Case study: For Us, By Us: Ora'anga Kopapa Matutu
A Tamaki Auckland, Cook Island Maori community-led development initiative

The Auckland District Health Board (ADHB) introduced Healthy Village Action Zone as a three year primary health initiative in 2006. They planned to use the main meeting place in a Pacific village, the local church, to engage Pacific Peoples in health promotion.

Alfred and Mokauina Ngaro of the Tamaki Church in Panmure were enthusiastic about a project based on empowering community development, however they did not want to support a project that was based on notions of deprivation and deficit. Previous service delivery strategies targeted on 'high need' communities had cast a shadow over the neighbourhood.  Experience had shown them that a deficit-based approach undermined community confidence.

The Cook Islands leaders in Panmure and Glen Innes saw an opportunity for collaboration between local residents, Pacific churches, physical fitness services, the ADHB and primary health organisations (PHOs). Alfred said "The key was to draw on community wisdom, knowledge and enthusiasm, and let the people take leadership."

Three Pacific Churches in Glen Innes worked together to develop a health promotion initiative.  Community discussions began. Communities came up with their key health concerns and designed the programme. Times were set to fit with the busy needs of diverse families. The funding and resources were provided by two local Pacific NGO health providers. The initiative was given a meaningful Cook Island Māori name – not an English name translated.

Eight months later 500 people participated in a launch where the Minister of Health and officials were the invited guests of the community. Community members shared a meal and their stories. It was an empowering and mind shifting event for the Pacific community.

Alfred Ngaro says Ora’anga Kopapa Matutu illustrates "core elements of community-led development in action." Parties focused on generating "concrete outcomes" through a focus on tangible results. Aerobics classes were led by a 68-year-old mama from the community. The classes were linked with healthy eating, weight loss, fitness and training for life skills and employment. Doctors, nurses and allied health professionals partnered with the community.  Together they provided an holisitc, health education programme for the entire family and also conducted medical check ups.

Prizes were donated by a local NGO and a family trip to the Cook Islands was won on the basis of: weight loss, family participation and sustained attendance. Alfred said "The prize was won by a man who lost almost 20kgs. His two daughters shed a combined 15kgs and they all earned certificates in aerobics instruction."

Alfred ranks the intangible benefits of community pride and ownership of health issues by the people as important as the measurable results.  "Taking down the fences between sectors has benefited all parties and increased the chance of sustainable results through community ownership and collaboration."

Lessons for both community organisations and the District Health Board are covered in the four points below:

1. Community ownership is crucial from the beginning for the initiative to be effective, in order to:
   • ensure the strong involvement of those most affected
   • produce tangible results for the individuals, families, community and the health authorities
   • provide health and fitness activities that are sustainable
2. It is essential to strengthen existing active local community connections, relationships, groups and organisations, to ensure local leadership and the involvement of the most relevant people.
3. By actively and carefully listening to each other, and agreeing common points for development we can stop 'talking past each other' and build a base for a shared development that  works with each other's strengths
4. Adapting to the developments as they occur keeps the initiative relevant and flexible.  It builds shared ownership, trust and  results and provides a basis for further developments.  It opens doors rather than putting up walls.
   

• Redefining themselves as active leaders in acknowledging health issues contributed significantly to community ownership of the initiative.
• It was crucial for local Pacific organisations to count the strengths of the community instead of  being defined from the outside by the deficits.
• Whole anau involvement across the generations was essential and achieved.
• Informal leaders with high influence such as Mama Nicholls are vital.
• Tamaki Pacific peoples named the initiative.  This ensured a name that was full of meaning, rather than staying with the programme name of Healthy Village Action Zones
  

• The ADHB moved from thinking about 'delivering a programme' to  a 'deprived area',  to developing clarity about the core principles and then listening to the wisdom and expertise of the local community.
• The ADHB developed more of a partnership in action.  This was reflected in the equal numbers of community members and District Health Board staff being  the 'team' to receive a national Healthy Innovation Award in 2008.  All other possible award  teams were from the government delivery organisation only.
• The ADHB's Pacific Advisory Committee identified the lessons learned from the approach of this initiative.  This in turn has contributed to the Board's new neighbourhood-based focus as a key policy drive for primary and public health care.

Case study uploaded December 2008.