th
Meeting Objective: To convene senior and deputy health leadership from the Territory of American Samoa, the Commonwealth of the Northern
Mariana Islands, the Federated States of Micronesia, the Territory of Guam, the Republic of the Marshall Islands and the Republic of Palau to discuss issues of regional significance, and by the end of the meeting, decide on critical priorities forward through official communiques, resolutions and recommendations.
Attendance Day 2: Executive and Associate Members: Minister Gregorio Ngirmang (Palau), Minister Phillip Muller (RMI), CEO Esther Muna
(CNMI), Director Livinson Taulung (Kosrae, FSM and proxy for Secretary Vita Skilling), Dr. Suzanne Kaneshiro (Guam and proxy for Director Jim
Gillan), Director Paulino Rosario (Pohnpei, FSM), Director James Gilmar (Yap, FSM), Jesse Tudela (CNMI), Warren Villagomez (CNMI). PIHOA
Secretariat: Emi Chutaro, Cerina Mariano, Regie Tolentino, Billie Hiraishi, Mark Durand, Greg Dever and Alicia Sitan. Guest Speakers: Captain
Randolph Daley (CDC Preparedness), Captain John Walmsley (Region IX HHS), Mark Burchess (Perry Point, via TC), Clarette Matlab (Palau, via TC),
Dr. Jonathan Mermin (CDC NCHHSTP), Bill Gallo (CDC OSTLTS), Vicky Rayle (CDC OSTLTS), Liza Corso (CDC OSTLTS), Carol Moehrle (PHAB), and Dr.
Kaye Bender (PHAB, via TC), Captain Cathy Wasem (Region IX HHS Hawaii), Mrs. Terry Ngirmang (PCC, Palau). General Attendees: Derrik Felix
(CDC NCHHSTP) and Andy Heetderks (CDC NCHHSTP) - for Dr. Mermin part only, and Temengil Temengil (Palau MOH).
Attendance Day 3: Executive and Associate Members: Minister Gregorio Ngirmang (Palau), Francyne Wase-Jacklick (RMI, proxy for Minister
Muller), Director Livinson Taulung (Kosrae, FSM and proxy for Secretary Vita Skilling), Dr. Suzanne Kaneshiro (Guam and proxy for Director Jim
Gillan), Director Paulino Rosario (Pohnpei, FSM), Director James Gilmar (Yap, FSM), Jesse Tudela (CNMI), Warren Villagomez (CNMI, and proxy for CEO Muna). Affiliate Members: Dr. Lee Buencosejo-Lum (UH and CCPI), Dr. John Ray Taitano (CCPI), Louise Santos (PBDA), Arielle Buyum
(PIPCA), and Clifford Chang (PIPCA). PIHOA Secretariat: Emi Chutaro, Cerina Mariano, Regie Tolentino, Billie Hiraishi, Mark Durand, Greg Dever,
Angela Techur-Pedro, Vasiti Uluiviti, Dr. Kristine Qureshi, and Alicia Sitan. Guest Speakers: Vanessa Lee (HRSA, via TC), Dr. Louise Iwaishi
(Hawaii), Duane Lopez (Hawaii DOH), John White (Shriners Hospital, Hawaii), Donald Zeke Schmus (Shriners Hospital, Hawaii), Susan Yamamoto
(Shriners Hospital), Gregg Nakano (UH), Dr. Ian Rouse (FNU), Dr. Chris Whelen (Hawaii State Lab), Dr. Philip Dauterman (CNMI CHCC), Dr.
Matthew Bankowski (Hawaii DLS). General Meeting Attendees: Colonel Jennifer Walker (Chief of Clinical Services, US PACOM), Captain John
Walmsley (Region IX HHS), Bill Gallo (CDC OSTLTS), Captain Cathy Wasem (Region IX HHS), Terry Ngirmang (PCC Palau), Dr. Rachel Novotny (UH),
Katie Sellers (ASTHO), Karl Ensign (ASTHO), Lindsay Strack (ASTHO), Ed Hope (Hawaii DLS), Louis Yamada (Hawaii DLS), Janos Barkos (UH), and
Emais Roberts (Palau MOH).
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Attendance Day 4: Executive and Associate Members: Minister Gregorio Ngirmang (Palau), Minister Phillip Muller (RMI), Director Livinson
Taulung (Kosrae, FSM and proxy for Secretary Vita Skilling), Dr. Suzanne Kaneshiro (Guam and proxy for Director Jim Gillan), Director Paulino
Rosario (Pohnpei, FSM), Director James Gilmar (Yap, FSM), Jesse Tudela (CNMI), Warren Villagomez (CNMI, and proxy for CEO Muna). PIHOA
Secretariat: Emi Chutaro, Cerina Mariano, Regie Tolentino, Billie Hiraishi, Mark Durand, Angela Techur-Pedro, and Alicia Sitan. Guest Speakers:
Temengil Temengil (Palau MOH), Clifford Chang (Executive Director, PIPCA) and Dr. Lee Buencosejo-Lum (UH and CCPI). Affiliate Members (for
HLC session) – Louise Santos (PBDA), Christine Deeley (PIPCA), Arielle Buyum (PIPCA), and Dr. John Ray Taitano (CCPI).
Time / Agenda Item
Discussion Decisions Made /
Action Needed
Welcome and
Acknowledgements: Emi
Chutaro, Executive
Director, PIHOA Secretariat
Nominations and Election of Board Secretary /
Treasurer: Emi Chutaro
Morning Coffee and Fruits / PIHOA Board Member Registration
Opening Prayer: Director Paulino Rosario, Pohnpei State Health Services
Emi welcomed RMI Minister Philip Muller, the newest member to PIHOA. Emi announced that Director Nua is unable to attend the meeting due to the Chikungunya outbreak in American Samoa; and that Secretary Skilling and Chuuk Director Marar are not able to attend due to priorities in the FSM. Dr. Livingston Taulung is Secretary
Skilling’s proxy. Emi announced that CEO Muna accepted Secretary Skilling’s request to preside over today’s meeting, but another member will need to preside over the rest of the meeting as she will be returning to the CNMI tomorrow. As there are no officers in attendance, Emi has asked CEO Muna that we jump ahead in the agenda to the election of the Secretary/Treasurer, so there will be an officer in attendance for most of the meeting.
Nominations were opened by Emi. Minister Ngirmang nominated CEO Muna. He explained that she has been on the board longer than others and he believes in seniority. CEO Muna shared that she has been the Secretary before; she accepts the
CEO Muna was unanimously elected
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Review and adoption of the
55 th PIHOA Meeting
Minutes: Esther Muna,
CEO, CNMI CHCC, presiding on behalf of the PIHOA
Board President
Review and adoption of the
56 th Meeting Agenda:
Esther Muna
Review and revision of the
PIHOA By-Laws, as amended 2004: Emi
Chutaro nomination, but welcomes anyone else who may be interested in serving in that position. Dr. Taulung seconded the nomination; and votes were unanimous. Emi promised CEO Muna that she would have the support of Secretariat staff. CEO Muna acknowledged the help provided by Secretariat Staff in the past.
CEO Muna called the meeting called to order at 9:10am.
Emi advised that in keeping with the Board’s decision earlier this year to Go Green, minutes were sent via email; but offered to print minutes for review if preferred. CEO
Muna asked members to review the minutes and suggest changes as needed. Emi reviewed the minutes, providing a synopsis of the agenda items and decisions made.
Minister Ngirmang moved to approve the minutes; seconded by Dr. Tualung.
Minister Ngirmang moved to adopt the agenda; seconded by Dr. Suzanne Kaneshiro.
This was tabled at the 55 th PIHOA Meeting, with the plan for Board members to work with Emi on reviewing the Bylaws and proposing amendments. Emi reviewed the
Bylaws with the Board and proposed suggested amendments; however, the following items were discussed in greater detail:

Associate membership: Emi shared that the lack of payments from most associates result in PIHOA having outstanding invoices, some for long periods of time (i.e. years in arrears). How should this be better managed? Jesse Tudela moved for the
Secretariat to develop a process to safeguard PIHOA from having outstanding payments due to this issue. Members suggested that associate membership be reviewed annually.

Membership dues: Emi reported that the current policy is that all past due membership dues are considered outstanding. Dues are a very important source of income for the organization. Board members asked if PIHOA members are obligated to pay past due membership dues. Also, what if a member decides that they can retain membership, then comes back and requests to be active?
Guidelines must be developed to address delinquent payments. Dr. Taulung commented that members need to support each other by paying dues timely.
Minister Muller asked what membership dues cost. Emi advised that starting in fiscal year 2015, executive member dues will increase to $15,000 annually and associate members will remain status quo at $500 annually. as Secretary /
Treasurer.
Minutes adopted.
Agenda adopted.
Emi will make revisions, send an updated version, and if time permits on Thursday, the
Board can review it on Thursday. Emi asked if the Board would like to convene a special committee to address this issue.
CEO Muna suggested they discuss this on
Thursday.
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
CNMI CHCC: CEO Muna asked Emi to clarify who are PIHOA associates now that
CHCC is a corporation. It is clear that the executive member is the CEO. CEO Muna asked if both the Director of Public Health and Hospital Administrator could be associate members. Emi advised that the CHCC could be handled the same as
Palau, which has the Minister of Health as the Executive Board member and the
Directors of Public Health and Hospital as Associate members.

Guam Behavioral Health & Wellness Center: Dr. Kaneshiro clarified that this is the same organization as the Department of Mental Health & Substance Abuse – they recently changed their name. Like the Guam Memorial Hospital, it is a separate entity from the Guam DPHSS. Emi noted that this organization was in severe arrears in their payment of dues.

Affiliate, Honorary and Advisory members: Emi reviewed the definitions for each category and asked if there a need for all three categories. o Emi shared that affiliate members are regional professional health organizations; most members of these organizations are staff of health departments; most
 regional organizations are independent of health departments and are funded from other sources. Their purpose as content area experts in their fields are to provide advice and support to the Board. Given this fact, should affiliate and advisory members be the same? o Emi pointed out that Advisory members seem to be funders, which could pose some conflicts. Dr. Taulung suggested that “Advisory Members” be revised to
“Support/Partner Agency Members.” Jesse Tudela suggested that this be stated as “Donor/Partner Agency Member.”
Honorary members: Emi shared that the original bylaws define honorary membership to be by invitation. There are only two honorary members. The length of honorary membership is unclear – is it in perpetuity or an annual basis? o CEO Muna suggested that a term should be specified. Also, the Bylaws seem to recognize organizations as honorary members, versus individuals. There also is some overlap between Associate and Honorary members. o Minister Muller stated that usually honorary members refers to individuals and not organizations.
Some changes were made to the definition and description of each membership category.
Page 4 of 42


Removal of Board Officer from office: Board members discussed the provision on how Neglect of Office is the responsibility by the Board of Directors. Members asked for an example of this issue. Emi explained that there are extreme cases where a Board member is just not communicating/engaging; or in some cases, are simply not paying dues.

