As you may have noticed, the management of health in Aotearoa is no longer in the hands of the 20 district health boards as it has been for the last 20 years.
The government came to the conclusion that the DHB system had become too complex and fragmented, and wasn’t adequately serving the needs of all New Zealanders.
So now we have Health NZ in charge of it all.
The new agency becomes the country’s biggest employer with around 80,000 people on the payroll and an annual budget in the billions. It will work alongside the Ministry of Health and the new Māori Health Authority.
And at the controls of this new agency is Fepulea’i Margie Apa, who grew up in Ōtara, in South Auckland.
Margie came from a job as the CEO of the Counties Manukau DHB — which includes Middlemore, the hospital carrying the heaviest Covid burden in the country. Here she is sharing her story with Dale.
Mālō, Margie. And congratulations on your appointment as the chief executive of Health NZ. You’ve been an influential woman for many years, but you’re especially important now. So, what can you tell us about Fepulea’i Margie Apa?
Well, Fepulea’i is the chiefly title from my father’s rural village in Savai‘i. Tuitama is my mother’s maiden name, and her family are from Faleasi’u in Apia.
So, two Sāmoans, a town woman and a country man, met in New Zealand. I think my mother named me Margie after somebody she worked with.
Apa is the family name of my husband, Riki. They hail from Moata’a, in Sāmoa, which is probably a bit better known because lots of famous rugby players (unfortunately, not Riki, though) come from that village.
How did your parents end up in New Zealand?
In the 1960s and ‘70s, they were both part of the migration of Sāmoans who came to work in our growing manufacturing industry. My dad, Fepulea‘i Filo, worked for DB brewery, and Mum, Seulu Hana, worked in various jobs as a healthcare assistant and retrained later as a kindergarten teacher.
She’s still in early childhood education, in her 70s, loving working with children, while Dad is retired, aged 74.
They must be proud of what you’ve achieved in your career, fulfilling the kind of hopes that so many Pasifika families have had for their kids? You were Ōtara-raised weren’t you, Margie?
Yes. My parents settled in what’s now called Clover Park, Otara. I think it was called Flat Bush when we first moved out there in the early ‘70s. It was a fantastic childhood, even though we might’ve been described technically as overcrowded by today’s standards. Our house was the place where the uncles and aunties from Sāmoa migrated to. My parents helped them get settled here.
I have two younger brothers who are construction workers — one in Sydney, and another here in New Zealand. Like you say, that’s what all our whānau want — to raise our kids to be healthy, and to support them to be educated and get a better life.
They could’ve joined the Stormtroopers.
Yeah, but lots of Stormtroopers have moved on to do great things in their lives, too.
Kia ora. Ōtara gets a bad rap sometimes. My wife works in Tangaroa College, and she appreciates the magic that exists within that community, even though from the outside looking in, it might look rough and tough. But what would you say of Ōtara?
Ōtara has certainly had an unfair hearing in the media. There’s so much richness that comes out of that community. I still go to Ōtara Pacific Island Presbyterian Church on Ferguson Road as my family church, and I love teaching young people there.
There’s such energy and aspiration and expectation in the community, most of which gets missed by the media.
Your faith seems an important aspect in the way you carry yourself, Margie. What would you say the role of the church was in helping to shape your life?
It’s been central to me, acknowledging that there’s a purpose bigger than just me. And that means my new job isn’t just about me being a CEO or being in leadership in the health system.
It’s about what I bring to this role that’s going to help our healthcare system do better for our patients, whānau and communities. What faith does is remind me that I’m here for a purpose and I’m here to serve.
All my life, my parents have drilled into us the importance of serving our family, extended whānau networks and our community — and church has been a big part of it. That has guided me through this whole journey.
In the 1970s there were strained relationships between the tangata whenua and newly arrived Pasifika. To some extent, it was an “us and them” situation. That’s fortunately been replaced by an overall “US”. Have you seen that change?
I think people in that Pacific migration wave who came to New Zealand were set up to believe that they were doing jobs that New Zealanders or Māori didn’t want to do. That’s the destructive power of the public discourse at the time. It was really pitching us against each other. But, over the years, that attitude has changed.
And that’s been helped by many whānau mixing. I have nephews and nieces who bring Māori whānau connections to our family, and we’re so much richer for it. And vice versa.
I think we Pacific people have a lot to reflect on to understand what it is to be a good partner. In our tuākana-teina relationship with Māori, we need to ask: How do we play a part in supporting Māori aspirations in this country? That’s a big challenge for us as a community.
I certainly know how fundamental land is to my family. We understand those fears of having land taken away from us. I can only imagine the distress that land loss has caused Māori over many years.
And then, on top of that, there are institutions that have ignored the Tiriti relationship and obligations we have. I’ve built my career in the public service, and I can see the public service slowly maturing its own sense of self and how it contributes to te Tiriti partnership through policy and implementation.
