The government is failing to make a dent in rheumatic fever rates across much of Auckland, despite millions of dollars being poured into tackling the problem.
The government has dedicated $65 million to its Rheumatic Fever Prevention Programme, which started five years ago with the aim of slashing incidents of the disease.
Though rates are falling across the country, children are still contracting the disease in the same numbers in the Waitemata and Auckland district health board (DHB) areas.
Under the Ministry of Health targets, Auckland DHB should have had seen seven new cases in the past 12 months. Instead it had 19 - two more than when the programme began.
It was a similar case in Waitemata which had around 12 cases last year - more than double its target number.
A prominent Auckland GP and the leader of a successful south Auckland prevention programme, Rawiri Jansen, said the DHBs were fighting against an increasing tide of child poverty and crowded housing.
"The key driver of acute rheumatic fever is housing and I think it is well known that there are concerns about he household crowding areas in wider Auckland. That may be the area where we need to increase our effort," he said.
He said rates of the disease may actually have increased had the prevention programme not been in place.
Child Poverty Action Group's health spokesperson Nikki Turner said the lack of progress was complicated and DHBs alone could not fix it.
"The overall bigger issue is we have significant child poverty. It affects the housing, it affects the child's immune status it affects their response to illness. We have to do something more than that other than just in healthcare services, she said.
Waitemata DHB paediatrician Tim Jelleyman agreed the solution was wider than just the heathcare sector, and said the stubborn rates were frustrating.
"The public health nurses, the GPs, the community health workers ... everyone involved has been passionate to see this happen. When you put work in and when you don't quite get there it is disappointing ... but we are going to keep going on this," he said.
South Auckland's Counties Manukau has the worst rates of rheumatic fever in the country but it has had success over the past four years.
The number of new cases has halved to 37 per year, thanks largely to an intensive programme that has put nurses in 61 schools.
However Dr Jelleyman and Dr Jansen both said that approach wouldn't work in the other DHBs where cases tend not to be concentrated in one area.
Minister of Health Jonathan Coleman said he was disappointed in the figures, but the ministry had given a further $875,000 to the two DHBs to help them tackle the problem.
The ministry has also launched a campaign to recruit 100 young people to spread the prevention message across communities and schools.
Dr Jelleyman said those who contracted the disease often needed months of bed rest, monthly antibiotic injections into adulthood and sometimes heart surgery.
"It's a disease with a long shadow," he said.
"For those that it affects it is a big impact of their lives and the lives of their families."
Auckland DHB would not comment on the figures as it said the problem was a nationwide one.