Northland Primary Health Care Collaboration Kaupapa Initiative

This narrative centres on a two and a half year collaborative kaupapa that has resulted in the 2019 formation of a trust-Te Kaupapa Mahitahi Hauora-Papa o Te Raki Trust. The mission of the Trust is to forge a new future for primary healthcare in Northland through a partnership between existing primary health organisations, the Northland District Health Board, Iwi, clinicians and communities, with the aim to empower whanau, patient and community-led health and wellbeing decision making, processes and outcomes. This collaborative kaupapa represents a groundbreaking health initiative in its scope, purpose, inclusion and process. Such cross system, paradigm-breaking initiatives are rare. This case narrative aims to make the core elements of such a venture visible – to those involved in the Collaboration Kaupapa Initiative itself, those in the health system more generally, those involved in delivery of health services in Northland, and all others aspiring to such goals.

The subject of this narrative is participatory, grassroots or so-called ‘adaptive governance’ and its focus is the very early stages of getting a cross system, paradigm-breaking initiative off the ground. We would argue  that these early stages are often invisible to both internal and external eyes but utterly vital if any progress is to result. This particular initiative has just recently become visible with the emergence of a new primary care provider – Mahitahi Hauora PHO – which has grown from two existing primary health organisations, Tai Tokerau PHO and Manaia PHO. It carries huge aspirations for the health of the people of Northland. The years preceding the emergence of Mahitahi Hauora PHO are the subject of this report as the spirit, ambition and synergy between stakeholders was forged then. The combination of this subject and this focus is unique. Internationally, and most certainly also in Aotearoa New Zealand, we are in the early stages of understanding collective, decentralized decision-making but are increasingly aware of its potential to address intractable and cross system challenges. Additionally early stages of pulling community, public sector and iwi groups together to embark on such an endeavor are rarely documented. The Collaboration Kaupapa Initiative is an
exceptional exemplar and this case narrative an attempt to document at least some of the core learnings. Our hope is that the case narrative offers recognition to what has already been achieved in order to establish Te Kaupapa Mahitahi Hauora-Papa o Te Raki Trust but to also give direction, hope and support to others wanting and needing to undertake similar ventures in other contexts.

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