A pandemic response framework for equitable and inclusive planning and decision-making

Rochelle Menzies
Research Fellow, Koi Tū: The Centre for Informed Futures

He aha te mea nui o te Ao? He tāngata, he tāngata, he tāngata.
What is the most important thing in the world? It is the people, it is the people, it is the people.

New Zealand is faring better than other nations impacted by the Covid-19 pandemic, but there are many matters to reflect upon. As a collective we flattened the curve, but what have we learned about pandemic preparedness? Informed by past pandemics, iwi mobilised swiftly to implement pandemic plans that protected vulnerable tribe members, while supporting Māori communities. Tribal responses are providing valuable insights into what culturally-responsive crisis management looks like, and what is required to support optimal effectiveness. Informed by iwi response, a framework is proposed for improved national pandemic response planning that emphasises partnership and active protection in crises. Equity-based, the pandemic response framework is underpinned by key principles, highlighted by Māori leaders and experts, as essential to kaupapa Māori response in the current pandemic: Kotahitanga, Tino Rangatiratanga, Kaitiakitanga, Whanaungatanga, and Manaakitanga.

Tino Rangatiratanga Principle

The principle of tino rangatiratanga acknowledges the self-determination of iwi exercised over recent months in attempting to minimise Covid-19 harm to Māori.

Lack of consultation with Māori in planning a national response to Covid-19, and the potential impact of that on the Māori population created concern. At both national and regional levels, the government’s pandemic response plan was based on western public health approaches, which assumed universality, i.e. a eurocentric population.

According to Māori health experts, the Covid-19 crisis highlighted how the current approach to pandemics is unresponsive to the unique needs of Māori people and their memories of the impacts of past infectious disease.  To correct this, iwi immediately responded to the pandemic with urgent Māori-specific planning around how best to inform, prepare and sustainably protect Māori, both regionally and nationally.

Consequently, The Royal Australasian College of Physicians issued a formal statement: “A pandemic response that supports, sustains and values Māori as tangata whenua and taonga of Aotearoa New Zealand will centralise partnership, active protection and equity…The guiding principles and objectives structuring Aotearoa New Zealand’s COVID-19 pandemic response must centre equity for Māori and embed the principles of Te Tiriti o Waitangi.” As such, achieving equitable pandemic planning goes beyond consultation or co-design, instead calling for co-determination from policy to response. In this way, national pandemic response plans require equitable partnership between iwi and the government for transparent and inclusive decision-making at national, regional, and local levels.

Kotahitanga Principle   

Kotahitanga relates to unity, through shared vision or purpose, which creates a sense of community. In crises, kotahitanga supports productive and effective collective action as well as co-determination. The Covid-19 crisis is providing insight into how national pandemic response can be improved to better support Māori response and collective action. Iwi Chairs Forum member, Dr Rawiri Jansen raised concerns about inconsistency in data collection, and uncertainty about accuracy of health data. Crucial ethnicity data, needed to inform Māori response, was missing due to irregular data collection. During the rapidly-evolving Covid-19 pandemic, access to high quality data is imperative for critical decision-making around immediate response, contact tracing, and frontline services. Hence, for well-informed equitable pandemic response, it is recommended that data collection be standardised for a national consistent approach.

Similarly, issues of inconsistency around government funding had impacts on iwi pandemic response plans. While some iwi have explicitly praised the government for rapid provision of funding, other iwi reported communication issues and inability to access funding. Concerned by funding issues, Dr Rawiri Jansen said primary and preventative care services were impacted, at a crucial time for protecting vulnerable Māori against Covid-19. Māori Ministers’ budget reprioritisation towards funding iwi plans was commendably responsive to need, but how can funding be more equitable and fit for purpose?

Furthermore, iwi organisations also reported delays in supply of influenza vaccines and PPE, distributed through District Health Boards (DHBs). Again, some iwi organisations received these essential supplies promptly, while in other regions delays hindered urgent preventative care for high risk groups of Māori. New Zealand Medical Association Chair, Kate Baddock, described vaccine supply as chaotic, with delays up to 10 days, as current distribution systems failed during Covid-19. Her recommendation to the Epidemic Response Committee was for Ministry of Health centralisation of vaccine distribution to control supply, according to need and circumstance. Is this indicative of the health system and devolved public health being too fragmented to sufficiently cope with pandemics?

Another aspect of national pandemic response lacking centralisation, is primary care communications, regarding Covid-19 information and evidence. Being a novel coronavirus, frontline services relied on emerging evidence and information, but according to Dr Chris Tooley, health providers had communication overload and information fatigue. There was no singular ‘comms’ point, critical for consistent collective response, so he suggested national pandemic response use a centralised communication system, integrated with regional and local level health providers, using clear concise channels.

