RESUMO
CONTEXT: In New Zealand, the government's key strategy to improve the health of the indigenous population is advanced through a policy where families are supported to achieve their maximum health and well-being: "whanau ora" (for a glossary of Maori words and phrases, see appendix). OBJECTIVES: This paper outlines the role Maori community health workers (CHWs) play in the delivery of whanau ora services and explores the tensions and challenges faced by these workers in carrying out their role. METHODS: Recent literature, existing qualitative research data and local level verification from a practising community health worker with 12 years experience. FINDINGS: Roles were complex, varied and generally executed in high need communities. Differing expectations between the contractual requirements, the community and the CHW's own expectations meant CHWs continually managed competing demands. CHWs describe training opportunities as being short-term and ad hoc, specific to a particular health provider's needs and offering only limited options for career advancement. CONCLUSION: CHWs form an integral part of the New Zealand health workforce acting as the interface between the health sector and Maori communities. By working in a culturally distinctive manner, they help give effect to Maori health development aspirations. Increasingly this work is carried out in complex and demanding environments. Key challenges that need to be resolved to further advance the position of CHWs in New Zealand include greater recognition of the unique role they play in the delivery of public health and primary healthcare services, linking this recognition to appropriate remuneration and ensuring ongoing role development is met within a Maori worldview.
