Critical Tiriti Analysis: Why the Health Workforce Plan Still Falls Short

Workforce development is vital for achieving equitable health outcomes for Māori. For decades, Māori have called for more Indigenous practitioners, as Māori-led care consistently produces higher quality, culturally safe results. Generic health services have often failed whānau and maintained systemic inequities. Effective planning must go beyond recruitment to eliminate institutional racism and decolonise the sector. By centering mātauranga Māori and kaupapa Māori initiatives, the system can finally reflect Māori aspirations. Ultimately, true equity requires Māori leadership and mana motuhake to ensure Te Tiriti commitments translate into measurable health gains.

As a Pākehā activist scholar, I’ve spent time dissecting the ways our health system continues to fail Māori. My colleagues Haidee Rēnata, Carlton Irving, Maria Baker, and I recently applied a Critical Tiriti Analysis (CTA) of the Health Workforce Plan 2023/24. While the Plan is a major driver for Te Whatu Ora, our review found it only partially aligns with the five elements of Te Tiriti o Waitangi. If we are serious about ethnic health equity, we have to move beyond symbolic gestures and address the root causes of systemic inequities.

The Plan was co-developed with Te Aka Whai Ora before its disestablishment by the National-led coalition government. The final document maintains a monocultural, Crown-led worldview. Our desktop review highlighted that Māori providers, practitioners, and academic voices were largely absent from the reference list, which consisted almost exclusively of Crown publications. Furthermore, tino rangatiratanga was not made explicit, and there was limited engagement with the evidence-based recommendations from the WAI 2575 Hauora Report. Even fundamental aspects of the Māori world, such as wairuatanga and specific tikanga, were notably missing or under-addressed in the text.

Current workforce data shows a stark reality where 19% of our population has Māori whakapapa, yet only 9% of the Te Whatu Ora workforce is Māori. Most of the Māori health workforce actually works outside of the main health authority, often in unregulated roles. By focusing primarily on a Western lens of improvement, the Plan shifts attention away from institutional racism and the necessary pursuit of decolonisation. Authentic Tiriti alignment requires more than mentioning principles; it requires a living framework that embeds co-governance and equal decision-making authority.

We must invest in Māori-led leadership programmes and expand established kaupapa Māori development organisations like Kia Ora Hauora, Ngā Manukura o Āpōpō, and Te Rau Ora. Māori must also lead their own health workforce data systems to ensure accurate and culturally relevant insights. We acknowledge the ideological battles fought by those who held the pen, but true equity will only be realised when Māori leadership and mana motuhake are central to the system's governance—not just appended to it.

Read the full paper: Rĕnata, H, Irving, C, Baker, M & Came, H. (2026). A Critical Tiriti Analysis of the Health Workforce Plan 2023/24: The need to strengthen health workforce planning. Journal of Indigenous Wellbeing Te Mauri Pimatisiwin 8(1), 181-197