released
Rationale: Primary care is the main method of immunisation delivery. Early primary care enrolment
is associated with improved immunisation outcomes. Primary care enrolment is necessary for
9

immunisation precal and recal s in the current Patient Management Systems. This timeframe allows
time for primary care services to accept and process enrolments.
Desired outcome: 100% of Māori newborns and Pasifika newborns are enrolled with primary care at
or before 12 weeks of age.
Limitations and Chal enges: The reporting system is likely the Whaihua portal and/or National
Enrolment Service (NES) data. At present, to accurately report on primary care enrolment access to
National Enrolment Service data is required. However, it appears a manual cross-check with NIR may
1982
be necessary.
Act
Immunsation Coverage indicators:
The purpose of population and outcome indicators is to provide information on the outcomes and
level of population immunisation coverage that is sought by the immunisation system.
Immunisation coverage is measured at ‘milestone ages’. Children are reported as ‘fully vaccinated’ if
they have turned the milestone age during a three-month reporting period and have completed
their age-appropriate immunisations.
Information
Indicator 7: Tamariki fully immunised at 8 months – Currently reportable.
Description: The percentage of tamariki Māori who met the 8-month age milestone within the
three-month reporting period and are fully immunised.
Official
Description: The percentage of Pasifika tamariki who met the 8-month age milestone within the
three-month reporting period and are fully immunised.
the
Description: The percentage of disabled tamariki who met the 8-month age milestone within the
three-month reporting period and are fully immunised.
Rationale: A high level of immunisation coverage will reduce vaccine preventable illness and
under
disability to the individual, and the community. Reporting at 8 months will show the uptake of
childhood immunisations at 6 weeks, 3 months and 5 months, and also allow for time to catch up.
This milestone aligns with existing national reporting.
Desired outcomes: 90% of tamariki Māori, 90% of Pasifika tamariki, and 90% of disabled tamariki are
ful y immunised at 8 months.
Released
Limitations and Chal enges: Disability data is not yet reportable.
10

Indicator 8: Tamariki fully immunised at 24 months – Currently reportable.
Description: The percentage of tamariki Māori who met the 24-month age milestone within the
three-month reporting period and are fully immunised.
Description: The percentage of Pasifika tamariki who met the 24-month age milestone within the
three-month reporting period and are fully immunised.
Description: The percentage of disabled tamariki who met the 24-month age milestone within the
three-month reporting period and are fully immunised.
1982
Rationale: A high level of immunisation coverage will reduce vaccine preventable illness and
Act
disability for the individual and the community. Reporting at 24 months wil  show the uptake of
childhood immunisations from 6 weeks to 15 months and allow for time to catch up. This milestone
aligns with existing national reporting.
Desired outcomes: 90% of tamariki Māori, 90% of Pasifika tamariki, and 90% of disabled tamariki are
ful y immunised at 24 months.
Limitations and Chal enges: Disability data is not yet reportable.
Information

Indicator 9: Tamariki fully immunised to four years – Currently reportable.
Description: The percentage of tamariki Māori who are ful y immunised up to the four-year
Official
milestone.
Description: The percentage of Pasifika tamariki who are fully immunised up to the four-year
the
milestone.
Description: The percentage of disabled tamariki who are fully immunised up to the four-year
milestone.
under
Rationale: A high level of immunisation coverage wil  reduce vaccine preventable il ness and
disability. This indicator shows the percentage of children on the NIR who have received al  the
childhood immunisations up to age four. This indicator includes children older than age four and
provides information on the total vaccination coverage for Māori, Pasifika, and disabled children.
Released
Desired outcomes: 90% of tamariki Māori, 90 % Pasifika tamariki, 90% of disabled tamariki are fully
immunised to the four-year milestone on the immunisation schedule.
Limitations and Chal enges: Disability data is not yet reportable.
11

link to page 74

Indicator 10: Hapū māmā pertussis immunisations – Under development
Description: The percentage of Māori hapū māmā immunised against pertussis
Description: The percentage of Pasifika hapū māmā immunised against pertussis
Description: The percentage of disabled hapū māmā immunised against pertussis
Rationale: Prevention of harm to Māori and Pasifika infants, and the infants of tāngata whaikaha  1982
from pertussis, including hospitalisation, cognitive impairment, and death.5
Act
Desired outcomes: 90% of Māori, 90% of Pasifika, and 90% of disabled hapū māmā are immunised
against pertussis during pregnancy.
Limitations and Chal enges: This indicator is not currently reportable on the current immunisation
data systems.

