Tell us about yourself and why you decided to become a Member of the Network.
Kia ora koutou. I’m Lisa Foster, Chief Executive of the Home and Community Health Association (HCHA), the peak body and national voice for home and community health and support providers across Aotearoa. HCHA represents varied organisations that enable people to live at home and within their communities: kaumātua, tāngata whaikaha, people recovering from acute illness, and those managing long-term conditions, often in rural areas.
I’m thrilled to join Hauora Taiwhenua because rural care is strongest when we are focused on the needs of our communities, with GP practice, homecare providers, community health professionals and the kaiāwhina workforce working in alignment. That connection is at the heart of what I hope to explore here. Where this alignment already exists in rural locations, the outcomes are noticeably better for it.
With the Rural Health Strategy setting a clear direction toward integrated, preventative care closer to home, the home and community health sector is a natural part of that picture. These priorities resonate deeply with home and community providers, and advocating together for their realisation makes every kind of sense. The effects of getting this right ripple outward: healthier whānau, more empowered communities, and reduced pressure on acute and residential services. Those benefits are not always easy to measure, but they are profound and they are real. The rural dimension of home and community health remains genuinely underserved in national policy conversations, and that is the other reason I am so glad to be part of Hauora Taiwhenua. Too often, policy for our sector is shaped around urban service patterns, leaving rural and remote communities to absorb the consequences, with compounding factors of workforce shortages, inequitable funding, and the quiet weight of geographical distance from decision-making. These are the challenges we share, and they sit squarely at the intersection of what HCHA advocates for and what this network truly understands. I’m here to learn, to connect, and where I can, to contribute.
What are some of the key challenges or opportunities you’re seeing in rural health right now, and how are you addressing them?
The most pressing challenge I see is the compounding effect of funding models that were never designed with rural delivery costs in mind. Home and community support workers and nurses in rural areas are often travelling significantly further between clients, absorbing fuel costs on reimbursement rates that haven’t kept pace with reality. This is a situation we’ve been advocating hard to change, and we recently secured a temporary uplift to the mileage reimbursement rate for kaiāwhina, which is a genuine win. But it points to a deeper structural issue: our pricing and funding models need to reflect what it actually costs to deliver care in rural Aotearoa, and investment in community-based care needs to be proportional to the gravitational pull that hospital funding continues to exert.
The opportunity I’m most excited about is the positive momentum of the Rural Health Strategy and the possibility of true integrated care, specifically the much closer alignment between home and community support, rural GPs, primary care teams, iwi, carers, NGOs, and whānau. When those connections work well, you get genuinely responsive, prevention-focused care that keeps people well at home and out of already-stretched rural hospital services and residential care. The challenge is that this requires sustainable funding and contracting systems that incentivise collaboration rather than siloed delivery. It is also the most cost-effective avenue available to us, yet it remains chronically underinvested in. That needs to change. We can only work smarter if the funding settings allow it, and while we’re not there yet, the conversation is genuinely shifting.
Is there a particular project, initiative, or success story you’d like to share that others in the sector might find inspiring or useful?
One initiative worth sharing is the recent uplift to the mileage reimbursement rate for kaiāwhina, secured after sustained advocacy through the early period of sharply rising fuel costs. The rate had fallen well behind cost reality, and despite the evidence being clear, it took considerable effort to make it heard. The in-between travel mechanism, introduced as a temporary measure in 2012, had received no increases since 2022, placing increasing pressure on providers and leaving their workers absorbing increasing costs. Closing that gap, even temporarily, is a meaningful win. It also illustrates a principle central to everything HCHA advocates for: that investing wisely in community-based care saves far greater cost downstream, in hospital admissions, residential rest home placements, and the invisible and heavy burden carried by whānau when support is absent or inadequate.
The success stories I find most inspiring, though, are not mine to claim. They belong to the kaiāwhina and providers across our membership who show up every day with remarkable compassion, skill, and commitment to the people and whānau they support throughout Aotearoa, including in rural and remote communities where that dedication often goes unseen. That is the real heart of our sector, and one of the reasons I’m glad to be part of a network that understands it.
What would you like other members or readers to know about, whether it’s a piece of advice, something unexpected about your work, or how they can connect with you?
Something that has genuinely surprised me about this work is how much of the most important advocacy happens in relationships. Not in formal submissions or briefing papers, but in ongoing, trusted conversations with networks and coalitions of the willing, and in the support of officials and ministers who take knowledge from frontline voices and make it valued and impactful. The sector I represent is often invisible to the public and undervalued by policymakers, despite being the thing that holds the rest of the health system together. Building visibility for the kaiāwhina workforce, for the providers, and for the whānau who depend on them, feels like the core of the work.
If you’d like to connect, I’m genuinely interested in learning more about the realities and opportunities of rural collaborative health care, and in conversations about workforce and integrated care at the rural interface. You’re welcome to reach out via HCHA’s website or find me on LinkedIn. Ngā mihi nui, I’m so glad to be part of this community and look forward to doing my part to support better health outcomes for all.
