To create a locality, listen to the people: Silao Vaisola-Sefo

The Ōtāra-Papatoetoe locality may be born of the health reforms, but it will be years before the community is able to make healthcare its primary focus, says the chief executive of the practice leading the prototype.

“People keep telling us health is not a priority,” says South Seas Healthcare chief executive Lemalu Silao Vaisola-Sefo.

“They are too busy looking after the kids, they are worried about their sick grandmother, they are in debt. It comes up again and again. It’s time we started listening to the people.”

Mr Vaisola-Sefo is part of the team, led by the community and iwi, working out how their locality will function.

He says the former Counties Manukau DHB made several attempts at creating a locality model in the past 10 years, but built it on a mainstream template “that didn’t quite fit the reality of the community”.

“We believe a locality is an approach to working with community. It is not just about fixing what is wrong, it is also about reinforcing the social cohesion of communities that have been really struggling, and the most encouraging part we have seen is how ready those communities are for it.”

Since the health reforms’ nine prototype localities were confirmed by health minister Andrew Little on 21 April, Ōtāra-Papatoetoe stakeholder meetings have been held every two weeks.

The team has been meeting with key partners and with PHOs, local government and officials from Te Whatu Ora – Health New Zealand.

Social welfare concerns dominate discussion, says Mr Vaisola-Sefo.

“In 2019, this community was hammered by measles, and they have been hit every year since then with the same families being hit the hardest.

“We need significant investment in south Auckland because this is always the front line. The impact of these outbreaks is going to be transgenerational.”

The greatest single healthcare measure the Government could provide right now, he says, would be to write off the COVID-related debts weighing families down.

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A Te Whatu Ora-commissioned analysis of the level of need within the locality’s various communities is now under way. Mr Vaisola-Sefo says it is “a massive piece of work” that will draw on multiple government ministries and community-based organisations.

“If we are going to design a new service delivery system, we really want to understand everything so we can step back and look at how services are being delivered.”

The result, he hopes, will be an interconnected network reaching from sports clubs and churches to general practice and hospital services, each connecting users directly to a full suite of support services ranging from fitness programmes to food banks and healthcare.

These services will only be available within the locality’s boundary, but Mr Vaisola-Sefo says they will be available to those living outside the area. He says this model has worked well during the COVID response.

The primary care element will be built on top of what Mr Vaisola-Sefo calls the village of providers, the 15 practices that came together during the COVID response.

“These are not big providers,” he says, “but we punch above our weight in service delivery and, if the government funds us properly, we could look after our communities and access would not be an issue.

“We have to move away from the traditional competitive environment to being more about collaboration. But we all keep our autonomy, each provider can do what it does, it’s the values driving us that bring us together.”