Abstract:
Aim: This thesis is an exploration of the measurement of the quality of Māori health providers and takes a critical look at how Tauiwi (non-Māori) paradigms impact on quality. These Tauiwi paradigms relate to various forms of power, including the expression of power through colonisation. The intention of the thesis is to provide a resistance to Tauiwi power and to re-claim, re-imagine and transform the status quo. Background: Tauiwi power, in primary health care, is manifest in the structures, systems and processes of general practice. General practice, as a system, fails Māori through the widespread inequity in most health outcomes. Māori health providers arose out of a widespread resistance to Tauiwi world views and the renaissance of Kaupapa Māori approaches. Despite the promise of Kaupapa Māori, significant barriers exist for Māori health providers in achieving their goals. Methods: This thesis uses a Kaupapa Māori congruent methodology, along with autoethnography, to explore the research question. A case study approach is used, in which one Northland based Māori health provider, Ki A Ora Ngātiwai, is analysed in detail. The development of the research question, approach to the research and analysis of the data is guided by a research whānau mostly associated with Ki A Ora Ngātiwai. Data was drawn from interviews, hui, document analysis and various reflections. Findings: Analysis of the data demonstrates that the contracts given by various funding agencies to Ki A Ora Ngātiwai, are restrictive, often full of rhetoric and perpetuate colonisation. Quality primary health care, as seen through the lens of funders is in contrast to the vision of quality seen through the lens of participants in the study. Participants describe quality as encompassing connections through whakapapa, rangatiratanga or self determination over health services, decolonisation of health and focussing on wellness rather than health. Conclusions: The thesis concludes with a description of a framework, that can critique Tauiwi power in relation to Kaupapa Māori primary health care, as well as a model of measuring quality for Māori health providers.