The setting within which organisations are set up, must be taken into consideration as they have a significant impact on the results. Pharmac demonstrates how well designed organisations which accommodate for politics can succeed. Pharmac is also seen as politically neutral, as it is not the result of a specific political party’s plan, but rather it instigated by the local level.
The DHB system is in stark contrast to Pharmac, where the top down initiated organisational reform did not consider how the political features of the health sector would function at a micro level. The aims desired by the DHB system are understood to have been achievable within the previous system, leaving the criticism to be made that the change in system was a result of party politics.
The policy response to address Maori health can be understood in the same way. The time at which the Maori Health Strategy was put into policy was a bad time for Maori-Crown relations, due to debate over seabed and foreshore legislation. In addition to this, there was significant political backlash over the ‘bridging the gaps’ policy where non-Maori viewed the policy to be privileging Maori (Humpage 2006).
The establishment of the PHO system further exemplifies the lacking of DHBs effectiveness and capacity. If the DHBs were able to effectively manage the relationships and interests between the various stakeholders, a strategy such as the NZPHCS would have been able to be implemented effectively within the DHB system. However, the risk of provider capture of the DHBs means a separate system was required in order to achieve the desired standard of primary care. It is a given that politics will be at play within political settings, however, the way in which the politics are managed has a great impact upon the effects of policy.
The Maori Health Strategy is a good example of this, where the political setting was not managed well, which resulted in policy which did little to address the needs of Maori health. Granted, the Maori Health Strategy can be seen as a stepping stone for the current implementation of Whanau Ora. However, what has resulted in effect is a policy spanning nearly 10 years, which does very little to address a very high needs group of the population (Taskforce on Whanau-Centred Initiatives 2010).