What do you make of the Māori Health Authority?
Only time will tell if the Māori Health Authority is the answer to Māori health needs. Maxine Jacobs reports.
Proof is what it will take to convince many Mā ori that a health authority created for tangata whenua will cater to their needs.
And it comes as no surprise that opinion on the Mā ori Health Authority was divided on the streets of Ngā ruawā hia, a place where Kīngitanga matriarch Te Kirihaehae Te Puea Hē rangi lay the foundations of a by Mā ori for Mā ori health system more than 100 years ago.
Her efforts were thwarted by bureaucracy, but today a revamped system that incorporates parts of Hē rangi’s vision comes to life under the Mā ori Health Authority.
Last year, Stuff spoke to
Ngā ruawā wahia locals who were clear on what the authority needed to do to provide better healthcare for Mā ori. They wanted access to local doctors without the long wait times, they wanted racism eradicated from the health system, more Mā ori faces in health spaces and to be heard.
For years Mā ori have endured horrific health inequities in the former health system that have proved fatal. Racism, both conscious and unconscious, at the heart of it.
The Mā ori Health Authority is expected to reduce those inequities as it starts to tackle the systemic issues spread throughout the healthcare system.
Led by chief executive Riana Manuel, the authority will work in partnership with the also newly formed Health New Zealand – which replaces the district health board system – and the Ministry of Health.
With the help of Iwi-Mā ori Partnership Boards across the country, the authority promises to drive better health outcomes for whā nau Mā ori by providing kaupapa Mā ori services that cater to Mā ori.
These strategies and policies, the authority hopes, will reduce barriers to care and enhance the health and wellbeing of tangata whenua.
This is the first of its kind, and while it looks good on paper, Mā ori have heard promises from Government officials and seen them broken in the same breath. Many are hoping for the best, but expecting the worst.
In the heart of the Kīngitanga country, Maine Tito, 29, is writing up reports at Ngā Miro Health Centre.
Across the road from her office is Tū rangawaewae Marae and at its heart is Mā hinā rangi wharenui, built by Herangi and the survivors of the 1918 influenza pandemic as a healing space for Mā ori by Mā ori.
She envisioned a whare that would incorporate tikanga (customs), rongoā (Mā ori medicine) and Western medicine under one roof designed aesthetically for Mā ori.
Ultimately, the hospital didn’t go ahead, but Hē rangi’s vision of healthcare lives on at Ngā Miro, Tito said.
Six months ago she left her job at the DHB working in general surgery to return home and help support whā nau through Covid-19 with immunisations, as well as taking on the role of clinical lead for diabetes.
Tito (Tainui) has seen both sides of the health coin, the resources and high turnover of the DHB, and the manaaki from staff in primary care.
Ngā Miro, like other Mā ori-led health centres, provides cultural understanding and places patients and their whā nau in the driver’s seat of care, reducing the anxiety of those who have faced racism and barriers to care at larger Eurocentric institutions, Tito said.
She’s cautiously optimistic that the authority will act as the voice for Mā ori in the highest level of healthcare, but when it comes to how that will affect the issues she sees at the local level, it gets a bit murky.
In her view, the biggest difference the Mā ori Health Authority can make to reduce the health inequities is shifting the resource allocation to Mā ori health providers, so they can serve their community before hospitals get involved – along with not going back to the status quo when the Western view of success isn’t met soon enough.
‘‘It’s the measures they go off, if they don’t see them in the short amount of time that they’ve allocated to see, then it’s cut’’ she said.
‘‘But there’s more than just a physical result, there’s the mental, social and emotional impacts that people are feeling that are not always a tickbox.’’
Care needed to be supported at the primary level, particularly in staffing and resourcing, so Mā ori can access the care they need early, rather than at the end of the line in hospitals, she said.
‘‘When I think about [Te Puea’s] vision, it’s not a hospital, it’s a health hub, which is what we have here,’’ she said.
‘‘When you need more extensive care you can go to a hospital-type setting, but the thing about hospitals . . . it’s still so Pā kehā .’’
May Nepia (Tainui, Tū wharetoa, Ngā ti Raukawa) doesn’t believe the authority reflects the vision of her tipuna, Hē rangi.
Nepia, 55, felt changes didn’t align with Hē rangi’s vision of Mā ori hospitals, and having the Western system entwined with hauora Mā ori (Mā ori health) wouldn’t bring about the changes she wanted to see most – the enhancement of rongoā Mā ori in healthcare.
‘‘They should allow us the right to come in and do our rongoā , and support it, support our people, because we are the people of the land.’’
And Patrick Kuka, 64, was also pessimistic about the authority. As he walked his dog through Patterson Park he said he wasn’t convinced it would make much of a difference for Mā ori.
‘‘Really, it’s just an old situation with a new name, moving it from one health authority to the next. With all the money they’ve invested in, there’s other things they can invest in.’’
Kuka (Ngā ti Ranginui) said a major problem was the pressure on staff at all levels, especially in the hospitals.
‘‘They’re just overworked. Having a new authority to look at it, I don’t know if it will do any good,’’ he said.
‘‘They say we need a different setup, we need a different sort of crew.
‘‘It’ll make a little difference, but it will take a while and, by the time the funding’s all run out, what are they going to do?
‘‘We have to wait and see, I guess.’’
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