Moving resources to the frontline: Harnessing NGO health and disability sector potential.

1. IntroductionsIntroductions

2. Sttmt of Govt intentions was seen as an opportunity. Fortunate coincidence of MoH staffers and NGO leaders with similar goals and frustrationsSttmt of Govt intentions was seen as an opportunity. Fortunate coincidence of MoH staffers and NGO leaders with similar goals and frustrations

4. Plunket celebrated its centenary last year. Family Planning has been going since 1936Plunket celebrated its centenary last year. Family Planning has been going since 1936

6. What is an NGO? OCVS has adopted the description used by the Johns Hopkins Centre for Civil Society Studies and very similar to the UN’s definition of non profit institutions (2003) organisations with some degree of internal organisational structure, meaningful boundaries, or legal charter of incorporation non-profit, that is, not returning profits to their owners or directors and not primarily guided by commercial goals institutionally separate from government, so that while government funds may be received, the organisation does not exercise governmental authority self-governing, which means the organisations control their management and operations to a major extent not compulsory, which means that membership and contributions of time and money are not required by law or otherwise made a condition of citizenship.

7. The NGO-MoH Health and Disability Forum Terms of Reference define an NGO as: ‘NGOs eligible to participate in the Working Group include independent community, and iwi/Maori organisations operating on a not-for-profit basis, which bring a value to society that is distinct from both Government and the market’. In this context it is used to convey community, voluntary and iwi/Maori organisations that are not for profit (mental health, public health, personal health)

8. Diversity of NGOs Type/focus – mental health, disability, Maori, Pacific, public health, clinical services, aged care Contexts Cultural focus National, local Size History MoH funded; DHB funded; partially funded; non funded What do we mean by NGO and health and disability sector? There is no singular commonly understood definition of NGO and no one way of describing who is and isn’t included in the term ‘ health and disability NGO’. The health and disability NGO sector is complex and include organisations across a spectrum of size, location, mandate and funding arrangements and the organisations that make up the sector do not fit wasily into one easily defined category: They provide services across the health and disability spectrum (including public health, primary care and other personal health support services, mental health, disability) and often more. Some NGOs work across health service delivery contexts and settings ( prvding for example both public and personal health services, or mental health and disability services; some work across wider social service/employment/education/housing contexts while others specialise in one specific health or disability service or sector. Some are mainstream services, others provide services catering specifically to maori, pacific or other ethnic or specialist communities (eg deaf) Some NGOs work nationally while many work in clearly identified communities They range in size from large national organisations, employing thousands of staff to smaller organisations with less than five staff and many with no paid staff at all. While there are some very large NGOs the majority of NGOs are small, lean mean organisations They have a variety of origins and were established for a variety of reasons – most as a response to community need or concern Ther are a variety of funding mechanisms supporting health and disability NGOs; some obtain al their funding from one or more health and disability sources (eg. MoH, DHBs, PHOs); others contract across a range of government agencies; most access philanthropic sources of funding; and many rely on significant voluntary effort What do we mean by NGO and health and disability sector? There is no singular commonly understood definition of NGO and no one way of describing who is and isn’t included in the term ‘ health and disability NGO’. The health and disability NGO sector is complex and include organisations across a spectrum of size, location, mandate and funding arrangements and the organisations that make up the sector do not fit wasily into one easily defined category: They provide services across the health and disability spectrum (including public health, primary care and other personal health support services, mental health, disability) and often more. Some NGOs work across health service delivery contexts and settings ( prvding for example both public and personal health services, or mental health and disability services; some work across wider social service/employment/education/housing contexts while others specialise in one specific health or disability service or sector. Some are mainstream services, others provide services catering specifically to maori, pacific or other ethnic or specialist communities (eg deaf) Some NGOs work nationally while many work in clearly identified communities They range in size from large national organisations, employing thousands of staff to smaller organisations with less than five staff and many with no paid staff at all. While there are some very large NGOs the majority of NGOs are small, lean mean organisations They have a variety of origins and were established for a variety of reasons – most as a response to community need or concern Ther are a variety of funding mechanisms supporting health and disability NGOs; some obtain al their funding from one or more health and disability sources (eg. MoH, DHBs, PHOs); others contract across a range of government agencies; most access philanthropic sources of funding; and many rely on significant voluntary effort

9. How big is the NGO health and disability sector Who knows? From information available in 2006, it is estimated that there were 700 Disability Support NGO providers in New Zealand serving approximately 30,000 – 33,000 consumers. Statistics NZ. Non-Profit Satellite Account (2004): 2210 organisations employing 15,090 staff and contributing $466,812 to GDP (excludes unpaid work) 80% had no paid staff MoH: correlation between funded NGOs and NPSA; subsector data – 427 NGOs funded for ‘Blueprint’ services in August 2007; 1 pager supplied to Committee – 30 contracts worth $500 million Charities Commission MSD Family and Community Services Directory This is an issue we have been grappling with since our inception. Bad news is that we still don’t know! Good news is that we are currently completing a scoping exercise on the sources of available data – see slideThis is an issue we have been grappling with since our inception. Bad news is that we still don’t know! Good news is that we are currently completing a scoping exercise on the sources of available data – see slide

