How a town of 200 people shaped the new Māori Health Authority boss

Thursday, 31 March 2022

Riana Manuel, the inaugural chief executive of the Māori Health Authority. Manuel is Ngāti Pukenga, Ngāti Maru and Ngāti Kahungunu.

Riana Manuel may just be the most un-bureaucratic of bureaucrats.

She jokes about makeup artists not bothering with lipstick for her TV appearances now that she wears moko kauae, and is unaffected by having her photo taken in a Wellington southerly at a moment’s notice.

Manuel (Ngāti Pukenga, Ngāti Maru, Ngāti Kahungunu) is the first chief executive for the Māori Health Authority, which will sit alongside the new Crown entity and mothership of the Government’s health reforms, Health New Zealand. More than 80,000 staff will come under Health NZ when the Pae Ora (Healthy Futures) Bill passes through Parliament, abolishing all 20 district health boards.

Manuel’s ardent energy may come from her upbringing– one that was rooted in shared responsibility and plenty of advice from aunties.

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Manuel was raised with whāngai brothers and went on to raise whāngai daughters herself.

Manuel, 49, is from Manaia – the Coromandel one, not the Taranaki one, she says, and not the mountain in the Far North.

“You are literally raised by a number of households – everybody has a say, everybody has a contribution to make in your life.

“I had a mum and dad who, you know, we didn’t have a lot of money growing up, but what we had was a really supportive community who made things collectively happen for a lot of us.”

For the town of about 200, everything revolved around the kura and the marae. Home time was when it got dark. Cousins rode bikes together on the quiet coastal highway to the river, where they’d swim all afternoon after the chores were done.

Manuel is the eldest of four, but was raised with three whāngai brothers – siblings born to different parents. She went on to do the same, raising three biological children and four nieces.

She was about 15 when her parents sent her to a full immersion Māori boarding school.

Manuel speaks at an announcement at Takapūwāhia Marae in Porirua, flanked by Health Minister Andrew Little and Associate Health Minister (Māori health) Peeni Henare in March.

Until then, her kuia and kaumatua were fluent, but “it was like a secret code, they’d do it when they wanted to keep us out of the know”.

“My husband and I made a decision that we would speak te reo Māori only to our babies to create first-language speakers, and so on for our mokopuna now. So it’s, you know, you have to work at it because as they say, it takes one generation to lose it and like five to reclaim.”

Her mother was the Plunket nurse, the public health nurse, the district health nurse and went on to build her own 20-bed resthome and 10-bed hospital in an old villa in Coromandel township.

The whānau still owns the resthome, but Manuel bought it from her mother in 2009, “and she now manages it for me … so cheeky”.

“But she was a massive example to me on the power of nursing.”

It’s what led to Manuel becoming a nurse herself, “because who doesn’t want to be like their mum when she’s a cool dude like that?”

Her father was an entrepreneur, trying his hand at a bit of everything.

Riana Manuel marshals traffic at the Covid-19 testing station in Coromandel township in August 2021, when she was chief executive of Te Korowai Hauora o Hauraki.

As a registered nurse, Manuel has worked in emergency departments, in the community, and in leadership, “which is really important because Māori nurses, there wasn’t enough – there still isn’t enough of us”.

She rose through to clinical leadership roles, including a nurse director role at Waikato DHB, and more recently was chief executive of Hauraki Primary Health Organisation and iwi-based Te Korowai Hauora o Hauraki.

Asked why she wanted the new role, she begins with a predictable answer about the rarity of major reforms and the opportunities they bring, but then there’s the most important reason: she has mokopuna.

“I’m a grandparent now, and I’m super-interested in the footprint you leave behind.

“Do we want to leave a mess, or do we want to leave a legacy for our children?

“I prefer the opportunity to leave a legacy for our children and one that says, actually we won’t have Māori die seven years younger than everybody else. And we are going to improve access and choice for our people, and we know that, when we invest in ‘by Māori, for Māori’, we see a massive improvement and health outcomes for all people. Because that’s been my experience.”

Te Korowai was run with a te ao Māori perspective. And although Māori made up only about half of all enrolled patients, the approach improved the outcomes for everybody, she says.

Manuel says a universal approach to Māori health won't work across all of Aotearoa.

“It’s not just about a GP practice, or nursing services, it’s about whānau ora, it’s about mental health services, disability services.

“We’ve improved access and opportunity. It’s a very low-cost access model, so everyone’s access improves by lifting up home-based support services.

“You know, it’s a whole wraparound kind of thing. And what it’s trying to do is adapt a few services to make sure you get to the heart of what’s plaguing people. So we get interested in, for instance, people’s homes. We want to know that they live in dry homes because actually that reduces the rate of respiratory illness for our people.”

Of course, the authority won’t be tasked with fixing all Aotearoa’s systemic inequalities, but rather connecting with those who were already doing the mahi and making sure they had the means to do it effectively, Manuel says.

“That’s the kind of application we want from the Māori Health Authority, to actually get alongside those Māori providers there, because most of them have been there for 30-plus years doing the hard yards and sometimes, you know, under-resourced in those efforts.

“We want to make sure we give rise to those opportunities.”

Manuel wants to make sure iwi and hapū – from those in villages like Manaia to those in metropolitan Auckland – have access to services that work for them, rather than a copy-and-paste model.

“We need to see services that are grown inside the communities that work for those communities, that seek to employ those communities. Because nine times out of 10, when you take that approach, people become invested in it, they stay invested in it, and they make sure that it endures and it’s successful.

“Unfortunately, you can’t just apply a universal approach to it, because it won’t work. What works in the city just won’t work out where I come from, and vice versa.”

She’s planning to have “the best few years ever”.

“You'll learn this about me. I will always be a person who looks at a cup half full, not half empty. And I’m more inspired by getting in there and trying something, even if it fails. There is so much to learn from that. And then we turn it around the week, and we do something with it.”

She and Margie Apa, who will be chief executive of Health NZ, are such a pragmatic pair they’ve decided to become flatmates. They’ll share a Wellington apartment for their trips to the seat of power.

“We thought that was a great opportunity so, should we not agree on something, we could go home and really talk it out and make dinner together and it’s sorted out before we go to sleep.”

It’s all very wholesome, I tell her.

“I know,” she says, “stop looking for the hook.”