Minister Ngirmang asked if there are any examples of how the President can work against PIHOA. CEO Muna explained that there are cases where the President is very new and would really need Secretariat staff support to guide them. o Emi mentioned that the New Board Orientation Packet is a tool to help guide members and engage those who may take on new positions. As Executive
Director, she would also provide support to new members. Emi apologized that due to funding challenges, she has not been able to meet in person with new members such as Minister Muller.

Further adjustments were made to the by-laws and tabled for Thursday afternoon for further finalization. Emi would then submit to the Board to review one last time and vote to adopt.
Note to PIHOA
Secretariat Staff – please update New
Board Member
Orientation Packet with new By-Laws once finalized and approved by the
Board.
N/A CDC Preparedness –
Regional Career
Epidemiology Field Officer
(CEFO) placement: Captain
Dr. Randolph Daley, Branch
Chief, Field Services, CDC
Office of State and Local
Readiness
Capt. Daley provided a presentation on Supporting Epidemiology Preparedness in the
Pacific Islands, with a focus on placement of a CEFO in the USAPI. Board member questions/comments:

If a needs assessment is conducted and it’s decided that additional CEFOs are needed, will CDC fund the additional CEFOs? Capt. Daley could not guarantee additional CEFOs, explaining that in the short term, that’s probably unlikely; however, he assured the Board that there is interest in placing other assignees that may augment the CEFO’s work, such as the Chronic Disease Epidemiologist. HHS would want to do this in a way that will maximize resources, with epidemiologists working collaboratively.

How long is the assignment? Typically, CDC insists the jurisdiction commits for a two-year period. Capt. Daley has told his leaders that CDC needs to commit to this
Page 5 of 42

for five years. This is mostly supported, but there are no guarantees; however his leadership has committed to funding this effort for five years.

How will the work be prioritized? This work will be collaborative. CDC needs someone embedded with PIHOA as a Supervisor/Technical Advisor to work with
CEFO and the Board, to ensure the Board is supportive of the CEFO’s work priorities.

Is there any idea of what funding is needed from local jurisdictions? Mainly just support/collaboration by allowing staff to work with the CEFO. The goal is to totally fund CEFO through CDC. There may be a need for travel funding in the future which can’t be paid with federal grant funds, but right now, there would be no expectation of funding support from PIJs.

The timeline seems very close. Have candidates been identified? Yes, there are a couple that CDC is looking at, but Capt. Daley can’t share that information. One person meets CDC’s criteria for a CEFO. A key point is that the CEFO is not supposed to replace current CDC support in the PIJs; the CEFO is supposed to add support.
Capt. Daley thanked the Board and Emi for inviting him to meet them on this project.
He wanted to do this for many years under another program, and is invested in seeing it succeed. He would like to meet with the Board at any opportunity as well as in each PIJ, to continue with this work. He encouraged the Board to speak with him over the next three days and share their thoughts about this work.
Emi reiterated 3 important points:
1.
Regarding needs assessment – PIHOA is having broader discussions with SPC and
WHO on this effort. SPC is considering placing an epidemiologist in their FSM
Office. There is talk of having a team of regional experts.
2.
Ongoing discussions with CDC Chronic Disease Program to place an NCD epidemiologist in the region. This person may be placed in the PIHOA Guam office.
This effort by CDC Preparedness will help pave the way for this additional resource.
3.
Involvement of Board in reviewing CEFO’s work plan – this is so important that the
Board be engaged in ensuring the work is appropriate to both individual PIJ as well as regional needs. This is a pilot approach.
Emi thanked the Board for signing off on the Communique to CDC officially requesting this support, which started the formal process.
Page 6 of 42

CDC Official Visit to the
Board – Dr. Jonathan
Mermin, Director of the
National Center for
HIV/AIDS, Viral Hepatitis,
STD, and TB Prevention
(NCHHSTP): Introductions
– Bill Gallo, Associate
Director for Insular Area
Support, Office for State,
Tribal, Local, and Territorial
Support (OSTLTS)
Bill Gallo welcomed everyone and expressed his pleasure in seeing everyone again. Bill shared that there are several concurrent meetings in Hawaii this week, one of which was with the HIV/AIDS, Viral Hepatitis, STD, and TB network in the region. Bill introduced the next speaker and special guest, Dr. Jonathan Mermin.

Dr. Mermin shared that his office in CDC has tried to adapt approaches for the
USAPI, to provide the best possible support, given our unique challenges. He appreciated the creative work of health departments to address HIV/AIDS, Viral
Hepatitis, STD, and TB shared at the PICSI meeting. He is joined by Derek Felix and
Andy Heetderks, of the TB Division. Bill shared that Derek and Andy have been instrumental in integrating and coordinating the work of programs in the Pacific, as well as the meeting this week. Bill explained that this was an opportunity to simply talk about how Dr. Mermin’s office could help the USAPIs.

Dr. Mermin posed two key questions: 1) How do we know enough about what is going on (what’s happening)? Surveillance that is more accurate and less expensive is needed; and 2) What do you do to address health so that you can increase life spans (what’s needed) and how can CDC specifically help? Dr. Mermin shared that he was struck by Emi’s presentation on Chronic Diseases in the USAPI. He asked what needs to be done to help address chronic diseases that would have the most impact.

Director Berry Moon Watson shared that about four or five years ago, there was a chlamydia study in Palau, but none have been conducted since then. What is the possibility of regular surveillance in this area? Per Dr. Mermin, this is possible.
When all else can’t be accomplished, a public health department should at least do good surveillance. There are ways to do this that can be very empowering for the health departments. One example, in the spirit of simplification and collaboration, is doing a survey for multiple symptoms and health problems. Dr. Mermin would be interested in talking with the Board about a survey that can capture information for multiple conditions / illnesses and uses.

Bill expressed his agreement and commented that we have to be mindful that CDC grant programs are set up in a way that don’t fit perfectly with USAPI needs (e.g. population based funding). CDC funding won’t address all public health needs, so focusing on maximizing resources, finding additional resources, and building local capacity needs to be a priority.
N/A
Page 7 of 42

WebIZ Data-Sharing
Agreement for
Immunization: Mark
Durand, PIHOA Regional
QA/QI/PI Coordinator

Dr. Mark Durand commented that this ties in well with discussions on having a
CEFO in the USAPI – building up local epi skills, creating a mechanism that is tuned in to the stakeholders in the region and in each PIJ. The Board’s feedback is clear direction for Dr. Mermin on needs of each PIJ, as well as support.

Dr. Mermin asked if there are training programs for epidemiology in the USAPI. Dr.
Durand replied that there is a proposal by SPC, which Dr. Tai Ho Chen of CDC is aware of, for a Field Epidemiology Training Program (FETP) for the region. This is in the works. Dr. Mermin commented that there are benefits to having an epidemiologist placed for a long period of time, providing ongoing consistent support. Bill commented that the timing is right – and combined with the Guam lab initiative that is on its way – all efforts fit well.

Capt. Daley shared that his office was very excited that just last month, they placed a jointly funded CEFO (with TB) in Puerto Rico/Virgin Islands.

Emi reminded the Board that there are pending Communiques at CDC, specifically the Interoperability of databases used by programs – not just CDC, but HRSA, SPC,
WHO, etc. Emi has asked Dr. Mermin to raise this issue with other leadership at
CDC that may be able to assist. Emi mentioned this issue at the PIHOA Day 1 meeting. Dr. Mermin shared that it would be beneficial to receive these communiques as he personally has not seen them and could also help address the issue, in an efficient way.

Emi asked about the process for submitting requests like communiques, asking if there one point of contact? Bill advised that for larger issues, correspondence should go to the Center Director, but Bill can help follow up to ensure other relevant Centers receive the information.
Dr. Durand reminded the Board of this discussion, which initiated at the March 2014,
55 th PIHOA Meeting in Pohnpei. This is an opportunity for Immunizations Program staff to track required immunizations for people who move island to island. Dr. Durand posed a question to the Board: Collectively or individually, are you interested in entering into an agreement to share Immunizations records? The current process requires staff in one island to contact staff in other islands by email or phone; and delays issuing immunizations until confirmation is received on a person’s immunization history. Dr. Durand proposed the Pros for this Agreement as:

Save staff time

Improve accuracy of decisions for giving vaccine doses
Board unanimously approved proceeding with the
WebIZ Data Sharing
Agreement, with the condition that all concerns are addressed by CDC.
Page 8 of 42


Increase immunization coverage and protection of your community from vaccinepreventable diseases
Cons: Removes one-by-one review of requests for individual records from your neighbors
Technical Issues: WebIZ Users Group
Comments/Questions:

Jesse Tudela reminded everyone that at the March 2014 meeting, Palau and RMI requested to table the discussion until they were able to speak with their program staff on this matter. Palau also wanted to meet with Dr. Durand on this matter when he was there for EpiTech training. Mr. Tudela asked if Dr. Durand was able to meet with Palau. Dr. Durand confirmed that he did meet with Palau MOH staff; however, he deferred to Director of Public Health, Berry Moon Watson, to comment on that discussion.

Mr. Tudela expressed support if the access is read-only (for review only) and could eliminate other needs for communication. He asked if tracking can be added to see who has accessed your information. Dr. Durand replied that the system is capable of doing that.

CEO Muna: the Health Information Exchange (HIE) allows an opt-out for providers; how does this impact that agreement/protection of information? The CHCC requires authorizations for release of information and they are very careful about releasing any information. Are there legal ramifications with the WebIZ Agreement and the HIE? Dr. Durand shared that this is pretty common in the US mainland, between different organizations within the state. CEO Muna commented that if sharing between states, patients need to be aware of this and give their approval.
If we agree to this, when will it take effect as CHCC would have to inform patients?
CEO Muna shared that the CHCC is trying to link WebIZ with RPMS so they aren’t working in silos.

Dr. Durand proposed that the first question for the board is: Is it a good idea to share information? He advised that control for sharing would be with each health department.

Minister Muller stated that he could see the usefulness of this Agreement, particularly for students who travel to Hawaii for school and may experience delays in starting school due to immunization information; however, there are concerns
Page 9 of 42

with security to ensure that no other information is shared or could be used for studies, research, etc. He wants to ensure that access is controlled and limited. Dr.
Durand replied that WebIZ is a standalone system; there is no access through
WebIZ to get information from the department’s health information system. There is also no way to run reports for the population. Mr. Tudela commented that if
WebIZ is linked to CDC, there should be securities in place. Dr. Durand commented that the WebIZ would only share demographic information.

CEO Muna asked if this Agreement is only for an individual’s status. Dr. Durand confirmed that it is and reminded the Board that their health departments are already sharing this information via telephone, fax or email. WebIZ just provides another way to share.

Dr. Kaneshiro shared that a law was passed last year on Guam that mandates that all providers’ immunization data is entered into WebIZ, with the ability to Opt-out.
Providers were given access to WebIZ and Guam is trying to give other islands access, but the problem is connectivity. It is a benefit for parents who may forget to bring their child’s shot record.

Jesse Tudela commented that informing patients of this data sharing would meet
HIPAA regulations.

Dr. Kaneshiro shared that she conducts HIPAA training on Guam and she knows that
HIPAA regulations allow sharing of information without patient consent for the purposes of treatment, operations and administration. This would fall under treatment. CEO Muna disagreed.

