Located in the upper reaches of the Makakaho Stream is the locality of Makakaho. The upper valley localities are particularly isolated, Ngamatapouri Primary School being  from Waitōtara village.
Makakaho is situated at the headwaters of the Makakaho Stream. The upper valley regions are quite inaccessible, with Ngamatapouri Primary School being a considerable distance from the nearby town of Waitōtara.