Press release issued with University of Otago 

A Turanga Health vaccination programme saved lives and created millions in social value, a seminal research project has shown. 

The University of Otago and Turanga Health social return on investment (SROI) evaluation released this month, reveals that people Turanga Health vaccinated for COVID-19 in 2021 and 2022 valued being kept out of hospital and reducing the severity and duration of lockdowns. 

SROI research is a well-known way to measure how much good something does, not just in money but also in helping people, the environment, and the community.

The study, funded by the Health Research Council of New Zealand, also translated Te Ao Māori values, experiences, and outcomes, into numerical values as part of the SROI research. 

“This is one of only a handful of projects done like this in the health sector,” says Dr Louise Mainvil, senior research fellow, Va’a o Tautai, University of Otago.

A substantial amount of government funding totalling $5.95 million over three years, was allocated to the vaccination programme in Tairāwhiti. The programme generated a significantly higher social value, amounting to $28.14 million.

Once all of the government’s investment was considered, the social return on investment ratio was $4.73 of value for every $1 invested. That means the government-funded vaccination programme in Tairāwhiti created more than four times the value for the community than the amount invested.

Turanga Health chief executive Reweti Ropiha says that hardworking taxpayers expect smart government investment, and this research shows that Turanga Health was a valuable organisation to invest in.

Without the vaccine programme, Gisborne Hospital could have been overwhelmed with COVID-19 cases, straining healthcare services and impacting non-COVID-19 patients. Hospital care is costly, so reducing hospitalisations saved lives and money. 

“Māori were better protected, and whānau could continue working and contributing to their communities. More than just a financial figure, the numerical value has a real-world impact.”

“The COVID-19 vaccination programme also reduced the severity of Government-imposed restrictions in the region and kept the regional economy going,” says Mr Ropiha.

Mr Ropiha says the seminal study complements a growing body of international work that examines the value of investing in indigenous health outside of traditional investment frameworks and conventional performance metrics.

“This foundational research focuses on the importance of culture and Māori concepts in programme delivery.” 

Between May 2021 and October 2022, Turanga Health ran 347 clinics in community-based locations and administered 20,081 doses of the COVID-19 vaccine. The organisation’s efforts accounted for 18 percent of all vaccinations in the Tairāwhiti region, and 23 percent of all doses administered to Māori in Tairāwhiti.

Some of the significant changes for whānau vaccinated by Turanga Health included social inclusion, protection from infection-related death, and preservation of whakapapa. 

Turanga Health staff benefited from increased skills and mana, particularly for kaiāwhina, who became vaccinators during the pandemic. They were at the coalface vaccinating thousands of individuals, and their approach to vaccination was rooted in hospitality, fun, generosity, and mahi aroha. 
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The University of Otago is continuing its work with Turanga Health and is now evaluating the SROI for the iwi health organisation’s pre-eminent Kaumātua Programme. 

Turanga Health has reached a new audience through streaming platforms and cartoons showcasing the story of how it helped Tairāwhiti in managing Covid-19. 

The Gisborne iwi health organisation is recounting its story through a graphic novel and an audiobook.
 
This is a new way of sharing our korero, says chief executive Reweti Ropiha. “We want to ensure that more whānau understand the lengths our kaimahi went to from 2020 to 2022 to keep Tairāwhiti safe.”

The digital presentation and graphic novel offer a retelling of findings from a Government-funded study on Turanga Health and the ongoing impacts of Covid-19.

“We wanted to think differently about how to share the facts of what happened. These new resources will be useful for the public and anyone working in the health environment.”

Reweti admits he never thought he’d be discussing the ability of cartoons to convey korero and emotion. “But it’s really important to me, that the story of our staff is more widely known.”

In the face of an unprecedented global pandemic, between May 2021 and October 2022, Turanga Health ran 347 clinics and administered 20,081 doses of the Covid-19 vaccine. The organisation’s efforts accounted for 18 percent of all vaccinations in the Tairāwhiti region, with 23 percent of doses administered to Māori.

