Community participation in the establishment of a primary health organisation in the Horowhenua : a longitudinal case study : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Management at Massey University, Turitea, Palmerston North, New Zealand

Abstract

In February 2001 the Minister of Health, in announcing the Primary Health Care Strategy (King, 2001), identified Primary Health Organisations as the vehicles for planning, funding and coordinating primary health care services throughout New Zealand. The requirement that communities be involved in their planning and development was integral to this strategy implementation. Investigation of the Horowhenua Primary Health Organisation establishment process from the inception of planning to the formation of a Primary Health Organisation provided an excellent opportunity to analyse the determinants of genuine community participation. This case study extended over a nine-month period. Data collected from multiple sources provided the basis for investigating the complex notion of community participation and the attributes which are essential for sustainable community engagement. The Horowhenua Primary Health Organisation Steering Committee comprised community representatives, iwi and local health professionals. This group along with the two external stakeholder groups - namely the District Health Board Funding Division and the District Health Board Primary Health Care Reference Group – were central to the analysis. The events recorded and observations made throughout the planning period formed the basis of identifying essential determinants of community participation. These included knowledge of the community and its unique “ways of doing”, the dynamic interdependencies both within the Horowhenua community and with stakeholders external to the Horowhenua, changing power relationships, managing material resourcing and accessibility to essential information. These all influenced how this rural community engaged in Primary Health Organisation planning. One common theme which emerges in the literature is the synergy between community participation and community development. A community development approach is a commonly agreed way of engaging communities in health service planning which is genuine, inclusive, self-reliant, and self-determining. This research demonstrated that the New Zealand context, where implementation of the primary health care strategy must be nationally consistent and comply with prescriptive, central government-determined criteria - as well as involving communities in a meaningful way - requires an alternative approach. The thesis presents a way of addressing power discrepancies, promoting interdependencies between stakeholders and achieving inclusiveness in all decision-making where “expert” stakeholders and community bring to the partnership a set of attributes and knowledge which collectively informs the entire planning process.