Emi asked if “Other Pacific Island Immunization Programs” on Dr. Durand’s slide refers to the Immunizations Program Coordinators. Dr. Durand confirmed.

Mr. Tudela suggested that the process require that health departments get some form of request for information and consent to opt out within ample time.

Dr. Durand commented that there is clearly a concern about HIPAA regulations.

Minister Ngirmang asked for clarification on: o Where the data will reside? In the cloud. o Who will hold information? CDC’s vendor. Health departments need to pay for access. Anyone asking for access to PIJ information need to ask permission from the health department leadership. This can be given and removed at any time.
Page 10 of 42

Regional Pharmaceuticals
Formulary: Capt. John
Walmsley, Public Health
Advisor, Region IX HHS, and
Mark Burchess, Perry Point
Chief of Logistics,
Warehouse and Logistics
Services, Program Support
Center, HHS, and Clarette
Matlab, Chief Pharmacist,
Palau Ministry of Health and President, USAPI
Pharmacy Association o A concern for his office is that when searching for one name, the system could pull up others with the same name, thus potentially disclosing data unnecessarily. Dr. Durand replied that this can be worked out on the technical end.

Dr. Durand asked if the Board wants to decide on whether or not they think the
Data Sharing Agreement is a good idea, but have the condition that CDC address their specific concerns; Or do any of the Board members want to agree now to share and move forward from there? o For CEO Muna’s concerns, maybe we can ask CDC for a formal legal decision on HIPAA violations. o Minister Ngirmang commented that Palau would want to participate as long as concerns are addressed; and that limitations are clear. o CEO Muna agreed that sharing of information is good and if this allows the patient to get the immunizations, then it is very useful; however, she wants to ensure HIPAA compliance. Also, how do they get other countries to comply as some illnesses resulting from lack of immunizations actually come from visitors?

Minister Ngirmang asked if there a cost for this system. Dr. Durand commented that he doesn’t think so unless you want specialized programming that is not already a capability of the program.
Emi asked Capt. Walmsley to provide an update on the HRSA-PIHOA draft
Communications policy while the operator tried to get other participants on the phone.
Capt. Walmsley discussed the HRSA-PIHOA Communications mechanism which was discussed at the last PIHOA Meeting and is currently under review at HHS. Capt.
Walmsley was ill at the last meeting so he wasn’t sure what decisions were made. Emi shared that the Board approved the draft document in principle, but Herb Schultz wanted more feedback from the Board. Capt. Walmsley shared that Herb is no longer with HHS, but his Deputy is now the acting head of HHS; however, he asked for feedback so that this document can be finalized. A conference call could be a way to test this mechanism.
Mark Burchess of HHS Supply Center and Clarette Metlab of USAPI Pharmacies participated by phone. Mr. Burchess took the lead in providing a PPT presentation. Mr.
Burchess shared that as part of his Master’s Thesis he worked to develop a regional
Board unanimously approved continuing to address this as a priority issue.
Page 11 of 42

formulary, if the Board would like to see it. Further, in the past two years he has worked with the local community college to develop an online accredited supply chain certification that can be used by the Pacific. His hope was that the USAPIs would be able to use this to build capacity.
Clarette asked for clarification on the following:

Who will own the formulary? Will it be the USAPI so they can share with other suppliers or will it be strictly Perry Point’s? It could be taken to any supplier and pharmacies can purchase from anyone.

Is this just for government sectors or can the private pharmacies purchase from
Perry Point? Only government.

What will be required of their governments/health departments to use this formulary? If the Supply Service Center is moving supplies to the satellite warehouse in Guam, they need to ensure there is a demand to support it.

Clarette shared that she is worried that PIJs will be required to make pre-payments or would be limited to buy from only Perry Point. Mr. Burchess replied that there is a requirement that islands stay current on their accounts, within 120 days.
Clarette shared that getting a regional formulary is a challenge because various professionals are needed to give input: pharmacists, doctors, lab workers. Clarette is communicating with all pharmacists in the region to try to develop a regional formulary.
Palau is aiming to have their formulary revised by 2015.
Mr. Burchess shared that he has worked with different embassies and finds that it is difficult to work with physicians on writing prescriptions that are name brand only, versus generic drugs that are more cost effective. Education of the doctors in writing
‘scripts’ is another thing that may help. Mr. Burchess also shared that the Supply
Service Center has adopted a new model for forecasting needs – this new, simpler model is just as accurate.
Capt. Walmsley asked Clarette to confirm that Palau’s formulary will be revised by July
2015 – she confirmed.
Page 12 of 42

CEO Muna shared that the CHCC used to work with Perry Point, but they don’t use them right now. They’ve considered working with them again, but due to higher costs, they’ve opted to use other suppliers. Also, local suppliers are able to deliver directly to the CHCC, versus the need for staff to receive shipments at the port and distribute orders that arrive from Perry Point. If there is a significant cost saving, then maybe
Perry Point can be an option again.
It would be helpful to Mr. Burchess to know if we should continue to move forward with this or not. Clarette stated that a regional formulary and bulk warehouse is perfect, but she agrees with CNMI’s concerns. She will continue to work with regional pharmacists on these issues.
Dr. Greg Dever requested clarification from Mr. Burchess on the online supply chain certificate.

Would it be useful for USAPIs? Can it be done by distance and/or by local community colleges? o The program is geared specifically for distance learning, created with Pacific basin people in mind. Mr. Burchess doesn’t believe it is something that can be done with other community colleges; but it is 100% online and is accredited, so student loans would cover it.

Are pharmacists from USAPI familiar with the curriculum? Do they see it as valuable/useful? o Mr. Burchess is not sure if anyone is familiar with the program. It is geared toward pharmaceutical/medical supplies.

Can the syllabus be shared with Clarette and her colleagues so they can review and see if it would be useful and to determine who could pay for it? Yes.
CEO Muna asked if the Board should vote to develop a regional formulary and to continue researching this effort.

Emi shared PIHOA Board Resolution #43-9, which was to establish a regional formulary. This was signed off by prior Board members, none of whom are currently on the Board.
Page 13 of 42

NPHII/Public Health
Accreditation –
Opportunities for the
USAPIs: Vicky Rayle, Public
Health Advisor/ NPHII
Project Officer and Liza
Corso, Senior Advisor for
Dr. Durand commented that it seems that a lot of this discussion is very technical and was wondering if the Board would like to ask the USAPI Pharmacists to study this issue and come up with recommendations.

Clarette commented that it can be done, but there are challenges based on where each PIJ is.

Capt. Walmsley asked Mr. Burchess to send the supply listing to Clarette to support this work.
Jesse Tudela asked if Mr. Burchess could identify highlight on the formulary the hard to procure items, due to shortage. CHCC pharmacy manager has advised him that there is a shortage of commonly requested drugs – that could be a resource that Perry Point could provide. He will do his best to do that.
Dr. Taulung shared that the FSM does not have a national formulary; the FSM States need to come up with their own formulary before a national formulary is developed.

Capt. Walmsley asked if it would help them to get the template for the formulary.
Yes, it would.

Capt. Walmsley asked Mr. Burchess to send the formulary template to both Emi and
Clarette. Emi offered to distribute to the Board and other key staff as needed.
Minister Ngirmang liked Dr. Durand’s suggestion to have the USAPI Pharmacists address this issue for Board review. Mr. Tudela agreed that PIHOA should continue to explore this issue for cost-saving and a consistent, timely supply source.
Clarette asked for funding support to bring regional pharmacists together to get this work done.
Carol Moehrle presented for PHAB; Kaye Bender thanked the Board for the honor of including them in the meeting agenda and looked forward to the discussion on this matter. Key discussion points:

Guam is going through the process of accreditation readiness, having completed the Community Health Assessment and now working on the Community Health
Improvement Plan. We also got help from ASTHO. Its achievable but will take a lot of work. It was encouraging to see that’s not as much work as we thought. If you went through the process, were there any domains and measures that really stuck
Board unanimously approved to have a formal communique to PHAB, program managers, and staff on the Board’s continued support of this matter, with
Page 14 of 42

Public Health Practice and
Accreditation
Division of Public Health
Performance
Improvement, OSTLTS,
CDC, Carol Moehrle, former President of the
Public Health Accreditation
Board of Directors (PHAB), and Dr. Kaye Bender,
President and CEO, PHAB out? Asked for a plan – not a specific plan – so that made it easier and we have a standing committee that meets monthly.

Yap just completed that (Organizational Self-Assessment) as well and just this week someone was going to come out to provide technical assistance. Ms. Moehrle asked for feedback on whether or not PHAB standards and measures work for the
USAPI. This was done with tribal organizations and adaptations were made as needed/appropriate.

Liza Corso pointed out that the PHAB standards and measures address state, tribe and local health departments. This is a compilation of the requirements for all three types of health departments. There is nothing set up for territories/the
USAPI, but this is an opportunity to do so.

Jesse Tudela shared that he just attended the ASTHO Senior Deputies Meeting and this is a hot topic for the states. He asked Liza to talk about the incentives for being
PHAB accredited and also about how the cut to NPHII funding affects everyone.
Liza shared that the end of NPHII was a huge shock for CDC as well – they are doing their best to address this, with initial focus on the Preventive Health & Health
Services Block Grant.

A CDC accreditation fact sheet was distributed and Liza shared that CDC recently began using a standard Funding Opportunity Announcement (FOA) which should include language about accreditation in each new funding opportunity. What’s exciting is language about accreditation in the budget guidance. This means that as long as work aligns with the funding purpose, some funds/plans can be used to advance accreditation. A table of all FOAs that have come out in the past year was created – in the electronic version it is hyperlinked to the FOA. Regarding incentives: incentives for accreditation preparation are being emphasized, versus those for being accredited. The focus is to try and elevate health departments to a higher level.

Vicky Rayle commented that it was very unfortunate that although NPHII was supposed to be a five-year period, funding was cut. This was really the beginning of the road and the Performance Improvement Managers (PIMs) were working very hard on laying the groundwork for this new approach, which was overarching and had required prerequisites. Small seeds have been planted in the Pacific and CDC hopes to continue to grow these efforts and not have them end with NPHII. They hope that the PIHOA Board as USAPI leaders will continue these efforts. support to the PIMs for them to work with PHAB on reviewing the
Domains, Standards and Measures for relevance and appropriateness to the USAPIs.
Page 15 of 42


CEO Muna added that the CHCC was heartbroken like everyone else when they learned of the end of NPHII and agreed with Vicky that the work for quality improvement must continue. The CHCC is committed to continuing this work. The idea of using different grants to fund these efforts isn’t always supported by
Program Managers.

Carol asked the Board if PHAB requests for input, should they be brought to the
Board or forwarded to their PIMs/staff? Who would be the right audience? The
PIMs.

Emi asked the Board if they wanted to have a group work on reviewing the PHAB
Standards and Measures through the USAPI lens. This was discussed in the past, but does the Board want to revisit this issue? Does the Board want to address this across the region or by PIJs? CEO Muna felt that the PIMs should address this for each PIJ.