Indicator 11: Hapū māmā influenza immunisations – Under development
Information
Description: The percentage of Māori hapū māmā immunised against influenza
Description: The percentage of Pasifika hapū māmā immunised against influenza
Description: The percentage of disabled hapū māmā immunised against influenza
Official
Rationale: Prevention of harm to Māori, Pasifika and disabled hapū māmā and their infants from
the
influenza, including hospitalisation, preterm birth and death.5
Desired outcomes: 90% of Māori, 90% of Pasifika, and 90% of disabled hapū māmā are immunised
against influenza during pregnancy.
under
Limitations and Chal enges: This indicator is not currently reportable on the current immunisation
data systems.

Indicator 12: School based HPV immunisation – Currently reportable
Description: The percentage of Māori children immunised against HPV by school year cohorts.
Released
Description: The percentage of Pasifika children immunised against HPV by school year cohorts.

5 Young, A., Charania, N. A., Gauld, N., Norris, P., Turner, N., & Wil ing, E. (2022). Knowledge and decisions about maternal
immunisation by pregnant women in Aotearoa New Zealand. BMC Health Services Research, 22(1), 779.
12

link to page 75

Description: The percentage of disabled children immunised against HPV by school year cohorts.
Rationale: a high level of HPV immunisation will prevent HPV transmission and reduce the harms to
the population from HPV infection. HPV is the most common cause of cervical cancer, and a range of
other cancers. Māori women have the higher rates of cervical cancer diagnosis and higher rates of
death from cervical cancer.6
Desired outcomes: 90% of Māori, 90% of Pasifika, 90% of disabled children (by school year cohort)
are immunised against HPV.
1982
Limitations and Chal enges: School based HPV programmes are delivered by school year cohorts and
Act
not date of birth. The efficacy of this programme is best observed by analysing immunisation
coverage by school cohorts. This is possible, but currently requires manual checking against the NIR.

Indicator 13: Māori and Pasifika adult influenza immunisations – Currently reportable
Description: The percentage of Māori aged 55 years and older who are immunised against
seasonal influenza
Information
Description: The percentage of Pasifika aged 55 years and older who are immunised against
seasonal influenza
Rationale: A high level of immunisation coverage will reduce seasonal influenza related illness and
Official
disability.
Desired outcome: 90% of Māori and 90% of Pasifika aged 55 years and older are immunised against
the
seasonal influenza.
Limitations and Chal enges: Disabled people are not included in this indicator as they are not
universally eligible for influenza from age 55 years.
under

Released

6 Te Aho o Te Kahu. 2021. He Pūrongo Mate Pukupuku o Aotearoa 2020, The State of Cancer in New Zealand 2020.
Wel ington: Te Aho o Te Kahu, Cancer Control Agency.
13

Appendix 1. The Priorities of the Immunisation Taskforce report
1. Expansion of vaccinator workforce
2. Authorisation of childhood vaccinators
3. Antenatal immunisations
4. Enrolment into health services from birth
5. Proactive outreach immunisation services
6. Catch-up immunisations
1982
7. Funding for providers that is long-term and sustainable
8. Governance, technical advice, and service coverage oversight
Act
9. Development of new provider and consumer-facing resources for immunisations
10. Quality and standards for providers delivering immunisations to tamariki in New Zealand
Appendix 2. New Zealand Health Strategies for Alignment
•
Protect, promote, and improve the health of all New Zealanders.
•
Achieve equity in health outcomes among New Zealand’s population groups, including by striving
Pae Ora (Healthy
to eliminate health disparities, in particular for Māori.
Futures) Act 2022
Information
•
Build towards Pae Ora (healthy futures) for all New Zealanders

•
Priority populations: Māori, Pacific and tāngata whaikaha
•
Implementing a population health approach
Te Pae Tata: Interim
•
Place whānau at the heart of the system to improve equity and outcomes.
New Zealand Health
•
Implement a national y consistent system of data capture, analytics and intel igence that supports
Official
Plan 2022
the use of health intel igence and insights to ensure equity of access and outcomes from al

health services across Aotearoa.
the

•
Children and families wil  be supported to have a healthy start to life.
•
The health system wil  work in partnership with Māori in the leadership, design, delivery and
The New Zealand
monitoring of services.
Health Strategy 2023
•
Action will be needed to ensure that people’s feedback and information on the experience of
under

health services are key indicators of success and underpin system monitoring and performance at
al  levels.

