The Waitangi Tribunal has raised the prospect of a national Māori health authority to improve the "grim picture" of indigenous health in New Zealand.
In its stark "kaupapa inquiry" report released this morning, the tribunal said Māori health funding was scant, poorly targeted and barely monitored.
The report rebuked the Crown for breaching the Treaty of Waitangi, both in its failure to close the "persistent" gap between Māori and non-Māori and its failure to guarantee tino rangatiratanga, or Māori sovereignty and self-determination.
All parties involved in the inquiry accepted the last major health reforms in 2000 had done little to substantially improve the state of Māori health.
"Māori continue to experience the worst health outcomes of any population group in New Zealand," the report said.
The tribunal found "serious Treaty breaches" regarding how funding was targeted and monitored, finding there were "few mechanisms in place to ensure accountability".
"Those mechanisms that did exist were rarely used in relation to Māori health," the report said.
The current funding arrangements also disadvantaged Māori primary health organisations and providers, with ongoing resourcing named as a significant problem.
"On the topic of funding, we found that Māori primary health organisations were underfunded from the outset."
Māori also did not have "adequate decision-making authority and influence" when it came to primary health care services, the report said.
The tribunal recommended an immediate law change, stating the sector should be committed to equitable health outcomes for Māori and be guided by Treaty of Waitangi principles.
It also proposed there be further discussion about the potential for "a national, Māori-controlled agency, organisation or collective" with control of Māori health-related spending and policy.
The report noted that the National Hauora Coalition wanted the government to set up an independent Hauora authority with a similar status as ACC or Pharmac.
The tribunal stopped short of backing the proposal, but recommended the government explore the idea in discussions with the Coalition and the Māori Primary Health Organisations and Providers.
The tribunal held hearings over three weeks at Tūrangawaewae Marae, Ngāruawāhia, in October and November 2018, with further sessions in Wellington in December 2018 and March 2019.