Vicky commented that the PIMs would have more knowledge of the standards and measures, but she feels that it would be very helpful for the leadership to gain a basic knowledge so that they can weigh in on it and provide feedback/guidance to
 the PIMs.
Dr. Durand shared that this was brought up at the 53 rd PIHOA meeting and the
Board replied that they wanted the PIMs to focus on this. Also, the PIMs were asked, after completing their Organizational Self-Assessments, to give feedback on this same issue. About six of the PIMs replied and their feedback was that the standards and measures are okay.

Jesse Tudela shared that at the ASTHO Senior Deputies Meeting, they were informed that Congress will be requiring quality improvement in all future funding opportunities.

Dr. Dever thanked Vicky for bringing everyone together. One thing that NPHII did was improve the public health literacy of the PH workforce in the USAPIs. This was transformational. Dr. Dever recommended that PHAB or CDC put together a stepwise curriculum – at least in the PHAB process – that can be taught in community colleges – this would be helpful and could be used in the USAPI.

Liza commented that they realize that when focusing on reviewing the standards and measures, the logistics may be different for the USAPIs as compared to the process used for states, tribes, etc.; however, they will try to support PIHOA as best as possible.
Page 16 of 42

Update on the Pacific
Island Network of Nursing
Education Directors
(PINNED): Terry
Ngirmang, Director of
Nursing Education, Palau
Community College and
Capt. Cathy Wasem, Senior
Public Health Advisor,
USPHS Commissioned
Corps
CEO Muna asked if the Board should vote to keep this as a priority area; ensure that the
PIMs will receive Board support; and have the PIMs work with PHAB on reviewing PHAB
Domains, Standards and Measures for relevance and appropriateness to the USAPI.
Emi suggested the option to have a formal communique to PHAB which can be shared with program managers and staff. CEO Muna made a motion for the communique, seconded by Minister Ngirmang.
Mrs. Ngirmang provided a PPT presentation, emphasizing that a lot of the work was accomplished in conjunction with PIHOA. CEO Muna expressed that PINNED did an excellent job. Capt. Cathy Wasem asked what PIHOA sees as their role in strengthening nurse leaders.

CEO Muna commented that all PIJs share the issue of nursing shortages and we want to have more of our people become nurses.

Jesse Tudela commented that he felt that PINNED goals are very appropriate. He understands that the NMC has approved Kaplan Testing Review for this year’s nursing cohort to aid graduates in passing the NCLEX for U.S. licensure and he encouraged other PIJs to provide this type of support, if appropriate. This is a constraint for the CHCC, although they are receiving more U.S. licensed nurses who come to the CNMI for reasons other than employment.

CEO Muna shared the challenge of moving hospital nurses to meet public health nursing requirements. Education of new nurses is a definite goal.

Mr. Tudela asked if the University of Maine is an option for all PIJs? Capt. Wasem replied that it is. They have been working with cohorts, with community college faculty serving as facilitators.
Capt. Wasem asked if any PIJ nursing position descriptions require that nurses serve as clinic instructors. This could be attractive for new nurses. Mr. Tudela replied that it is not required by the CNMI CHCC.
Dr. Taulung asked how far are we in moving RNs to the BSN level as there is a need for nursing leaders. Capt. Wasem replied that several are in the pipeline and it would be nice to have this set up at the University of Guam. Maybe PIHOA can aid in this effort, through discussions with the Pacific Post-secondary Education Council (PPSEC). Dr.
PINNED will come back to the Board for a more formal request for the support they need.
Emi will work with the Board to call a meeting to discuss the request.
Page 17 of 42

Meeting wrap-up and close: Esther Muna
Time
Taulung shared that lack of a strong foundation in science and math is a barrier to recruit and retain nurses.
Emi raised the discussion point – how can this work more efficiently when trying to cycle staff to get professional development, but ensuring that services are not negatively impacted? Also, how would you incentivize this?
Regie provided guidance on the meeting venues and transportation for the next two days.
Emi will send the draft communique on the WebIZ Data Sharing Agreement to the
Board tonight for their review. A final copy will be printed for signatures on Thursday.
Emi will work on drafting the communique on the review of the PHAB Domains,
Standards and Measures for the board to review.
Emi thanked CEO Muna for accepting the last minute request to preside over today’s meeting. CEO Muna thanked everyone for their patience with her as well as for her election as Secretary/Treasurer. CEO Muna also commented that it was a very good meeting and thanked the Secretariat for their support.
Minister Ngirmang thanked CEO Muna for stepping up to the plate and accepting the nomination. CEO Muna advised of the need to identify a member to preside over the rest of the PIHOA meeting as she will be leaving tomorrow. Minister Muller indicated that he is new to PIHOA, so would like to defer to Minister Ngirmang. CEO Muna recommended Minister Ngirmang, and this was seconded by Dr. Taulung.
Minister Ngirmang moved to adjourn the meeting; seconded by Dr. Taulung.
Agenda Item
Morning Coffee and Fruits / Registration for Invited Guests
Call to Order, Opening Prayer and Roll Call: Minister Ngirmang presided on behalf of the PIHOA Board President; prayer provided by Dr. Taulung. Emi provided a brief
Presenter/Facilitator
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Page 18 of 42

Regional IX HHS – Maternal and Child Health / COIIN:
Vanessa Lee, Project
Officer, Maternal and Child
Health Bureau, HRSA on
behalf of CDR Gor Yee Lum
Emergency Services for
Children and PIER / CDR:
Dr. Louise Iwaishi ,
Department of Pediatrics,
Kapi’olani Medical Center for Women and Children on behalf of Theresa
Morrison-Quinata,
Director, HRSA Emergency
Services for Children and
Duane Lopez, Hawaii DOH
Shriner’s Hospital: John
White, Hospital
Administrator and Donald
Zeke Schmus, Chairman,
Board of Governors,
Shriner’s Hospital summary of the prior day’s meeting and reviewed the day’s agenda. She also advised meeting participants that Secretary Skilling and Director Nua were not able to attend due to obligations in their home countries.
Minister Ngirmang thanked Ms. Lee for her presentation and welcomed participants to ask questions. No questions were asked. Ms. Lee welcomed any questions that may arise in the future and thanked the Board for the opportunity to present to them. Emi offered to compile questions from the Board and to forward them to Ms. Lee when she arrives in Honolulu for the COIIN Summit later this month.
Dr. Iwaishi provided an overview of the EMSC and PIER, along with Duane Lopez who presented on more specific work with USAPIs.

Dr. Dever commented that there is no similar focus for health as that of EMSC. We can use the EMSC process to improve overall EMS in-country. There is a telemedicine community which Dr. Iwaishi has been actively involved, with communications facilitated through UH TASI. How can all these efforts improve
EMSC and EMS in general? Developing guidelines with Hawaii is one way, but this doesn’t mean we’re limited to referrals to Hawaii, as USAPIs often refer to other areas; but the fact is that resources are here and people are willing to work with us at all hours. Dr. Dever looks forward to Dr. Iwaishi organizing the committed humanitarians in Hawaii who will be helping us in the islands.

Dr. Iwaishi replied that it takes time, but by providing education and support, the
USAPIs will be no different from the other Hawaiian Islands. All who get funding from the federal government should be committed to improving this effort. It is clear that there are many people in Hawaii who feel the same.
Mr. White and Mr. Schmus provided an overview of the Shriner’s Hospital. Susan
Yamamoto presented on Telemedicine.

Dr. Kaneshiro expressed appreciation for Shriners’ visits to Guam twice a year.

Clifford Chang congratulated Shriners on their new facility. He asked if their dental clinic is only for patients with orthopedic issues. Mr. White shared that the dental clinic is in development; initially it is only for Shriners kids, but there has been so much interest that they are looking into expanding the program to include dental surgery.

Dr. Taitano extended blessings to Shriners for their wonderful work, stating that if there was a corporate award for health, they deserve it. Dr. Taitano asked if the
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Page 19 of 42

888-number is accessible from Guam. Mr. White replied that it is and thanked Dr.
Taitano for the recognition and appreciation.

Dr. Ian Rouse expressed excitement for the work done by Shriners as there is clearly a need for more work in pediatrics. The Fiji School of Medicine hopes to graduate five pediatricians soon. He would like to visit Shriners facilities to see first-hand how they are set up. Telemedicine is also of great interest to him. In Fiji, the bandwidth is now superfast, so there are great opportunities in tele-health.
Oftentimes, medical professionals come to Fiji to do procedures, but they don’t educate. What is Shriners’ position on education? o One of Shriners’ core principles is research and education. They have many students working with them. Dr. Ono wanted to express to PIHOA that education and building local capacity is a big deal for them. How that will be worked out is not clear and they are open to hearing more about what would work. o Dentistry is also an interest for Dr. Rouse, particularly working with the early intervention services. There is a lot of dental ill health, which contributes to the overall health and well-being of the child. Mr. White asked Dr. Rouse to contact them via email to continue discussions.

Mrs. Terry Ngirmang requested that when Shriners teams come out to the USAPI, to provide a lecture on their visits. Mr. White shared that there is usually a nurse in the group, and they have been tasked by Dr. Ono to teach as well when they are visiting other countries.

Dr. Emais Roberts, a General Surgeon from Palau asked if Shriner’s staff are familiar with the website Pacific Island Healthcare Project. This is a forum for making referrals. Does Shriners have a program like that? They don’t; however, their referrals can be facilitated via email.

Dr. Dever suggested that Ms. Yamamoto revisit communication between Tripler and Shriners because PIJs could request referrals through this system. Ms.
Yamamoto stated that she will revisit it. Dr. Roberts shared that it is a great resource to be able to make a referral on this website and get input from others in the forum.

Minister Ngirmang thanked the Shriners team for the work and support they provide to the Palauan community.

Ms. Yamamoto invited everyone to visit the Shriners hospital for a tour.
Page 20 of 42

Global Heath Security,
Climate Change and
Disaster Preparedness:
Gregg Nakano, Program
Coordinator, University of
Hawaii National Disaster
Preparedness Training
Center
PIHOA QA/QI/PI and HIS
Update: Dr. Mark Durand,
Dr. Kris Qureshi, PIHOA
AQ/QI/Nursing Advisor, Dr.
Ian Rouse, Dean of FNU
College of Medicine,
Nursing and Health
Sciences
Questions/comments:

Dr. Dever asked if Mr. Nakano is familiar with PIHOA’s Emergency Declaration on
NCDs. He commented that this emergency has been PIHOA’s focus, and that building resilient communities increases the chances of successfully addressing these challenges and risks.

Mr. Nakano shared that everywhere he turns, people comment about “low hanging fruit” – but he feels that a lot of times people don’t know what others in their community are doing. If they did, their efforts and successes could be multiplied.
How could we take the work that we are doing and build it up for the long term?

Emi commented that for many pacific islands, this discussion is really more about survival. Island nations like Kiribati and Tuvalu have mandated 40-year outmigration plans.

Dr. Durand provided a brief summary of QA/QI/PI and HIS efforts under PIHOA and invited requests for SOP development projects; QA-QI-PM program assessment and strengthening; Performance indicator development and methods (dashboards); and
Support for college-partnered QI courses

Dr. Durand asked the Board if they would like to continue the PIHOA QA-QI-PM initiative when current grant funding expires. o Mr. Tudela asked when grant funding expires. Dr. Durand advised that the bulk of funding is NPHII, which ends in September 2014.

