About the review
The Government commissioned a review of Well Child Tamariki Ora in late 2018 in response to concerns about equity of access, outcomes for tamariki and whānau, and the financial sustainability of the programme.
The Review was carried out during 2019/20 with input from Māori, DHBs, Well Child Tamariki Ora providers and Government agencies. A report on the Review was considered by the Government in April 2021.
Review scope and approach
The Review looked at the design and delivery of the Well Child Tamariki Programme to investigate:
- how well the programme is working and to what extent it is meeting the needs of pēpi, tamariki and whānau
- what has been working well
- opportunities for improvement and change.
The guiding whakataukī (vision) for the review was ‘Poipoia te kākano kia puawai’ – Nurture the seed and it will blossom. This vision will be achieved when:
- pēpi and tamariki are prioritised as taonga in Aotearoa
- whānau are enabled to achieve the hopes and aspirations they have for their pēpi and tamariki
- communities provide nurturing environments that support pēpi, tamariki and whānau to blossom and reach their potential
- services and supports are whānau-focused, connected, holistic and responsive
- the wellbeing system is integrated and coordinated across the life span and enables pae ora – applying the principles of tino rangatiratanga (Māori self-determination) and mana motuhake.
The Review team was advised by an Advisory Rōpū made up of experts from within the sector. Governance was provided by a Steering Group with a broad range of relevant expertise and experience.
The Review process included engaging with key stakeholders with experience within the sector and consumers of Well Child Tamariki Ora services, analysing relevant research and data, and considering the Government’s strategic intent and priorities for supporting tamariki and whānau.
Review findings and next steps
The Review found that while Well Child Tamariki Ora is making a positive difference to the health and wellbeing of many tamariki, change is required to achieve equity for Māori tamariki and Pacific children.
The Review identifies that a shift to a more responsive, integrated, and evidence-based approach that is led by whānau is needed to ensure equitable outcomes and to fully support tamariki who are Māori or Pacific, are living with disabilities, are in state care and/or have high needs.
To achieve this, the following changes have been identified to respond to the changing needs of whānau, and to better integrate with other health, maternity, social and early learning services:
- A shift from a stand-alone, outputs-based programme to a whānau-led, outcomes-based ‘early years system’ of integrated services and support
- An evidence base informing the future design of the system that reflects Māori, Pacific and local research as well as international evidence, together with a system design that reflects and incorporates te ao Māori and Pacific worldviews of health and wellbeing
- Devolved commissioning to enable better integration and local decision making to achieve outcomes that matter to whānau and communities.
- Meaningful partnership with Māori embedded across governance, design, delivery and monitoring functions, together with leadership by Pacific people and those with lived experience of disability, living in state care or having higher needs, to ensure the unique needs of these groups are met.
- Te Tiriti o Waitangi responsibilities being upheld with Māori as co-designers of transformative change and exercising tino rangatiratanga and mana motuhake over the wellbeing of their tamariki
Investment to address gaps in critical infrastructure (information and technology, workforce, quality, governance and accountability) at both the system level and the service level to support equity, equality and integration.
The Ministry has already started progressing several short-term actions to strengthen current service delivery while improving equity. These include:
- establishing a mechanism to support stronger leadership and participation of the kaupapa Māori and Pacific workforce
- reviewing funding allocations to better support sustainability and equity
- improving information systems and streamlining reporting
- improving the active monitoring of newborn enrolments with providers.
These resources have been identified and collated by Well Child Tamariki Ora health providers in the central region as part of Whakapakari Hunga Tautoko, a three-year project that aims to address inequities in access to clinical and professional support infrastructure (see links to project reports below).
Frequently Asked Questions
What is Well Child Tamariki Ora?
Well Child Tamariki Ora (WCTO) is New Zealand’s key programme that provides early childhood health and development services to all tamariki under five years and their whānau.
The primary objective of the current programme is to support whānau to nurture the early development of their tamariki, establishing a strong foundation for health and wellness throughout life.
The programme provides the opportunity for early intervention through referrals to other primary, specialist or intensive health and social services. For more information please go to Well Child Tamariki Ora visits.
What is Well Child Tamariki Ora Review
The Well Child Tamariki Ora review (the Review) was completed by the Ministry of Health to improve the quality and long-term sustainability of the programme. The aim of the Review was to identify the issues that need to be addressed to achieve improved and more equitable outcomes for our tamariki and their whānau.