Pae Tu: The Māori
•
Growing the Māori health workforce and sector to match community needs.
Health Strategy 2023
•
Ensuring accountability for system performance for Māori health

•
The health system grows and supports strong Pacific health leadership and a resilient health care
Released
Te Mana Ola: The
workforce that reflects the population it serves.
Pacific Health
•
The health system better understands the needs and aspirations of Pacific peoples and
Strategy 2023
communities and enables them to exercise authority over their health and wellbeing.

•
Pacific peoples [wil ] have equitable immunisation and screening rates.

14

•
“The new system must require al  NZ health providers, [. .] provide al  health-related information
that is available to any other person in the requested accessible format …”
•
Embed self-determination of disabled people and their whānau as the foundation of a person and
Provisional Health of
whānau-centred health system.
Disabled People
•
Ensure the health system is designed by and accessible for disabled people and their whānau and
Strategy
provides models of care that suit their needs.
•
Increase the visibility of disabled people in health data, research and evidence as part of an active
learning system.
•
Ensuring the availability of screening and immunisation in al  rural communities, with a focus on
children and women with caring commitments.
1982
•
The higher amenable mortality rates for rural Māori and rural non-Māori, when compared to
their urban counterparts, suggests that there are additional chal enges faced by rural
Rural Health Strategy
Act
communities.
•
We need to design and deliver health services in ways that work better for rural communities.
•
A wider range of service options are available in the home or in the community, including from
outreach options (such as mobile outpatients’ clinics and digital solutions).
•
Continue work to join up care and create pregnancy and early years care pathways to improve
quality, safety, and equity of outcomes for all pregnant women and people and their whānau into
the first few years of their children’s lives.
Women’s Health
•
Ensure accessible, quality and cultural y safe antenatal and birthing care, including wrap-around
Strategy
support, for wāhine hapū, and for wāhine Māori and whānau during the early years of a child’s
Information
life.

Appendix 3. Exclusions from Immunisation Indicators
Official
1.  Additions to the childhood immunisation schedule
the
The NZ immunisation schedule has evolved over time with the addition of new vaccinations.
For these indicators, children wil  be deemed to be ‘ful y vaccinated’ if they are up to date with
al  immunisations on the schedule at the time that they met a milestone.
For example, Meningococcal B immunisation was added to the immunisation schedule on March
under
1, 2023. For this reason, if the immunisation was not on the schedule at the time a cohort of
children met an age milestone, they do not require that immunisation to be deemed ‘ful y
vaccinated’.
2.  COVID-19 vaccination
COVID immunisation for high-risk populations is excluded from these indicators. This is because
Released
eligibility for immunisation includes a six month stand down period from a previous booster or
infection. It is not feasible to define what proportion of the high-risk population meet this
eligibility criteria.
15

3. Rotavirus vaccination
Rotavirus vaccination is only delivered to children under the age of 25 weeks. After this time,
catch-up immunisations are contraindicated. For this reason, rotavirus vaccination is excluded
from the definition of ‘fully vaccinated’.

1982
Act
Information
Official
the
under
Released
16

Te Manawa Taki Regional Integration Team
Purpose and Functions on a Page – DRAFT

Notes from the RIT workshop on 21 September 2023
•  Purpose of the workshop was to develop simple messaging for communications
about the RIT Purpose and Functions. The document attached as Appendix 1 was  1982
used as the basis for the workshop
•  Audience - The audience for the key messages is Whānau.  The intention is that RIT
members can share the key messages about the purpose and functions of the RIT
Act
with Whānau in every-day language, free from health system ‘speak’, and that they
are easy and memorable for the RIT members.
•  The following plain language messages were agreed to describe the Purpose and
Functions.
•  The RIT agreed to continue to work through the key messages for the areas of
Accountabilies and Responsibilities at it’s next hui on 30 October 2023.

