Lack of partnership in health sector changes - Iwi Partnership Boards
Iwi Māori Partnership Boards (IMPBs) are concerned their role in the health system will be reduced under the government’s Healthy Futures (Pae Ora) Amendment Bill.
The Health Select Committee released its final report on the bill in November, recommending it be passed. It is expected to have its second reading in the coming months.
Minister of Health Simeon Brown said the changes being made were focused on ensuring a clearer structure that delivered better results, including for Māori, and a key part of this is clarifying the role of Iwi Māori Partnership Boards.
The 15 regional Iwi Māori Partnership Boards were set up in 2022 to ensure the voices of Māori are heard in healthcare decision-making and improve hauora outcomes for Māori.
Te Kāhui Hauora o Te Tauihu covers the top of the South Island, its Pouwhakahaere Dr Kim Ngawhika said currently IMPBs have three main functions: first to provide a whānau voice, second to monitor the health system and third to work with Health NZ in developing priorities for improving hauora Māori.
Under the Pae Ora amendments those functions would be reduced to one, providing a voice for whānau, she said.
“It does kind of put us on the outer as far as partnership is concerned, we’re still there, we’re still going, but is has reduced our responsibility considerably.”
Ngawhika (Kāi Tahu, Kāti Mamoe, Te Arawa) said it feels as if the partnership is being reduced as much as possible without shutting down the IMPBs outright.
“Of course we will adapt, Māori have always adapted, as governments come and go we remain. Our focus for Te Kāhui is our whānau voice.”
Ngawhika said the focus for the IMPB remains on working with whānau and continuing to engage in the health system despite the uncertainty of what the future holds.
When Te Aka Whai Ora, the Māori Health Authority was disestablished the IMPBs took on some of its responsibilities, and the previous Health Minister Dr Shane Reti indicated that they would be empowered to take on a much broader remit. https://www.rnz.co.nz/news/in-depth/514549/how-the-coalition-plans-to-replace-the-quickly-scrapped-maori-health-authority
Ngawhika said there was some great encouragement from Reti in his initial contact with the IMPBs during what was a time of uncertainty.
“There was a lot of work that happened in that time and it was a time of great change too because Te Aka Whai Ora was being disestablished and I think that the Iwi Māori Partnership Boards just put their heads down and got on with that piece of work.”
The Manahautū of Wellington IMPB Āti Awa Toa Hauora, Hikitia Ropata is concerned that the IMPBs will lose their direct relationship with the Minister of Health under the changes, which would see the Hauora Māori Advisory Committee (HMAC) providing advice to the Minister instead.
But as Ropata (Ngāti Toarangatira, Te Āti Awa, Ngāti Raukawa, Ngāti Porou) notes, the members of HMAC are appointed by the Minister.
“So what we want is the opportunity to influence at that really regional, local level. I know there are public servants working hard to try and enable that to happen. But when your legislative framework changes so much, it’s hard to keep the faith in a system when you know you want the best for your people.”
The IMPBs have now been around for three years now and in that time have worked hard to build relationships both with the communities they serve and with Health NZ, she said.
“At the end of the day, I think that IMPBs have a better crack at building trust and getting information from our own people than if health officials go out and try and do it.”
Ropata is also concerned that among the raft of changes the Bill also strips key health sector principles designed to address inequities by removing the requirement for the Government Policy Statement (GPS) to consider any national health strategy.
These strategies, such as the Māori health strategy and Pacific health strategy, provide important evidence and data and Ropata is worried the health system will “lose its compass” without them.
“If we can’t use that evidence and that data for our way forward, how the heck are we going to know where we’re heading, how the heck are we going to achieve better equity for our people in our community? Our people, iwi and Māori people in our local areas, but also everyone.”
The amendment breaks the link between long-term health planning and the political direction of the day, she said.
“Basically, IMPBs could be left monitoring ongoing inequities for the government, but not have it influence what the government aims to do in its government policy statement.”
Te Taura Ora o Waiariki, the IMPB for Te Arawa, also expressed concern at the removal of the strategies for groups most affected by inequity, including whaikaha (disabled) whānau.
“Removing strategies for those already struggling to be heard is dangerous. These inequities are avoidable, unfair, and unjust. The amendments make them worse,” said Chair Hingatu Thompson.
Both Māori voices and those of supportive non-Māori organisations have been ignored, he said.
“When you remove evidence, ignore submissions, and downgrade Te Tiriti, you’re left with political ideology interfering with the democratic process. And that ideology is clearly anti-Māori,” he said.