10. How big is the NGO health and disability sector MSD Family and Community Services Directory 1335 organisations under health 311 under addiction 385 under mental health 944 under disability 684 under family violence Ability to breakdown by service type (eg Alzheimers, breastfeeding, young people etc) and region also available (count taken in April 2009 – note providers can choose more than one category to be included under) This is an issue we have been grappling with since our inception. Bad news is that we still don’t know! Good news is that we are currently completing a scoping exercise on the sources of available data – see slideThis is an issue we have been grappling with since our inception. Bad news is that we still don’t know! Good news is that we are currently completing a scoping exercise on the sources of available data – see slide

11. What do NGOs do? Fence at the top of the cliff – prevention; health promotion; early intervention; population health Ambulance at the bottom – integration, rehabilitation; support for chronic illness and aging Support the health sector – provide the glue; cover the gaps

12. What do NGOs contribute to health outcomes? Delivery of cost effective services. Characterised by innovation, flexibility, responsiveness and often a high degree of specialisation Harness volunteer participation. Many are in rural areas. Many work with specific populations, often the most vulnerable high need populations e.g. home based care, in care, mobile youth.

13. What do NGOs contribute to health outcomes? (cont) A means of partnering with communities – providing community leadership and community based services. NGOs know their communities, and are trusted by them. Are an ideal means of communication with local stakeholders. Offer a wide range of services based on a proven, strong commitment to the social and economic wellbeing of their communities. Willingness and skill in collaboration – work across sectors, not only in health. Motivated by outcomes, not profit. Have a wider, holistic view of health We believe they are essential community leaders who , in partnership with clinical leaders, can provide a strong and cost efficient health system for New Zealand.

14. How can NGOs Add Value ? NGOs have significant influence and represent considerable economic value. The NGO share of Vote Health has been estimated at nearly $2 billion (MoH), of which 60% - 70% is spent on staffing. The 2004 VAVA report (NZFVWO/PricewaterhouseCoopers) identified that, in general, voluntary groups provide $3 to $5 worth of services for every $1 of funding. NGOs fundraise outside the sector NGOs harness the voluntary sector and benefit from the ‘care’ factor. People will work for less in the sector because they care about outcomes and populations.

15. What currently stops NGOs from making a greater contribution to health outcomes? General Limited consideration Lack of understanding of NGO role and potential The predominance of a medicalised model of care At times, invisibility in the Primary Health Care Strategy, in consultation, planning, tendering, communication, and funding structures. Financial vulnerability – funding, pricing and contracting issues, including the MECA. Short term contracts and transaction costs. .Increasing transaction and compliance costs e.g. HPCA Act. They carry much of the risk but cannot always influence the issues.

16. What currently stops NGOs from making a greater contribution to health outcomes? (contd.) The MoH/DHB/PHO environment Parity with PHOs Demand – tendering, funding, contracting processes; Supply - effectiveness, service delivery impacts, service integration; value for money… DHB provider arms versus community providers Difficulty, often, in linking effectively with PHOs Lack of service integration Many NGOs are not directly linked to DHBs and are overlooked in planning, consultation or new ventures. 21 DHBs – Tension between local control and national co-ordination Lack of consistency - regional variations in funding, service specs, process around contracting; relationships Multiple audits Waste and duplication, inefficiencies .MoH/DHB interface – lack of clarity of purpose and responsibility .

17. What currently stops NGOs from making a greater contribution to health outcomes? (continued) Sector issues Often relatively weak IT systems. (Platform Research) In order to address recruitment and retention issues funding is increasingly diverted to salaries, risking investment in quality, infrastructure and professional development Workforce issues – recruitment, retention and workforce development. Large numbers of low paid ‘non-regulated staff’. MECA salary rates are some 15 - 20% higher than the NGO sector, plus MECA members have 24hrs professional development leave; 16 hours portfolio development leave, and practice allowance. This raises a range of parity issues between professional colleagues. MECA rates for public health units further increase parity issues. Few or non existent HR personnel, and no senior staff available for contingency planning. NGOs have clinical and community leaders so issues raised with respect to clinical leaders in the DHB/PHO sector need to be looked at in the NGO sector – weaving in ‘time to care’ and ‘hard to staff’ nursing specialties cf Tony Ryall’s International Nursing day speechesNGOs have clinical and community leaders so issues raised with respect to clinical leaders in the DHB/PHO sector need to be looked at in the NGO sector – weaving in ‘time to care’ and ‘hard to staff’ nursing specialties cf Tony Ryall’s International Nursing day speeches

19. Ways Forward NGO Working group Mechanisms: Regular meetings Part time secretariat. NGO/MoH website. NGO desk MoH. Elected Working Group with 2 individuals representing each directorate/sector. Fortnightly updates and email list to sector. Annual Forums for NGOs, MoH and DHBs. Increasingly, a structural relationship with DHBNZ NGO Working Group workstreams

20. Thank you