Our Purpose
Information
Te Whatu Ora and Te Aka Whai Ora working together with our whānau and communities to
achieve health and well-being in Te Manawa Taki

Our Functions (what we do):  Official
1.  Identify health and well-being priorities based on those who most need help
2.  Plan how we wil  respond to thse priorities
3.  Build trusting relationships wiht key stakeholders
the
4.  Lead change
5.  Monitor system wide performance

under
Accountabilities and Responsibilities
[To be agreed at the RIT hui on Monday 30th October]

Released

Appendix 1:

Te Manawa Taki Regional Integration Team
Our kaupapa/purpose:
Our purpose is to ensure cohesion and alignment across Te Whatu Ora business units and
Te Aka Whai Ora within the Te Manawa Taki region and deliver an agreed regional work
programme.   Our  Rōpu adopts  a  collaborative  approach  to  ensure  that  the  health  system
1982
across the region is delivering the Pae Ora (Healthy Futures) Act Requirements and
implementing system-wide transformation priorities.
Act
The Regional Integration Team is not a decision-making function and does not commission
healthcare services. It is a leadership and oversight group to ensure we function as a unified
regional health system.

Who we are:
Our Rōpu brings together key regional leadership positions of the national service delivery
and enabling functions within each region and has representation from Te Aka Whai Ora,
Pacific Health, Hospital and Specialist Services, Clinical Leadership, Wayfinder-
Information
Commissioning, Service Improvement & Innovation, National Public Health Service, Data and
Digital and People and Culture.
What we do:
Our role is to drive vertical and horizontal integration across all delivery services across the
Official
Te Manawa Taki Region and deliver a nationally-consistent regional work programme.
Functions include:
the
•  Driving regional coordination across core healthcare delivery functions and initiatives
including:
  o  Service planning
o  Staffing and resourcing
under
o  Adoption of new systems and technologies
o  Preventive healthcare e.g. immunisation, screening

•  Regional data collation to provide a clear picture of our region-wide system capacity,
capability and pressures to inform decision-making

•  Setting regional priorities which reflect national frameworks

•  Collaboration with the Iwi Māori Partnership Boards
Released
Our accountabilities & responsibilities:
Members of the Regional Integration Team hold collective responsibility and accountability for
system-wide outcomes.  We are responsible for ensuring we meet Te Tiriti obligations and
partner with Iwi Māori Partnership Boards in key decisions. This includes accountability for
prioritising and addressing equity gaps within the region.

Our Rōpu is accountable for delivering on key national priorities as well as those identified in
Regional Plans. In general, these wil  be key deliverables which require integration and
success across multiple service delivery areas.
We wil  ensure our teams work together, as a team of teams, to deliver on this regional work
plan and wil  identify any support required.
We are charged with bringing together our collective knowledge influence and leadership to
ensure key elements are given primacy in the work we do, ensuring we have understood and
recognised how the  Te Tiriti response is present, that equity and the populations most
impacted by negative determinants of health, particularly Māori & Pacifica are prioritised, and
1982
that Whānau voice is present in all we do.
We are responsible for managing key partner relationships that span multiple delivery services
or enabling functions.
Act
Our respective responsibilities include:
  National Public Health Service – responsible for reviewing what the key priorities
are for the whole population. This programme of work has the most alignment with
the aspiration of Mātauranga Māori
  Te Aka Whai Ora – responsible for driving transformational change and outcomes
for Hauora Māori
  Hospital and Specialist Services – responsible for improving the delivery of hospital
Information
services for whānau
  System Innovation and Improvement –  responsible for enabling Business Unit
leaders and teams to think differently about their services and how best to deliver
innovation and improvement at scale, strengthen collaboration across the health
system and accelerate evidence-based change in service delivery. Equity is a core
driver of our work programme.
Official
  Pacific Health –  responsible for the implementation of the Interim Government
Policy Statement, Te Pae Tata Interim New Zealand Health Plan and Ola Manuia
Interim Pacific Health plan, for Pacific peoples.
the
  Wayfinder-Commissioning  –  responsible for overseeing, developing and
implementing new programmes of work that achieve the aspirations of Pae Ora
and redesign and reimagine current programmes of work so they too can meet this
aspiration. Wayfinders take a whole-of-system approach and are key to bringing
under
the connection to the different parts of the system.
  Data and Digital –  responsible for ensuring that we have the data and digital
systems, services and processes in place to deliver our vision and strategic
priorities; to support the health system to achieve Pae Ora, healthy futures for all
New Zealanders, in partnership with Te Aka Whai Ora.
  People and Communication - responsible for the functions of HR, Communications,
Health, Safety & Resilience, Emergency Management, and more.
Released

