Immunisation Programs In Bay Of Plenty: Challenges And Recommendations

Low availability of primary health care services in Bay of Plenty

Question:

Discuss about the Increased Immunisation for Bay of Plenty.

The current topics access the health scenario of the Bay of Plenty (BOP) province of New Zealand with reference to increased immunisation programs. The study and the regional statistics shows that the region is comparatively low with respect to the availability of primary health care services.  This is particularly found in the Maori and Pacific ethnicity and could be attributed to low economic condition and lack of sufficient knowledge. These people are low on the immunisation rates which possess a greater risk to the surrounding population as a whole. The greater rates of immunisation have been found to lower the risk of transmission of highly contagious infections.

In this respect, a number of recommendations have been suggested for the target population group such as the promulgation of sufficient amount of health literacy channels with special emphasis upon immunisation programs. Additionally, sufficient policies and documentation could also help in highlighting the exact figures about the deprived population. The documentation also helps in formulating important policies and procedures which can provide future assistance to the target population.

The proposal has been drafted in accordance with the national immunization register which notices a sharp gap in the immunization rates of the overall New Zealand population and the BOP residents in particular.

The current topic focuses on the concept of the importance of governance structure and policies in ensuring optimum health services for individuals, communities and families living within a region. For the current study, the governance structure of New Zealand has been taken into consideration. In this context, a target population size has been selected for the implementation of a particular health initiative within the population. The health initiative chosen for the current study is increased immunisation. The topic has been further narrowed down by focussing upon a particular region within the New Zealand continent. The region chosen over here is the Bay of Plenty (BOP) which is a large open bay located on the Northern coast of New Zealand’s northern island. It stretches from the Coromandel Peninsula in the west to cape way Runaway in the east and spans for over 259 km open coastline. The current topic focuses on the health and immunisation requirements of New Zealand. As per reports and evidence, poverty and lack of sufficient knowledge are some of the factors which hold back majority of the population from getting immunised.

Recommendations for improving immunisation rates in Bay of Plenty

The three major areas have been identified in the BOP which requires rapid immunisation such as children less than 2 years including premature babies and neonates, pregnant women, immune-compromised patients. The New Zealand health department plans to achieve 95 % vaccination rates (Ashton, 2015).  In this respect, effective policy implementation helps for arching an overall target of 95 %. This helps in reaching a stage known as ‘herd immunity’, through a gap of 5% remains. This could be attributed to several factors such as poverty, lack of education or other serious health conditions where an individual cannot handle a vaccine. This is particularly relatable in context of an individual receiving treatment for cancer care.

The government of New Zealand aims for the achievement of a 100 % immunised populations. However, a number of challenges are faced where the population is not aware of the health benefits of vaccination.  The Bop region is far from reaching the 100 % immunization rates due to two particular groups of people the deprived and the objectioners (“About the Ministry”, 2017). As commented by Palmer et al., (2016), the objectioners not only risk the health prospects of their own children but of the community as a whole by and large. A number of health initiatives are undertaken by the New Zealand Government over here. These are maintaining a national immunization register introduced in 2005 to provide 80% coverage to children aged six months.  The register helps in keeping track of the important vaccination doses to be delivered to the children.  As mentioned by Le Menach et al., (2014), active documentation helps in preventing missing of vaccine doses. Additionally, implementation of evidence-based communication approaches can also help in educating the parents sufficiently about the vaccination and immunisation programs and their benefits (Harris, Cormack & Stanley, 2013). Reports and evidence suggest that 5 % of the parents are still unsure about the benefits providing vaccination can do to the health of their children.

The bay of plenty harbours the Maori and Pacific ethnicity people who had been most deprived in receiving supportive care. This could be attributed to a number of factors such poverty and limited access to health care services. These people do not get timely access to health care services due to remote location. As per reports and evidence, the Maori people are more connected to their spiritual faith and beliefs. The cultural beliefs and paradoxes possessed by such people often limit them from approaching the basic health services (Harvey, Reissland, & Mason, 2015).  The current health scenario with respect to the Maori and Pacific ethnicity can be discussed with reference deprivation of health care services.

