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Immunisation - the secret report

Labour 2000 web site

Labour health spokesperson Annette King has released a report which condemns the current approach to immunisation.

"The report comes from the government's own advisory body, the National Health Committee.

"It has reviewed the Health Funding Authority's strategy for immunising 'hard to reach' children. The committee has found there is NO strategy; that the HFA has failed miserably to meet immunisation targets; that its funding policy is a disaster; it has failed to set up a much needed national database; and it has hampered rather than helped immunisation providers.

"The Health Minister Wyatt Creech has sat on this report for over a month. He has shown no concern for the health needs of New Zealand children - his only concern is for the political health of the National Party.

"The report makes sorry reading and is a stark reminder of the abject failure of National's approach to healthcare."

The findings include:

The immunisation strategy - a failure:

"Current responsibility for immunisation is shared between several HFA operating groups: Public Health, Maori Health, Pacific Health, Personal Health and the Child and Youth Health group within Personal Health. This leads to difficulties in co-ordination and diffusion of accountability for immunisation coverage outcomes."

"There is no specific strategy for 'hard to reach' children."

"There has been little evidence to date of collaborative locality planning from the HFA."

The immunisation target - a failure:

"Coverage levels (are) far below the target levels, with particularly poor uptake by Maori and Pacific children."

In the Far North "the coverage rate remains between 40 and 50%."

"The failure to achieve high coverage levels results in reactive expenditure in an effort to limit epidemics. This is an inefficient use of health dollars…"

"Despite contractual requirements concerning immunisation performance, there has been very little monitoring or external audit of immunisation coverage by the HFA."

The funding policy - a failure:

"There are few services contracted to actually immunise children. Funding a broader range of providers and developing 'outreach' immunisation services are important steps to improve accessibility."

"There is a fundamental problem with the HFA's desire to 'pay the same amount for the same service across the country' in primary care. It costs more to provide services such as immunisation in a community with a high proportion of 'hard to reach' children than it does to deliver the same number of immunisations in an affluent area."

"There is little evidence that purchasing separate services to encourage people to use health services will actually improve immunisation coverage unless the barriers to the use of primary services are also addressed: financial barriers, cost of transport, cultural barriers, distance, attitudes of health professionals, distrust etc."

"There has been considerable disappointment at an apparent lack of support by the HFA for 'local solutions.' Provider frustration… was exacerbated by the discovery that substantial, long term contracts had been awarded to particular providers without all services having the opportunity to tender."

"Fairness requires that services achieving high coverage by dropping the 'hard to reach' off their books are not rewarded at the same level as those services which genuinely strive to deliver immunisation services to the 'hard to reach.'

The relationship with providers - a failure:

"Several (community-based) services describe a continual struggle to maintain the levels of provision necessary to achieve health gains in an environment where they are… constantly required to justify their funding to HFA staff wanting to standardise contracts and prices."

"Providers who have been strongly motivated, innovative and successful in immunising 'hard to reach' children, often with minimal extra funding, should be supported and rewarded. Instead most report frequent episodes of poor communication with HFA staff, that their effort and investment in trialing new approaches is often not acknowledged, that their limited resources are expended orientating new HFA staff, and high transaction costs erode the value of their contracts. In some cases, services have had their viability threatened, not due to any shortfall in performance, but because of changing HFA staff, procedures or direction."

The immunisation database - a failure:

"There has been an expectation for several years that the HFA, and RHAs before this, would develop an information system to provide accurate coverage data. The HFA has failed to deliver in this vital area."

"The committee has made 16 pages of recommendations to the Minister on how to improve New Zealand's dismal immunisation record," Annette King said.

"The Minister, more concerned with battling for his political survival, has ignored them. Labour will not.

"The recommendations include:
-Setting a new achievable immunisation target - 90 % of all two years olds within 3 years.
-A change in the funding formula to recognise population and regional differences
-Establish a central immunisation database
-Ensure every baby is enrolled with a primary care provider and is referred to a Well Child provider by 6 weeks of age
-Develop outreach services for 'hard to reach' children
-Review the level of payment to providers and introduce performance-based payments
-Educate primary care providers on the value of 'opportunistic' immunisation
-Specific education campaigns to target 'hard to reach' families
-Effective consultation with community providers to develop appropriate local solutions
-Encourage schools and pre-schools to take active steps to access immunisation for under-immunised children.

"I will be seeking a meeting with the HFA at the earliest opportunity after the election, and I will expect immediate action on immunisation," Annette King said.

"For our children's sake, we must improve immunisation rates."

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