Exploring Approach 3: Tāngata whenua perspective

What could be some of the intended and unintended costs & consequences of doing what this approach suggests and what tensions or conflicts would have to be worked through for this approach to be successfully implemented?

The Maori people seem not to be well-informed about pre-birth testing and services related to this issue. Hence, the government need to spend more money to build suitable channels to provide adequate information for them to make well-informed decisions such as by post or in person, as face to face discussions are important to many Maori.

In addition, it may be that their incomes do not allow them to access pre-birth testing services without support from the government. Therefore, subsidising the service’s price for them is one possible solution, but may become a burden for the state budget.

Creating more equal opportunities for Maori people, especially for those who live in rural areas and those with low incomes is the key approach that can help to make the implementation successful. Possible approaches are having a Maori language version, introducing pre-birth testing in their community groups and churches, and asking for support from iwi and hapu leaders.

As this approach focuses more on a specific group, I think the challenge will be to create fairness for other ethnicities, such as NZ European/Pakeha, Asian or Pacific peoples. Although it is true that Maori is one of the disadvantaged groups in terms of accessing pre-birth testing services, providing accessible health service for all ethnicities also need to be prioritized by the government. Otherwise, the initial intention to create equity can instead result in inequity. As many have mentioned, I agree that the government should create a system that is accessible and suitable for Maori's needs. But if I may add, I think the government also has to consider to give other ethnicities good access to health service too. Hence equity can be created for all.

We know that mainstream services work for some Maori.  However, where services do not, Maori frameworks are far more effective.  There will be many tensions and conflicts to work through to successfully implement Approach 3, most of which can be addressed by organisational culture and systems change that involve addressing existing workforce racism, implementing cultural leadership training, incorporating Māori core values and beliefs into pre-birth testing policies and service delivery, power sharing with Maori, and increasing Māori-focussed resources.  These are obvious strategies that will require courage and increased resourcing.

I agree with what @Janice Hemi has said, in that a major tension to work through at the system level would be successfully implementing the approach in a very Western-orientated health care environment -- and ensuring that there is ongoing resourcing so that it is enduring. Resourcing would be required to not only to up skill practitioners, but also to allow for the potential implications this approach would have in terms of funding per patient (as funding requirements might differ depending on what approach is taken, e.g. if there are implications for appointment length, number of appointments required, who practitioners need to engage with, etc).

Nice work, Janice and Beth. Challenging and changing structures and cultures is difficult but it sounds like you think we need to and that there are some practical ways of improving things for everyone.

Let's finish up our exploration of Approach 3 now

Thanks everyone for the quality of your communication and for covering so much ground so quickly - we spent 2 days exploring this approach, something that took 6 days when this process was run with the public.

Going fast does have some advantages - lots of posts in a short time create energy and momentum, and the rapid sharing of ideas and perspectives can help form supportive relationships between participants - yes, this can happen online! A disadvantage however is that there is less time for people to reflect on what's being said, on what they think about it and what they're going to say next. When the balance between speed and reflection is right, the discussions are very rich and innovative thinking can occur.

I would normally write a summary of your day's work to close it off but I'm not going too as I don't think it's necessary for the purposes of this simulation. I'll start a new thread for the next stage of the process - starting the search for common ground - shortly.