What next for Te Aka Whai Ora? Uncertainties surround the future of the Māori Health Authority

As I write, the country knows the final election results, but we don’t know the make up of the Government or how the coalition negotiations have gone. This means that we don’t know which of the pre-election policies of National, Act and NZ First will be prioritised and which will be scrapped.

But we know that things will change for Te Aka Whai Ora, the Māori Health Authority, given that all three parties talked about getting rid of it while electioneering. Introducing legislation to disestablish the authority is on the National Party’s 100-Day Action Plan released in October, so it seems National is reasonably confident it can get agreement across coalition partners on this, too.

How exactly you get rid of a Māori Health Authority, and what you replace it with (as the work of setting policy, commissioning health services, developing locality plans, and monitoring will continue in some form regardless of what you call the agency that does it) will inevitably be questions the new minister(s) will need to answer almost immediately once in office.

Pre-election, National suggested that at least some of the functions would be given to a “strong Māori health directorate inside the Ministry of Health”.This would be like the situation before the Pae Ora (Healthy Futures) Act 2022. Back then, the Māori health unit within the ministry had policy and research functions and responsibility for implementing the Māori Provider Development Scheme and administering a small amount of project funding.

Returning to this situation has the greatest appeal in consolidating the two organisations’ policy functions and removing any potential duplication. Policy and providing direct advice to ministers were roles retained by the ministry through the most recent health reforms. But the new legislation made an exception for hauora Māori, where Te Aka Whai Ora also had a legislative function to provide policy and strategy advice to the minister.

Te Whatu Ora has retained many of the roles carried out by DHBs in our previous health system. DHBs often (although not always) had dedicated Māori health teams.

The functions of these teams varied, but included a mix of five main roles:

• providing advice and support (including kaiāwhina services) within DHB-run hospitals and health services
• contracting for Māori health services
• building and maintaining iwi-Māori relationships in the community
• having responsibility for or influencing DHB funding and planning, and
• supporting improved DHB performance, for example, through data and monitoring.

These parts of the role of Te Aka Whai Ora could be absorbed and become the responsibility of a substantial team within Te Whatu Ora.

And, in theory, it could mean that Te Whatu Ora would be better equipped to do its business in relation to Māori health.

Such is the power of rhetoric that positions fairness and ensuring Māori have some basic rights as being separatist

Whether Te Aka Whai Ora gets fully absorbed into either Manatū Hauora or Te Whatu Ora, it signals a return to what we already know does not work in terms of improving Māori health outcomes.

It seems odd that political parties who are focused on improving outcomes and getting results would make their flagship health policy about returning to something that has failed to do that. But such is the power of rhetoric that positions fairness and ensuring Māori have some basic rights as being separatist.

For those of us who are committed to ministers getting the best quality advice on all issues, including Māori health, there are some alarm bells about Manatū Hauora taking on the policy functions. The public service is meant to provide free, frank, and fearless advice to ministers so that they can make well-informed decisions. That is, regardless of what the stated political position of a minister or party is, officials have a duty to do things such as identify inequities and racism and give advice on how to eliminate both.

But this is not always the experience of policy advisors. At various times, we get told we can’t use words like equity or racism, either directly or indirectly (with the words crossed out and sanitised by reviewers). Or we need to talk about socioeconomic or rural inequities only, ignoring the fact that both sets of injustices are even worse for Māori populations.

I also worry that it means policy advisors will be discouraged from disagreement in favour of just agreeing to make the best out of a bad situation. In the Hauora Māori Advisory Committee’s assessment of Te Aka Whai Ora (after less than a year in operation), it was noted that developing a Hauora Māori Strategy had become vexed because of disagreement between officials: “It was intended that the process should be jointly run by the two entities, however, challenges arose in the relationship between those Te Aka Whai Ora and Manatū Hauora managers due to differing views on how the strategy development process should run.”

It isn’t a good sign that the disagreement led to disruption or delay to the strategy (which the committee’s report implies). But it highlights the value of having a Māori policy advice function outside of Manatū Hauora. These kinds of disagreements rarely happen within one agency because the organisational hierarchy encourages agreement and positions dissenting views as being courageous (because they are “career limiting”).

My view, as you might have gathered across a few years of columns for New Zealand Doctor Rata Aotearoa, is that Te Aka Whai Ora has heaps of potential to reshape the health system so that it works for Māori.

My concern has always been that it is too close to the Government and not protected sufficiently from political change.

More recently, my concerns have been that it is tied up in too many of the mechanics (aka bureaucracy) rather than being able to get on with things that will make a tangible difference to the health and wellbeing of whānau. However, neither of these concerns got in the way of what I saw was a landmark move to fix the health system and align it with Te Tiriti o Waitangi guarantees.

Whatever happens to Te Aka Whai Ora, I hope that the very best bits – the prioritising of mātauranga Māori, its faith in Māori health providers, its ability to increase funding for Māori provider development and its commitment to improving Māori health outcomes – are retained in a way that recognises its value.

I hope that the new Government’s focus on targets and performance ensures that outcomes improve for Māori and that the performance of publicly funded services is monitored for Māori as Te Aka Whai Ora would have done.

Gabrielle Baker (Ngāpuhi, Ngāti Kuri) is an independent health policy consultant