“If a graphic novel allows a young reader, or an audiobook allows a smartphone owner, to easily immerse themselves in the story without as much of the heavy lifting, then that’s got to be good,” Reweti says.  

The content was drawn from a Ministry of Health funded study published in June last year. 

“As well as revealing the racial, historical, and bureaucratic barriers that the organisation had to break to be able to look after our community, the story also captures the heart of an iwi Māori health organisation,” says Reweti. 

The study was printed as the hardcopy pukapuka Mānuka Takoto Kawea Ake Te Purongo Arotake: Tūranga Tangata Rite and includes images by local photographer Brennan Thomas.  

Then, Turanga Health kaimahi Luke Bradley voiced the audiobook version. 

The graphic novel Reke Tū is a shorter retelling. 

“Public engagement with science is more important now than ever,” says Reweti. “In today’s world, trusted local voices are often drowned out by misinformation on social media and other channels, which can cause real harm. We wanted to deliver the findings of the report in a real way, that regular people would understand.”

“This is more than just a story,” adds Reweti. “It’s a testament to the strength of whānau and community.”
Copies of Mānuka Takoto Kawea Ake Te Pūrongo Arotake: Turanga Tangata Rite, are available at Turanga Health, HB Williams Memorial Library, and Alexander Turnbull Library. 

The audiobook, narrated by Turanga Health kaimahi Luke Bradley, can be accessed here.  

Graphic novel Reke Tū is available at Turanga Health. It will be gifted to kura and schools in the region. 

With more whānau choosing Turanga Health’s Well Child Tamariki Ora service we’re making a significant impact on lifelong and intergenerational wellbeing for Māori, says chief executive Reweti Ropiha. 

Turanga Health’s 2024 annual report Reke Tū released this month reveals that the iwi health service now looks after the wellbeing of over half of the districts under five-year-olds. 

In the 12 months to June 2024, 1,496 babies and under five-year-olds were enrolled in Turanga Health’s Well Child Tamariki Ora programme, 275 more than last year. 

Eighty-five percent of clients identified as Māori, and 4.5 percent identify as Pasifika. 

“Conventional evidence clearly supports investing in the first 2,000 days to give every child the strongest start in life,” says Mr Ropiha. 

Mr Ropiha presented Reke Tū at Turanga Health’s annual general meeting yesterday presided over by representatives from Rongowhakaata, Ngāi Tāmanuhiri, Te Aitanga-a-Māhaki and Te Rūnanga o Tūranganui-a-Kiwa [Wednesday 13 November].

Reke Tū tells the story of a hectic 12 months of health sector change during which time Turanga Health continued its work in the community. 

“We got into sprint mode and weren’t pre-occupied by what was going on around us,” says Mr Ropiha, referencing changes in government, local representation, and the health sector. 

“We asked our kaimahi to dig deep and lean into the relationships that remained. It was a time to focus on what we do best and not be distracted by events unfolding behind the scenes.”

Reke Tū reveals that in one single 60-day period Turanga Health: 
• hosted the New Zealand Secondary Schools Kī-o-Rahi National Tournament
• supported the opening of Mātai Medical Research Institute
• hosted the Ngārimu Scholarship awards
• looked after 190 registered Pasifika whānau
• hosted vaccination events nine weekends in a row
• expanded its vaccination footprint into Ruatoria and Māhia
• published national research on its Covid-19 response, and
• continued business as usual for its 3000 registered whānau. 

Turanga Health board chair Pene Brown says while some organisations within New Zealand’s primary health sector including general practices are struggling and turning away patients, Turanga Health staff continue to step in and look after people. 

Turanga Health has 107 staff including a GP, 20 nurses including a nurse practitioner and two community nurse prescribers, and 12 kaiāwhina vaccinators. It runs a general practice in Te Karaka with 1,728 enrolled patients. 

In other annual report results, staff vaccinated 972 people against influenza in just three months; helped 77 wahine catch up on cervical, breast, and bowel cancer screening; helped 23 whānau quit smoking;  carried out hundreds of staff health checks at 23 primary industry workplaces; and hosted an average of 155 kaumātua at each monthly Kaumātua Programme. 

