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Back in 1908, one of the country’s first Māori registered nurses and midwives, Akenehi Hei*, struggled to get the government to pay for her work. More than a century later, nurses working for Māori and iwi health providers are still struggling with pay equity issues, says Kerri Nuku, kaiwhakahaere of Te Rūnanga o Aotearoa NZNO.

Nuku says the pay gap between iwi nurses and their district health board counterparts has now got to the point that she knows of iwi nurses taking on extra jobs or contracts to make up for the low wages and to ensure a reasonable standard of living for their families. (see Akenehi Hei story below)

The journey for pay equity for these nurses began back in 2006. It followed the ‘pay jolt’ ratified in 2005 for district health board nurses, which initially saw the pay gap widen between all non-DHB nurses and their DHB colleagues. A further pay gap subsequently emerged between nurses employed by Māori-led healthcare organisations and their counterparts employed by primary health organisation (PHO) funded general practices. At the crux of the issue is a government funding model for Māori and iwi health providers that differs from that of a typical neighbourhood general practice.

An 11,000-plus petition was presented to Parliament back in July 2008, pointing out the inequity and calling for the Government to work with NZNO and Māori and iwi PHC employers so that pay equity could be funded and delivered to their nurses and other health professionals.

In 2009, in response to the petition and other evidence presented, the Health Select Committee recommended to Parliament that a working group look further into the petition issues – including recruitment and retention issues for the providers that deliver targeted services to Māori communities – and report back in six months. But Nuku says the Committee’s recommendation was vetoed by the Government and the working group never formed.

She says there is also increasing frustration that health workforce projects keep setting Māori health workforce targets to meet health needs but as yet New Zealand still doesn’t have a single data repository showing what the current Māori workforce looks like, let alone addressing pay equity issues impacting on retention and recruitment of that workforce.

Nuku says after a decade of unsuccessfully petitioning, lobbying and negotiating for more data and improved funding so Māori and iwi health providers can close the ever-widening pay gap, the rūnanga have said “enough is enough”.

“How do we shine the spotlight on this discriminatory practice that has been going on for way too long?”

There are documents such as 2012’s Thriving as Māori 2030, which says health services need to “at least triple” the Māori workforce by 2030 to reflect the communities they serve, and the tripartite Nursing Workforce Programme, which late last year set 2028 as the date that the percentage of Māori nurses needs to match the percentage of Māori in the population. But Nuku says that initiatives to date have done little to grow the Māori proportion of the nursing workforce, which has been basically static since the 1990s.

“So we have been feeling quite aggrieved for a wee while,” she says. But after years of being wary of speaking out, she says rūnanga members are readying themselves for a ‘big year’ in 2016 and to start challenging the status quo. She says they are now viewing pay parity for Māori and iwi providers, and the lack of information on Māori health workforce data, as human rights issues. To this end, NZNO has written to the Universal Periodic Review (the United Nation’s Human Rights Council process that reviews the human rights situations of all 193 UN member states) to express its concerns about the issues and has also raised its concerns with New Zealand’s Equal Employment Opportunities (EEO) Commissioner, Dr Jackie Blue.

Pioneering nurse Akenehi Hei

In 1901 Akenehi Hei began a basic nursing skills programme intended to make her an “efficient preacher of the gospel of health” when she returned to her village as a “good, useful wife and mother”. In 1905 the scheme was extended to offer full nurse training and the still-unmarried Hei qualified as a registered nurse in mid-1908. She quickly completed her midwifery training in the same year in readiness to be part of a 1907 Public Health Department scheme to employ Māori district nurses (working in public hospitals was not envisaged or encouraged for the first Māori nurses.)

But by 1908 there were still no government funds allocated to pay for Māori district nurses and it wasn’t until June 1909 that she was offered a two-month post nursing in a Northland typhoid epidemic. After that it took several more months until she was finally offered another post in New Plymouth. Tragically, she succumbed to typhoid herself in late 1910 after returning to Gisborne to nurse family members ill with typhoid.

Her biography in Te Ara – The Encyclopedia of New Zealand states she not only had to deal with institutional racism – her postings were seen as a test case “to see how these Māori nurses act” – but also with little support from a department which was concerned with minimising costs and was not fully committed to Māori health work.

SEE ALSO related MAIN ARTICLE: MĀORI AND PACIFIC NURSES: IS BURNOUT INEVITABLE?