Well Child Tamariki Ora Review

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. 

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.

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.

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.

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.

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.

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. 

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.