All three of the parties who will form the next government have campaigned on disestablishing the Māori Health Authority. What does it even do, and what will happen if it's scrapped?
Dr Emily Gill, Te Pāti Māori co-leader Rawiri Waititi and Associate Health Minister Peeni Henare at the presentation of a petition calling for commissioning rights for the Māori Health Authority in February 2021. Photo: Lynn Grieveson / Newsroom
It was to be a gamechanger that would give Māori a strong voice in the health system.
But nearly 18 months on, the incoming National-led government wants to scrap Te Aka Whai Ora (the Māori Health Authority) saying it hasn't achieved anything worthwhile in its short existence.
RNZ In Depth te ao Māori journalist Ella Stewart (Ngāpuhi) says the Māori Health Authority was changing the balance of power in the health system.
"Te Aka Whai Ora came into effect in July 1st, 2022. It is the first time in Aotearoa that we've had a commissioning agency for Māori at that upper central government level with the power to do a whole bunch of things," Stewart says.
"That includes commissioning Māori [health] services and also monitoring performance of the publicly-funded health system. It was this idea that it's putting power back into the hands of Māori so that tino rangatiratanga, that mana motuhake – that sovereignty, self-determination and independence – to make decisions for Māori and by Māori, and that is informed by speaking with Māori on the ground."
Riana Manuel was appointed chief executive of the Māori Health Authority. Photo: RNZ / Cole Eastham-Farrelly
How do they do that? Iwi-Māori Partnership Boards are tasked with speaking to local Māori and Māori health providers about what works best for them, then going back to the Māori Health Authority and asking them to commission certain services.
In today's episode, The Detail visits the offices of Turuki Health, a South Auckland-based kaupapa Māori health provider.
Its CEO Te Puea Winiata (Ngāti Ranginui) explains what's changed from the days of the district health boards (DHBs).
"The DHB contracted us to deliver certain services. When we saw a contract that we thought we could deliver, we applied with a range of other providers who might also see themselves delivering that service. It was a contestable process and the DHB chose one provider or a few providers to cover a wider geographic area," Winiata says.
She says the Māori Health Authority has turned that model on its head.
"They sent out proposals to say 'hey, if you were to meet the needs of this particular community, with these particular issues, how would you go about that and would you be interested basically in entering into a design process, along with us, to look at how we could achieve better outcomes for our communities'."
Te Puea Winiata (Ngāti Ranginui) is the CEO of Turuki Health in south Auckland. Photo: Supplied
She treads a careful line when discussing the proposed disestablishment of the Authority.
"I would hope that whatever government is in power at the time while we do this work, that they will be supporting the delivery of services that are most meaningful and most relevant to whānau."
Hikitia Ropata (Ngāti Toa Rangatira, Ngāti Raukawa, Te Āti Awa, Ngāti Porou) is the chair of the Āti Awa Toa Hauora Partnership Board.
Despite a report being released that says, among other things, that the role of the boards have lacked clarity, Ropata says she's "150 percent" clear about what its tasks are.
"Our main job is to interact with our community, our Māori whānau, and collect and analyse their voice and bring that back to the system to influence [and] encourage demand for what services are in our communities in the future."
And she's calling for the Māori Health Authority to be kept.
"We're iwi. It doesn't matter which government's sitting there, we've been having this fight for a long, long time to have our voices heard.
"What I do want to say is they need to give it a chance. What we've got here is the opportunity to have our people – have Māori people – really have what I call self-determination and rangatiratanga. After all, isn't that what any government would want? For people to self-determine what their health needs are?"
To find out more about how the Māori Health Authority works on the ground, listen to the full podcast episode.
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