Turanga Health staff also hosted hundreds of fitness sessions for communities and school children, created cooperative schemes so families could grow their own food and save for essential items, and continued to be the main primary care contact for the region’s RSE workforce. 
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“There is no doubt that by working in its own backyard Turanga Health is essential for helping iwi enjoy sound good health throughout life. From individual, to whānau, to hapū, to iwi, Turanga Health is making a difference,” says Mr Brown. 

Annual Report

TURANGA Health has helped shore up this region’s viticulture and horticulture sector vaccinating 23 recognised seasonal employers from the Republic of Kiribati and Samoa earlier this month.

Staff with specialist employment company Thornhill and Coxco Labour Solutions were vaccinated against serious illnesses measles, mumps, and rubella, as well as influenza, during a busy health and wellness morning hosted at Turanga Health’s Manawaru community space in the Titoki footprint, Elgin.

Thornhill pastoral care coordinator Linda Ngarimu says the whanaungatanga shown by Turanga Health staff to the RSE’s who are so far away from home, is hugely appreciated. “It’s really nice to have been welcomed and for things to have been explained clearly.” Interpreters were available on the day.

Coxco manager of human resource and training Tim Beattie says the one-stop vaccination clinic was a convenient and nurturing process for the workers. “We came to one hub, everyone knows what to expect, there is a warm greeting, and then we move next door for a kai.”

Lalokava Stowers says it’s important to he and his family that he stay healthy and strong so he can work to his full capacity while in Aotearoa.

Miller Faoagali agrees, saying he and his colleagues don’t want to get sick. “We want to work every day, that’s what we are here for.”

Aotearoa is at very high risk of a measles outbreak, and it would take only one case of measles in a close-living community such as local RSE workers, for the disease to take hold. It’s also important that the workers do not take any illnesses home with them, says Turanga Health’s Dallas Poi.

“It’s our privilege to help look after staff while they are here and in doing so, help our region’s primary sector continue to thrive.”

Visitors to the Manawaru vaccination clinic also received a winter wellness pack containing a flask, gloves, beanie, socks and hygiene products.

Turanga Health has stepped up its involvement with Pasifika whānau since their vulnerabilities were exposed during Cyclone Gabrielle. As well as regular health checks and vaccinations, this year the organisation created Mataola programmes for Pasifika whānau to reconnect, stay active, and learn.

It was also involved in the Vaka Tairāwhiti Festival, a post-Cyclone Gabrielle recovery project that celebrated Pasifika culture.

CLINICS offering support with everything from dental fillings to childhood immunisations are empowering wahine to better manage their own health and that of their babies.

The versatile clinics were held for the first time at Turanga Health’s community outreach space, Manawaru, situated on Childers Road in Elgin.

While at Manawaru, visiting māmā could have their children vaccinated, catch up on Well Child Tamariki Ora checks, visit a dentist, and access carseats. Babysitters were also on hand.

One māmā said she couldn’t have attended her appointment without the wraparound support on offer.

“This experience has been amazing. Normally I don’t like going to the dentist because of the cost and because I have found it traumatizing. But after today, it makes me want to look after myself a bit more, and it made me feel more confident.”

After five, day-long clinics, 27 babies and children had been vaccinated to keep them safe from serious but preventable childhood illness. Nineteen families went home with a carseat appropriate for their child’s age and size.

The dental care service was provided by mobile community dental health group Trinity Koha Dental. Its volunteer team of dentists, dental therapists and dental assistants, came with their state-of-the art dental clinic in a caravan.

Over the week, dental staff saw 40 māmā, extracted 49 problem teeth, and repaired cavities with 61 fillings. Another 28 māmā had their teeth scaled and cleaned by an Ocean Dental Centre therapist.

Trinity volunteers work in communities across the North Island offering free dental care. The volunteer team relies on local faces in local spaces to put clinic visitors at ease, and that’s where Turanga Health fits in.

“Turanga Health’s depth of relationship with whānau has meant we’ve been able to get people in who might otherwise be terrified of the dentist,” says Trinity Koha clinic coordinator Julia Parker. “They trust Turanga Health and because of that, they trust us.”

