Backing for fully empowered Māori Health Authority
The Association of Salaried Medical Specialists and the New Zealand Medical Association are making clear their support for the establishment of a Māori Health Authority with full commissioning rights, as a new pathway to deliver health equity for Māori.
The Final Report of the Health and Disability System Review included a recommendation for a Māori Health Authority. However, Review members were split on whether it should have the power to commission and fund services. An “alternative view” in the report called for these greater powers.
A Māori Health Authority was also part of Labour’s 2020 election promise in its Next Steps to Rebuilding Our Health System. The Minister of Health Andrew Little said late last year, “Māori are suffering in a health system that is not treating them equally. If we’re going to have a Māori Health Authority, I’m determined that it genuinely has the authority to really make a difference for Māori. I want to be sure that we’re doing everything we can, that it’s a game-changer for Māori.”
The NZMA and ASMS believe health must no longer remain a one-size-fits-all model, and now is the time to have a ‘for Māori-by-Māori’ holistic approach encompassing mātauranga Māori and rongoā (healing and medicines).
“Māori making decisions for Māori embodies the Treaty imperative of tino rangatiratanga, and we know that the current health system is not treating Māori equally. The Government has shown us it can take decisive action as it did with Covid 19. Now we need courageous decision-making for Māori wellbeing as the current model does not work,” says NZMA Chair Dr Kate Baddock.
ASMS Executive Director Sarah Dalton says, “all the data tells us that the current system discriminates against Māori so it stands to reason that a new system must be designed by Māori for Māori if we’re serious about making a positive difference in health outcomes for all New Zealanders”.
It is also critical that a Māori lens is firmly applied to all areas of the health system to promote and create more equitable access in mainstream services.
Both organisations strongly favour a Māori Health Authority that is empowered to create, commission and fund structures and services for Māori, and encourage other health organisations and professional bodies to add their voices in support.
The Health and Disability System Review’s Final Report (specifically pages 26-28) was released on Tuesday 16 June 2020 and recommended the formation and operation of an independent Māori Health Authority.
Recommendation for a Māori Health Authority
However, the authors of the Report could not come to a consensus on the powers of the proposed MHA. Therefore, an ‘Alternative View’ (pages 181-184) forms part of the Final Report and describes what a commission framework will look like; as below.
Alternative View Definition (Page 181)
A potentially transformational future where the Māori Health Authority has a role to commission health services as well as enabler services for Māori using an indigenous driven model within the proposed system to achieve equity.
Over time, substantial Māori commissioning roles should be incorporated within an integrated health system. This would provide the capacity and leadership required to alter the trajectory of Māori health inequities.
The MHA would be established as a kaupapa Māori entity (Māori owned, governed and operated). An example of this type of approach is a recent model associated with revitalising te reo Māori (Te Mātāwai).
The MHA would be a full commissioner in its own right, operating within a coherent and unified system, as well as being required to support national, regional and local commissioning and workforce developments.
Consideration needs to be given to establishing a more consistent and focused funding stream that prioritises Kaupapa Māori services and does not necessarily depend on DHB priorities. This would recognise the multi-sectorial nature of Kaupapa Māori services and the importance for Māori of early intervention coupled with better management of health-specific, social and cultural determinants of health.
In addition, a Mātauranga Māori commissioning frame, which builds on the Whānau Ora Commissioning model and recognises the inseparability of health, education, housing, income, and civic responsibilities, warrants further consideration and would enable Mātauranga Māori to be prioritised and led by Māori experts.