One exciting part of my job is having a partner in the Māori Health Authority, and really setting, from the top down, how we model our behaviour as a public institution to put into practice those Treaty principles.
Some might say that the Treaty is between Māori and Pākehā, but, in fact, here in Aotearoa it affects all of us. So, Margie, I assume you see the Treaty as definitely being for you, too?
Absolutely, it’s for me. People sometimes describe us as tangata Tiriti, people of the Treaty. And, particularly in the public roles I’ve taken, I am an agent of the Crown and I’m discharging those duties.
Of course, we need to mature and improve the way we think about how we discharge our duties. In healthcare, we don’t need to wait for the politics to justify it, but we do have a responsibility as public servants and public health professionals to play our part, particularly with respect to equity.
As a student, you took an interesting line of study. Going from high school at Papatoetoe High School then doing a BCom at Auckland University and a Master of Public Policy (Executive) at Victoria. And you’ve done management studies, labour relations and health economics, too. They’re not the subjects most people study. Were there some Pacific academics who inspired you on that journey?
Oh yes. The Tongan sociologist, Epeli Hau’ofa, who was writing in the ‘80s and ‘90s.
Epeli’s writing spoke to me as a young brown woman in a white institution. He encouraged us as Pacific people to just stand confidently in who we are and where we come from.
It reinforced to me that identity is a journey and that we need to be open to influences in how we shape that — but never to be ashamed or have any judgment about why we are the way we are, or where we are.
In my early university years, there was a bit of unhelpful public dialogue about what being Pacific really was. You weren’t a Pacific person if you weren’t born in the islands, or you didn’t know your language, or you weren’t embedded in the culture.
And that was incredibly divisive public dialogue for young Pacific people who were born in New Zealand, not by any choice of their own, and who were raised by families trying to navigate living in a western society while still trying to hold true to their cultural roots. And Melani Anae really helped to shape our sense of identity in that context.
One of the most inspiring lecturers I had was Ella Henry. She helped when I was struggling as a young mum in management school. I was trying to be this superwoman, studying while looking after my baby as well.
I remember a day when I was so frustrated, because university at that time was a horrible place to take a baby. I had to change and breastfeed her in the most awful places for privacy. In one lecture, I remember Ella picking up my crying baby, holding her to settle her, and carrying on lecturing in a class of younger people.
That was an incredible moment of grace that made me feel so included in an institution that wasn’t built for me. I just loved Ella and her thinking and the dialogue and conversations that she inspires about diversity.
Was there any pushback from whānau? In patriarchal societies, sometimes when women are advancing with careers and into management, that doesn’t sit comfortably with the men. I’m hoping in your whānau model that they supported you all the way. Could you touch on that for a moment?
I’ve been lucky to have the support of my family, in particular my husband, who is a career counsellor by training. It’s never a question of “can you?” or “should you?” It’s always been: “Of course you can do it.”
My mother’s guidance over the years has been that every time I get the next big job, she’ll challenge me: “Well, yeah, that’s a big job, but are you educating yourself? Are you learning?”
And having that perspective of, it’s not about the job, it’s about developing yourself and growing yourself as a person — that has always inspired me.
Have you retained your reo Hāmoa?
Colloquially, I am a fluent Sāmoan speaker, but I have to work at oratory, and I’m not ashamed to say that my father coaches me from time to time just to make sure I’m not embarrassing him or myself when addressing matai or other leaders. It’s an ongoing journey.
Did you detect any discrimination as you advanced through public service health administration into management?
Yes. That was very early in my career. You know, I’ve had those moments where I’d stop and go: “Did you really just say that to me?”
But as I’ve become more senior, I’m more inclined to ignore it and work past it. I don’t look for it. I choose to focus on getting the job done and doing it well and taking people with me on the journey because I have to work with teams and build teams.
One privilege that comes with being senior is that I see my job as creating an environment where discrimination is just not acceptable.
But, yes, hearing the odd comment and being excluded from conversations was an early experience in the office.
One of the life-changing experiences for me was winning a scholarship that sent me to Wellington. And being one of a few brown faces in an organisation that was largely Pālagi was a culture shock for me coming out of South Auckland.
But, for the most part, I’ve been surrounded by supportive people, of all ethnicities. And I have been mentored by people throughout my career — many of them Pālagi men — who really instilled in me a faith that I’m capable of doing what I do.
I sometimes say to people: “You can choose your boss. If you’re working for someone who doesn’t grow you or nurture you or value your experience, you can choose differently.”
Everybody brings gifts to their workplace, and my job as a leader is to model that inclusion, much like Ella did for me at university. It’s about being respectful of the diversity of voices whether they’re Māori, Pacific, women, people with disabilities, and so on.
