One year after the dismantling of the Māori Health Authority, Te Aka Whai Ora, Māori health advocates say the Government’s new Pae Ora Amendment Bill risks further weakening Māori influence in health decision-making and undermining progress toward equitable outcomes.
Janice Kuka, a long-time Māori health leader and co-claimant in the Wai 3307 claim before the Waitangi Tribunal, says the past year has already revealed the consequences of removing a dedicated Māori health authority from the system.
Since Te Aka Whai Ora was disestablished, many Māori providers and community organisations have reported a loss of direct pathways into decision-making around funding priorities, service delivery and programme design. Advocates say the removal of a Māori-led commissioning body has meant that the ability to respond quickly to community-specific health needs has been weakened, with Māori health initiatives once again being filtered through centralised systems.
The Pae Ora Amendment Bill is now raising further concerns across the sector. Critics argue the legislation reduces the formal influence of Iwi Māori Partnership Boards and shifts their role further toward advisory functions rather than decision-making partners within the health system.
For many Māori health leaders, that change signals a wider retreat from Te Tiriti-based governance arrangements that had begun to emerge under earlier reforms.
Kuka and others say the removal of direct Māori authority in the system suggests the Crown is moving away from shared decision-making models and back toward a structure where Māori input is consultative rather than authoritative.
The concern is that this approach risks repeating patterns that have historically contributed to poorer health outcomes for Māori, including reduced responsiveness to whānau needs, less culturally grounded services, and limited local control over how health resources are deployed.
Supporters of Te Aka Whai Ora have also pointed to early progress made during its short period of operation. The authority had begun commissioning services directly from Māori providers, strengthening workforce development initiatives, and prioritising preventative approaches rooted in kaupapa Māori models of care.
Those involved in the sector say these early gains demonstrated the potential benefits of Māori-led commissioning and governance, particularly in communities where mainstream health systems have long struggled to engage effectively with whānau.
Critics of the new Bill argue those lessons appear to have been largely set aside in favour of a more centralised approach to health system management.
Another area raising concern is the Bill’s emphasis on universal health targets. While such targets are often intended to improve system performance overall, Māori health leaders warn that a one-size-fits-all approach can obscure persistent inequities between population groups.
Without targeted strategies that reflect the realities faced by Māori communities, advocates say universal targets risk masking disparities rather than addressing them.
There are also fears that broader structural changes in the health system could open the door to increased private sector involvement in service delivery, potentially reshaping how care is funded and delivered.
For critics of the current reforms, the question is not only about governance structures but about restoring trust between Māori communities and the Crown.
Many argue that a genuinely Te Tiriti-compliant health system would include shared governance arrangements, clear decision-making authority for Māori institutions, and long-term investment in kaupapa Māori health providers and workforce development.
Such an approach, they say, would recognise Māori leadership not as advisory but as an essential component of designing and delivering health services that work for whānau.
As debate over the Pae Ora Amendment Bill continues, Māori health advocates say the stakes are high. The direction taken now will shape how the health system responds to persistent inequities and whether the Crown is willing to uphold the partnership principles embedded in Te Tiriti o Waitangi.
