Concerns have been raised over a closed tender process and perceived conflicts of interest regarding a $1.35m DHB contract for a Pasifika health service, Laura Walters reports
More than $1.3 million of discretionary funding for Pasifika health in the Wellington Region was awarded to members of the DHB’s Pasifika advisory group, without an open tender process.
Capital and Coast District Health Board (CCDHB) gave the $1.35 million in discretionary funding to establish a new nursing service in Porirua East.
The money, which Newsroom understands is the only discretionary funding available for Pasifika health equity initiatives in the CCDHB region, was awarded to Central Pacific Collective to set up the nurse-led neighbourhood service, called Vaka Atafaga.
Tino Pereira, the chair of the Central Pacific Collective – a Pacific-focused consultancy – is also the chair of the Pacific Strategic Health Advisory Group which advises the Capital & Coast, Hutt Valley and Wairapapa DHBs (known as the 3DHBs).
The head of the Vaka Atafaga nursing service, Dr Margaret Southwick, is also a member of the 3DHBs Pacific advisory board.
The conflicts of interest and seeming lack of transparency have caused concerns among Porirua’s Pacific community and a local, established Pacific health provider.
But CCDHB executive director of strategy, innovation and performance Rachel Haggerty said there were no conflicts, as the Sub Regional Pacific Advisory Group did not make recommendations for the commissioning of services. The funding allocation was managed by the Pacific Health Director (who has since left), Haggerty, and the executive leadership team.
Pereira’s conflicts of interest were registered alongside his position in the DHB’s Health System Committee, but Haggerty said the committee only noted that the service was being established – it did not have a role in commissioning it.
Meanwhile, the lack of a formal, open tender process has also raised questions.
The only publicly available information regarding the service came in a press release to announce its launch, in May. And in February, a CCDHB Health System Committee paper outlined the plan to set up the Pacific nurse-led neighbourhood service, saying it would be funded from resources allocated within CCDHB to improve equity.
CCDHB’s Haggerty said the decisions to commission Pereira’s Central Pacific Collective to create the service was recommended to her by the former Pacific Health Director. This came after Southwick first pitched the idea to the DHB in 2018.
“As a consequence, an exemption to the open procurement process was authorised – including by the CCDHB Board – and the service directly commissioned from the CPC,” Haggerty said.
“This exemption is used by government agencies to develop providers with specific attributes – in this case, Pacific leadership and a deep understanding of Pasifika approaches in a nursing context. The service was commissioned in April 2019.”
‘It’s just not kosher’
Pacific businessman and primary health provider John Fiso said the way the funding was allocated and the conflicts of those involved in creating the service was “just not kosher”.
Fiso was told about the plan to develop a nursing service and wanted to put in a bid for the $1.35m fund to grow the workforce at his clinic in Cannons Creek, Porirua.
However, he was never given the opportunity as there was no competitive tender process.
Fiso’s clinic, Pacific Health Plus, is the sole Pacific practice in the CCDHB area – it is owned and governed by Pacific people, for Pacific people.
Of a total enrolled population of 2190, 1775 are Pasifika (81 percent). The proportion of high-needs patients at the practice is 93.7 percent – the highest of all the high-needs, low-cost practices in the region.
At CCDHB, life expectancy for Pacific peoples is estimated to be eight years lower than for non-Māori non-Pacific peoples (76 versus 84 years). This gap in life expectancy has not narrowed over the past 10 years.
Currently, Pacific Health Plus is funded at $280 per patient, significantly lower than other low-cost practices in the area due to the discretionary funding they receive from the DHB, Fiso said.
The $1.35m could have made a significant difference to the practice, and the community.
While it could have funded a number of nurses, it could also have paid for four more doctors at the clinic, meaning more people could be seen, and faster. The clinic currently has 1.5 doctors.
“The resource of four doctors going into that community would be huge. Instead they’ve wasted it.”
If the money had gone to an established practice, like Pacific Health Plus, or Porirua Union Community Health Service (47 percent Pacific enrolled patients), it would have gone further, he said.
Instead, a significant portion of the limited funding had gone to consultants and setting up infrastructure for the nurse-led service.
The CCDHB Health System Committee paper from February said the service would work with other Pacific health providers and existing community nursing resources. It also said there would be sharing of infrastructure and technology in order to remain cost-effective.
Fiso said there did not appear to be collaboration with other Pacific health providers in the area.
Pacific people falling further behind
The issues over the funding allocation comes at a time when there is rising concern over Pacific health outcomes.
CCDHB documents show Pacific people in Porirua have high preventable hospital admission rates, and high rates of diabetes and metabolic disease.
The prevalence of type 2 diabetes is considerably higher in Porirua than in other areas in the Wellington Region. And the number of young people with type 2 diabetes is also rising.
Meanwhile, a CCDHB Pacific population health profile equity report from November said: “There are marked and long-standing inequities in health outcomes between Pacific and non-Māori non-Pacific peoples. These inequities are driven by a higher prevalence of risk factors and long-term conditions and poorer access to primary health care.”
At CCDHB, life expectancy for Pacific peoples is estimated to be eight years lower than for non-Māori non-Pacific peoples (76 versus 84 years). This gap in life expectancy has not narrowed over the past 10 years.
“I recognise a lot of our people can’t do the talking because they’re in jobs that they need. On the other hand, I’m not getting employed by the DHB, and to be honest I’m quite happy to be an advocate for things when they’re not quite right.”
One of the Government’s five priority areas for its inaugural Wellbeing Budget was delivering for Māori and Pasifika.
Those in the community who spoke to Newsroom said the same promises had been around for a long time now, but decision-makers lacked cultural competency.
This meant Pacific voices and priorities were not amplified and heard, leading to imposed solutions, which were not fit for purpose, and not sustainable.
They said they wanted it to be a level playing field when it came to the allocation of funding.
“I recognise a lot of our people can’t do the talking because they’re in jobs that they need. On the other hand, I’m not getting employed by the DHB, and to be honest I’m quite happy to be an advocate for things when they’re not quite right,” Fiso said in regard to the issues around the funding, and the wider health problems facing Pacific people.
CCDHB’s Haggerty said the nursing service received $450,000 a year for three years, which was subject to performance requirements being met.
The first measurement evaluation is scheduled for April 2020.
To date, the service had responded to 56 referrals – most received from the Pacific Health Unit for discharged patients needing follow-up in the community, she said.
Haggerty said the DHB was monitoring the service through meetings about establishment, progress against the project plan, and impact on families.
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