Project 2: Macro/Meso Level – Policy, governance, strategy and planning

Project outline

This project is specifically concerned with the bigger picture of policy evolution and implementation in primary health care. Our aim is to produce an account of how organisational relationships and planning, funding, and accountability frameworks are supporting the drive for primary health care change.

We are particularly interested in Aotearoa New Zealand’s Primary Health Organisations (PHOs). Internationally these type of general practice meso-level organisations are garnering interest as a way of managing the complexity of interests in primary health care.

Despite this interest our knowledge of how these organisations have developed in Aotearoa New Zealand is generally patchy. Earlier work by the team[1] identified that while some PHOs are acting as facilitators of innovation, others have had few incentives to change.

Our aim is to understand more about how PHOs have overseen both developments in population health and the collective interests of general practices. We are interested in the variations that have occurred and are exploring what works, for whom, and in what circumstances.

For further information, contact:

Dr Lesley Middleton (Health Services Research Centre / Te Hikuwai Rangahau Hauora)

Associate Professor Tim Tenbensel (University of Auckland)

Project update

Given the COVID-19 crisis, the project is now split into a pre and post COVID-19 phase.

Pre COVID-19, over 40 interviews were held with national informants and DHB primary health care specialists, as well as those on PHO Boards and individuals leading PHOs.

Using a realist interviewing structure, these interviews probed for the most significant changes in primary health care policy, explored the compatibilities and tensions between different objectives for primary health care, and drew out examples of successful innovations.

In addition, we compiled dashboards for each PHO outlining key aspects of their history, governance and operations.

Post COVID-19, we are exploring the longer lasting implications of COVID-19. As a major disruptor to primary health care in Aotearoa New Zealand and elsewhere, the opportunity exists to examine what the response to the crisis has taught us about the strengths and weaknesses of the way primary health care works in Aotearoa New Zealand.

Further group-based interviews are planned. However, conscious of the need to do these at a time when primary health care leaders have the head space to be reflective, we will be monitoring when best to conduct these.


Middleton, L., Dunn, P., O’Loughlin, C., & Cumming, J. (2018). Taking Stock: primary care innovation. Wellington, New Zealand: Productivity Commission.

The team

Lesley Middleton

Lesley Middleton is a health services researcher and senior lecturer (health policy) at the School of Health, Victoria University of Wellington. Having held senior roles in the health and science and technology portfolios, she has a longstanding interest in how explicit and implicit intentions for health sector improvement translate into desired changes.

Tim Tenbensel

Tim Tenbensel is an Associate Professor and has specialised in health policy research since the late 1990s. He has been part of research teams investigating the implementation of New Zealand health sector reforms, including the early years of District Health Boards, the National Health Targets of 2009-18 and the System Level Measures framework. He has published extensively on comparative health policy, performance management, institutional continuity and change, and complexity theory and health policy.

Laura Wilkinson-Meyers is a health services researcher and senior lecturer based in the University of Auckland’s School of Population Health. Her work focuses on stakeholder and community engagement to understand and improve the equity, accessibility, quality and efficiency of health and social services. She has a particular interest in work to improve care and outcomes for people who experience disability.

Lynne Russell (Kāi Tahu, Ngāti Kahungunu, Rangitāne, Ngāti Porou, Kāti Māmoe, Te Wainui a Rua, Ngāti Raukawa) is a senior Māori health researcher in the Health Services Research Centre / Te Hikuwai Rangahau Hauora, within the Victoria University of Wellington Faculty of Health (Te Wāhanga Tātai Hauora, Te Herenga Waka). Her primary role within this team is to work with its members to ensure tikanga, Māori ethical processes and protocols are respected, so that the research produces findings that can support Aotearoa New Zealand to improve primary health care services and reduce health inequities for Māori. She will conduct interviews with key Māori stakeholders and lead the analysis and interpretation of this data.

Marianna Churchward is a senior Pacific health researcher with the Health Services Research Centre/Te Hikuwai Rangahau Hauora, within the Victoria University of Wellington Faculty of Health (Te Wāhanga Tātai Hauora, Te Herenga Waka). Her primary role is to work alongside the team specifically to contribute through research to improve health services for Pacific people.

Claire O’Loughlin is a part-time Research Fellow at the Health Services Research Centre, Victoria University of Wellington. Her current work at the Centre contributes to a programme of policy-oriented research on issues relating to the health system and health services. She enjoys working in interdisciplinary research teams and on projects that have the practical outcome of improving practices/services for end users.

Pushkar Silwal is a public health professional with more than ten years’ experience in health services research and policy in developing countries. He is currently completing a PhD at the University of Auckland, Health systems department in the area of New Zealand health systems performance improvement and policy development.


Get in touch

    Te Herenga Waka — Victoria University of Wellington

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