Protecting Whānau Ora: Why long-term relationships matter for child health

In March 2025, three commissioning agencies lost their contracts for Whānau Ora,¹ one of Aotearoa New Zealand’s (NZ) most effective programmes in addressing child health inequity. The Whānau Ora programme coordinates family access to services and care in ways that work for them. 

Several reviews and studies have shown that Whānau Ora improves social and health outcomes.^2,3 This is important because not all children in NZ have the same chance to experience good health. Research shows that Māori, Pasifika, disabled, LGBTQ+, rural, and low-income children often experience worse health outcomes due to systemic inequalities.^4,5 Many live in damp homes, struggle with poverty, and face barriers to accessing healthcare.^6,7 These inequities cost around $170 million annually.⁸

Te Puni Kōkiri’s rationale for the changes is to better localise services.⁹ For example, with new commissioning agencies like Te Tauraki in Te Waipounamu (administered through Ngāi Tahu), the change presents the possibility of iwi-community co-design. At the same time, new commissioners may engage new providers, which risks losing a decade of relationships and engagement built up by current Whānau Ora providers.¹⁰ 

Our recently published peer-reviewed research examined what was working well to reduce inequities in child health in NZ.¹¹ We found connection and long-term relationships were often the springboard that all other outcomes bounced from (see Appendix). This supports the value of programmes like Whānau Ora which improve health equity because they engage at the flax-roots of communities through their  years of trusted relationships.¹⁰

To inform our study, we engaged with Purapura Whetu, Te Puawaitanga ki Ōtautahi Trust and Early Start, as three effective child and youth organisations in Canterbury. Several of the key mechanisms that emerged as key for kaimahi (community health workers) to achieve improved equity and outcomes are:

1. When families were visited frequently and consistently by kaimahi (context) then they felt safe and belonging (mechanism) leading to identifying and overcoming challenges to greater individual and collective wellbeing (outcome).
2. When kaimahi engaged in culturally embedded ways (context), young people and family felt their mana (value and agency) was enhanced (mechanism) leading to greater participation in programmatic, cultural and social activities (outcome).
3. When kaimahi supported the priorities of families (context) then family members felt freed from immediate concerns (mechanism) leading them to take active steps towards their futures (outcome).
4. When families and kaimahi shared their life experiences with each other (context), then they formed a working relationship (mechanism) leading to families taking active steps towards their futures (outcome).

Our study joins others that identify the value of comprehensive approaches, leadership by Māori and addressing rights as key to improving health outcomes.⁵ Community-based child health providers who engage with Kaupapa Māori approaches to health care play a crucial role in improving equity, just as they have for adult chronic conditions.^12,13 These providers need more (not less) funding, and they need the space to go ahead with what they know works. 

Our study identified that flexible, long-term and relationship-based service commissioning is essential to the success of child health providers. The organisations we studied identified that the best processes are outcomes-based contracting using community-defined success measures, as seen in Whānau Ora initiatives.

We also found that shared life experiences (peer support) by kaimahi, strengthened connection and led to codesign of care that increased the relevance and effectiveness of services. Lived experience / peer participation in child health care brings insights that differ from professional perspectives and leads to more relevant and acceptable innovations for service-users.^14,15

 We also found that child health services are most effective when they prioritise the most urgent needs of families, which has been core to Whānau Ora’s success.^3,13 This study joins others that underscore the importance of addressing upstream health determinants—such as warm housing and access to transportation—alongside social determinants like community support and reducing loneliness.^15,16

This study and others referenced here, build on qualitative and social science research. Social science research is critical to evaluate government policy implementation i.e. what works best, for whom, and how.¹⁷ While many studies focus on shortcomings and deficits in health services and care, research must also examine what is working well.^18,19 Recent funding cuts, e.g. to the Marsden research funding²⁰ for social sciences, may mean that policy makers make decisions without the appropriate evidence. 

Conclusion

Addressing child health inequities in NZ requires a shift from narrow biomedical models to broader, community-led and strength-based approaches. Long-term contracts allow providers to build trust, connect with community relationships, and address social determinants with their services, all of which can significantly improve outcomes.

Authors details

Associate Professor Kaaren Mathias, Te Kaupeka Oranga Faculty of Health, University of Canterbury | Te Whare Wānanga o Waitaha

Associate Professor Annabel Ahuriri-Driscoll Ngāti Porou, Ngāti Raukawa, Ngāti Kahungungu - Te Kaupeka Oranga Faculty of Health, University of Canterbury | Te Whare Wānanga o Waitaha

The authors declare they have no competing interests

Appendix

Programme theory of how organisations improved equitable outcomes.  

In this study, researchers and the Child Health Advisory Group worked together to develop an initial programme theory based on existing literature, and their own knowledge and pragmatic experiences to identify anticipated contexts (including interventions), and mechanisms that triggered the outcomes of improved health, wellbeing and greater equity. Following data collection and analysis, we synthesised the six specific CMO (context, mechanism, outcome) hypotheses to develop the mid-range programme theory (sometimes called final programme theory) as a more refined and generalised theory that emerges from the evaluation process. It explains how mechanisms operate across different contexts to produce outcomes and bridges the gap between specific programme theories and broader theoretical frameworks. This can offer practical insights for policy and practice.

Table A1. Specific mechanisms supporting equitable outcomes for young people identified by each participating organisation.