New times, new relationships: mental health, primary care and public health in New Zealand

Abstract

In New Zealand, the role of voluntary agencies in healthcare provision has gone through significant change in recent years. Overall, there have been changes in the relationship between the state and the voluntary sector, with tensions evident between central and regional/district levels of decision making as health funding has been devolved but central constraints maintained. This chapter describes the changing environment of health non-governmental organisations (NGOs) involved in the health and disability sector in New Zealand under state restructuring from the mid-1980s to 2005. First, it discusses the emergence of a representative health and disability NGO collective organisation, which are supported by the state and with access to high levels of government and the bureaucracy. Second, it describes how three key groups of agencies — community mental health, primary healthcare, and public health agencies — have dealt with specific issues in different ways. Third, it explains how decentralisation resulted in variable regional responses, especially in service organisation and contracting. The introduction of the internal market in the 1990s resulted in the rapid growth of health NGOs, as well as in the emergence of substantial regional differences in contracting relationships and public accountability. At the same time, however, the new decentralised contracting environment, while encouraging innovation, undermined good service practice by making it more difficult for health NGOs to cooperate with each other and represent their communities effectively.