Note: this is a living document and may be updated and edited

NAME:

Regional Integration Team: Risk workshop pre-questions
In order to get the most value from the planned risk workshop on 30th October I would like to
generate some material to use at the meeting. Please complete the fol owing questions and submit
back to me by end-of-day Thursday 26th October. Email to [email address]
Don’t stress about exactly how things are articulated, just get down your ideas.

Question 1: Please tell me what are your top risks? – by that I mean the things that keep you awake
at night, and the things that relate to your own area of operation.
Risk Description
Level of Risk (circle)
Confidence in controls  1982
1.

Low  Medium  High   Extreme
None  Low

High

Act
2.

Low  Medium  High   Extreme
None  Low

High

3.

Low  Medium  High   Extreme
None  Low

High

4.

Low  Medium  High   Extreme
None  Low

High

5.

Information

Low  Medium  High   Extreme
None  Low

High

(space for more risks if needed)

Low  Medium  High   Extreme
None  Low

High

Official

the
Question 2: Optional extras – are there risks in other areas that you are also concerned about?
Risk Description
Level of Risk (circle)
Confidence in controls
1.

Low  Medium  High   Extreme
None  Low

High

under
2.

Low  Medium  High   Extreme
None  Low

High

3.

Low  Medium  High   Extreme
None  Low

High

4.

Low  Medium  High   Extreme
None  Low

High
Released

5.

Low  Medium  High   Extreme
None  Low

High

Guy Hobson 17/10/2023
RIT Risk Survey

Useful background materials

Risk Rating Matrix

Consequence
Likelihood  Description
Minimal
Minor
Moderate
Major
Severe
Almost
This event is expected to

Certain
occur imminently

1982
(>95% chance of
Medium
High
High
Extreme
Extreme
occurring)
11
16
20
23
25

Likely
Has occurred several

Act
times and is likely to occur

again in the near future
Medium
Medium
High
High
Extreme
(51 – 95% chance of
7
12
17
21
24
occurring)
Possible
There is evidence of this

event occurring before

(21 – 50% chance of
Medium
Medium
Medium
High
Extreme
occurring)
6
8
13
18
22

Unlikely
Events of this type could

occur but may not have

occurred before
Low
Medium
Medium
High
High
Information
(5 – 20% chance of
3
5
9
14
19
occurring)

Rare
Events like this have not

occurred and are not

expected to occur
Low
Low
Medium
Medium
High
(<5% chance of occurring)
1
2
4
10
15
Official

the
Use the Likelihood and Consequence descriptors to help decide the level of risk.
under
Released
Guy Hobson 17/10/2023
RIT Risk Survey

Risk Domains – the sub-domains give a little more detail on the scope of risks covered
Risk Level
Risk Domains
Risk Sub-Domains
Strategic
Failure to engage Treaty partners
Workforce imbalance and lack of diversity
Institutional barriers to care
Under resourcing of Te Aka Whai Ora
Equitable Health Outcomes (Mana
Data systems limitations
Tangata)
Standards outside of a healthcare setting
Health literacy and awareness
Access to healthcare in proportion to needs
Access to primary care
1982
Disparity of distribution
Building and maintaining trusted relationships
Governance and organisational structures  Act
Delivering Health Reforms
Variation of contracted services
Clarity of value proposition

