IronMaori organiser Heather Skipworth has lost her seat on the Hawke's Bay District Health Board (HBDHB) and been replaced by first-time candidate Ana Apatu according to a 99 per cent vote count.
Outgoing Central Hawke's Bay mayor Peter Butler also failed in his bid for the board.
The elected board are Kevin Atkinson, Peter Dunkerley, Diana Kirton, Ana Apatu, Jacoby Poulain, Helen Francis and Dan Druzianic.
Skipworth was hailed as just what the doctor ordered when first elected three years ago. Poor Maori health is the HBDHB's greatest challenge.
Her boardroom seat will be ably filled By Ana Apatu, with a career covering both health and social work.
She is chief executive of the U-Turn Trust, which supports the wellbeing of Flaxmere families, based at Te Aranga Marae in Flaxmere.
Originally a nurse, her previous role was senior population health adviser for the HBDHB.
She is a member of the HBDHB Maori Relationship Board and chairs primary healthcare service Directions Youth Health Centre and the Hawke's Bay Youth Health Trust.
She said was fortunate to be centred in Flaxmere, learning from families and the community, "but if you want to make a big-picture difference you need to be at a strategic level".
Mr Butler campaigned on Central Hawke's Bay concerns, which may not have had wide-enough appeal to replace incumbents.
There were seven positions contested by 15 candidates.
The Government will make further appointments to the board, to reflect the wider community the HBDHB serves.
It was Mr Druzianic second election. He was a government appointee but entered the previous elections on the suggestion of board members, who sought continuity of his financial expertise in case there was a political change nationally.
With a half-billion dollar budget the HBDHB is the region's biggest employer.
It is also the Health Minister's financial pride and joy, running successive multi-million-dollar surpluses from its operating budget to fund multi-million dollar health facilities.
While a team effort throughout the organisation, much of the credit for the successful financial stewardship has been laid at the feet of chairman Kevin Atkinson, the highest-polling candidate.
He said it was most likely his final term "but you never say never".
"I'll look at that in three years' time," he said.
"We have some good young people coming up through the board and it might be time to hand over the mantle."
Mr Atkinson was part of the board that was sacked and then reinstated by the Minister of Health in 2008, amid allegations of poorly managed conflicts of interests.
Every member of the sacked board who stood for re-election was successful, also including re-elected board members Peter Dunkerley, Diana Kirton and Helen Francis.