Fepulea‘i Margie Apa is the head of the new health organisation Te Whatu Ora | Health New Zealand. It employs around 80,00 staff, having merged twenty District Health Boards and a further seven shared service agencies into one organisation. Simon Minto chats to her about her background and asks where she wants the organisation to head.
You learn a lot about health from spending twenty-five or so years in the health sector, and you learn a lot more when you grow up in South Auckland during the 1970s and 1980s. Fepulea‘i Margie Apa is the new head of Te Whatu Ora Health New Zealand, and she brings an amazing background to this role. Most of her time has been spent at the former Counties–Manukau DHB, as well as a short time at Capital Coast.
Her chiefly title, Fepulea‘i, is her father’s title and was given to her by her father’s family in 2014. The title is from her village on Savai‘i in Sāmoa. It’s awarded to those who serve and look after their family. Margie is now responsible for a much larger family.
Insights from experience
New Zealand underwent huge economic changes in the 1970s and 1980s, and these changes had a drastic effect on Margie’s community in South Auckland. She saw the factories and freezing works closing down and witnessed the direct effect on families, particularly the young men in her community. “I saw the loss of face from unemployment and the resulting health issues. Alcohol became a problem. Several peers in my church died by suicide.” While she saw it happening around her, it wasn’t until later that she realised what contributed to these problems and what it all meant for people’s health. That experience formed many of her ideas around the health system.
“It strikes me that a universally available health care system is critical.” She sees people who are unable to work and support families because they have poor health. “Although people in South Auckland were happy people, we were also pretty unhealthy.” Many of these health problems are preventable “but it’s not a one size fits all”. The needs of South Auckland are different from other parts of the country.
It’s this understanding about the power of prevention that has got Margie excited about the future.
Twenty years of change
In her time, Margie has seen huge changes in healthcare. “It’s totally different now, and the big thing is prevention.” Breast and bowel screening programmes were unheard of twenty years ago. “Seventeen hundred cases of bowel cancer have been detected through the national screening programme. That’s amazing.”
She’s seen the introduction of the Primary Options for Acute Care (POAC) service. This gives resources to primary health care providers like GPs and health clinics so they can have tools like MRI scanning in the community. “So much can be done in the community, but this needs to be expanded. It isn’t done consistently around the country.” These changes mean that fewer people with health care issues should have to go on waiting lists or go to hospital. “Hospital is not a bad place, but too many people are going there.” It is often a sign that they haven’t received the healthcare they should have had earlier.
Margie sees the whole area of prevention as having the most opportunities for people and is the thing she gets most excited about. “We have the science; we have the technology. It’s about how we choose to apply it.” It’s all around getting services into the communities so they can provide the services those communities need the most. This is the thing that can save and extend lives. She believes there are too many geographical boundaries to healthcare. People in rural or marginal communities have different needs from others but have different levels of service.
Te Aka Whai Ora | Māori Health Authority
Margie sees the establishment of Te Aka Whai Ora as the most amazing innovation. Both Te Aka Whai Ora and Te Whatu Ora are agents of the Crown and have the job of improving health outcomes for Māori. This provides a chance to work for Māori at all levels. “We need to be joined at the head, heart, hips, hands, and feet.”
It’s often a problem with agencies that they develop an idea or a programme and then they consult with Māori. The people feel these programmes are often imposed. “We have to let go and share. Māori know what’s best for them, so we have to create space.”
What comes with this understanding is a recognition that health services have not always been accessible to Māori and Māori have often not had positive experiences of the health system. This negative experience has been passed down through the generations. A kaumātua may be snapped at by a health worker. That experience is passed through the community so there’s a deep suspicion of the health system and who it really serves. “We are wise to the fact that Māori come into a health organisation with a history, and we must make the organisation more acceptable to Māori.”
Another aspect to this is that the health system has a mostly non-Māori workforce. This can create a barrier to people coming in and reaching out for help. It’s about creating spaces for Māori to engage more with health services and feel they can access healthcare when they need it. “The challenge is huge, but we know what we need to do.”
A critical part of the innovation of Te Aka Whai Ora is that it partners with iwi so that health services and programmes are designed, implemented, and evaluated in partnership. Iwi have decision-making powers and mana motuhake in line with the partnership model outlined in Te Tiriti.
Lessons from COVID
One thing COVID taught us is that the health system can achieve major things and can make major shifts. “Who would imagine that we would get devices into people’s hands so they could test their own oxygen levels?” The experience has been hugely empowering. Regulations were changed quickly and had immediate benefits. Vaccinations could be given in communities by kaiāwhina under supervision. It allowed different models of care to operate. “But we are now at risk of slipping back to the old ways of care. We need to go forward. But what it shows is that the health system can adapt and it can move when it wants to.”
For Margie, the response to COVID is a sign of what’s possible. “When we’re focused, just see what can be achieved.” And this sense of achievement is what’s most exciting about working in the health sector. It’s having a genuine effect on people’s lives in the most fundamental way. “But we can always do more. There’s lots we can do to prevent the slow diseases, like diabetes and cancer. These are all preventable. Working in the health sector is about saving lives and extending lives, and that’s what gets me excited.”
He Tipua: The Life and Times of Sir Apirana Ngata by Ranginui Walker
“My leadership textbook. The copy I have I stole from my best friend. A biography of an Indigenous leader by another Indigenous person.”
The Lost Boys (1987)
“A funky sort of movie. Something about it touched me, and I’ve watched it over and over again. So my children hate it now.”
A dog called Henry
“The light of my life. The only thing that adores me unconditionally.”
“I played club rugby for Pōneke when I was in Wellington. I’m loving the Women’s Rugby World Cup.”
Favourite travel destination
“I don’t really have a favourite travel destination, but as Chair of World Vision New Zealand, I’m really looking forward to going to Ghana. The challenges there are on a different scale, but the people’s resilience is inspiring.”