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In Aotearoa New Zealand, accessing the required level of hospital care can mean a patient is transferred away from their home base. Being transferred away from familiar surroundings inequitably impacts on people who live in rural areas, including Māori. During such transfers, whānau (family) of Māori patients who travel to support their unwell family member are also away from wider support systems. This paper presents the findings of 17 semi-structured interviews with 19 whānau from across the Central North Island region. Whānau discuss their experiences of being away from home and of providing support to their hospitalised whānau member. Our analysis draws out nuanced responses regarding communication of information and access to the wider service-scape. Experiences and challenges are discussed within a context of inequity, produced vulnerability, and the impact of distress and emotionality. Implications are considered in light of the global pandemic and recent health system reform, offering suggested ways to navigate Māori whānau remaining engaged in the care of their loved one during a hospital transfer. [ABSTRACT FROM AUTHOR]

This paper highlights two methodological issues that arose for a group of Maori researchers during the first few months of a Maori CoRE funded project. The issues were in relation to defining 1) the evolving construction of Maori whanau in New Zealand, and 2) an away from home hospital transfer. Through the process of reflexive practice about our knowledge constructs the research team highlight some of the complexities that we as indigenous researchers had to navigate when working within a cultural context. We describe the details of the Hospital Transfers project and reflect on the learning experienced during the pilot interview phase of a three year project. Keywords: Maori whanau, away from home, hospital transfers, Introduction The most consistent and compelling inequities are reflected in health outcomes between Maori and non-Maori in New Zealand (Ajwani, Blakely, Robson, Tobias, & Bonne, 2003). As a consequence efforts [...]

To authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1467-9299.2009.01784.x Byline: JOSEE LAVOIE (1), AMOHIA BOULTON (2), JUDITH DWYER (3) Abstract: Contracting in health care is a mechanism used by the governments of Canada, Australia and New Zealand to improve the participation of marginalized populations in primary health care and improve responsiveness to local needs. As a result, complex contractual environments have emerged. The literature on contracting in health has tended to focus on the pros and cons of classical versus relational contracts from the funder's perspective. This article proposes an analytical framework to explore the strengths and weaknesses of contractual environments that depend on a number of classical contracts, a single relational contract or a mix of the two. Examples from indigenous contracting environments are used to inform the elaboration of the framework. Results show that contractual environments that rely on a multiplicity of specific contracts are administratively onerous, while constraining opportunities for local responsiveness. Contractual environments dominated by a single relational contract produce a more flexible and administratively streamlined system. Author Affiliation: (1)Josee Lavoie is in UNBC-Health Sciences, Prince George, British Columbia. (2)Amohia Boulton is in the Research Centre for Maori Health and Development, Massey University, New Zealand. (3)Judith Dwyer is in the School of Medicine, Flinders University, South Australia. Article History: Date received 4 July 2008. Date accepted 26 January 2009.