Branding
Organisation - Reputation - Governance
Key relationships and partnerships
Maintenance of ongoing performance
Stakeholder relationships
Complexity of integration
Setting culture and accountability
Trust and Confidence
Timely treatment
Service delivery
Information
Quality systems and clinical governance
Transfer of care (handover)
Policy and Procedure
Clinical Patient Safety
Infection Prevention & Control
Clinical Equipment
Patient Transfer
Adverse Event Management (HQSC)
Official

Medication Safety

Clinical safe staffing

Training and competency
the

People Culture & Capability
Staff and skil s mix

Non Clinical Workforce shortage

Workplace culture

Violence and aggression

Injuries resulting from work activities and exposures

Health, Safety and Wel being
Psychological harm
under

Inability to work safely in the community

Financial provision

Effective budgeting and planning

Organisational Sustainability
Procurement and contracts

Unbudgeted costs
Enterprise and
Operational
Asset planning, management and maintenance
Impact of funding shortfal s
Infrastructure and Asset Management
Changes to healthcare delivery models
Regulatory non-compliance
Climate change impacts
Released
Critical systems
IT processes
Data & Digital Systems and Services
Breach of systems /cyber security

Breach of information / data security
Data management
Vendor management
Guy Hobson 17/10/2023
RIT Risk Survey

Financial management
Physical assets
Digital strategy and planning
Investment
Preparedness to respond
Natural disasters
Business Continuity
Climate change impacts
Essential Utilities
Pandemic planning
Legal chal enge
Legal and regulatory non-compliance
Legal and Regulatory Compliance
Certification processes
1982
Fraud
Auditing and professional standards
Change
Programmes and Projects
Time
Cost
Act
Quality
Scope
Stakeholder engagement
Benefit realisation

Information
Official
the
under
Released
Guy Hobson 17/10/2023
RIT Risk Survey

Regional Integration Teams
Terms of Reference
This document lays out the Terms of Reference (TOR) for the Regional Integration Teams (RIT).
1982
Pae Ora – Healthy Futures
Pae Ora – Healthy Futures is the vision for the reformed health system where people live longer in good health
Act  ,
have improved quality of life and there is equity across all groups.
The Pae Ora (Healthy Futures) Act 2022:
•  requires Te Whatu Ora to provide or arrange for the provision of services at a national, regional and local
level. Nationally planned, regionally coordinated and locally delivered services are the key to achieving equity
in health outcomes among New Zealand’s population groups.
•  requires Te Aka Whai Ora to ensure planning and service delivery respond to the aspirations of whānau, hapū,
iwi and Māori; and design, deliver and arrange services that achieve the best possible health outcomes for
Information
Māori.
Te Tiriti o Waitangi is the foundation for achieving health aspirations and equity for Māori.  Upholding our
obligations to Māori under Te Tiriti is essential to realise the overall aims of Pae Ora (Healthy Futures) Act 2022.
Kaupapa/Purpose & Functions  Official
The purpose of RITs is to ensure consistency and alignment of service planning and service delivery within regions,
including to improve the connections between local, regional and national arrangements that together determine
the overal  effectiveness of Te Whatu Ora and Te Aka Whai Ora. RITs will:
the
•  Give effect to the principles of Te Tiriti o Waitangi as embedded in the Pae Ora Act.
•  Ensure equity is prioritised, particularly for Māori.
•  Maintain oversight of integrated performance across a region and identify inequitable variation in outcomes
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within and between regions.
•  Maintain key regional relationships including fostering strong connections with relevant social sector leads.
•  Take a collaborative approach with communities and providers to promote a health system able to deliver the
Pae Ora Act requirements and implement the resultant system-wide transformation priorities.
•  Develop and monitor delivery of Regional Health and Wel being Plans that set clear and consistent direction
by joining national system design and local community aspirations as expressed in locality plans.
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•  Promote  collaborative  decision-making for solutions  implemented  at a regional level, including  to  address
emergent pressure points.
•  Identify new or improved ways to design or deliver services to improve the value of health spend in the region.
•  Provide regional context and advice to inform national strategies, policies and frameworks

•  Partner with other RITs  and national teams to ensure consistency in decision-making  where appropriate,
including through regular sharing of learnings and insights.
Membership
The following leads form the accountable membership of each RIT:
•  Te Aka Whai Ora Regional Director (co-Chair)
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•  Regional Wayfinder (co-Chair)
•  Pacific Health Regional Director
•  National Public Health Service Regional Director
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•  Hospital and Specialist Services Regional Director
•  Clinical Lead (Te Aka Whai Ora)
•  Clinical Lead (Te Whatu Ora)

SI&I leads are critical partners and wil  have a permanent seat on each RIT, with the expectation of serving as both
enablers, e.g. through the proactive and responsive supply of data among other things, and to support the RITs’
performance accountability within Te Whatu Ora and Te Aka Whai Ora.

