DIABETES COMMUNITY COORDINATORS
Kaiāwhina mate Huka

Diabetes Community Coordinators operate as a part of clinical teams, usually including registered nurses and other health professionals. Their focus is to reach whānau members in outlying areas, through both inhouse clinics and a mobile outreach unit.

The Diabetes Community Coordinator model is a successful community-based model to support those with diabetes and improve equity in accessing the healthcare system. The current model works within the Long-Term Conditions framework. At the moment, delivery is mostly integrated with the PHO Model and fits within the current health model but is flexible and can be delivered in any Primary Healthcare locality.

The success of the model lies in its ability to better connect the health sector with those communities that experience barriers to access. For example, we work directly with Māori health providers to take services directly to Māori communities.

There is potential to locate the role within Māori/Pacific health providers, Health NZ localities and, by principle, we will place people where they will make the most difference. The strength of the model is that it works alongside Primary healthcare clinicians enabling access to healthcare, improving equity, and offering patients’ psychosocial support.

The overarching aim of the Diabetes Community Coordinators programme is to reduce the incidence and improve management of diabetes in at-risk populations, and to reduce the equity gap and improve health outcomes for Māori and Pacific whānau.

Diabetes Community Coordinators work collaboratively as part of general practice clinical teams to assist whānau to improve their health and wellbeing through supporting them to better self-manage. Together, the teams work to ensure that whānau become independent in terms of their own knowledge and use of the full range of support services.

Diabetes Community Coordinators can be the first point of contact for whānau into the health system alongside community services. They are an essential part of the service providing appropriate acceptable and tikanga Māori values and practices. They play a key role in encouraging whānau to identify their own priorities for change, supporting them to make positive lifestyle changes, and where applicable helping them to work on reducing high-risk behaviours and managing stressors within their lives.

Each Diabetes Community Coordinators is part of a continuum of services and developments provided by clinical teams designed to support people with long term conditions in addressing their physical, emotional, social and spiritual needs.

Diabetes Community Coordinators provide support to develop and implement care plans created in partnership with each patient and their clinical team.