Legacy work – leading the Māori Health Authority

Elizabeth Brown | Senior Communications Advisor

Going back through the generations in Riana Manuel’s husband’s family, you won’t find a man who has lived much past 50 due to cardiovascular disease and decades of poor health.

It is that kind of statistic that lies at the heart of health inequity for Māori and one that the head of the new Māori Health Authority/Te Mana Hauora Māori is out to change.

Riana (Ngāti Pūkenga, Ngāti Maru and Ngāti Kahungunu) describes her new role and what the Māori Health Authority is about to embark on, as legacy work. “The aim is to save lives of people who don’t necessarily need to die seven years before others in their communities,” she says.

Riana has seen the health system through several lenses. She trained and worked for many years as a nurse. More recently she led Te Korowai Hauora o Hauraki and the Hauraki Primary Health Organisation.

“I’ve seen many different systems come and go during my time in health. In my career this will be the last time we get a major reform. The Government has made a very bold decision to create the Māori Health Authority and I thought this is the system change I want to be part of.”

Keeping it local

She’s also a firm believer in locally driven health care based on her experience in Hauraki, seeing how effective it can be when Māori health workers design and provide care for their communities.

“It’s a model driven by the aspirations of the people who it seeks to serve, and as a result it delivers a good service. That’s what I want to bring nationally.”

“The Government has made a very bold decision to create the Māori Health Authority and I thought this is the system change I want to be part of.”

If you live in the Hauraki region, you will still see her out at weekends administering Covid tests.

She also still does the odd shift at her small familyowned rest home and hospital in Coromandel. Asked whether there is a conflict of interest over that, she says it’s something she declared when she took on her new role, and she’s confident there is no risk of crossover in terms of funding pathways.

So far Riana’s top priority has been the Pae Ora legislation, which will formalise both the Māori Health Authority and Health NZ so they are ready to go on 1 July.

Putting in place concrete milestones and markers will be an early next step. As an example, she gives increasing self-screening for cervical cancer for Māori women, which can have an enormous impact on lives saved.

“Increasing screening, improving access, and applying a clinical judgement that is driven towards that key population which is underserved – that’s a milestone that you can tick off and show transformation over time. People won’t tolerate not being able to see the difference being made,” she says.

Mokopuna pae ora

As a proud grandmother to 12 mokopuna, an important personal plank of Riana’s is mokopuna pae ora – making decisions to build the life and world we want for our grandchildren.

“We need to make sure we put the best opportunities forward for young people so when they become adults, they are not going to be fighting the big fights we’re fighting now.”

According to Riana, social determinants are everything in health because “they are the things that will move the needle on equity”. “We need to make sure we put the best opportunities forward for young people so when they become adults, they are not going to be fighting the big fights we’re fighting now.”

“It’s about making sure we have a strong economy for our people, that everyone has a job, a home, and people have great educational opportunities. It’s about being strategic and looking at these problems from all directions – that’s the opportunity here.”

Political football

The Māori Health Authority has already turned into a political football and has found itself at the centre of the co-governance debate. Both the National and ACT parties have said they would scrap it. Riana acknowledges the political aspect to her job but isn’t fazed.

“I take hope that we are really starting to discuss our history and co-governance arrangements after 182 years. It’s an important conversation to have because then we can understand why we need co-governance, why we should honour the Treaty and why we need to understand the difference between tangata Tiriti and tangata whenua.” She is keen to see urgent work get underway on a doctor training pipeline to ease staffing shortages and increase opportunities for Māori trainees. “We need more clinicians full stop, but it’s not an overnight solution – it’s a pipeline so we need to start now.”

As a nurse she’s aware of the pressures the workforce is under and gives a huge mihi to specialists, who she says do an amazing job.

“I take hope that we are really starting to discuss our history and co-governance arrangements after 182 years.”

Riana says working collectively will be key to the success of Health NZ and the Māori Health Authority. “Every opportunity in the reformed health system should be geared towards ensuring that people get the right services in a timely fashion and that we take care of our workforce.”

Riana will be based in Auckland alongside Health NZ chief executive Margie Apa, with whom she shares a close working relationship, but will be in Wellington regularly. She will also be heading home to the Coromandel as often as she can and plans to continue her frontline mahi to keep up her practising certificate. More importantly, in terms of her role as head of the Māori Health Authority, she wants to ensure she stays relevant as she forges a new path for Māori health in Aotearoa.