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Kia ora koutou, kia orana, malo e lelei, talofa lava, greetings, 

As the DHBs’ funding gateways to primary health in New Zealand, Total Healthcare and other PHOs around the country have had to respond quickly to community need in the challenging months of 2020. 
But, for us, that isn’t something new. Identifying and anticipating resource need is inherent in Total Healthcare’s investment in early innovation and early adoption of care modalities aimed at high needs communities within our region. 
As a seed funder of the Gandhi Nivas programme, we have seen a near 60% reduction in reoffending among males who committed family violence.  We have pioneered a Best Start to Life programme for over 430 vulnerable young mothers and their children. We have led the health sector in the introduction of Manage Better mental wellbeing health coaching.
Our position at the forefront of early intervention delivery has relied on our partnerships and close collaboration with community agencies and NGOs across our region to identify need and opportunities to improve health outcomes. It also relies on the guidance of an experienced board of community representatives who have focussed not only on the medical but also on psychological and social determinants to prioritise our health investment.
I am pleased to see that our approach has been vindicated by the Ministry of Health’s recent Letter of Expectation that has identified similar priorities in its expectations of the health sector in the coming year.  The top two priorities of the ministry are improving child wellbeing, including family and sexual violence screening, breaking the cycle of domestic violence and mental wellbeing. In this newsletter, we put the spotlight on some of these services already in place.

Ngā mihi,

Mark Vella

Chief executive officer
Total Healthcare Charitable Trust

Gandhi Nivas sees substantial reduction in family harm

The Gandhi Nivas family harm support programme has shown the value of working directly with perpetrators of family violence in the community, reducing reoffending by almost 60% over five years.
Results of a long-term study of the Auckland programme by Massey University released at an event at Parliament on 30 June showed it “saved lives”, says Police Minister Stuart Nash.
“This is a programme that I think needs to be rolled out not just across Auckland, but every community across New Zealand.”
Total Healthcare is very proud to be one of the original partners and seed funders of the ground-breaking project that sees the men who have harmed their families removed from the family home and provided with 24/7 temporary housing and counselling, in combination with a wraparound support service for whānau. Read full story

New self-test for cervical cancer can save lives

Cervical screening rates in South Auckland fell dramatically during the COVID-19 lockdown, lending new impetus to our call for the introduction of fully funded home testing kits for the region.
“In this region we have a high needs Māori and Pasifika population, and we have a situation nationally where deaths of Māori women from cervical cancer is 2.5 times higher than that of non-Māori,” says Kate Moodabe, general manager of Total Healthcare.
“We have had years of underscreening in these women, and one of the major contributors is their distress and embarrassment about the invasive nature of a cervical smear test in a clinical setting.
“After a successful trial of a viable self-administered alternative, we want to see some of the funding from the cervical screening programme diverted towards this option for our South Auckland population.” Read full story

Robust systems needed to protect community funding

Total Healthcare CEO Mark Vella says there are a number of positives in the Government’s recent Health and Disability System Review and its focus on population health and wellbeing, but he is concerned about the impact of change on people with high needs.
Currently, general practice gets just 5.3% of the total health spend and yet the majority of need is in the community, he says. Total Healthcare’s providers are seeing more than 3000 patients a day or 1 million patients a year.
“The DHBs will need to recognise the extra load that is proposed by the review on primary care providers whose job it is to prioritise patients’ needs, especially those with high needs. There is a real risk that funding for their services could be diluted by competing demands within the much larger new-look DHB being proposed. Robust systems will need to be put in place to prevent this happening.” Read Mark's blog here

Giving high needs children the best start to life

Pictured: Tāmaki Health Maternity Services Coordinator Bijal Soni 

Our Best Start to Life programme has helped more than 400 young pregnant women to secure health  and social services support since its launch 18 months ago.
Total Healthcare funded the programme to address inequities in the care of our high needs population, and it targets registered Māori and Pasifika women under 22 who live in South Auckland. Our network maternity coordinator, Bijal Soni, works with each young woman from the time they test positive for pregnancy through to the early years of her child’s development. 
“Many of these young women really struggle with this huge change in their life,”  Bijal says. Read full story