Ngawhika made note that one of the minor changes the Bill makes is a change to its name, switching from Pae Ora (Healthy Futures) to Healthy Futures (Pae Ora). “This is yet another way of silencing our voice,” she said.
Minister of Health Simeon Brown said under the changes IMPBs will continue to do what they are best placed to do: engage directly with their communities, identify local barriers, and provide deep insight into what is driving outcomes on the ground.
“IMPBs will also continue to engage with Health New Zealand at a district level, ensuring community perspectives directly inform how services are delivered in each region.
“For example, Māori children continue to have lower vaccination rates than non-Māori. Understanding the specific local issues behind those rates is essential to improving them, and that insight comes from IMPBs.
“These insights will also be provided to the Hauora Māori Advisory Committee, whose role is being strengthened to provide independent national-level advice on Māori health priorities to the Minister and the Health New Zealand Board. This creates a clear and consistent pathway from local insight to national decision-making.
“This approach will support more effective, community-informed responses to issues such as childhood immunisation and outbreaks, particularly in areas where Māori outcomes can be improved.”
Original Article Source: https://www.rnz.co.nz/news/te-manu-korihi/581888/lack-of-partnership-in-health-sector-changes-iwi-partnership-boards
Healthy Futures Amendment Bill Is “An Attack On Māori Development”
Te Taura Ora o Waiariki, Iwi Māori Partnership Board says the Health Select Committee’s recommendation to pass the Healthy Futures (Pae Ora) Amendment Bill undermines Te Tiriti o Waitangi, ignores overwhelming public submissions, and is “an attack on anything that strengthens the future for Māori,” said Chair Hingatu Thompson.
At a time when iwi hauora leaders are raising concerns about racial discriminatory government policy at the United Nations, Hingatu says the Bill continues a pattern of sidelining evidence, weakening Indigenous rights, and eroding the foundations of the health system.
“At a high level, the Bill feels like an attack. Anything that strengthens Māori futures seems to be under assault by this government. The Pae Ora framework was built on Tā Mason Durie’s vision of a healthy future, and now they’re pulling apart everything that upholds it.”
He says both Māori voices and those of supportive non-Māori organisations were ignored. “When you remove evidence, ignore submissions, and downgrade Te Tiriti, you’re left with political ideology interfering with the democratic process. And that ideology is clearly anti-Māori,” he said.
The Bill removes localities, downgrades te reo Māori in legislation, weakens Iwi Māori Partnership Boards voted in to the governance role by their Iwi and hapū, and replaces genuine partnership with the Crown appointed Hauora Māori Advisory Committee.
“This feels like Colonisation all over again. The unwillingness to include Māori kupu signals a deeper dismissal of Māori knowledge too. Advisory committees can have amazing people, but they’re still hand-picked by government which is controlling the outcome. That is not partnership or tino rangatiratanga.”
Hingatu warns the government is out of step with the rest of the country. “Aotearoa is ready for a more substantive expression of Te Tiriti. The public is ahead of the government, look what is happening with the schools’ response to the proposed changes to the Education and Training Amendment Bill. This regression doesn’t reflect who we are as a nation.”
He says the changes undo decades of Māori health advancement. “It has taken forty years to build what we have. One term of government should not be able to unwind it. Undermining whānau undermines the future of Aotearoa. Our rangatahi won’t sit quietly, they expect to be heard.”
Te Taura Ora is also alarmed by the removal of strategies for groups most affected by inequity, including whaikaha whānau. “Removing strategies for those already struggling to be heard is dangerous. These inequities are avoidable, unfair, and unjust. The amendments make them worse.”
Hingatu says political interference in evidence-based policy risks public trust. “When Māori die seven years earlier, and decades of evidence explain why, you expect a government to act, not ignore it. Ideology interfering with the democratic process is dangerous,” he said.
Despite widespread opposition, the coalition has the votes to pass the Bill Hingatu anticipates. He believes this will trigger further action, including a Waitangi Tribunal claim and international scrutiny.
Regardless, Te Taura Ora will continue to work with iwi, hapori, and whanau to protect Te Tiriti and achieve better outcomes in Hauora Māori for whānau.
Original Article Source: https://www.scoop.co.nz/stories/AK2512/S00085/healthy-futures-amendment-bill-is-an-attack-on-maori-development.htm
We need a significantly scaled-up Māori health workforce
Lauren James is co-chair of Te Taura Ora o Waiariki IMPB, the legislated Iwi Māori Partnership Board for the Rotorua area.
OPINION: It’s clear that our health system is in crisis, and Māori will feel the impact more than other parts of the population.