Turanga Health’s Dallas Poi says the clinics targeted young mums where there was a proven need for accessible, well-resourced dental care, and continued support looking after their tamariki.

As it has done so often in the past, Turanga Health helped create a solution that better meets whānau need. “The māmā were happy to be there. It was nice to see people leaving with a smile.” The number of childhood immunisations provided over the week was particularly important.

“Immunisation saves lives. As well as protecting yourself from dangerous diseases, getting your tamariki immunised is one of the best ways to set them up for a healthy future. We hope to hold more clinics like this in the future.”

One grateful māmā said the clinic was wonderful to visit. “When I got here the environment was very calming. A beautiful atmosphere. It feels really good,” said the busy wahine, who brought her four tamariki to the appointment.
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The wraparound clinic service in Elgin was created in response to whānau need and was Government-funded. Turanga Health and Trinity Koha Dental Clinic extend thanks to the Tairāwhiti Toitu Te Ora Iwi Māori Partnership Board, Te Whatu Ora Tairāwhiti, Tairawhiti Localities, Trust Tairāwhiti, and Ocean Dental Clinic for their contributions. 

TRUST Māori health providers to look after Māori communities in a pandemic, says Turanga Health in a government-funded report on how it managed Covid-19 in Tairāwhiti.

The decision to vaccinate people at every opportunity, even when it meant deviating from the Government’s established criteria, was pivotal to achieving high rates of vaccine coverage in Tairāwhiti, the report says.

Turanga Health administered nearly 21,000 vaccinations between May 2021 and December 2022, with 60 percent of the vaccinations received by Māori. Turanga Health held 185 drive-through and 161 static clinics at 173 urban and 65 rural settings, 33 workplaces, and 30 education centres.

“We recognised the urgent imperative for action and vaccinated all whānau at every opportunity,” says Dr Shirley Keown, who is Turanga Health’s quality and research clinical advisor and the locally-based senior report researcher.

The report Tangata Rite is part of nationwide Ministry of Health-funded research into ongoing impacts of Covid-19 and future pandemic responses.

The local research included an exhaustive review of all the work carried out between 2020 and 2022, as well as interviews, surveys and wananga with kaimahi and stakeholders. Public feedback collected in real time was collated to help recapture the experiences of people who were vaccinated.

Dr Keown says in the early days of vaccination in 2021, the region’s largest primary health care provider faced a dilemma whether to vaccinate family attending vaccination events along with their older family members.

“At the time, systematic barriers were preventing us from vaccinating everyone despite us being right there in those hard-to-reach vulnerable communities.”

“Around Aotearoa we were watching regions like ours struggling to reach vaccination targets. We were feeling frustrated that local Māori would miss out on Covid-19 vaccination if we didn’t take advantage of all the opportunities we were creating,” says Dr Keown. Staff vaccinated allcomers.

Turanga Health’s nimble whānau-focussed response illustrates the value of Māori expertise and knowledge of local communities, says Reweti Ropiha, chief executive of Turanga Health.

“We learned the importance of being bold, being responsive, and doing what is right by our people. We were willing to back ourselves to develop and implement a local approach that was proactive rather than reactive.” 
Māori communities have borne a disproportionate burden of mortality in previous pandemics, and we didn’t want that to happen again, he adds.  

Recommendations to come out of the review urge the Government to position Māori health providers at the forefront of any future pandemic responses.

Recommendations include that essential service status be automatically granted to Māori health providers; vaccinating staff have real time access to national immunisation data; and organisations receive more resources for mobile health services. Māori health providers should not only co-design national health measures, they should co-decide, the report stresses.

The research also looked at Turanga Health’s quick adoption of the kaiāwhina workforce in the vaccination space, and the way it created a whānau fun atmosphere at vaccinations events with music, kai, and koha. These were recognised to have increased the number of Māori vaccinated.

JOHN Pomana has spent a lifetime sharing the love and guidance he received from his Tūhoe step-grandparents with whānau and staff he’s helped over the years.