Importance of governance structure and policies for optimum health services

The deprivation could be attributed to a number of causes such as relatively high cost charged by the general physicians, which prevent them from consulting about the vaccination requirements of their children. Additionally, lack of support and unavailability of health care centres within near location also contributes towards the immunisation targets not being met (Clark, Templeton & McNicholas, 2013). As per the health reports two in five (39%), Maori residents have experienced unmet need for access to primary health care services (Filoche et al., 2013). The rates have been comparatively higher in women and children. As commented by Turner, Charania, Chong, Stewart, & Taylor (2017), inadequately vaccinated children have often been seen to contradict more lethal and serious health conditions in the future. The child immunisation records as presented by the national immunisation register shows that in 2014 and at the age of 8 months, 88.9 % of Maori children had completed the required doses of immunisation compared to the herd immunity target of 95 % (“About the Ministry”, 2017). As per the recorded data by 2 years of age 91.9 % of the Maori children aged 2 years were vaccinated compared to the overall New Zealand score of 92.8% (Hobbs et al., 2017). Therefore, consecutive gaps were recorded which calls for more awareness and support from the parent of the government.

Further data collection and analysis puts more emphasis upon exact documentation along with placing more stress upon communicating the exact health information. However as argued by Blakely et al., (2014), the government has been implementing sufficient reforms on its part for improving the health condition of the Maori women and young girls. Provided the deprivation of health advocacy and knowledge the government decided to introduce free of cost Human papillomavirus immunisation (HPV) programs for young girls till the age of 20 (“About the Ministry”, 2017). This was done to reduce the risk of cervical cancer and other HPV related disease later in life. On the contrary, the rates covered for the Maori people living in BOP were much higher compared to the New Zealand mainland (Phillips et al., 2017). Therefore, on comparing the represented data we can decipher that a combined participation of the local and the federal level government agencies are required to achieve maximum possible health targets.

The current study focussed upon the different loopholes within the health care system of the New Zealand government. In this respect, special reference has been given to the people residing in the bay of plenty region and who have limited access to health services. The unavailability of sufficient health care services had been further divided based upon particular group people such as the deprived and the objectioners. The proposal highlights the issues faced by the different groups of people. A large portion of the population is still sceptical about the health benefits of the vaccine. Thus, in my opinion, incorporation of sufficient health advocacy strategies by the New Zealand government, Department of health could be beneficial.  Additionally, poverty and high cost of health services are other hindrances in the equitable distribution of health services. Therefore, the management team of local and regional health care services need to conducts surveys highlighting the barriers faced by the Maori and the Pacific ethnicity people dwelling in BOP in availing the healthcare services. In this respect, the data could be collected with the help of conducting with the help of an SBAR tool (S-situation, B-background, A-assessment and R-recommendation.

Target population and health initiative for the study

The data collected could be compiled into government health reports, which helps in focussing upon some important issues such as provision of primary and basic health care services along with effective vaccination programs. The management of the local healthcare team should also lay stress upon timely home visits to the people dwelling in the countryside. The federal and the local health care agencies could also provide free vaccinations to the below poverty level. For further scoping of the project sufficient funding and support is required from the local and federal level government.  The survey data focussing upon the various health requisites can be used to draft a report. The report could be forwarded to the concerned government health departments for the allocation of sufficient amount of funds and tender.

