Strong te ao Māori-based health agency essential

Rob Campbell

Opinion

The declared intent of National/Act to abolish Te Aka Whai Ora is a mistake from many points of view.

When, some months ago, I discussed this with Christopher Luxon he said they would establish a Māori unit in the Ministry of Health to more effectively and efficiently do its work.

He appeared unaware that such a unit had been a fixture in the ministry for a long time and remained there. I was also touched by the naivety of his view that locating anything within that ministry was a step towards efficiency or effectiveness.

I had the privilege of working with Te Aka Whai Ora (Māori Health Authority) in its establishment and early life. I consider the goals they have and the people involved as highly valuable.

To achieve Pae Ora/Healthy Futures for this place I regard it as essential that we have a strong te ao Māori-based health agency.

Why move backwards, creating sunk costs, when we could move forward creating new value?

That is not to say that there are not problems with the agency as it stands. I offer these thoughts towards a more positive way to think about its future from a tangata Tiriti perspective.

Just as the strength of Te Whatu Ora suffers from presenting itself as an agency “to” rather than “for” the health services sector and its staff, Te Aka Whai Ora has a struggle to establish itself as genuinely “by Māori, for Māori”.

Rather than going backwards, it would be lifted by a higher degree of independence from the Crown in its governance and in setting strategy.

It must be, and be seen to be, a form of mana motuhake, not just another “public service agency” or its effectiveness will be constrained.

So, too, must its role be strengthened by allocating a much more significant part of general health spending to Te Aka Whai Ora.

At present, this is farcically low and out of balance with the overheads reasonably necessary to establish itself. It is urgent that Te Whatu Ora and the minister get this reallocation moving.

This is not necessarily more money in total (desirable though that is) but a significant reallocation of spending. The current imbalance is more dependence than partnership.

Equally important is sorting out the roles of the Iwi Māori Partnership Boards and the “localities” within the overall health services system. While these may look OK on paper, and while there did seem merit in having widespread involvement in the process of defining their roles in practice, the reality has created confusion and cynicism.

Kaupapa Māori health services are torn in multiple directions for the strategy and accountability they are working within and the sources of funding they should use.

Recall that Whānau Ora is already a significant and established presence in this as well. These services do not need more time and resource-consuming networks or hierarchies or contracts, they need clarity and certainty.

If there are weaknesses in Te Aka Whai Ora they are the product of these confusions, and on top of this the limited skilled, trained and experienced people available to meet the organisation’s needs.

I have met with many who think these things show that Te Aka Whai Ora was set up to fail, not to thrive.

I do not accept this, but proposals to dismantle what is being created will only fuel that suspicion and Māori are not unused to such treatment.

We should all get behind Tipa Mahuta, Riana Manuel and their colleagues and create the space, independence and resources they need to succeed.

■  Rob Campbell is a professional director and former chair of Te Whatu Ora.