NICOLE PIHEMA

from the president, new zealand college of midwives, nicole pihema

‘Hapaitia te ara tika pumau ai te rangatiratanga mo nga uri whakatupu’. Foster the pathway of knowledge to strength, independence and growth for future generations.

The Annual General Meeting for the New Zealand College of Midwives will be held at the Novotel, Cathedral Square, Christchurch on Wednesday 14 October from 7.00pm.

If you would like to give notice of a remit or raise an issue for discussion at the AGM please send details to Lynda Overton lynda.o@nzcom.org. nz or New Zealand College of Midwives, PO Box 21-106, Edgeware, Christchurch 8143. Arotake Pūnaha Hauora-Whaikaha Hoki, (Health and Disability System Review) was published in March and acknowledges the need to reshape our healthcare system in Aotearoa in a way that provides equity of access for all. It particularly acknowledges the need to address the historic absence of equity for Māori. It should not come as a surprise for anyone that the report admits: “The fact that Māori health outcomes are significantly worse than those for other New Zealanders represents a failure of the health and disability system and does not reflect Te Tiriti [Treaty of Waitangi] commitments.”

One of the main recommendations is for the establishment of a new organisation, the Māori Health Authority. It is recommended that this be the principal advisor on all Hauora Māori [Māori health] issues. But the report stops there, recommending the Māori Health Authority as an ‘advisor’. This does not go far enough to action changes that are essential for a real improvement in equity; this includes the right to make decisions about funding and commissioning of services. Heather Simpson, chair of the review panel states that there was no consensus on the extent to which the Māori Health Authority should control the funding and commissioning of services for Māori. All members of the review’s six-person Māori Expert Advisory Group and four members of the seven person review panel envisaged a much more decisive role for Māori and outlined this in an alternative review included in the report. This is concerning when the Māori Advisory Group is disregarded for the adoption of a more mainstream view; a sign that really there is no real commitment to change and is likely a reflection of the environment in which the Māori Health Authority would be ‘advising’.

The alternative view says that “a comprehensive indigenous commissioning framework should be developed, which uses every enabler and lever, at every level, to ensure the system successfully delivers improved health and wellbeing outcomes for whanau”.

“The commissioning framework should be Tiriti [Treaty of Waitangi] compliant and designed by Māori as an active expression of rangatiratanga [authority, ownership, leadership] and mana motuhake, [self determination, autonomy] in a way that is not possible within mainstream organisations. The time is right for action around a broader indigenous commissioning framework in Aotearoa, that could be world leading in addressing inequity.”

The lack of consensus indicates that there is still a lack of trust in the ability of Māori to direct funding and commissioning. Partnership implies trust between the parties involved. But when it comes to implementing the partnership in a Te Tiriti re-shaped health service, the trust does not seem to be there.

There are echoes for midwifery in the way that the proposals we have put forward to reorganise the funding model for community midwifery – proposals that have been developed over several years as part of our mediation agreement with the government – seem to have been sidestepped. We welcomed the $242 million funding package the government announced recently for the maternity sector but it is disappointing that there seems to be a lack of trust in the model we have proposed. We will continue to fight for a system that protects our autonomy and the continuity of care for women that midwives in New Zealand have fought so hard to achieve. Likewise Māori will continue to fight for autonomy within a re-shaped health service, something many believe will be essential if we are to achieve equity at all. square