TRIBAL HEALTH GOVERNANCE

Mara’s story relates to a PHD topic that she is midway through completing.

I did not have a PHD on my radar until I was visited (while living in Vancouver Canada) by Professor Sir Mason Durie who was speaking at a national conference in the city in 2012. Our local whānau (friends and family) there invited him and his lovely wife for dinner – and soon after he began effectively interviewing each one of us, making connections to our relatives (all of whom he seemed to know!) and asking what each of us was currently studying or pursuing from a learning perspective. Pretty much all of us said we weren’t currently studying as we were busy working. Then it was my turn. I tried to cover my embarrassment of not studying at the time by saying that I had continued my interest in Tribal Self-Governance (TSG) in health systems in the United States – ever since a World Health Organisation (WHO) Fellowship I had done in 1998. Suffice to say, by the time we had finished talking, I had been convinced to enrol for the PHD program at Massey University and to use the ‘spare time’ I had while living in Vancouver, to write up my learnings from the United States experience.

My WHO Fellowship was done during my employment at the former Health Funding Authority in Aotearoa. I focused my learning on indigenous health care in the USA as I felt it would be relevant to my role as a Māori Health Manager. What I saw was a well-developed model of Tribal Self-Governance of health services where responsibility had been legally transferred from the Federal Government (Indian Health Service) to Tribes under a Government-to-Government provision in the self-governance legislation. The arrangement wasn’t just a procurement contract like many we had in New Zealand. It was a legal transfer of full authority and responsibility to Tribes without any impact on the Government’s Trust or fiduciary responsibility to Native Americans or Alaska Natives. I thought that their journey and experience might provide useful information and lessons for Iwi in Aotearoa / New Zealand to consider in their quest to have greater governance and decision-making over health care for Māori. I learned so much during that 1998 trip across several Reservations and into Canada – and have continued to learn even more as the decades go by, and the US Tribes continue to advance their knowledge, strategy and influence on their health systems.

I finally began my PHD by enrolling in 2018 and my topic is “Critical Success Factors for Tribal Self-Governance of Health Services”. I am pleased to have developed a number of key relationships with indigenous friends from the Federal Indian Health Service; from Tribes governing their own health care; from Regional and National bodies supporting Tribes such as Area Indian Health Boards and the National Indian Health Board (NIHB), as well as the Alaska Native Tribal Health Consortium. These good friends are key informants for my study and have shared so much with me already and I am very motivated to share these learnings to help inform future health developments in New Zealand.

So thank you Mason for forcing me to write down what I’ve learned so it can be shared (although at times I must admit I wonder what the heck I am doing trying to do a PHD while still working full-time LOL??). I will get there though – I owe to the many indigenous Tribal and Government leaders who have shared their journey and offered the lessons from the “ups and downs” of the pathway to self-governance. I will continue to share some of these learnings in more specific details over coming weeks and months…and yes, I will get to finish this PHD no matter how long it takes me.