Putting a young mum in control  

Pictured from left: Ana Woonten, Anaiyas Woonten, Bijal Soni 

When 20-year-old Ana Wooten first found out she was pregnant, she was full of anxiety about what lay ahead. At eight weeks pregnant, she was referred by Local Doctors to the Best Start to Life programme and maternity coordinator Bijal Soni.
“The first thing Bijal did was organise a midwife for me,” Ana says. “I had had no idea where to look or what to look for in a midwife. Bijal asked me about what I wanted for my birth and then gave me some options. Without her it would have been really overwhelming.”
Instead, Ana says, Best Start smoothed the way for her, though the COVID-19 lockdown threw a curve ball that restricted Bijal’s physical visits. Throughout Ana’s pregnancy, Bijal checked in regularly with her, helping her with everything from booking vaccine appointments to arranging scan referrals. ­Read full story

Big increase in flu vaccinations of pre-schoolers

The lockdown provided one welcome boost to health outcomes across our region – a huge increase in flu vaccinations among young health-compromised Māori children.
Two of our hard-working paediatric nurses, Carmina Velez and Suman Lata, spent the period contacting families of children aged four and under who had been hospitalised previously to visit their local clinics for a free flu jab.
Their efforts saw the rate of vaccination rise from just 4 %of a total number of 2368 children in February to 23% by the middle of this year.
This phone outreach is ongoing.


Pacific Youth Health Expo a success

Pictured from left: Total Healthcare Community Manager Lorenzo Kaisara with PYHE coordinator Esmerelda Lo Tam, and former Miss Samoa Janine Tuivaiti 

Improving health literacy among Pasifika youth in a bid to reduce the risk of premature death was the aim of the inaugural Pacific Youth Health Expo (PYHE) held in Auckland before lockdown.
Seventy per cent of premature non-disease related Pasifika deaths can be linked to behaviours and habits that form in adolescence. In response, the expo was organised by Ei8ght Sports to empower youth to take control of their own health and wellbeing and the result was an outstanding attendance of over 200.
Participants heard from health professionals and researchers addressing health literacy, digital addiction, mental health, rheumatic fever prevention, mother and child health and healthy relationships.
Total Healthcare and Tāmaki Health were sponsors of the two-day event and our community manager Lorenzo Kaisara volunteered his time to act as master of ceremonies.

Total Healthcare joins GPNZ

Total Healthcare has taken a seat at the table of General Practice New Zealand (GPNZ), which represents the primary healthcare needs of over four million New Zealanders.
“GPNZ has been able to showcase the agility and readiness of PHOs to step up in times of need to the Ministry of Health and DHBs, and we see our membership as our recognition and support of their work,” says Mark Vella, CEO of Total Healthcare.
“At the same time, we will continue to work alongside them by retaining our own advocacy mandate representing our largely high-needs population to Government.”
Total Healthcare supports a population of 230,000 people across the metropolitan Auckland region, nearly two-thirds of whom are deemed high needs.
GPNZ is the representative body of the majority of general practices in New Zealand across its 20-strong PHO membership. Membership covers 80% of the enrolled Māori population.

Read GPNZ's press release

Working together to improve health outcomes

Total Healthcare contracts Tamaki Health as its management support organisation to provide medical and management services required in the PHO/DHB contracts across Auckland. Tamaki Health providers include Local Doctors and White Cross networks.

We are a substantial, responsive, innovative provider of Pasifika primary healthcare.

Total Healthcare is the largest primary healthcare provider to Pacific Island patients in the Counties Manukau DHB area. Our network health provider teams are made up of a diverse range of ethnicities representative of our patient populations. Our PHO board is chaired by Willie Ropata and over 50% of our board members are Pasifika. Our provider's director of clinical quality is Dr Richard Hulme of Samoan descent and our community liaison manager is Lorenzo Kaisara, also Samoan.
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