Dr Fiona Bolden – October 2025

Kia ora tātou

In this October edition of the newsletter, I wanted to share that it is now six months until our National Rural Health Conference in April 2026. Our conferences have always been a great place to gather, learn, connect, and collaborate. This one, though, will be extra special, as we will be sharing it with Rural WONCA, which is a first for us in Aotearoa. WONCA, the World Organisation of Family Doctors as its better known, was established in 1972 with the aim of improving the quality of life for peoples of the world through promoting its values, including respect for universal human rights, gender equity and fostering high standards of care in general practice, in particular continuity of care for the individual and family in the context of the community and society. How relevant does this sound for us in rural New Zealand?

Extremely relevant, I would suggest, especially with our key theme being around Mātauranga Māori, incorporating Indigenous knowledge into health care for rural Māori to achieve health equity. Over recent years, WONCA has widened to include nursing as well, and we are hoping to showcase the New Zealand experience of rural health multidisciplinary teams. “Rural WONCA” is the rural working party of WONCA, and as such, it represents rural communities from all around the world. There is a World Rural Council that will be holding a council meeting and an assembly prior to our conference.

One key relationship of WONCA is with the WHO, and they will be sending a representative over for the assembly and as a keynote speaker. The pressures that the WHO are currently under with the global political situation became very apparent during the most recent WONCA conference, which I attended in Lisbon. WHO has seen improvements in health service coverage stagnate since 2015. In 2021, 4.5 billion people (more than half the world’s population) were not covered by essential health services. Even where there is national progress on health service coverage, the aggregated data masks inequalities. WHO is particularly concerned about the global health workforce shortage, with a projected shortage of 11.1 million by 2030. We were reminded of the four “Ts” that contribute to high-performing primary healthcare: teams, tools, technology, and tailoring of care. WHO also stresses the importance of the four “Ds”: data, dialogue, decisions (correctly informed and evidence-based), and dollars. These underpin the ability to deliver quality, equitable healthcare. Rural data is still poor, or not reported upon, or held where it cannot be accessed. This was evidenced by the most recent Ministry of Health Annual Report for the year ended 30th June 2025, where nothing was reported by rurality, there was no reference to the progress of the rural health strategy, and the only mention of rural was Ministers Doocey’s rural health roadshow and the rural focus of the Medical School at Waikato. This is simply unacceptable.

Next year, by hosting Rural WONCA, we will have the opportunity to hear from others all around the globe about our common challenges and the different solutions from which we can learn. We can also show our own unique Kiwi way of doing things, which has stretched the limited dollar with which we have been provided in productive and innovative ways, with some amazing results. Regarding the global challenges for healthcare for Indigenous peoples, this is something that is of particular concern to the WHO and to Rural WONCA. Almost three out of four Indigenous people live rurally, although they only account for 5% of the world population. They play a huge role in the sustainability of the planet, managing an estimated 80% of biodiversity and 40% of protected areas. Westernised approaches to healthcare have not always resulted in positive health outcomes for them. Māori, in many ways, have led the way in how they use their worldview to determine how they want to access services, and which services are appropriate for them. Although we still have a long way to go before Mātauranga Māori is incorporated into “mainstream,” there are many positive stories and examples that can be a source of encouragement for both us and the global rural Indigenous whānau.

So next year it is a time to celebrate our achievements, to reignite our passion for rural health, to collaborate and share learnings with our international colleagues. It is also time to draw a very clear light upon the lack of progress of the rural health strategy, what needs to be done to ameliorate this, and to ensure that it remains a guiding document which is used and reported to no matter which government is in power. Central to this is the necessity to report all health outcomes, all decisions around health service and infrastructure funding, with rural data. Only by showing the figures clearly will we ever begin to address the huge inequity in the funding of rural healthcare, which impacts rural communities across the rohi and leads to the inequity of rural health outcomes , particularly for Māori, that we are well aware of and which we will continue to highlight in the hope of seeing progress towards a more equitable Aotearoa.

Ngā mihi mahana ki a koe

Fiona