Tribunal makes final recommendations on reforming Māori primary health system

The Waitangi Tribunal has released its final recommendations arising from stage one of the Health Services and Outcomes Kaupapa Inquiry (Wai 2575). These recommendations comprise the final chapter of the Tribunal’s 2019 report, Hauora: Report on Stage One of the Health Services and Outcomes Kaupapa Inquiry and conclude the first stage of this ongoing inquiry into the Crown’s response to health inequities experienced by Māori.

The 2019 report addressed two claims concerning the Crown’s legislation for, and administration, funding, and monitoring of, the primary health care system in New Zealand since the passing of the New Zealand Public Health and Disability Act 2000.

The Tribunal found that the Crown had breached the Treaty of Waitangi by failing to actively address Māori health inequities and failing to uphold its Treaty obligations in the primary health care sector. The Tribunal made interim recommendations urging the Crown and claimants, who represent several Māori health providers and primary health organisations, to work together to:

  • explore the possibility of a Māori Health Authority;
  • agree upon a methodology which could be used to quantify the extent of underfunding of Māori primary health services since 2000; and
  • review and re-design the current partnership arrangements across all levels of the primary health sector.

In the report’s final chapter, the Tribunal reviews the progress the Crown and claimants have made towards fulfilling these interim recommendations. The Tribunal considers that the Crown’s health system reforms and the establishment of a Māori Health Authority, both announced earlier in 2021, are significant developments.

However, it notes that the detail of the reforms are yet to be fully confirmed, including the level of funding for and decision-making power of the Authority and Iwi/Māori Partnership Boards.

Importantly, the Tribunal considers that it is not yet clear whether Māori will truly wield the Authority’s mandate, and it calls for a governance arrangement that empowers tino rangatiratanga. It recommends that the Crown continue working with the stage one claimants on the operational details of the Māori Health Authority, to make sure it upholds the Treaty guarantee of tino rangatiratanga.

With respect to its second interim recommendation, the Tribunal comments that a report commissioned by the claimants in 2020 has provided a useful starting point for quantifying historical underfunding of Māori primary health organisations and providers, and the compensation owed to them.

However, the Tribunal expresses disappointment that the parties have not yet agreed on a final underfunding methodology, and reiterates that continued delay will only compound the depth of prejudice Māori have suffered. It therefore recommends that the Crown and claimants urgently progress the outstanding work needed to agree upon a methodology.

Once agreement is reached, the Tribunal recommends that the Crown pay the full compensation due to Māori health organisations, and use this underfunding work to inform future funding for primary care.

The hearings for stage two of the Health Services and Outcomes Kaupapa Inquiry, which will investigate alleged Treaty breaches prejudicing Māori with disabilities, are due to start in December 2021.

The Waitangi Tribunal’s final recommendations from stage one of the Health Services and Outcomes Kaupapa Inquiry are now available to download as a standalone chapter of the Hauora report:

Hauora Chapter 10 [PDF, 1 MB]

The chapter completes the Hauora report, which is also available to download as released in 2019:

Hauora(external link)

A full version of the report, with this final chapter incorporated, will be released at a future date.

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