Maori representation in the health sector appears to be under threat as targeted initiatives are scaled back.
A study revealed the Ministry of Health disestablished their Maori policy team, Te Kete Hauora, last year along with revoking mandatory district health boards' Maori health plans and reporting, and scaling back the requirements of DHBs to consult with Maori.
AUT senior lecturer in Maori health and author of the study Dr Heather Came believed these were examples of the Ministry "quietly downsizing" their checks and balances to ensure Maori representation. "These were structural mechanisms to help address institutional racism and enable Treaty obligations to be met. They've removed those and are relying on good faith ... I don't want to leave it to chance.
"If the responsibility of the Government is to have Maori involved in decision-making there needs to be dialogue with Maori at all levels and specific about what they're trying to do."
The study stated the cuts were detrimental to positive health outcomes for Maori and disregarded the New Zealand Public Health & Disability Act 2000, Te Tiriti o Waitangi and the Ministry's Maori health strategy He Korowai Oranga.
But Ministry of Health spokeswoman Alison Thom said Maori representation had shifted, not disappeared altogether.
Thom said when the Ministry restructured last year, the staff from Te Kete Hauora were moved to work on Maori health issues within relevant business units. Maori health plans were incorporated into DHB annual plans and health boards were still required to consult with Maori on those.
This made the DHB chairs and boards more directly accountable to the Minister when it came to Maori health, Thom said.
"The Ministry continues to ensure there are better health outcomes for Maori through its four year plan and its strategic priorities.
"Maori health is one of the Ministry's six strategic priorities and in a number of key areas, we're actively working to drive services to the highest need, for instance through the Better Public Services targets."
Thom cited the increase in immunisation for Maori infants from 78 per cent in 2012 to 91 per cent in 2016 as an example of success.
Came said a few "admirable" DHBs had said they would still follow a Maori health plan, but it was no longer compulsory. She believed the solution would be to financially and politically resource a dedicated Maori team within the Ministry to ensure the Maori voice was heard at all levels.
Te Puea Marae chairman Hurimoana Dennis was worried for the future of Maori representation. He said it was needed to address the obvious health disparities for Maori.
Dennis believed if Maori influence was taken away it would be harder to get the quality of support needed.
"We need discussions with the right people who know our Maori business.
"If we're trying to explain our model to someone who is not Maori or not in our space it becomes a very difficult conversation."
Maori Party co-leader Te Ururoa Flavell said the current health and social indicators for Maori was evidence the Government wasn't doing enough to address Maori health inequity.
He said removing Maori influence would be "a recipe for worsening Maori health".
"Challenging the status quo and addressing Maori health inequity at every level is needed, as well as a reorientation of whanau-centred investment incentives, linked to measurable outcomes."
Counties Manukau DHB acting chief executive Margie Apa said their DHB chair and board still required them to produce Maori health plans for 2017/18 "as a public signal of commitment to improving Maori Health in the metro-Auckland region".
She said all three Auckland DHBs wanted to accelerate Maori health gain for the 190,000 Maori who live in Auckland.
The viewpoint paper Unravelling the whariki of Crown Maori health infrastructure was published in the New Zealand Medical Journal on Friday.