No appointment can be delegated except with the permission of a National Director of Te Whatu Ora or Te Aka
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Whai Ora.

Enabling functions’ regional leads (or other roles) will be invited to attend as the agenda requires.
Accountability
All regional lead roles will report into their respective national directors. As the line manager for Regional
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Wayfinders, the National Director, Commissioning, is the Te Whatu Ora sponsor for RITs at the Executive
Leadership Team (ELT).
RIT members operate in a context of collective responsibility and accountability for integrated organisational
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outcomes within the scope of their delegations. They wil  be responsible for ensuring the work of the RITs meets
Te Tiriti obligations as set out in the Pae Ora (Healthy Futures) Act 2022 and engaging with Iwi Māori Partnership
Boards in key decisions. This includes accountability for prioritising and addressing equity gaps within the region.
RITs will be accountable for delivering on key priorities in national plans as well as those identified in regional
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plans. In general, these wil  be key deliverables that require integration and success across multiple service
delivery areas, e.g. Winter Plans.
RITs will promote a team of teams approach to deliver on regional work plans and will identify any support
required.
Reporting
RIT minutes wil  be submitted to ELT.
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RITs will report quarterly to ELT on achievements, risks, opportunities and challenges of/for the RIT.
As part of those reports, RITs should include:
•  insights on performance, including from periodic performance reports provided to the RIT by other parts
of Te Whatu Ora and Te Aka Whai Ora;
•  advice to ELT for enhancing the interface of national, regional and local arrangements.

Delegated authority
RIT members will have no additional delegated financial or non-financial authority above their individual roles in
line with organisational delegation policies. Decisions outside these delegations must be authorised by other
appropriate roles.
Regional Health and Wellbeing plans will be submitted for endorsement to Te Aka Whai Ora’s ELT and approved
by Te Whatu Ora’s ELT.
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Frequency of Meetings
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RITs wil  meet at least once a month.  Out of cycle meetings wil  be convened if required.
Quorum
A quorum is five (5) appointed members, one of whom must be a Te Aka Whai Ora member.
Attendance by others
With the approval of the Co-Chairs, authors of agenda papers or advisors required to speak to items on the
agenda may be invited to attend RIT meetings.
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If unable to attend a meeting, an appointed member may send a delegate though this should be exceptional and
not the norm. RIT colleagues should also be informed in advance when this will be occurring.
Distribution of papers
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Papers will be distributed three (3) working days prior to the meeting. Any late papers for tabling at the meeting
wil  be considered at the discretion of the Co-Chairs prior to the meeting.
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Minutes
The minutes will include record of attendance, conflicts of interests register (including mitigations where
applicable), summary of action points (including outcomes/resolution) and recommendations for the Te Whatu
Ora and Te Aka Whai Ora ELTs and DFA holders.
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The minutes and progress on the action points wil  be confirmed/discussed at the subsequent meeting ahead of
provision to ELT.
Conflicts of interest
Where any member has a potential or actual conflict of interest pertaining to an agenda item, that member shal
bring notice of that possible conflict of interest to the attention of the Co-Chairs for consideration.
The Co-Chairs shall decide whether any actual or perceived conflict of interest exists. If so, the Co-Chairs will
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decide how to manage the conflict, such as whether to exclude a member from discussion and/or decision-making
in relation to the item.

Review of Terms of Reference
The Terms of Reference wil be reviewed annual y, with the process led by the National Director, Commissioning in
conjunction with RIT Co-Chairs.
Issued by
These Terms of Reference are issued by Fepulea’i Margie Apa, Chief Executive, on 24 October 2023.
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