“Tawa and Timitimi Turipa were beautiful grandparents to us. We had nothing but love in that home of galvanised tin,” remembers John fondly.

Born and raised in Gisborne and Waikaremoana, John, Rongowhakaata, was educated in Gisborne. He left Gisborne Boys’ High School aged 16, moving into a fitter and welder apprenticeship and establishing himself as a skilled craftsman. John built everything from boat cabins to barbecues with Gisborne Engineering, before moving into machinery repair work for Hawea Contractors.

Turanga Health kaumātua Libby Kerr, who is related to John’s wife Helen, introduced him to the iwi health provider in 2004. John is forever grateful to the inspirational uncle who passed away in 2023. “I still feel the pain of Libby’s loss. It has been one of the saddest things for me.”

Despite no formal health or social work training, John has always had a natural affinity for active listening, advocacy, and empathy. He’s earned the trust of everyone he’s been in contact with, be it through sport, whānau, kapa haka, or church.

At Turanga Health, John worked in a range of supportive roles for 20 years. “I guess I just went on the love I had received from my koro and other people I’ve met and liked throughout my life.” Importantly, John includes his Rongowhakaata grandparents Hori Reremoana Pomana and Teo Keakea Whaitiri in this group.

John’s skills were adapted to good use in Men’s Health and then with the Whānau Ora team in mental health. John sometimes biked to Turanga Health from Patutahi and has never considered any day as “work”. “It was like looking at myself in the mirror with a lot of the tāne. The enjoyment of connecting and sharing whakapapa was enough.”

John pays credit to Turanga Health kaimahi Norm Namana and Billy Babbington for helping expand his own skills. “The things they do for whānau have always amazed me. They have helped people be more self-sufficient, and look after their own families, each in their own way.”

These days, much to the relief of Helen, the 73-year-old has reduced his busy schedule. He remains a mentor for younger Turanga Health kaimahi, and, as ordained Ringatū minister Rev John Pomana, offers prayers and spiritual support for those who want it. John is also a much-loved musician and recently accompanied Te Hauora o Tūranganui a Kiwa kapa haka group at Tamararo 2024. “I’m just the old guy with a beard and a guitar at the back.”
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Outside of work, John and Helen have raised two sons, and two nieces (“our daughters”). He is Papa John to many tamariki. John says he’s content to be sharing more time with them and doing the dishes for Helen! 

​IF you’re elderly or unwell and then you get flu on top of that, it could be hard to fight it off, advises a Turanga Health senior nurse, ahead of this year’s flu vaccination campaign.

Turanga Health staff are vaccinating whānau against this year’s influenza strains by visiting rural locations and workplaces around the rohe. The mobile team has been out and about doing the mahi since mid-April.

Influenza, or the flu, is not the same as a common cold, warns primary care kaiwhakahaere Bobbie Cameron. “It can make vulnerable people such as kaumātua, and those with health conditions, extremely unwell.”

Bobbie asks that if you know someone who would benefit from vaccination “please bring them to one of our clinics.” While you’re there, choose vaccination for your own health and wellbeing too, she adds. “Influenza can make you very sick, even if you’re fit and healthy.”

Despite the warm weather the region has been experiencing this autumn, it’s important to get vaccinated before the cold months hit. “Stick with your normal routine and get your annual influenza vaccination now,” Bobbie says.
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“We’re all busy and it’s hard to find the time but the best chance of protecting yourself is to get your flu shot. It’s free. We’re coming to you. Why would you leave it to chance?”

Turanga Health will be at rural locations and worksites offering influenza vaccinations and Covid-boosters during May and June. There is a mix of drive-through and location-based clinics.
 
The team features 25 vaccinating nurses and kaiāwhina. New to the vaccinating team this season are Hotorene Brown, Franzee Nuku, and Luti Ovaleni.
 
As always, Turanga Health’s vaccination events prioritise manaaki and wellbeing. “You and your whānau will experience being cared for and nurtured, and you can have a cuppa!” assures Bobbie.

WAIKOHU Health Centre whānau experiencing distress, anxiety, or low mood, are being supported by a new team of kaimahi.

