Māori Board Members and the District Health Board

Model: Experiences, Issues and

Challenges

Te Mata o Te Tau Weekly Seminar Series27 July 2006

Dr Amohia BoultonRCMH&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 methodologya formative evaluation of the

implementation of the new structure and strategies

a comparative public policy approach

Health Reforms 2001 Project

Mixed methodsPublic telephone surveyDocumentary analysisKey informant interviewsPostal QuestionnairesCase studies

Large, multi-site, multi-disciplinary research team

Health Reforms 2001 Project

Key themesGovernanceAccountabilityStrategic decision-makingFunding, purchasing and contractingSector relationshipsOverall performanceTreaty of Waitangi/ Māori HealthPacific peoples/ Pacific health

Māori Health Theme Additional Māori Board member

interviews9 face to face interviews2 written submissions

Four topics of inquiryexperiences of Board membershipBoard member roleGovernment intentions for Māori

healthDistrict 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

IdentifierStatus in

2004Appointed or

Elected

Expert or Tangata Whenua

Representative

Previous DHB

Experience

Previous Health

Experience

MBM1 Current Appointed Expert None Yes

MBM2 Current Appointed Neither 1 term Yes

MBM3 Current Appointed Both None Yes

MBM4 Current Appointed Māori Rep None Yes

MBM5 Current Appointed TW Rep None Yes

MBM6 Resigned Appointed Expert Yes Yes

MBM7 Current Appointed Māori Rep None Yes

MBM8 Current Appointed Neither Yes Yes

MBM9 Current Elected N/a None Yes

MBM10 Current Appointed TW Rep 2 terms Yes

MBM11 Current Appointed Expert Yes Yes

Māori Board Member Experiences Distinction between a Māori Board

member and a Board member who happens to be Māori

Range of responses regarding rolestrategic 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 ActWhose views are being sought?Manawhenua vs Mataawaka vs MāoriImplementation 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