We need to create an environment where they all feel able to contribute and feel comfortable about being in the team.
On the other hand, do you think that having a Pacific whakapapa has helped you identify and perhaps prioritise Pasifika interventions to help our large brown population in the hood?
It was certainly of great value for me at Counties Manukau, where two-thirds of our population identify as Māori, Pacific or Asian. But I think there’s also a different worldview that comes from the mentality of doing the right thing for your wider clan. That’s something I take into my workplace, where people tend to be very hierarchical in an organisation context.
In the Pacific, we know how to manage relationships within large extended families or clans. And in a big organisation that helps.
Before we move on to your new mahi, can I just touch on the chiefly title that you carry. Can you take us through the feelings you had when that title was bestowed on you?
The process of being offered a chiefly title isn’t one that happens overnight. People don’t just say: “Yeah, let’s pick this person.” There was a growing consensus among my family and extended family that this was an appropriate thing to offer me. And I was one of three cousins in my father’s family who all had our saofa’i at the same time.
But what’s also important in that process is the obligation that is placed on us. It’s a responsibility to care for our family. And my father reminds me when we have family events that the mark of a chief is how well we support the most vulnerable people in our family — our older people, widows, women with children, young families.
I’ve been fortunate to have my father and my uncle model those principles of awhi and manaakitanga, and of caring for the vulnerable in our family and not allowing privilege to blind you to that.
When the political decision was made that DHBs should be phased out and replaced by Health New Zealand, did you support that change? And what’s to be gained from a more centralised approach?
I’ve been in the health system for more than 24 years, and I’ve worked in local DHB roles and nationally in the Ministry of Health. And I was in the health system before DHBs were formed.
The early benefits of district health boards and having community voices was worthwhile. But, over the years, I think we’ve made it hard for ourselves to make decisions. With the DHBs, there are 20-plus decision-makers in the health system, and it’s hard to share innovations and improvements across the country.
The benefits of the reform is that we can simplify our environment. We don’t need so many decision-makers making decisions on minor matters, like what kind of toilet paper we have in hospitals. There are some things that we should be working to standardise or be consistent about, and that will help us to manage costs.
It’s important, though, that we balance that with maintaining the voice of local place-based providers and with seeing that we’re flexible about how they can provide diverse models of care for Māori, for Pacific, and for rural communities.
There’s a benefit from having national organisations that simplify and unify the healthcare system and helps us to share resources.
For example, if there’s a DHB that’s struggling to get cataract operations done for people, and we can see that in another DHB or hospital there’s some spare resource, we’ll have the ability to move that resource around to try to get equity so that everybody is able to access the service regardless of where they live. Those things will be made much easier because we are one organisation across the country.
What we don’t want is to be a centralised bureaucracy that holds everything up. What we do want is to be an enabler of more flexibility and to make things work better for local communities.
How do you sit with the establishment of a Māori Health Authority, and can it complement the work that you’re about to do?
I think it’s the most exciting part of the health reforms. It’s a privilege to be working in partnership with Riana Manuel, the chief executive of the Māori Health Authority. And both boards have set the tone for partnership. It’s a great opportunity for us that we now model that partnership from the top down.
I think this is an exciting phase for the healthcare system, where we live and practise our Tiriti partnership, behaviour and values, and make it real for our people.
Of course, health inequities can’t be addressed in isolation, and we all know that it needs focus on how societal influences such as housing, education and so on are affecting overall health. How can we achieve better results if those societal challenges aren’t addressed?
Again, the advantage of being one national organisation is that we can work nationally with other national organisations, like the Ministry of Social Development and Kainga Ora. It’s very important that we do relate to each other as national organisations.
That makes it easier for us to have innovations in our teams at a regional level. We have the flexibility to work together.
Wāhine are taking up the reins in many aspects of our society, and it’s refreshing because a lot of sectors have been so male-dominated over the decades. What do you think wāhine bring to the sort of mahi that you do, Margie?
I’m not very familiar with what the research says but, in my experience, women bring a much more inclusive way of managing. We’re more likely to engage and invite and work with teams, and also provide a broader perspective on various issues.
Health is certainly an area where you can’t be effective if you work in silos. You need to have a much broader view and be able to step back and see whole systems and look for opportunities and integration. I believe that research confirms that women do tend to do this more easily than men.
We’ve been talking a lot about your work but what are some of the other ways you spend your time? Are you musical? Sporting?
Our family are very musical, and we’re shopping for a new piano ourselves, because we gave our old piano away.
I also love to read and I’m trying to get back into running, although Covid has really disrupted my fitness routine.
We have a family volleyball team, and Aunty Margie manages to keep up okay with the 20-something nieces and nephews. And my daughter, Hinauri, and I are learning to crochet. I like to learn new skills, so that’s our latest project.
(This interview has been edited for length and clarity.)
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