References

About the Ministry. (2017). Ministry of Health NZ. Retrieved 30 October 2017, from https://www.health.govt.nz/about-ministry

Ashton, T. (2015). Measuring health system performance: A new approach to accountability and quality improvement in New Zealand. Health Policy,  119(8), 999-1004. Retrieved from: https://doi.org/10.1016/j.healthpol.2015.04.012 [Accessed on 28 Oct.  2017]

Blakely, T., Kvizhinadze, G., Karvonen, T., Pearson, A. L., Smith, M., & Wilson, N. (2014). Cost-effectiveness and equity impacts of three HPV vaccination programmes for school-aged girls in New Zealand. Vaccine, 32(22), 2645-2656. Retrieved from: https://doi.org/10.1016/j.vaccine.2014.02.071 [Accessed on  28 Oct. 2017]

Clark, R. G., Templeton, R., & McNicholas, A. (2013). Developing the design of a continuous national health survey for New Zealand. Population health metrics, 11(1), 25. Retrieved from: https://doi.org/10.1186/1478-7954-11-25 [Accessed on 27 Oct.  2017]

Filoche, S., Garrett, S., Stanley, J., Rose, S., Robson, B., Elley, C. R., & Lawton, B. (2013). W?hine hauora: linking local hospital and national health information datasets to explore maternal risk factors and obstetric outcomes of New Zealand M?ori and non-M?ori women in relation to infant respiratory admissions and timely immunisations. BMC pregnancy and childbirth, 13(1), 145. Retrieved from: https://doi.org/10.1186/1471-2393-13-145 [Accessed on 30 Oct.  2017]

Harris, R. B., Cormack, D. M., & Stanley, J. (2013). The relationship between socially-assigned ethnicity, health and experience of racial discrimination for M?ori: analysis of the 2006/07 New Zealand Health Survey. BMC public health, 13(1), 844. Retrieved from: https://doi.org/10.1186/1471-2458-13-844 [Accessed on  28 Oct. 2017]

Harvey, H., Reissland, N., & Mason, J. (2015). Parental reminder, recall and educational interventions to improve early childhood immunisation uptake: a systematic review and meta-analysis. Vaccine, 33(25), 2862-2880. Retrieved from: https://doi.org/10.1016/j.vaccine.2015.04.085 [Accessed on  28 Oct. 2017]

Hobbs, M. R., Morton, S., Atatoa-Carr, P., Ritchie, S. R., Thomas, M. G., Saraf, R., … & Grant, C. C. (2017). Ethnic disparities in infectious disease hospitalisations in the first year of life in New Zealand. Journal of paediatrics and child health, 53(3), 223-231. DOI: 10.1111/jpc.13377 [Accessed on  29 Oct. 2017]

Le Menach, A., Boxall, N., Amirthalingam, G., Maddock, L., Balasegaram, S., & Mindlin, M. (2014). Increased measles–mumps–rubella (MMR) vaccine uptake in the context of a targeted immunisation campaign during a measles outbreak in a vaccine-reluctant community in England. Vaccine, 32(10), 1147-1152. Retrieved from: https://doi.org/10.1016/j.vaccine.2014.01.002 [Accessed on 29 Oct. 2017]

Palmer, T. J., McFadden, M., Pollock, K. G. J., Kavanagh, K., Cuschieri, K., Cruickshank, M., … & Robertson, C. (2016). HPV immunisation and increased uptake of cervical screening in Scottish women; observational study of routinely collected national data. British journal of cancer, vol. 114(5), pp. 576-581. doi:10.1038/bjc.2015.473 [Accessed on 29 Oct. 2017]

Phillips, B., Daniels, J., Woodward, A., Blakely, T., Taylor, R., & Morrell, S. (2017). Mortality trends in Australian Aboriginal peoples and New Zealand M?ori. Population health metrics, 15(1), 25. Retrieved from: https://doi.org/10.1186/s12963-017-0140-6 [Accessed on 29 Oct.  2017]

Turner, N. M., Charania, N. A., Chong, A., Stewart, J., & Taylor, L. (2017). The challenges and opportunities of translating best practice immunisation strategies among low performing general practices to reduce equity gaps in childhood immunisation coverage in New Zealand. BMC nursing, 16(1), 31. Retrieved from:  https://doi.org/10.1186/s12912-017-0226-2 [Accessed on 28 Oct. 2017]