Abstract
Background The Aotearoa New Zealand COVID-19 pandemic response has been hailed as a success story, however, there are concerns about how equitable it has been. This study explored the experience of a collective of M & amacr;ori health and social service providers in the greater Wellington region of Aotearoa New Zeland delivering COVID-19 responses.Methods The study was a collaboration between a large urban M & amacr;ori health and social service provider, T & amacr;kiri Mai Te Ata wh & amacr;nau ora collective, and public health researchers in Aotearoa New Zealand. Two online workshops were held with staff of the M & amacr;ori service provider, collectively developing a qualitative causal loop diagram and generating systemic insights. The causal loop diagram showed interactions of various factors affecting COVID-19 response for supporting wh & amacr;nau (M & amacr;ori family/households) at a community level. The iceberg model of systems thinking offered insights for action in understanding causal loop diagrams, emphasizing impactful changes at less visible levels.Results Six interacting subsystems were identified within the causal loop diagram that highlighted the systemic barriers and opportunities for effective COVID-19 response to M & amacr;ori wh & amacr;nau. The medical model of health service produces difficulties for delivering kaupapa M & amacr;ori services. Along with pre-existing vulnerability and health system gaps, these difficulties increased the risk of negative impacts on M & amacr;ori wh & amacr;nau as COVID-19 cases increased. The study highlighted a critical need to create equal power in health perspectives, reducing dominance of the individual-focused medical model for better support of wh & amacr;nau during future pandemics.Conclusions The study provided insights on systemic traps, their interactions and delays contributing to a relatively less effective COVID-19 response for M & amacr;ori wh & amacr;nau and offered insights for improvement. In the light of recent changes in the Aotearoa New Zealand health system, the findings emphasize the urgent need for structural reform to address power imbalances and establish kaupapa M & amacr;ori approach and equity as a norm in service planning and delivery.