Kaitiakitanga Principle

Kaitiakitanga, or guardianship, speaks to responsibility for active protection and prevention of harm. With pandemics a significant threat to the Māori population, safeguarding their regional communities is paramount to iwi. As Covid-19 cases increased, without internal border controls, high deprivation Māori communities at greatest risk were vulnerable. In the absence of greater communication and action, worried Māori communities, especially in East Coast and Far North regions, felt unsafe. Taking matters into their own hands, iwi set up checkpoints, in an effort to prevent spread into tribal communities. These have been undoubtedly controversial, but if carried out in collaboration with relevant authorities, they set the groundwork for the testing and contact tracing efforts. As such, to promote co-determination in active protection of Māori, in what ways and in what circumstances could authority be allocated to iwi during

Manaakitanga Principle

Collectively, iwi pandemic response plans have operationalised manaakitanga by caring for Māori communities through outreach initiatives, and supporting kaumātua and vulnerable whānau, especially throughout the Level 4 lockdown. Many iwi responses included regular contact with kaumātua, checking on their wellbeing and needs. With limited government funding, iwi organisations utilised iwi resources, non-government funders, and private sector donors to fund distribution of food parcels, care packages, and other essentials. Exemplary iwi pandemic response, by Ngāti Kahungunu, utilised seven established regional hubs to coordinate a comprehensive emergency response, Tihei Mauri Ora. Through the regional hubs, a range of provisions, food, and koha were efficiently distributed throughout the whole tribe to uplift and support whānau wellbeing during the lockdown period.

Although iwi pandemic response is extensive, a large proportion of Māori are urbanised, with 1 in 4 living in Auckland.  Many urban Māori are residing at a distance from their tribal regions or disconnected from iwi, and not captured by iwi-based pandemic response. However, the Northland, Waitematā, Auckland, and Counties Manukau DHBs collaborated to provide support for Auckland and northern Māori. First, they launched The Whaanau Guide for Covid-19, a daily Māori Television broadcast that featured panels of Māori health professionals answering questions, asked through its Facebook platform. Then they partnered with Māori health providers, to establish the Ngā Kaimanaaki outreach service of community care workers who assist whānau in need to access services. Still in considering the sheer number of Māori in Auckland and other cities, would a Māori national pandemic response plan better ensure protection for all Māori?

Whanaungatanga Principle

Whanaungatanga, or relational connectedness, is paramount for Māori engagement in pandemic response plans, due to a general mistrust of medical approaches. For Dr Chris Tooley, of Te Puna Ora o Mataatua, this cultural inclination was apparent within initially low uptake of Healthline services, Covid-19 testing clinics, and influenza vaccinations by Whakatane Māori. Providing a localised alternative to Healthline, the Māori Health clinic set up a 24 hour Covid-19 phone service, which fielded high numbers of enquiries from regional Māori. Efforts to reduce barriers to accessing Covid-19 testing clinics included kaupapa Māori and whānau ora approaches to engage Māori communities, and involvement of local health and community workers who local Māori know and trust. Mobile testing clinics also allowed Māori health providers deeper outreach into rural Māori communities, to better engage with local whānau and provide vaccinations, testing, information and advice.

Similarly, communication of pandemic information needs to be culturally-specific and from a trusted source, to engage Māori and inform communities. At regional levels, iwi networks and media potentially provide communication channels for pandemic information to reach Māori communities. But for national pandemic communications, Dr Tooley suggested a consistent national Māori voice, alongside the Prime Minister, would be more relatable for Māori to promote trust during pandemics. Additionally, he found this pandemic revealed communications with kaumātua need development, and Age Concern reports need for pandemic-related information that is not online. With older generations most at risk from Covid-19, perhaps more suitable information channels could be determined while the pandemic is still ongoing.

As these are very uncertain times, we need to collectively remain mindful of the potential impacts of pandemics and how best to respond. Insights can be gained as Covid-19 illuminates what is working, what isn’t, and what needs improving, to inform better response. A kaupapa Māori response to pandemics is underpinned by key cultural concepts, providing a ready framework for broader application. Equity-centred, this principle-based framework creates an opportunity for inclusive and effective national responses for future crises.

Rochelle (Te Aitanga-a-Māhaki, Ngāti Kahungunu) has recently joined the Koi Tū team, bringing with her expertise in Kaupapa Māori research. Previously, Rochelle has worked as a Māori health researcher and Kaupapa Māori practitioner on a variety of population health and psychological medicine research projects. She has experience of health sciences, public health, health systems, Māori studies, and health psychology within undergraduate and postgraduate teaching settings. Rochelle’s areas of interest include health equity, indigenous health, child and youth mental health, Māori health and wellbeing, tamariki Māori wellbeing, and whānau wellness. Rochelle has a BHSc (psychology) from Massey University, and a PGDipHSc (health informatics) and MHSc from the University of Auckland. She is currently near completion of a PhD in Health Sciences at the University of Auckland.