The process of community consultation between the Porirua community and the Central Regional Health Authority

Abstract

This thesis examines the process of Community Consultation from a community perspective using the Porirua Community Health Group as a Case Study to establish a baseline for consultation. The obligation by Regional Health Authorities to consult with the community about health purchasing has changed the dynamics of the decision making process. Community Consultation is grounded in the idealism of the Ottawa Charter (WHO:1986) which promotes the concept of'Wellness'. It incorporates a more holistic approach to health. Wellness promotes empowerment of the community through community development to help achieve its goals. In direct contrast to the Ottawa Charter is the rationale of a market driven economy where decisions are based on cost, efficency and accountability when purchasing health services. The Case Study of the Porirua Community Health Group is an example of a successful method by which Regional Health Authorities might consult with communities. The evidence shows Community Health Groups can be a valuable consultation tool, if used as a first point of contact when accessing a community to discover their health priorites. Using Grounded Theory as a theoretical basis, it was possible to analyse the strengths and weaknesses of the current form of consultation by constantly comparing the differences and similarities of the groups involved in the process. As a Participant Observer in the process, I had access to information which provided a better understanding of the process than conventional methods used for Grounded Theory. Information obtained from the Porirua Community Health Group compared with other groups, provided a more indepth understanding of the consultation process. The present consultation process in Porirua could be described as a pivot between the Central Regional Health Authority and the Community Health Group. The views of both parties need to be considered to be able to provide real consultation. The findings show the major drawback with the current consultation process is the lack of definition or guidelines for operation. The Central Regional Health Authority has not used Community Health Groups as a method of consultation before and the present arrangement is loosely defined leaving the interpretation open to a narrow or broad definition of consultation. The Central Regional Health Authority is currently reviewing the way they consult with the community, and to date there has been no research to assess their effectiveness as a tool. The strength of Community Consultation in Porirua was the strong identification with the community. The networking activities combined with projects undertaken by the working parties linked the community with health services, providers and funders. The process of consultation formed by the networking links have improved the communication channels in Porirua and has begun making inroads to reducing the fragmentation of health services, especially in the Mental Health area. The difference for Porirua, compared to other community health groups, was the stronger health networks formed by the members of the Porirua Health Partnership. The Porirua Community Health Group is a member of the Health Partnership. Together they have identified a consultation process that works well for their community. The direction has come from the community rather than being directed by the Central Regional Health Authority.