Takoha: A Health Promotion Framework for Aotearoa

<b>Takoha is a tool to understand if, and how, we are making a difference to the health and wellbeing of all New Zealanders. </b><b>Watch a video overview of Takoha</b><b>.</b>Developed by the research team within Te Hiringa Hauora | Health Promotion Agency, Takoha helps us set out what we do and how that links to the results we want to achieve. It also helps to answer important questions like:How do we know if what we are doing is working?How do we know if it is having the effect we planned for?Could we be doing something else to make more change?Is this the right thing to invest in?Are the people we are aiming to support, benefitting from these activities?Do the communities we say we support, feel they are supported in ways that work for them?Are we doing what we said we would do?Anyone in health promotion can use Takoha to help align their work to the articles of Te Tiriti o Waitangi and equity, in order to achieve Pae Ora – healthy futures.Using TakohaTakoha links together health promotion activity and the vision of Pae Ora, which is healthy futures for Māori and for all New Zealanders. It positions health promotion as part of a collective effort to transform the Health and Disability Sector. Takoha also outlines how to look for evidence of success. Using Takoha, the health promotion contribution to Pae Ora is measured across five broad areas (indicator domains); Tiriti o Waitangi, equity, whānau ora, mauri ora and wai ora. Takoha describes the ways of working which will contribute to the collective effort towards Pae Ora. Within the role of health promotion, we want to make sure we are working in ways that align with the enablers, because we know these are the things that will make improvements for health promotion in Aotearoa.For example, how does our project demonstrate Mahi Tahi? How does it align with Ngā Manakura and Te Mana Whakahaere? Having evidence of some of these enablers in our mahi shows that we are working in a way that will contribute to Pae Ora.These enablers should be considered at the beginning of projects. Think about how we are working and how these enablers will be included into our projects from the outset. It is less about what we are doing and more about how we are doing it.Transformative actions are things that need to happen across all levels of health promotion and the health and disability system, to achieve the outcome of Pae Ora. These are things that will help make the biggest improvements for health promotion in Aotearoa.Health Promotion in AotearoaTakoha is grounded in Aotearoa New Zealand health promotion thinking. It positions Te Tiriti o Waitangi as foundational, emphasises equity and community-centred approaches and is based on Māori concepts of health.Takoha draws on:<b>Māori health promotion models‍</b><br>‍Kia Uruurumai a Hauora<b> </b>describes the concept of Māori health promotion as the process of enabling Māori to increase control over the determinants of health, strengthen their identity as Māori and thereby improve their health and position in society (Ratima 2001).<br>Te Pae Mahutonga identifies two prerequisites of Māori health promotion, Ngā Manukura and Te Mana Whakahaere, which are concerned with community leadership and self-determination (Durie 1999).<b>Pacific approaches to health promotion</b><br>At the forefront of Pacific health promotion is the need for greater control by Pacific peoples of their own futures and their desire to lead Pacific health promotion action (Tu’itahi &amp; Lima 2015).<br><b>Ottawa Charter-based Western models of health promotion</b><br>The Charter also seeks to enable people to increase control over the determinants of health.Tracking the healthy futures storyThe Pae Ora (Healthy Futures) Bill lays the foundation for the transformation of New Zealand’s health system. It is designed to support all New Zealanders to live longer and have the best possible quality of life.Across the health and disability sector many groups will work towards a system that is more equitable, accessible, cohesive and people-centred. It is important to have a way of tracking and telling the story of the contribution you/your group is making to this change and its effectiveness.Government agencies, Non-Government Organisations and communities working together adds energy and pace to achieve real and equitable change. But it also makes it hard to demonstrate which actions have caused the change and what effect they had - especially since these things are often measured over a long period of time. Takoha helps us measure them now.For example, health promotion. To demonstrate how well health promotion is working in Aotearoa, this framework helps describe the links between health promotion activities and outcomes. It guides the work of health promotion practitioners, and informs decisions around health promotion investment.The story of Takoha<b>Development</b><br>In 2020, Te Whatu Ora Health New Zealand (then Te Hiringa Hauora) set out to develop a performance framework which would help the organisation understand whether investments were effective, efficient and equitable. Te Hiringa Hauora needed a framework to demonstrate how and where it was making a difference.<br>The development of Takoha included reviewing key strategic documents and literature, and interviews with key stakeholders and experts in Māori and Pacific health promotion. Following this engagement, it became clear that the focus should be on how we work rather than what we do. This recognises the constant journey toward Pae Ora, rather than the arrival at pre-determined outcomes.‍Ngā mihi ki a koutou to those who supported this journey and were involved in the development of Takoha. Special acknowledgements to Dr Mihi Ratima, Dr Erena Wikaire, Hilary Sharpe and David Dundon-Smith for their critical input.<b>How we got here</b><br>Te Hiringa Hauora was a Crown agent established by the New Zealand Public Health and Disability Act 2000. It became part of the National Public Health Service under the health reforms and Pae Ora (Healthy Futures) Bill 2021.<br>The name Te Hiringa Hauora was gifted to the Health Promotion Agency by the late kaumātua New Amsterdam (Amster) Reedy of Te Aitanga a Mate and Uepohatu. It is a reference to a 500 year old oriori, He Oriori mō Tūteremoana, that speaks about ‘te hiringa i te mahara’ or the power of the mind. By replacing the word mahara, with hauora – the new name ushered in a pinpoint focus on ‘the unrelenting pursuit of health and wellbeing’.Over years of experience in health promotion, Te Hiringa Hauora developed a way of working that was based on facilitating intergenerational, positive change. At its heart was a commitment to Te Tiriti o Waitangi, equity of health outcomes and sustainability.Te Hiringa Hauora described itself as Tiriti-dynamic. This meant it placed Te Tiriti at the forefront of its work and thinking. It saw sharing power, building trusted relationships, enabling community-driven priorities and equitable resourcing as key to being Tiriti-dynamic and creating meaningful change.It championed change through identifying the key life stages where interventions and prevention would have the most impact.<b>The name</b><br>Takoha means, the gifting of a gift, donation or contribution. The word koha is more commonly used.<br>A Takoha is recognising the giver as gifting their greatest contribution to a cause. It is gifted with the best of intentions and through whatever means are available; skills, time, food or money. The word carries a sense of collective action where everyone has something valuable to add in order to achieve, or acknowledge, a valued kaupapa. Takoha are given with humility, gratitude and respect. It is expected they will be received in the same way. There is also a notion of reciprocity.Takoha - A Health Promotion Framework for Aotearoa is a gift to the new health system. Both in name and as a tool, it outlines the way in which we can all contribute to healthy futures throughout the system.

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