With 395 people standing for election to New Zealand's health boards - at the same time as council elections - you could be forgiven for knowing little about them.
Judith Aitken Photo: Supplied
And that's why those in the health system want major changes to how DHBs, which are made up of elected and appointed members, are voted on.
Capital and Coast DHB member Judith Aitken, who is standing down from the debt-plagued organisation after 15 years, said asking voters to know who was standing for DHBs and other local body roles was asking too much.
"You're confronted in the case of Capital and Coast with 20 candidates," she said.
"I think in one election some years ago there were up to 58 candidates, an impossible task. And you're not only confronted with 20 health board candidates with whom you might have heard of three, but you also have to look for regional councillors, district councillors, city councillors, community boards and mayors.
It would make more sense for DHB elections to be held at the same time as the general election, she said.
"A district health board should be elected at the same time as a general election occurs because they are Crown agents, and tax funded.
"And it's not only difficult and complicated for the voter but it's inappropriate, I think, for those elections to be held at the same time as local government."
Wellington GP Ben Gray said public input was vital whatever the constraints.
"This is a democracy, it's the only chance we have to influence anything. My experience is that I'm not sure that it will make a huge amount of difference but I think it will be even worse if none of us vote."
Professor Robin Gauld of the Otago University Centre for Health Systems, said an independent inquiry was needed to assess how effective boards were.
"You're having people elected to boards who are not necessarily receiving the endorsement of a large number of voters, who aren't necessarily bringing to the board table the background and skills necessary to govern very very complex, very large, very costly organisations [with a] billion dollar budget."
He said he also thought DHB members were not free to speak their minds.
"It's pretty clear that they won't speak out unless they have a collective agreement within the board to speak out about a particular issue, and the legislation once again says that they are first and foremost accountable to the government.
"So one might draw that conclusion that, yes, there is an element of gagging."
Dr Aitken said board members were not gagged but bound by collective decisions.
"You have to find another way to change the decision or to change the nature of it. I don't think people feel gagged."
Dr Aitken said she had enjoyed being on the board, despite its massive financial challenges.
"We are in a very difficult position because we have a large tertiary hospital funded on the basis of a population that was too small by international standards for a tertiary [full range of services] hospital, but required to accommodate the service demands of about a million people," she said.
"You just have to come to understand the constraints of being a Crown Agent subject to direction by the Minister, tax-funded and with a large number of [funding] formula."
Elections take place on 8 October for all but Southern DHB, which is led by a commissioner.