PODCAST: Revamp for once-neglected boards

The revamped iwi Māori partnership boards are a crucial element of the new health sector landscape – but the biggest challenge to their success is lack of investment over the 22-yearlong DHB era.

In the latest System Fix podcast from New Zealand Doctor Rata Aotearoa, host Barbara Fountain is joined by regular panellist Gabrielle Baker and guest Simon Royal to consider the challenges facing these new boards.

Listen to the full podcast here

The boards are the Treaty partners in a system that has a key priority of achieving equity in health outcomes for Māori.

Health policy consultant Ms Baker (Ngāpuhi, Ngāti Kuri) says the lack of investment in the old boards is clear. “If we had been investing in this for 22 years, we would have a whole range of people with skills, to be able to discharge those roles now,” she says in the podcast.

After looking through Cabinet papers from 2000, Ms Baker notes the Government intended for DHBs to formalise an operational partnership with iwi, but for many districts, this never happened.

“DHBs never saw this as enough of a priority to truly invest in, and the Ministry of Health didn’t go to the effort to make sure that these things were happening,” she says.

Former National Hauora Coalition chief executive Simon Royal says the past iwi Māori partnership boards experienced “significant failure” to influence DHB decision-making.

The extent to which iwi were “holding their own, in terms of their own mana motuhake” (self-determination and control over one’s own destiny) appeared to signficantly reduce its influence in the DHB, Mr Royal (Ngāti Raukawa ki Te Tonga, Ngāti Wharara, Ngāti Hine, Ngā Puhi) says.

“The DHB was always in control, they knew that, and they would tell me that when we would break for a cup of tea.”

Mr Royal was pleased to see the Government provide “a little more prescription” in how the new partnership boards were established, and what mana and powers they hold.

The new system is asking a lot of iwi, he says: “We’re asking the representatives of these boards, the iwi boards, to come from being disempowered in the old system to suddenly now having to hold a very responsible part of the system.”

A challenge to the success of the boards will be overcoming the “asymmetry of knowledge and information”, says Mr Royal. “[The old iwi boards] simply didn’t understand how the primary care industry functioned and operated… our people are not trained, they should have been trained by now,” he says.

“And if it fails, my fear is that this could be used as a way of putting the blame back on Māori for failing to adequately inform or participate.”

Mr Royal says the old boards never looked like partnership to him, and the DHBs were scared of the latent power and influence that iwi possess.

“They felt like they were boards that were a risk to be managed, rather than a resource to be supported and partnered with,” he says.