Effectiveness of Primary Health Care Services in New Zealand for Minority Refugee Populations: A Case Study of Bhutanese Refugee Women

© 2016 Dr. Jaga Maya Shrestha-RanjitA significant number of people have been displaced from their country of origin and become refugees, mostly due to armed conflicts, political violence and human rights abuse. Refugees’ traumatic past and uncertain future, together with complex health needs, present significant challenges for resettlement in their host country. Bhutanese refugees are Bhutanese citizens of Nepali origin. During 1991–1992, more than 100,000 Nepali- Bhutanese became refugees. After spending more than 18 years in refugee camps in Nepal, most of these refugees have now been resettled in various countries including New Zealand and Australia. The aim of this thesis is to examine the effectiveness of primary health care services in meeting the health needs of Bhutanese refugee women resettled in New Zealand. The conceptual framework of this study was guided by the globally accepted philosophy and principles underpinning the Declaration of Alma-Ata for Primary Health Care and the Ottawa Charter for Health Promotion. This qualitative exploratory study was conducted in two phases; the first phase comprised focus group discussions with 32 Bhutanese women and eight Bhutanese men; and the second phase involved individual interviews with 12 health service providers including four general practitioners, five nurses and three midwives. All focus groups with the Bhutanese sample were completed in Nepali, and were later transcribed in Nepali and translated to English. Phase one of the study revealed that resettlement in New Zealand had mixed impacts on Bhutanese women’s health. In general, there had been an improvement in physical health, however, their self-esteem and overall mental health status had deteriorated due to compounding stressors related to their traumatic refugee journey as well as resettlement challenges that they had been enduring. In addition, these women faced a number of barriers in accessing and utilising health services in New Zealand. In phase two of the study, health professionals identified common attributes of Bhutanese women that could impact positively or negatively in addressing their health needs and articulated a number of challenges and some enablers in addressing their health needs. Overall, the findings of this study have revealed that there have been inadequacies and constraints in the provision of culturally safe and effective primary health care services to Bhutanese refugee women and provide evidence for recommendations to address these inadequacies. These findings demonstrated that although New Zealand has had a powerful and enduring primary health care policy commitment, there are limitations in the implementation of this policy in practice. While this study was undertaken with one specific group of people, the results are likely to be transferrable to other minority refugee populations. It is anticipated that the results of this study will contribute in planning and implementing future strategies to better address the health needs of minority refugee populations in New Zealand