Māori Board Members and the District Health Board Model: Experiences, Issues and Challenges Te Mata o Te Tau Weekly Seminar Series 27 July 2006 Dr Amohia Boulton RCMH&D

Overview Background to the Health Reforms 2001 Project Background to the Māori Board Member Interviews Legislative Framework Experiences Issues of Concern Challenges for the Future

Health Reforms 2001 Project Purpose to chart the progress of, and evaluate, the health reforms enacted by the New Zealand Public Health and Disability Act 2000 Research methodology a formative evaluation of the implementation of the new structure and strategies a comparative public policy approach

Health Reforms 2001 Project Mixed methods Public telephone survey Documentary analysis Key informant interviews Postal Questionnaires Case studies Large, multi-site, multi-disciplinary research team

Health Reforms 2001 Project Key themes Governance Accountability Strategic decision-making Funding, purchasing and contracting Sector relationships Overall performance Treaty of Waitangi/ Māori Health Pacific peoples/ Pacific health

Māori Health Theme Additional Māori Board member interviews 9 face to face interviews 2 written submissions Four topics of inquiry experiences of Board membership Board member role Government intentions for Māori health District Health Board ability to contribute to Māori health gain

Legislative Framework New Zealand Public Health and Disability (NZPHD) Act 2000 “In order to recognise and respect the principles of the Treaty of Waitangi, and with a view to improving health outcomes for Māori, Part 3 [of the Act] provides for mechanisms to enable Māori to contribute to decision-making on, and to participate in the delivery of, health and disability services.” NZPHD Act 2000 Part 1 section 4

Legislative Framework DHB functions: to establish and maintain processes to enable Māori to participate in, and contribute to, strategies for Māori health improvement to continue to foster the development of Māori capacity for participating in the health and disability sector and for providing for the needs of Mäori to provide relevant information to Mäori for the above purposes NZPHD Act 2000 Part 3 section 23

Legislative Framework Membership of Boards Boards are to consist of 7 elected members and up to 4 Ministerially appointed members when appointing, the Minister must ensure that Māori membership of the board is proportional to the number of Māori in the DHB’s resident population and that in any case there are at least 2 Māori members of the board NZPHD Act 2000 Part 3 section 29

New Zealand Public Health and Disability Model over-arching health strategies to set national priorities 21 District Health Boards (DHBs) to purchase or provide services for geographically defined populations input by local communities into DHBs through elected representation and health needs assessments

Māori Board Member Experiences

Distinction between a Māori Board member and a Board member who happens to be Māori Range of responses regarding role strategic advice, advocacy, monitoring, support, representing community concerns, upholding Crown/iwi relationship Multiple accountabilities evident

Issues of Concern Act provides for mechanisms to enable Māori to contribute to decision-making on, and to participate in the delivery of, health and disability services.” Interpretation of the Act Whose views are being sought? Manawhenua vs Mataawaka vs Māori Implementation of the Act, structures, systems, processes

Issues of Concern Relegation of the Crown/Iwi partnership Capacity, competency and depth of Māori workforce The regular collection of good quality ethnicity data Collection and analysis of data by Māori providers

Challenges Identified by Māori Board Members Ensuring momentum is not lost when board members leave, or are not re- elected or re-appointed Achieving health gains for Māori with limited resources (financial and human) Implementing Whānau Ora “on the ground”

Challenges Identified by Māori Board Members Ensuring strategies for Māori are inclusive of all Māori in a DHB’s catchment Working intersectorally Managing multiple accountabilities, multiple expectations

Final Thoughts Great variety of experiences in even a small number of DHBs On the whole appears to be a willingness to achieve improvements in Māori health outcomes, even if the means to achieve this are contended Period of stability required

Further research Attitudes of appointed versus elected District Health Board members Follow-up with Māori Board members post-2004 election Comparison of the implementation of the Māori Health Strategy in deficit vs non-deficit DHBs

Acknowledgements