Health coaches are an emerging workforce in Aotearoa New Zealand. They’re helping general practice teams look after whānau who need support with psychosocial issues such as stress, isolation, or worry.

“Their mahi is to support people by being available to respond in the moment,” says Tracey Crosbie, who is one of two health improvement practitioners working in general practice, helping generate referrals.

“Our wonderful coaches help build people’s motivation and capability to better understand and self-manage their physical and emotional wellbeing needs.”

Turanga Health’s four health coaches come from a variety of backgrounds.

Rhonda Pohatu is an experienced kaiāwhina who has worked in bowel screening, smoking cessation, and Whānau Ora. Amanda Prebble has a background in recruitment with LeaderBrand and Gisborne District Council, Dawn Tamanui used to work as a supported coordinator with ACC, and Tracey White has come from a hospitality background.

If Waikohu Health Centre general practitioner Mark Devcich or nurse practitioner Kylie Moressey think a person would benefit from support with mental health, they can refer them to the in-house health improvement practitioner at the time of presentation.

In recent months Tracey has seen many whānau still reeling from the impact of Cyclone Gabrielle. After creating a plan with the person in need, and or their whānau, Tracey will then hand the person over to a health coach.

The barrier-free service is called Te Whatu Aho Rua. Turanga Health’s primary care practitioner Dr Patrick McHugh says people do not require a previous or current mental health diagnosis to be seen.

Te Whatu Aho Rua gives general practitioners another tool to use. “Rather than applying a disease-centred approach, we’re adopting a wellness framework.”

Te Whatu Aho Rua is reducing wait times for support. It’s a free service with referral criteria aimed at increasing access and equity for whānau who need help at a time when they are feeling vulnerable or low. The service is intended for brief interventions.
 
In the past six months Turanga Health’s team have met with 173 referred whānau.
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Tracey says whānau are grateful to have been able to lead the process. “It’s a bottom-up approach. This is their journey, and we respond to what they are asking for, as well as using our own assessment tools.”

MORE local students have been introduced to Gisborne’s complex and layered history now that Turanga Health’s heritage trails have been adopted by Gisborne Boys’ High School.

This month around 160 GBHS Year 10 students took part in the year's first Heritage Trail walk giving tāne an up-close-and-personal insight into the history that surrounds them.
 
The trails dovetail into our school’s te reo Māori and physical education department curriculum, says Gisborne Boys’ High School principal Tom Cairns.

“It covers off our history and our tikanga, and all the while, the boys are active.”

Turanga Health’s Heritage Trails are a walking or running series that combines fitness with local historic treasures.

Students can cover around two to four kilometers during each hikoi so it’s a unique opportunity for participants to be active and connect to history at the same time.

There are three heritage trails exploring local history: Turanganui River and Titirangi; Oneroa Walkway and seafront; and Taruheru River. 

The trails combine Māori and Pakeha history traversing stories around early navigators, those who visited, those who returned, and those who made this place home.  

Stories of the original Māori ancestors Kiwa and Pāoa are combined with the history of meeting houses, Cook’s arrival, and European settlement.

Mr Cairns says the heritage trails also fit into the school’s Tu Tāne growing good men programme.

“Knowing who you are, where you’re from, and discovering shared histories amongst communities, is important for young men.”

Turanga Health has used heritage trails for several years to engage rangatahi in physical activity and as a way of helping them learn local history.

“Students can find themselves standing next to and looking upon sites of significance,” says Turanga Health chief executive Reweti Ropiha. “They learn, and that mātauranga can be translated into their daily connections and life.”
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Rongowhakaata historian and heritage consultant Jody Wyllie created the heritage trails for Turanga Health. Mr Wyllie is a Treaty of Waitangi negotiator and researcher. He’s spent hours passing on his years of historical research to Turanga Health kaiāwhina who lead the guided walks. The Turanga Health trail guides are Hotorene Brown, Avenir Maurirere, Richard Brown, Luke Bradley, Lewis Ria, Haydn Pomana and Waldo Horomia. They have support from other staff who help with transport and refreshments.