Māori experience a stark health disparity, with an average lifespan seven years shorter than non-Māori; face a cardiovascular disease death rate twice as high; see their tamariki suffering a mortality rate one-and-a-half times that of non-Māori children; and are disproportionately diagnosed and die from cancer.
The evidence tells us that high need and Māori sit hand in hand in this country. The current status quo doesn’t work for us; quite the contrary, it kills us!
Iwi Māori Partnership Boards (IMPBs) were stood up as part of the government response to Wai 2575 (Waitangi Tribunal Health Services and Outcomes Inquiry) and the Simpson Report (Health and Disability System Review), to address the glaring disparities that Maori faced in health and wellbeing.
Yet while the intent of the Government for these IMPBs and now disestablished Te Aka Whai Ora (Māori Health Authority) was honourable, the execution was poor. The entities’ efforts have been underfunded, under-resourced, and burdened by unrealistic expectations.
The resourcing for IMPBs felt like little more than tokenism at best, and blatant inequity at worst – yet two years since our establishment, and despite a change in government, we remain standing.
Not only are we still here, but against all odds, IMPBs have created Community Health Plans that reflect our most cherished taonga—the voices of our whānau and locality data.
They are boldly advocating for long-term, evergreen contracts to sustain our backbone of Māori health providers, striving to strike a principled balance between the needs of our people and the demands of government. I believe both can be achieved.
We are flexible, agile, and ready to challenge the system, pushing for bold, innovative solutions that prioritise social value over financial gain.
IMPBs are only a small part of the health system, but like all good things that come in tiny packages, we are dynamic, explosive and already punching well above our weight.
We should be encouraged by what our 15 IMPBs have achieved in record time. Minister Reti set a deadline in July for our plans, and most of them have been delivered. Now we wait for the official response.
Currently our Māori health providers’ contracts have been rolled over to June next year only, experiencing their own budget forecasting uncertainty in the context of a billion-dollar deficit in Te Whatu Ora Health New Zealand.
Advocating for greater investment in Māori health providers is critical, especially when it’s claimed that Māori prefer mainstream providers. How can we speak of choice when only 2% of health funding goes to Māori providers, yet the demand by our people is massive? This minimal investment strips people of genuine choice, leaving them with few alternatives in the care they can access.
Some, like our whaikaha (disabled) whānau, are particularly underserved as seen in the evidence filed in Wai 2575. This is due to the way the system allocates contracts to the huge players who dominate procurement, which perpetuates ongoing inequity.
We need a significantly scaled-up Māori health workforce – our doctors, nurses, midwives, lead maternity carers, allied health professionals, non-clinical staff, and even the cleaners – everyone who serves our communities. We need more of them, and we need them now.
What sets IMPBs apart is our accountability to whānau, hapū, iwi, and communities; we serve them first and foremost. Their voices make it clear: we can’t afford to wait for the system to change, especially when whānau pass away while waiting in emergency departments.
This reality shows us that the system is in crisis. As we’re continually reminded of the health system’s financial struggles, let’s not forget that health should never be about profit; it must be about people and whānau. We recognise that we can’t do this alone, but being comfortable to share safe space together and have honest conversations about what we can all do better is a great place to start.
IMPBs across the country are eager to engage in conversations with all branches of government, from health to housing. We understand that health alone cannot deliver the answers to whānau wellbeing. Let us unite to strengthen whānau, hapū, iwi, and communities together.
Original Article posted on the Sunday StarTimes: https://www.thepost.co.nz/wellbeing/350447368/we-need-significantly-scaled-maori-health-workforce
Minister Reti in Christchurch
Minister of Health Dr Shane Reti addressed Iwi-Māori Partnership Boards in March of this year and affirmed he will strengthen the role of IMPBs nationally. His speech spoke of a new dream for Māori Health that included timely access to quality healthcare and acknowledged that wider social determinants play a critical role in the overall health and wellbeing of whānau.
“I want to paint a vision for Māori and all New Zealanders. My vision is that all New Zealanders will have timely access to quality healthcare. That is the mission statement”
Te Taura Ora o Waiariki travelled to Otautahi for this hui and had the priviledge of speaking with the Minister one on one where we discussed the social issues our rohe faces and how we can support our people by breaking down cross sectoral silos. The Minister acknowledged that 80% of a persons overall wellbeing is determined by socail impacts and only 20% can be attributed to clinical health.
Do not be daunted. I know that each IMPB will have its own aspirations and plan, and we would like to work with you to facilitate a process where you are resourced to test and develop ways of working, which would then provide good evidence to inform longer-term resourcing. I know there are models that have worked before that we can better support, like the COVID-19 Care in the Community model.
Click here to read the Minister’s speech in full
