Where are all the Māori nurses and midwives...?

1 April 2010


Despite a multitude of workforce development documents and initiatives over the past decade, Māori nursing and midwifery workforce statistics have shown relatively poor improvement.

Over the past ten years there has been a marginal improvement in the number of Māori nurses and midwives in the health workforce. A total count of nearly 45,000 nurses and midwives with current practising certificates in New Zealand indicates that only 7.1 per cent identify as Māori. In fact the actual numbers are more compelling with only 2869 active registered Māori nurses and 166 active registered Māori midwives.

With an indigenous population over-represented in the poorest health statistics in the country, and accounting for 12 per cent of the total population, there is a dire need to ensure robust workforce planning and development.

Some promise has been shown in the sector in recent years with various initiatives developed with the aim of improving the situation.

The following kōrero (discussion) is an overview of various initiatives across Aotearoa seeking to address workforce issues. It is not portrayed as an exhaustive account, as there are many wonderful and successful activities occurring that have not had widespread promotion. It is hoped over the next five years we will see the evidence of how truly successful these initiatives are.

The active promotion of health careers to rangatahi (youth) is important if we are to address the future needs of the current ageing workforce. The Whakapiki Ake programme, led by The University of Auckland, is an example of an initiative that promotes health careers to secondary school students. Translating as ‘to support and raise’, the Whakapiki Ake programme encourages young Māori students to pursue a career in medical and health sciences.

The Hawke’s Bay District Health Board was a national innovations Health Awards winner in 2008 with the initial launch of their Incubator programme. The Incubator programme is another initiative aimed at nurturing a passion in young people for a health vocation through harnessing the experience and knowledge of people from within the health sector. Additional DHBs have since adopted and adapted the programme to suit their population needs.

Utilising online gaming and video profiles, the Kia Ora Hauora programme is one of the newest health careers promotion programmes. It is a web-based portal that is led by Counties Manukau DHB and Te Rau Matatini and aims to recruit 1000 new Māori health participants into the workforce. Four regional coordination hubs in Waitemata, Lakes, Capital & Coast and Canterbury DHBs support the national programme.

One of the key barriers to pursuing a career in the health sector is the actual and associated costs related to education and training. Significant investment has been made at national, regional and local levels to support interested candidates into the health workforce.

At a national level the Ministry of Health’s Hauora Māori Scholarships aim to build Māori workforce capacity in the health sector. Support provided by Te Rau Puawai (administered and managed by Massey University) focuses on health careers within the Māori mental health domain and includes scholarship support as well as a wider network of academic guidance. Whilst initially focused on the Māori mental health workforce, various Te Rau Matatini scholarships are now available for wider support to the health workforce both at undergraduate and postgraduate levels.

From a regional and local perspective there is support from iwi organisations (rūnanga and Māori health providers), and employers such as DHBs. The Māori Education Trust also manages a comprehensive list of scholarships.

The over 18 national tertiary providers in Aotearoa provide their own varying pastoral and academic support mechanisms for Māori students. However, all Māori students in nursing and midwifery programmes are eligible to participate in the annual Tauira Neehi Māori conference, facilitated by Te Kaunihera o Neehi Maori, the National Council of Māori Nurses. Māori student nurses and midwives are able to share their successes, learning strategies and insights to assist others in their journey of becoming a health professional.

Local nursing groups also provide support for undergraduate students, with tuakana-teina roopu support networks developed to provide advice and guidance from Māori nurses and midwives in different areas of the country.

Research into Māori nurse and midwifery aspirations undertaken by Te Rau Matatini in late 2008 and reported in 2009 were followed by regional workshops exploring what was needed to improve recruitment and retention of Māori nurses and midwives. The outcomes of this kōrero have provided valuable insight and guidance into up-and-coming workforce initiatives.

One such initiative is Nga Manukura o Āpōpō, a national Māori nursing and midwifery workforce development programme. Informed by various Māori workforce development documents such as Te Rau Matatini, Auckland DHB was approved to lead the Nga Manukura o Āpōpō programme and has since established an advisory group of dynamic wahine toa (strong women) that has achieved a huge amount in a short space of time.

Nga Manukura o Āpōpō is a four-year programme with one of its three work streams being to increase recruitment and raise nursing and midwifery’s profile amongst rangatahi and mature adults. This component will link into the Kia Ora Hauora health careers programme.

The professional development workstream aims to enhance current undergraduate programmes and improve access to professional development opportunities.

The advisory group is also cognisant of the ‘in good hands’ document and the need for greater clinical leadership, so has prioritorised the emerging and advanced leadership workstream of the programme. Service specifications have been completed and requests for proposals (RFPs) are currently being sought from professional Māori organisations.

The name ‘Nga Manukura o Āpōpō’ (meaning ‘Leaders of Tomorrow’) was chosen as a more appropriate (and memorable) name to encompass the programme’s aims than the ‘Māori nursing and midwifery workforce development programme’.

Nga Manukura o Āpōpō is represented by a tohu (symbol, logo) which visually expresses the intent of the programme. The overall shape of the logo is symbolic of the prow of the waka (canoe, in this instance is used as a metaphor for guidance, direction). The prow is the leading edge of a waka and thus represents the direction of our journey. It curves upwards, reaching for the stars and navigating the path. The bottom points of the curves refer to the beginning, the starting point. The spiral in the middle with connecting koru at the centre references support, knowledge, nurturing, learning and life force – the opening is releasing the learning and knowledge to the world.

The tohu, while developed specifically for Nga Manukura o Āpōpō, is relevant to all the workforce development initiatives covered in this kōrero. Each is represented somewhere within the wider workforce ‘waka’, along a continuum which will hopefully reach its destination sooner rather than later. That destination is to have a workforce that is fit for purpose, and meets the needs of our whānau where we are able to provide services that are for Māori, by Māori, of Māori.

Any enquiries regarding the Nga Manukura o Āpōpō programme, please contact the project manager Cathrine Waetford via email cathrinew@adhb.govt.nz. For references from this article, please email: editor@nursingreview.co.nz