Dr. Qureshi provided an update on the ongoing International Council of Nursing’s
(ICN) Leadership For Change training which is being provided for USAPI nurse leaders and other health department staff through a collaboration between ICN, UH
Manoa School of Nursing and PIHOA. Seventeen staff completed Workshop #1 in
June and they are back in Hawaii this week for Workshop #2. These staff will be working on projects in-country and will return in January 2015 for Workshop #3. o Minister Ngirmang asked if there will be an evaluation at the end so that
Board members know if their staff passed or failed. Dr. Qureshi replied that there is a pretty vigorous evaluation, the main part being the success of their project. For Workshop #3, those who are successful will be included in the Train-the-Trainer segment, which is the last 2 days. We can share the results of these evaluations with the Board. Dr. Qureshi asked that the
Board check in with these staff to see how they are progressing and to provide encouragement.
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Page 21 of 42

PIHOA HRH Update: Dr.
Greg Dever, PIHOA
Regional HRH Coordinator, and Dr. Ian Rouse, Fiji
National University (FNU) o Minister Ngirmang shared that some programs have not been as successful as they would like; partly due to a lack of evaluation and discussions on improvements that could be made to ensure program success; and then sending feedback up the chain to management. o Dean Rouse asked if the ICN work will be published or written up. He commented that skilling-up nurses is a great need. Dr. Qureshi shared that
ICN asked her to present a talk in South Korea in June about doing work on a regional level. There have been discussions to have nurses write up their projects to possibly put together a monograph via the ICN. Dr. Qureshi is careful about going out to the USAPI to gather stories for publication as it can be a sensitive matter, but having USAPI staff do the write ups and sharing them via our networks would be helpful. Dr. Rouse clarified that he is interested in simply telling the story, versus peer reviewed journals. Dr.
Qureshi invited everyone interested to attend the graduation.
Health Information Management: Dr. Durand provided an overview of HIS assistance provided by PIHOA as well as regional products resulting from this work. Issues for
Board consideration: Nominations to DDM3; Strategic approach to epi/data skills
(Identify data & epi staff as target for EpiTech); and Communiques related to EpiTech-
DDM.
Dean Rouse was invited to share his thoughts on the EpiTech-DDM partnership with
PIHOA. He provided a PPT presentation for the Board. He shared that he really enjoys collaboration with PIHOA as no organization has enough resources to address all health needs.
Emi asked that if any questions arise they be forwarded to her or you may email Dr.
Durand or Dean Rouse directly.
Dr. Dever provided a brief summary of HRH efforts under PIHOA.

Ms. Francyne Wase-Jacklick, proxy for Minister Muller from RMI, commented that she didn’t see Nurse Practitioners mentioned in his presentation. She thanked Dr.
Dever and Dean Rouse for their work and hopes to see more done with nurse practitioners in the near future.
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Page 22 of 42


Dr. Durand commented that there is a Public Health Training Program in Guam and
American Samoa Community College is currently recruiting students to attend their first public health program that is starting next week.
Dean Rouse presented more on Post-Secondary Education in the Blue Continent.

Minister Ngirmang thanked Dean Rouse for his support in the Bachelor in Nursing
Degree Program in Palau (Public Health). He asked if it is possible to develop a
Bachelor’s in Clinical Nursing Degree Program. Dean Rouse replied that it is. Two years ago they started a Bachelor’s in Nursing Program in Fiji; they are looking at a bridging program focused on clinical nursing.

Capt. Daley asked Dean Rouse to comment further on his final point about the challenges of training a workforce and keeping them in the Pacific? How do you make that happen? Dean Rouse shared that the challenge is in the health system.
From his point of view, all of the key programs are internationally recognized, but for medicine, you can’t just go and practice anywhere – you have to be licensed. So how do you create an environment where people will want to stay with challenges like not being able to match salaries? You have to try and increase the person’s pride and desire to help their home. Create an environment that is an enjoyable place to work. In Fiji, there is not enough of an effort in this area; there is still more to be done. Ease of migration and students’ abilities to pass entrance/licensing exams makes this harder. We somehow have to find a way to make them stay.

Dr. Dever asked Dean Rouse to explain more about the FNU’s evaluation of the
Cuban Medical School graduates from the Pacific. Dean Rouse shared that this was a fascinating situation in which about 200 Pacific Islanders were trained in Cuba and returned to their islands. They required a two year intern training program, which
FNU helped to support for Kiribati, with AUS Aid support. This is a much longer internship than is done in Fiji. The initial assessment of Cuban graduates is that their training was pretty reasonable with primary health care, but not so good with clinical skills. Another issue was translating course work from Spanish to their native languages and vice versa. Initial assessments of the interns are that most students are doing well. It’s been very positive and the feedback from Kiribati is that it’s incredibly positive for their healthcare system. Solomon Islands is the next group and they have the capacity to run their own intern program, but they have
Page 23 of 42

PIHOA Lab Strengthening
Update: Vasiti Uluiviti,
PIHOA Regional Lab
Strengthening Coordinator;
Dr. Chris Whelen, Hawaii
State Lab Director; Dr.
Philip Dauterman, CHC Lab
Director, CNMI; Dr.
Matthew Bankowski,
Diagnostic Lab Services
(DLS) Lab Director asked FNU for help. They are optimistic that most of the students, after the two year internships, will be doctors.
Vasiti welcomed special guests in the lab network and provided a brief summary of Lab
Strengthening efforts under PIHOA.
Director James Gilmar from Yap asked for clarification on Vasiti’s comment that labs in the FSM could apply for accreditation. How do they do that? Vasiti replied that they simply need to communicate their request to Vasiti or PIHOA to initiate the process.
Dr. Matthew Bankowski of DLS provided a brief overview of their organization and the work they do in the USAPI. He thanked Vasiti for her excellent efforts in this area, acknowledging her key role in the progress made to date.

Mr. Gilmar asked that since DLS has labs in Guam and Saipan, is there still a need to send specimens beyond those islands? Yes. DLS Hawaii is the reference lab so they run a lot more tests.
Dr. Chris Whelen presented an overview of the Hawaii State Department Labs and the work done to support the USAPI.

Director Paulino Rosario asked about the average turnaround for testing. Dr.
Whelen advised that usually test results can be reported in two days, but for urgent matters like the current measles/Chikungunya, they try to do in one day. Results are communicated via email to Vasiti and health departments and are sent without patient identifying information.
Dr. Philip Dauterman presented on recent efforts to improve the CNMI CHCC lab. Dr.
Dauterman thanked everyone who helped in these efforts.

Jesse Tudela thanked Dr. Dauterman for all his hard work as he was instrumental in this progress and CLIA Certification. He asked Dr. Dauterman to share with the
Board and DLS their ventures with the GeneXpert capacity. Dr. Dauterman shared that the GeneXpert machine has 16 slots, but only four are operating. They want to increase to having eight slots working. The CHCC will need to buy additional components to do a multitude of other tests. They have gone live with gonorrhea, chlamydia and TB testing at this time.
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Page 24 of 42

USAPI NCD Response
Roadmap Re-Visited and
Regional Stock Take
NCD Surveillance: Update and Next Steps: Emi
Chutaro and Mark Durand,
PIHOA Secretariat

Mr. Tudela asked Dr. Dauterman to speak about physician’s responses to having timely results. Two years ago, a lot of tests were not being done. Clinicians were not happy. The lab is now able to do all basic chemistry tests daily, brought micro back in-house with relatively fast turnaround time on in-house micro, and are doing
GeneXpert testing. Mr. Tudela thanked DLS for being CHCC’s reference lab, although they have drastically reduced the sending of specimens’ off-island.

Minister Ngirmang asked if Dr. Dauterman could share the costs of the lab upgrades, excluding the EHR. Per Warren Villagomez, it was quite costly with a lot of work involved, for an approximate cost of $300k. Mr. Villagomez thanked the
Hawaii State Lab for their support to the CNMI as well.

Clifford Chang gave kudos to the CHCC for all their efforts in turning around the situation at CHCC.

Emi commented that the situation with the CNMI, as with American Samoa in obtaining/maintaining Medicare certification requires the support of many partners and collaborations to succeed.
Emi gave an update on PIHOA’s efforts to address NCDs in the region. Dr. Rachel
Novotny gave brief updates on childhood overweight/obesity meta-analysis and the
Children’s Healthy Living (CHL) Program data collection & management. Emi acknowledged Dr. Lee Buenconsejo-Lum and her team at the UH Pacific Cancer
Programs who PIHOA contracted to develop the content for the NCD Policy Toolkit, working in collaboration with Secretariat staff Billie Hiraishi and PIHOA web manager
Jason Aubuchon.

Mr. Gilmar asked why Yap was not included in the Hemodialysis study. Emi explained that it was mainly due to the very small pot of money for the study.
Kosrae was not originally included, but Kosrae asked to be included and invested their funds to do so.

Capt. Walmsley shared that he understood that a number of congresspersons approached DOI about concerns of the impact of FAS migrants to their areas. He believes that between them, they identified the locations to be studied.

Dr. John Taitano commented that when dealing with limited resources and looking at the results of the dialysis study, we need to look at how dialysis treatment is administered. Hemodialysis doctors love the business, but we, as a society, need to consider quality of life for patients who are no longer functioning members of
Page 25 of 42

society. It’s not a popular position, but from a clinician’s point of view, that is how he looks at it.

Dean Rouse commented that when looking at the cost of dialysis, you’ll never get much of a positive side economically, except for the doctors. He also asked about the progress on the NCD Policy Summit. Emi advised of roadblocks such as changes at the Taiwan Embassy in Palau and budgetary constraints. Dr. Rouse replied that this is a critical, important issue. The sooner we can get it to happen, he will be a great supporter. We need to rekindle the enthusiasm from 2010-2011.
Dr. Durand provided an update on NCD Surveillance. He reminded everyone that it was the PIHOA Board that directed the Secretariat to focus on NCD surveillance. Dr. Durand proposed that updates are needed to PIHOA’s Regional NCD Surveillance Framework, even after just two years. He also emphasized the value of PIHOA-driven NCD products
& tools because they are comprehensive of all major risk factors, include church and traditional leader policies, include input from multiple agencies/experts, they were developed by USAPI technical working groups, efforts included PIHOA Affiliate members, and they are specifically tailored to the Pacific Islands.
Dr. Durand asked the Board to consider: a Communique to HLC to request an update on the NCD Core Surveillance Framework and continuing regional NCD Surveillance and
Progress Updates.
Questions/comments:

Dr. Roberts shared that the Palau government, about six years ago, banned shark fishing and that has worked. Greater work needs to be done with island leaders to take stronger measures to address NCDs. If we need to ban cigarettes, then ban them.

Dr. Durand commented that one challenge is that the PIHOA Board does not make policy, but maybe the NCD Policy Summit could have an impact on engaging the policymakers.

Angie Techur-Pedro commented that since PIHOA is issuing these reports and our
Board of Directors are the heads of health departments, is there anything the Board can do to ensure we get NCD data that is lacking? Dr. Durand replied that a lot of this is the reality that multiple TA agencies in a small area come in and recommend
Page 26 of 42

different things, but no one is really coordinating this at either the PIJ or regional level. Things are not well coordinated, but they can be.

