Understanding the implementation of New Zealand’s immunisation health target for two year olds

Abstract

Health targets have been used internationally to stimulate change and improve performance within specific areas of a health system. While some countries have a long history of using health targets, their use within the New Zealand health system is relatively recent. Previous research on health targets has shown that they can be an effective policy mechanism for improving accountability and focusing attention on priority areas. However, critics of health targets have argued that they can create dysfunctional consequences within a health system that can have a negative impact on performance. This research used case study methodology to explore the implementation of New Zealand’s immunisation health target for two years olds within four case study District Health Boards. Understanding the implementation process allowed the researcher to consider how effective the health target was as a policy mechanism for improving immunisation coverage and addressing immunisation inequities between Māori and non- Māori children within the context of the New Zealand health system. The research findings demonstrated that the immunisation health target created strong accountability mechanisms across each level of the New Zealand health system. This vertical dimension of accountability focused attention on immunisation and elevated it as a priority on local policy agendas. However, the immunisation health target was actually implemented at the local level along a horizontal dimension through network coordination. Network coordination allowed the case study District Health Boards to take a universal systems approach towards improving immunisation coverage in their region. This increased immunisation coverage for all children, including Māori children, in a way that previous policy attempts had failed to achieve.