What was the key findings of the Review?
The overarching finding from the Review is that although the current programme contributes to health and wellbeing outcomes for many pēpi and tamariki, we need to design, deliver and resource it differently to promote equity and ensure WCTO achieves its full potential for pēpi, tamariki and whānau who are Māori, Pacific, have disabilities, are in state care or have high needs.
How many tamariki are currently missing out of services? Who are they? How are we monitoring coverage and following up on those who are missing out?
Most babies born in New Zealand are enrolled with and will receive services from our early years programme in their first year of life.
In 2020, a total of 87 percent of all new babies born in New Zealand were enrolled and received a service from a Well Child Tamariki Ora provider in their first year of life. However, enrolment rates were lower for Māori (79 percent) Pacific (83 percent) and whānau living in high deprivation areas (82 percent).
The majority (82 percent) of all babies born in New Zealand will receive their first contact on time. However, these rates were also lower for Māori (75 percent), Pacific (76 percent) and whānau living in high deprivation areas (78 percent).
In 2020, three-quarters, or 75 percent, of all babies enrolled in service received all their core contacts across the first year of life. However, once again, this was lower for Māori (60 percent), Pacific (59 percent) and whānau living in high deprivation areas (66 percent)
Inequities for these population groups were also evident in timeliness and completeness measures for the B4 School Check. This results in inequitable access to referral services required before tamariki start school.
Data on 18 different WCTO indicators is published every six months on the National Service Framework Library. Data reported using the WCTO QIF has predominantly been used by District Health Boards to inform funding decisions and quality improvement action.
This data, together with feedback from the sector, shows that the programme is not delivering consistent outcomes for all whānau in Aotearoa and has been contributing to inequities that are unfair and avoidable.
How will the changes ensure whanau who are currently missing out are offered services and can access them?
Work is being progressed to improve information systems, provider technology and access to coverage data. Access to real-time information will improve the way the workforce can assess and respond to whānau need. Improvements to information systems will also provide whānau with faster information and improved communication with their Well Child Tamariki Ora provider.
Insights have been and will continue to be collected from whānau who are currently missing out on services to understand some of the barriers they face in accessing services. Work to co-design new models of care will include engaging with those who are currently missing out to ensure services will be accessible, acceptable, engaging and appropriate for their needs.
How will the proposed changes support a more appropriate WCTO service that supports new parents and families?
The long-term changes to Well Child Tamariki Ora will help create a responsive, integrated and evidence-based system of prevention and early intervention that meets the needs of all tamariki and whānau, by:
- improving equity of access to Well Child Tamariki Ora services
- increasing the quality and effectiveness of Well Child Tamariki Ora services
- improving early childhood health, development and wellbeing outcomes
- building a stronger foundation for ensuring lifelong health and wellbeing of our tamariki.
How does the review relate to the wider Health and Disability System Review?
Redesigning the Well Child Tamariki Ora funding and commissioning model to address equity issues was specifically recommended by the Health and Disability System Review report, and is clearly supported by recent announcements.
How does the review relate to Oranga Tamariki?
There are critical linkages for the delivery of child health, development and wellbeing services across the health and disability, early childhood education and social service systems. The Ministry of Health works closely with other agencies, including Oranga Tamariki and the Ministry of Education, as key agencies with opportunities for integration of services for children and whānau. Children in care are a priority population group under the Review, so we can ensure they receive the Well Child Tamariki Ora services they need, as well as other services.
Was B4 School Health Check included in the Review?
The Review covered the entire Well Child Tamariki Ora programme, including the B4 School Check (B4SC).
The B4SC is the final check in the Well Child Tamariki Ora programme. It happens when children are four, to allow time for any health or wellbeing issues identified to be managed or resolved before starting school. One of the tools used in the B4SC is the Strengths and Difficulties Questionnaire (SDQ), which aims to identify children who may need extra help in social, behavioural, or emotional areas.
The Review found pre-school contacts such as B4SC should be better integrated with the earlier assessments in the WCTO Schedule. The exact age for pre-school contacts will be informed by further technical advice on the screening tools and timing for vision, hearing and developmental screening.