Mr. Gilmar believes that data/information is available, but maybe better communication and understanding is needed. Dr. Durand replied that there are various reasons for the gaps, but more effort just needs to be made to fill the gaps, surveillance teams need to ensure they have a plan and work needs to be done to analyze the data.

Dr. Lee Buenconsejo-Lum commented that this issue of surveillance and the difficulty PIJs are having is not new. CDC has changed their expectations for grantees to be as data-driven as possible and to have measureable outcomes. We are starting to see more energy and mandates to get data. The issue of coordination and communication is challenging at every level, even within CDC.
Messaging from CDC to PIJ staff who handle data bases still needs some work.
Some PIJs collaborate well, sharing data; but for others, this can still be a problem.
For some jurisdictions, the data just isn’t there, although the communication / coordination systems are in place. At the last CCPI/Tobacco meeting, there was a lot of interest in coming up with a minimum data set that PIHOA has already endorsed. Barriers include hesitancy at PIJ level due to lack of staff, lack of data, holding onto data, etc. Most data is available, but there are challenges with coding and other requirements that prohibit use.

Dr. Novotny expressed her enthusiasm to work with PIHOA and partners in these efforts. On one hand, her program looks at how they can contribute, but also considers who needs to be at the table. In the next year, CHL will be able to offer data from all PIJs; perhaps they can have a working session on how to add children’s data into surveillance efforts. CHL also has PIJ trainees who are returning home and need support to carry out projects.

Bill Gallo asked the Board where PIJs are with plans. Do they have timeframes?
Budgets? Are all needs being met? Is anyone tracking progress? What supports are needed? o Dr. Kaneshiro replied that on Guam, the new NCD Plan was published this year. The NCD Consortium meets monthly, divided into five action teams.
They have goals and timelines. They are very active.
Page 27 of 42

o In Palau, they had a 3-day workshop to develop their NCD Plan, with help from WHO. It hasn’t been published yet, but once done it will be shared.
They passed a tobacco tax increase, which will increase annually. o Dr. Durand commented that everyone has had NCD Response Plans, but most haven’t had NCD Surveillance Plans which are linked to the NCD
Response Plan. o Bill shared that CDC grant program staff will be the first to say that CDC funds are not sufficient to implement these efforts. o Emi asked Cerina to share progress of Guam’s NCD Consortium policy efforts, which Cerina is engaged in actively. Cerina shared that although each of the NCD Working Groups has a policy activity in their plans, there is no strategic approach to implementing policy interventions.
Emi thanked everyone for their attention and acknowledged that more discussion is needed to keep this moving forward. Emi encouraged participants to contact PIHOA
Secretariat for more information that they may want to review.
Capt. Walmsley wanted to mention that Region IX will be having a Region IX Prevention
Strategy Summit, focused on tobacco-free and healthy living on August 27 th , here at UH
Cancer Center.
Meeting wrap-up and close Minister Ngirmang, presiding on behalf of the PIHOA Board President, thanked everyone for their participation today. He acknowledged that there was a lot of information to digest and that require a Board decision, which they will work on tomorrow. Minister Ngirmang again thanked Dean Ian Rouse for his help with the Palau
Nursing Program.
Time Agenda Item
Morning Coffee and Fruits
Presentations
Call to Order, Opening Prayer and Roll Call: Minister Ngirmang, presided on behalf of the PIHOA Board President; prayer provided by Director Paulino Rosario.
Presenter/Facilitator
Page 28 of 42

USAPI NCD Law and Policy
Summit and Logistics: Emi
Chutaro and UH JABSOM
Rep (TBC) and Temengil
Temengil on behalf of
Minister Ngirmang, Palau
Minister of Health
This item was moved up on the agenda as the presenter was scheduled to leave in the afternoon.

Emi advised that the proposal for the NCD Policy Summit with a proposed budget was submitted to the Palau Ministry of Health for transmittal to the Taiwan
Embassy in Palau, who was interested in co-sponsoring the Summit with the Palau
MOH. She shared how the Health Leadership Council would be engaged in the planning of the Summit. The ultimate goal of the Summit is to have a supportive environment in place for program people who are working on NCD policy. Emi shared that a critical component is to build in strong evaluation processes – both regionally and by jurisdiction – so that we know if our work is effective. Emi also shared that it has been difficult to identify funding for the Summit. Both Minister
Ngirmang and former RMI Minister Kabua suggested approaching the government of Taiwain, and that leads us to the update that Mr. Temmy Temengil will provide.

Temmy provided a briefing to the Board, which was a timeline detailing PIHOA’s work with the Palau MOH on the NCD Policy Summit. This was discussed at the
March meeting, with November 2014 as the target date for implementation. At that time, a few PIHOA Board members requested time to get clearance from their governments on any political concerns. In April a proposal was submitted by PIHOA to the Taiwan Embassy and we are awaiting a decision from the Republic of China
(ROC)/Taiwan on this any time. Temmy stated that if support from Taiwan is not available, the Palau MOH is willing to host the Summit, covering venue and food, but they are not able to pay for travel costs.

Emi shared that if able to get funding, 2-3 months is not sufficient to plan the
Summit well. Another planning consideration is that MCES and APIL have meetings twice a year, which coincide pretty closely with PIHOA meetings. We could have discussions with them on convening our meetings in Palau at the same time. It may be difficult, but we can ask. If Palau is willing to host the Summit, it would coincide with Palau’s Integrative Medicine Conference.

Dr. Livinson Taulung asked if anyone has considered that by November, there could be new Secretaries, Ministers and Directors of Health, as well as new APIL and
MCES members due to elections.

Minister Muller suggested continued discussions with the ROC about funding support. He is meeting with them tomorrow and asked if it would be okay for him to discuss the need for their support. Minister Ngirmang agreed with this idea. Emi
Emi will draft the communiques per
Board discussion and decisions.
Board unanimously approved Palau as the venue for the next PIHOA meeting to coincide with the
NCD Summit, targeting the first two weeks of March
2015.
The next PIHOA jurisdiction meeting will be hosted by the
RMI (early 2016).
Page 29 of 42

will provide Minister Muller with background information so that he is wellprepared for the meeting.

Minister Ngirmang clarified that regardless of whether or not we get funding, we will not have the Summit until after elections in November. Emi asked the Board to identify a target date. Board members discussed scheduling the Summit back-toback with the next Board meeting in March/April 2015.

Minister Ngirmang asked Temmy to give some information about the Integrative
Medicine Conference in Palau in November 2014. Integrative medicine looks at balancing approaches of western, eastern, traditional medicine, etc. The meeting is scheduled to coincide with the NCD Summit, but Palau is also working around the schedule of a key presenter, Dr. Weil, who will be in Palau from November to
December. Minister Ngirmang advised that once dates for the conference are confirmed, they will let Board members know.

Emi asked for the Board’s decision on the NCD Policy Summit. Minister Ngirmang stated that it will be sometime in 2015 and may coincide with the next PIHOA meeting. The venue for the next meeting needs to be decided and it should be in one of the PIJs. Emi provided a history of PIHOA PIJ meeting venues, from the most recent and back: Pohnpei, CNMI, Guam, Palau, American Samoa and RMI. Minister
Muller commented that it may be time for the RMI to host the next PIHOA meeting and volunteered to do so.

Mr. Gilmar asked Emi to clarify when the MCES meeting will be held. Emi replied that they usually have it around March/April each year. Minister Muller requested time to review his schedule, but requested that the Board meet again to finalize the
 date. Minister Ngirmang agreed.
Minister Ngirmang asked that if we get support from ROC, will we have time to coordinate the Summit by November. Emi replied that we can do it, but she isn’t sure it well be done as well as we’d like. Minister Ngirmang commented that the election is also an issue. Minister Muller commented that if we have the PIHOA
Board meeting and Summit back-to-back, we should have it in one place due to cost. If this needs to be done in Palau, that is fine. The next PIHOA meeting can be held in RMI. Dr. Kaneshiro agreed with this plan. Warren Villagomez commented that attendance could be better if hosted in one venue.

Emi suggested that the Board vote to have the next meeting in Palau, followed by the RMI for the jurisdictional meeting. We will target March, if all schedules work
Page 30 of 42

out. Warren asked for tentative dates as federal partners will also be planning their activities around that time. Emi suggested that the Board identify dates and we can communicate that to CDC for their planning purposes. Minister Ngirmang suggested the first two weeks of March. He suggested that no more than one full week be planned for both the PIHOA meeting and the Summit, so that people aren’t away from work/home too long.

Emi asked about next steps, suggesting PIHOA formally communicate Summit plans to MCES, APIL, and key partners like SPC, WHO, CDC, DOI, etc. Emi offered to draft a communiques for the Board; one communique will be for technical partners and another can be to decision-making bodies such as MCES, APIL, Traditional Leaders and PIHOA. We will need signatures of all Board members.

Emi asked who should be part of the organizing committee. Minister Ngirmang asked if partners such as SPC, WHO, etc. could be invited as technical experts; that would allow them to use their budgets for travel. Emi advised that some organizations like SPC have policies that don’t allow them to use funding from jurisdictions for their participation, but in the Summit budget, we did include funding for others who may not have funding available. Minister Ngirmang suggested that the PIHOA Secretariat lead the organizing committee. Emi suggested that not too big of a group be brought together as it could complicate planning. She suggested a core group, a Board representative, as well as participation by NCD program staff or consortium members. Warren Villagomez recommended that each PIJ have a representative. Emi asked if the Board would consider including a representative from MCES and APIL Secretariat as well as someone from the Traditional Leaders. The next meeting of the Traditional Leaders is in Majuro. Dr. Taulung recalled past discussions that the Summit would be geared to policy makers who could be champions for NCD policy to promote and implement the NCD Emergency Declaration, as well as to build capacity for sound, reasonable health policies. Limiting involvement could exclude the very people who were expected to be the target audience for the Summit. Dr. Kaneshiro suggested keeping the organizing committee limited to one representative small, one per partner. Emi clarified to have one each from MCES, APIL, Traditional
Leaders, and PIHOA Secretariat.

Emi asked if the Board would like to see content area/technical experts such as
WHO’s partner, the International Development Law Organization (IDLO), who have
Page 31 of 42

Strengthening Engagement with HRSA-funded
Community Health Centers in the USAPIs: Clifford
Chang, Executive Director,
Pacific Islands Primary Care
Association been doing a lot of work in NCD policy. Dr. Kaneshiro felt it was a good idea as they can help with subject matter topics and field experts/resources. The Board was okay with including content area experts.

Minister Ngirmang reminded that while planning, we also need to look at cost. Emi agreed and shared that while developing the budget, the costs of a face-to-face meeting of the core planners was included, as well as communication costs.
PIPCA staff, Arielle Buyum, presented on a new HRSA FOA for New Access
Points/Community Health Centers (CHCs). PIPCA is available to help health departments with their applications.

Yap Director James Gilmar asked if information on the new FOA has been passed on to Yap and other regional CHCs. Cliff confirmed that it was sent out to the PIPCA contacts at the CHCs. Mr. Gilmar commented that Yap is building a new facility but they are hoping to get some funding assistance from programs. Cliff offered to communicate with Mr. Gilmar on how PIPCA can assist.

