Aotearoa New Zealand's health system is contributing to inequitable enrolment and immunisation of pēpi, a University of Otago – Ōtākou Whakaihu Waka-led study has found.
Lead author Dr Amber Young, of the School of Pharmacy and Pharmacology, says pēpi are missing out on enrolment in primary care because of a range of widespread challenges. These include poor communication and lack of data sharing to complexity in enrolment services, persistent barriers in accessibility, and unwelcoming health services.
Dr Amber Young
This is highly concerning because being enrolled and engaged with primary care is associated with timely immunisation uptake, she says.
"We did this work because we know that if pēpi are enrolled in primary care early they are more likely to get their six-week immunisations on time, or close to it, which then leads to continued timely immunisations.
"Immunisation continues to be an extremely important way to keep whānau healthy and safe. However, in Aotearoa New Zealand we continue to have low immunisation uptake, meaning pēpi and tamariki are vulnerable to vaccine preventable diseases and outbreaks, particularly those living in areas of high deprivation.
"However, Māori and Pacific pēpi are less likely to be enrolled in primary care, and these pēpi are less likely to receive the support to get them vaccinated, leaving them vulnerable to infection," Dr Young says.
For the study, published in the Journal of Primary Health Care, the researchers wanted to find out why pēpi are not being enrolled in primary care soon after birth, and what can be done to support enrolment and, ultimately, timely immunisation delivery to pēpi and whānau.
The researchers interviewed primary health care providers with all saying the current system was not adequately serving communities because of poorly designed systems, limited resourcing, and inconsistent approaches. Many believed this contributed to inequitable enrolment and immunisation of pēpi.
"For people working at point of care, there are many barriers to delivering efficient and timely healthcare. This includes digital systems, unclear guidance, and lack of interoperability. Enrolment needs to be simplified, with integrated and automated systems to reduce administrative burden for staff.
"Another important component of healthcare is cultural safety and manaakitanga, to ensure people feel welcome in healthcare spaces. We need to know if this is being done well throughout Aotearoa and if the system is set up to allow healthcare providers to build relationships through whanaungatanga and provide supportive hospitality to all whānau.
"We want the system to work for whānau, but sometimes it doesn't, and that isn't the fault of whānau, it is system failures."
Thankfully since the research was undertaken, positive changes have been made to support enrolment in primary care.
"For example, there was a lot of confusion over the need for whānau to produce a birth certificate before pēpi could be enrolled, but this comes at a cost – $35 – and is actually not necessary for most pēpi. There has now been education campaigns and clearer information about this online so people enrolling infants know they may not need to ask for this.
"Also, importantly, there has been work undertaken to ensure pēpi are not being declined enrolment due to GP practices having closed books, which was a huge problem."
However, further efficiencies need to be made such as ensuring administrative tasks are not burdensome for practices, and for staff to have adequate cultural safety training to support whānau when accessing services.
"Overall, we want enrolment to be straightforward and as automatic as it can be and also we want whānau to want to engage with practices so they can be supported to receive immunisation on time, every time."
The study is part of a larger project which also involved talking to whānau about their experiences with immunisations, which the researchers are hoping to publish soon.
"It is extremely important to hear from whānau and bring their voices to the table. There were similar themes identified from whānau as in this one, particularly around whanaungatanga and building of relationships with people in the health system to establish trust.
"The more research I do in healthcare, the clearer the message of trust-building is to me. This is fundamental to delivering equitable healthcare and immunisations," Dr Young says.
Publication:
Newborn enrolment, engagement, and immunisation in primary care: a qualitative study of healthcare providers' perspectives
Amber Young, Christine McIntosh, Felicity Ware (Ngāpuhi), Emma Best, Nikki Turner, Nadia A. Charania, Andrew Campbell, Te Atarua Davis (Tainui) and Samantha Marsh
Journal of Primary Health Care
DOI: 10.1071/HC26025