Dr. Durand asked if it was possible to submit an application for more than one New
Access Point. Arielle replied that each application is capped at $650,000 for all sites included in the application.

Minister Muller asked for a status update on the Laura CHC site – Cliff shared that
PIPCA does not have an update at this time, although there have been past discussions with RMI MOH staff. Minister Muller appreciated the information as some of the past RMI staff have since retired. He will follow up with his staff.
Cliff presented an overview of HRSA Operational Site Visits to the CHCs.

Dr. John Taitano shared that on Guam, he may want to refer patients from the hospital to the CHC, but limitations like CHC hours and limited appointments is an issue. Arielle acknowledged that PIPCA is trying to address this and commented that the CHC should not be used as an Urgent Care area. It can be used as a followup; the CHC is a primary care provider and regular patients can be received as walkins. The CHC should not be an overflow for the emergency room. Cliff expressed that PIPCA would like to help the CHCs with follow-up care for patients discharged from hospitals. Dr. Taitano shared that on Guam they are still working on an agreement between the CHCs and hospital.

Palau Director Berry Moon Watson asked about agreements with other providers for services they can’t/don’t provide. Arielle confirmed that you could have a
N/A
Page 32 of 42

Health Leadership Council:
Patrick Luces, Health
Leadership Council and Emi
Chutaro referral system which requires the provider to follow the CHC’s sliding scale/costs but there are other referral systems that don’t require adherence to CHC costs.

Warren Villagomez asked if Rota and Tinian will have a separate Board. Arielle replied that this has not been completely decided, but they are looking at adding representatives from Rota and Tinian to the existing Kagman Board.

Ms. Watson asked if MOU/A need to specify credentialing and privileging for each licensed staff member who works independently at the CHC. Arielle advised that the MOU can state that the MOH will do the credentialing, but the CHC Board of
Directors will approve the process/policy for privileging, ensuring that the appropriate treatment is provided. Arielle offered help to anyone who needs it.
Minister Muller asked if this can be a problem when most Board members are not medically trained. Cliff replied that the Board has final approval of the privileging, but they rely on CHC staff who have the knowledge/skills to ensure competence of clinicians hired to do appropriate work at the CHCs.
Cliff reiterated PIPCA’s goal to help CHCs to meet HRSA requirements and asked the
Board to communicate with them on how they can do that. He shared that PIPCA relies a lot on PIHOA staff, Drs. Dever and Durand, for information on what happens at the
CHC and thanked them for their support. Arielle commented that the HRSA grant, with a co-applicant, can be very confusing and is tedious, and they appreciated the Board’s attention to their presentation. Minister Ngirmang thanked Cliff and Arielle for their very informative presentation.
Emi reminded the Board that all presentations will be provided to them in a flash drive.
She announced that the US Department of Defense Pacific Command, Admiral Chin and staff would like to meet with some Board members, tomorrow, August 15 th at 9am at the PIHOA conference room. Palau, CNMI and Guam have confirmed. Emi will arrange for pick-up at Ala Moana hotel to the PIHOA office.
Clifford Chang of PIPCA presented on behalf of the HLC, providing an overview of the history and rationale behind the creation of the HLC. He advised that Board the HLC leaders (Va’a Tofaeono, Chief Councilor from CCPI; Patrick Luces, Vice Councilor from
PCDC; and George Cruz, Secretary from PPTFI) were not able to present due to conflicting travel schedules.
HLC matter tabled pending further review and update of the Terms of
Reference and that
Page 33 of 42


Minister Ngirmang asked for clarification on the HLC seeking funding support and if there will be an effort to ensure the HLC does not duplicate what PIHOA and others are doing. Cliff replied that the HLC is cognizant of this concern. The HLC has no intention of competing for funding opportunities with PIHOA and other partners.
HLC needs funding to support efforts such as monthly conference calls; however, they will not compete for funding. HLC wants to leverage what others are doing, working synergistically to overcome silos, and to strengthen relationships and the work we do. The NCD Road Map is based on three tiers: 1) each individual organization’s plans to address NCDs; 2) collaboration between/among organizations to address NCDs; and 3) regional efforts by all or many organizations to address NCDs.

Dr. Lee Bueconsejo-Lum of UH/CCPI shared about the National Comprehensive
Cancer Control partnership, which consists of numerous national organizations who have individual goals but collaborate to address cancer. The HLC is organized similarly to address NCDs. She explained that if we know what each other are doing, we can communicate on how we can share resources to move our work forward. She gave examples of how this has been done.

Director Berry Moon Watson asked if the HLC will replace PIHOA as a regional leadership body. Cliff replied that it will not. PIHOA represents the governments of all six USAPIs. The HLC is more like non-government/non-profit organizations and focuses on working with government.

Jesse Tudela commented that what is confusing is that PIHOA is a member of the
HLC. It’s odd that PIHOA is part of the HLC when the HLC is a technical advisor to
PIHOA. Mr. Tudela suggested that it’s a matter of name changing as you’d want the
HLC to report to PIHOA. There was a lot of discussion on PIHOA’s role with the HLC when it was first organized. At that time, PIHOA offered to help provide funding support to support the HLC (primarily through conference calls) as well as to provide Secretariat support. Mr. Tudela understood the need and the approach, but the financial aspect confuses things. Cliff reiterated that the HLC would not compete for funding, but is seeking financial support for the HLC’s efforts. Mr.
Tudela clarified that his concern is regional organizations coming to PIHOA asking for financial support to participate in HLC activities, when PIHOA is also a member of the HLC. all Board concerns are addressed.
Page 34 of 42


Emi shared that her understanding from Michael Epp was that the PIHOA leadership, when addressing NCDs, asked who could provide help/advice. Emi stated that it’s really about how PIHOA effectively utilizes its affiliate members. The
Board has agreed that affiliate membership helps to serve as advisory for the Board.
The concept of the HLC wasn’t to create another separate entity, but it was creating a mechanism to ensure communication and collaboration between organizations to address issues, such as NCDs, as mandated by PIHOA. The HLC should not be doing anything independently from the Board – their work should be directed by the
Board and aligned with PIHOA’s work. Emi has discussed this with the HLC, to ensure that the hierarchy is clear between PIHOA and the HLC. Emi acknowledge that the Board’s concerns are very valid. She has discussed with the HLC leadership the need to update the HLC Terms of Reference. Emi suggested that the Board review the Terms of Reference and suggest changes, as needed to the HLC.

Berry Moon Watson asked how the Terms of Reference relate to the individual organizations. Emi reviewed the Terms of Reference with the Board.

Minister Muller asked if Emi could provide information on what each of the regional organizations is doing. It seems that there are so many meetings and travel, but we need to see more being done on the ground to address issues and to better understand how these regional groups help the individual USAPIs. Emi replied that almost all members of regional organizations are health department staff.

Minister Muller asked what PIHOA can do to speed up service delivery to our people. Emi stated that this is exactly why the HLC was created – to be able to have these discussions, better communication, and leverage resources. Minister Muller stated that we are competing for the same resources but it seems that funds are spent more administratively and need to have a bigger impact on the people. Emi acknowledged that the HLC is not the best mechanism, but it is a start.

Emi acknowledged that there is a need for the HLC to communicate better with the
Board. This is a work in progress.

Berry Moon Watson agreed with Minister Muller that nothing is trickling down to the ground. There is no clear direction of what needs to do in terms of policy and other aspects of NCDs, with the exception of surveillance. It is very fragmented.
Emi suggested that this be fed back to the HLC. Ms. Watson stated that at the end of the day, our concern should be the population. She sees the HLC as another layer of bodies.
Page 35 of 42

PIHOA Financial Status:
Alicia Sitan, Finance
Officer, and Emi Chutaro,
Executive Officer, PIHOA
Secretariat

Dr. Taulung shared that two years ago it was the Board’s decision to endorse the
HLC. Many of the affiliates attended the Board meeting and shared how they are addressing NCDs. At that time it was clear that there was a need to bring these affiliates together and it was decided that PIHOA needed to be part of the HLC as the policy arm. Dr. Taulung suggested that the Terms of Reference be changed to ensure that there will be no conflict with the mandate of the PIHOA Board – that there will be no competition with PIHOA in any way. Cliff commented that when looking at the members of the HLC, it needs to be clear that not all organizations are required or need to be affiliated with PIHOA, but choose and request to do so because they recognize the value and importance of doing so.

Minister Ngirmang stated that the purpose of HLC as presented by Cliff and Emi are slightly different, as is the Terms of Reference. He commented that numerous concerns have been raised that need to be addressed. He suggested that we continue discussions and look at the Terms of Reference for revisions. Emi agreed with the Minister’s direction and shared that she has had discussions on these same issues with HLC leaders and members.

Jesse Tudela asked about ASTHO funding – Alicia reported that most funds are program related. Is QA included in that work? No. There are four projects funded by ASTHO: HRH, Resource Management, Senior Leadership Development and Lab.
We were just advised by ASTHO that $155k was just approved for an HIS project.
Emi explained that the HIS project will help with WebIZ work that was discussed on
Tuesday, as well as surveillance training. There are a number of pending work plans from a few years ago that have not moved forward pending progress in other areas.
Dr. Durand commented that there might be ideas for HIS help/work that may be covered under this project and he would like to hear about any interest. Emi will provide copies of the HIS project to the Board.

Emi shared plans to be able to account for specific work done for each PIJ. When
PIHOA submits grants, we are trying to ensure that a majority of grant funding goes to the PIJs, which presents a challenge for providing sufficient salaries for
Secretariat staff. Minister Muller asked if the Board could get financial information
 for their individual jurisdictions for the last year or two years, which is very helpful.
Minister Ngirmang commented that Alicia estimated $1.5M annually for PIHOA operations and reported that there would be a deficit. Alicia explained that the majority of administrative costs are covered by CDC and HRSA grants, which will be
Board voted to hire the PCO Director as a full-time staff position.
Page 36 of 42

ending soon. Emi shared that the loss Alicia mentioned in her report was referring to unfunded salaries resulting from cuts to grant funding. Dues were used to cover some of these costs. Alicia reported on grants which PIHOA applied for which, if funded, will help cover that deficit. Emi advised that she could provide copies of the grant applications to the Board if they would like to review them. Emi shared that there is a possibility that personnel funding will be impacted and she has discussed this with Drs. Dever and Durand.

Alicia specified the following decisions needed from the Board: o PIHOA needs to continue to find a multi-year funding source to cover basic operational expenses o Hiring of PCO Director to be primary contact for PCO activities related to our HRSA grant - Emi explained that this is a HRSA requirement. Dr. Dever has been doing some of this work, but he has expressed that this is not his field of expertise or major interest. For the past few years, PIHOA has had a small contract with Angela Techur-Pedro to do HPSA/MUA work under this grant. Dr. Dever has offered to continue to provide guidance and support to Angela, but encouraged Emi to hire Angela at the full-time level as she has the expertise. Dr. Dever’s time will be reduced as a result of this decision. Director Paulino Rosario moved to hire the PCO Director full-time; seconded by Minister Muller.

Emi is 90% sure we will get the HRSA grant; 60% sure of the DOI and is unsure of the PICH grant. If these grants do not come through, we will have to have to cut staff time for Dr. Dever, Dr. Durand and Emi, but Emi stressed the need to keep
Administrative staff at 100% to ensure grant compliance. Vasiti’s position has been pretty secure as funded by DLS and APHL. Alicia suggested that PIHOA revisit
ASTHO budgets and propose revisions.

Emi discussed the Secretariat’s efforts to address sustainability. Emi shared that in
March the Board discussed a Foundation or Endowment Fund for PIHOA. That may take years, but we will have to start looking into this now. Emi shared an opportunity under Amazon Smiles, through which someone requested to donate a percentage of their purchases to PIHOA. It’s a smaller scale effort, but it’s a start.
Another option is seeking help from philanthropic groups like the Gates Foundation.
Some efforts have been made to reach out to these groups, but eligibility is an issue. Director Berry Moon Watson asked if PIHOA applies for NIH grants. Emi
Page 37 of 42

Launch of the USAPI NCD
Policy Toolkit: Emi
Chutaro, Dr. Lee
Buenconsejo-Lum of UH
Pacific Cancer Programs and Billie Hiraishi
ASTHO Senior Leadership and Strategic Resource
Management
Competencies: Emi
Chutaro replied that she has looked into the grants but PIHOA was not eligible for most. Dr.
Lee Buenconsejo-Lum added that many NIH grants are research-based, and although efforts have been made to get NIH to consider community-based research, they have not been successful. Emi asked the Board to consider helping to identify funding sources to support the Secretariat. Emi has reached out to SPC and WHO and they are also going through funding challenges. How can we do business differently as a Board to address the situation? Minister Ngirmang suggested Emi look at cutting operational costs before affecting staff time. Emi shared that PIHOA had experienced significant loss due to over-expenditure in some areas, but we have since eliminated that problem. We have also implemented account coding to be better accountable for staff time and other costs. Lastly, we passed financial policies and procedures in March to guide efforts.

Dr. Taulung commented that given PIHOA’s work on NCDs aligns with that of the
Joint Economic Management Committee (JEMCO) and Joint Economic Management and Financial Accountability Committee (JEMFAC), maybe DOI funding could be accessed to support PIHOA’s work. Emi shared that unallocated Compact funding needs to be funneled through each PIJs respective Compact budgets. The DOI grant we applied for is under the DOI’s TAP grant.
Emi provided an overview of the work that led up to the development of the toolkit, which was completed through a contract with UH Pacific Cancer Programs. Dr.
Buenconsejo-Lum and Billie reviewed the Toolkit with the Board.
Minister Muller shared the challenge of unintended consequences experienced when implementing tobacco policies (black market) in the RMI.
Senior Health Leadership

Emi provided the Board with an update of the Secretariat’s efforts to identify training opportunities for Board members and their senior leaders. She shared that both this meeting and the March PIHOA meeting were supported by these ASTHO grant funds.

Emi requested the Board’s approval on a report that explains the current status of
USAPI health leadership and a tool that identifies the competencies for effective health leaders. She presented the American College of Healthcare Executives
(ACHE) Healthcare Executive Competencies Assessment Tool 2014. Emi reviewed
Board approved use of the ACHE
Healthcare Executive
Competencies
Assessment Tool for completion by Board members and senior health department staff.
Page 38 of 42

the tool with the Board. Director Berry Moon Watson shared that this tool could be used by health department leadership staff as well as the Board.

Minister Ngirmang asked Emi to clarify how the assessment works. Emi explained that it is a self-assessment, so you rate yourself. Dr. Kaneshiro asked if anyone evaluates the results. Emi replied that we are communicating with ACHE to ask for guidance on the rating – whether it’s done in-house or if we send it to the ACHE.

Minister Ngirmang asked if there was any more information to reference for the assessment if areas are unclear. Emi and Cerina advised that the document lists references and reading material which were used to develop each section of the assessment tool. Secretariat staff have been in contact with ACHE to ask if about adapting the tool and to see if there is a shorter version. Minister Ngirmang asked if there was guidance on estimated time to complete the assessment. Minister
Ngirmang expressed his interest in assessing his staff rather than himself. Emi replied that the tool could be used by senior health department staff.

Emi asked if the Board and senior health department staff would be willing to complete the assessment tool and when completed if the Board could give feedback to the Secretariat on elements that they felt were missing from the tool.
Secretariat staff will compile the results and report back to the Board. Dr. Taulung moved to approve Emi’s request; seconded by Mr. Gilmar.
Strategic Resources Management

Emi explained about historical concerns with USAPI grant programs’ inability to spend funds, which has led to budget reductions and discussions on defunding grant programs, and the need to gather data to better understand this issue. In her experience at SPC, she used indicators such as Fund Utilization Rates and Cash Burn
Rates. Fund Utilization Rates look at total expenses versus awards over the entire project period. Cash Burn Rates are broken down by fiscal year – looking at how much was awarded and spent each year. Ideally this is done by activity areas – this can be difficult.

Emi has begun collecting data on major grant funders. We have some information from CDC and we have communicated with SPC, WHO, and others. Funders are able to provide award data as this is public information, but they cannot release expenditure data. We can either get expenditure data directly from PIJ health departments or Board Members can give their express permission to allow their
Board approved to give Secretariat staff access to health department grant expenditure data.
Emi will prepare
Concept Paper that will be given to finance offices as advance notice on this project and detailing the specific data requested.
Board approved the
USAPI Resource
Management
Capacity
Questionnaire and the conducting the survey with health department staff.
Page 39 of 42

governments/funders to release data to the Secretariat. Emi explained that PI information will be limited to herself, Dr. Durand and Cerina. Emi asked the Board: o Do you want us to have access to expenditure information? o How would you like us to access the information?

Minister Muller wholeheartedly supports this effort. Every year, the RMI returns hundreds of thousands of dollars to the U.S. government.

Warren Villagomez suggested that to be sure information is accurate, we should get data directly from health departments because there can be redirections that the funders may not be aware of.

Berry Moon Watson asked if Secretariat staff were asked by donor agencies to do this study for them. Emi replied that we had not. We have heard complaints from various funders for some time, which has prompted discussions internally that we need to see the data so that we can communicate better on this matter. Also, if threatened with defunding, USAPIs need to have some way to reply/respond back to funders.
Emi shared that she has another tool that she’s seeking the Board’s approval to use, which is the USAPI Resource Management Capacity Questionnaire. This will allow us to gather data from health department staff who manage grant programs to better understand their education/skills/competencies levels; training received; and other information that will help us to build capacity for grant managers in the USAPI.

Dr. Kaneshiro shared that she was asked to do an online survey. She didn’t do it and the organizers knew she didn’t do it, so there seems to be a way to track who has completed the survey. Emi replied that there may be a way to track this, but we won’t ask for individual names. Raw data will be available for Board review.

Minister Ngirmang feels it would be good for senior managers to know how their staff do on the survey to enable them to work with their staff on professional development. Emi replied that we can include names in the survey tool, but she feels it may make participation difficult. Ms. Watson suggested coding the names.

Ms. Watson asked if the tool is completed. Emi replied that its 98% completed and may be piloted on Guam.
Emi advised if the Board votes to allow the Secretariat to access expense information, we will work with the Board on getting signatures for consent forms after the meeting.
Page 40 of 42

Open discussion /
Resolutions and
Communiques
Jesse Tudela moved to approve the requests; seconded by Warren Villagomez. Minister
Ngirmang suggested we give some advance notice to finance offices on the effort and what specific data is requested.
1.
Progress in the Fight Against NCDs in the USAPI: 2000-2013; publication drafted by
Dr. Durand: Emi reviewed the draft report with the Board, which has been prepared for publication. Dr. Durand advised that this was sent to technical partners and the Board for comments and feedback. He explained that releasing this document is valuable because: 1) it’s a product for grant funders who supported this work; and 2) it is a way to gather more support to fill the gaps identified in the paper. a.
Minister Ngirmang felt that Dr. Durand’s comment is helpful to understanding the need to publish this document. b.
Jesse Tudela asked if the information is up-to-date. Emi replied that the information was up-to-date as of March, but it has been sitting since then. Mr.
Tudela requested that if all Board members agree to release this document, then require that another document be generated as soon as possible with updated information. Dr. Durand agrees that this is a good process to continually update it. Dr. Durand said that this can be done by communicating with USAPI staff who have surveillance data, which Secretariat staff can do with Board approval. Dr.
Durand suggested the option to gather new data in the next month, to update the document, and release it then. Mr. Tudela was worried that since this was addressed by the previous Board, he felt the report should be issued as is, with an update provided soon after. He would prefer more updated information be released. c.
Dr. Liv Taulung acknowledged that FSM data is missing and that is an internal challenge but they don’t want to hold other USAPIs back. d.
Minister Ngirmang asked why data is missing. Dr. Durand explained that not all blanks will be filled-in based on how often surveillance is conducted. There are key surveillance areas that you want to track regularly. There are also problems with comparability of data sets. Minister Ngirmang asked if that has been noted in the report. Emi replied that this is noted in the Discussion section.
2.
Emi reviewed Board communiques from this meeting. a.
56-01: USAPI Immunization Data-Sharing Agreement (WebIZ)
Board agreed to release this document, with a mandate for
Secretariat staff to update the report annually.
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Closing Remarks b.
56-02: Increased engagement of PHAB with PIHOA and the USAPIs c.
56-03: Appreciation to WHO for support by Dr. Rodel Nodora for HRH d.
56-04: Appreciation to Rapid Project for DDM-EpiTech Training e.
56-05: Appreciation to SPC for DDM-EpiTech Training f.
56-06: Appreciation to CDC for DDM-EpiTech Training g.
56-07: Appreciation to WHO for DDM-EpiTech Training
Minister Muller asked if the Executive Director could sign the letters of appreciation instead of the Board. He explained that Board members are members of organizations like SPC and this is the type of help they expect of them. Emi replied that she could do that, but in the past, letters of appreciation have generally come from Board members.
Dr. Kaneshiro indicated it is more meaningful to our partners if it comes from the Board themselves.
Emi asked the Board to complete a meeting evaluation.
Minister Ngirmang, presiding on behalf of PIHOA Board President, commented on three pending items:
1.
NCD Law & Policy Summit – funding
2.
HLC Terms of Reference – given that the PIHOA President and Vice-President had concerns, along with other Board members, this needs to be resolved. We didn’t decide on when this well get done and it may not be addressed until the next faceto-face meeting, but we’ll need to communicate via email and narrow down issues to be able to make decisions regarding the HLC at the March meeting.
3.
PIHOA Finances – continue to look at operational costs for saving measures as well as how PIJs can help.
Minister Ngirmang expressed that this has been a very productive meeting. He thanked
Emi for her leadership and the support of Secretariat staff. He shared that he initially questioned the rationale for having the meeting in Hawaii, but sees that it is valuable to have the many partners that were able to attend the meeting, which may not happen in the FAS jurisdictions. It was an honor to preside over the last two days of the meeting.
Emi thanked everyone for their attendance and participation, and especially to Minister
Ngirmang who came to the meeting not expecting to take on this extra responsibility.
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