<PIHOA letterhead>
March, 2015
PIHOA Communique #___________
Dr Ursula Bauer
National Center for Chronic Disease Prevention & Health Promotion
US Centers for Disease Control and Prevention
Atlanta, Georgia
<send similar letter to Randolph Daly or whoever is in charge of PH Preparedness Program>
Subject: Requesting endorsement of a unified approach to data and surveillance dapacity building in
the USAPI
Dear Dr Bauer
In recent years, the Pacific Islands Health Officers Association (PIHOA) has increasingly recognized the
need to improve the use of surveillance systems to guide disease response among its member states, as
set forth in PIHOA Resolutions 41-7 (“Recognizing the importance of improving the region’s surveillance
system to promote early detection and response to disease” March, 2006) and 48-01 (“Declaring a
regional state of health emergency due to the epidemic of non-communicable diseases in the United
States-Affiliated Pacific islands”, April, 2010). The recent placement by the CDC Public Health
Preparedness Program and the National Center for Chronic Disease Prevention and Health Promotion of
two epidemiologists with PIHOA in our Guam office has the potential to greatly improve the capacity of
our health agencies to manage data and surveillance well.
One of our biggest challenges in capacity building in the USAPI is the dis-coordination between the
various technical assistance agencies in the region. To make best use of the CDC epidemiologists who
have been placed with us, we are proposing the alignment of effort of our CDC epidemiologists through
the creation of a unified “Regional Epidemiology Capacity Building Unit” (REU) which will work toward a
set of common capacity building objectives, and subscribe to a common set of guidelines for
engagement in our countries (see attached concept brief).
We are very aware that both of our CDC epidemiologists also have imperatives from CDC that are part of
their job expectations; these will be incorporated into the objectives of the REU to allow both the
assigned epidemiologist, and also the rest of the team to address them.
With this letter we are requesting that you endorse this unified approach to capacity building in the
USAPI, subject to any statutory limitations that you have.
Thank you for your kind consideration of this request.
Sincerely,
<PIHOA Board Signatures and Title Lines Here>
ATTACHMENT:
Concept Brief: USAPI Regional Data & Epidemiology Capacity Building
Unit (REU)
Introduction:
With the placement of Drs Thane Hancock and Haley Cash, there are now three epidemiologists working
for PIHOA. This provides an historic opportunity to build epidemiology and data capacity in the region,
as called for in PIHOA Board resolutions #41-7 and #48-01.
Goal: Build core workforce and system elements in USAPI health agencies to improve the use of data
for health.
Core Capacity Elements:
Workforce- cohort of Epi-Technicians (10-12 for larger agencies, 5-6 for smaller) and 1-2 fully qualified
applied epidemiologists for each USAPI, able to function across program areas. Technicians may include
data-responsible officers for preparedness, Non-Communicable Disease (NCDs), communicable disease
(CD), vital stats, performance management, environmental health, maternal and child health (MCH),
mental health and substance abuse (MHSA), and information technology (IT).
System Elements CD surveillance & response standard operating procedures (SOPs)
 Functional EpiNet outbreak response teams
 Routine weekly CD surveillance reports (linked to functional EpiNet teams and incident
command systems)
 Timely, high-quality outbreak & public health emergency situation reports
 Annual CD surveillance summaries
 NCD monitoring & surveillance plans that fit with the USAPI NCD Core Surveillance Framework
 Annual NCD core surveillance and response profiles (linked to NCD coalitions and the USAPI NCD
Policy Commitment Package)
 Annual CD and NCD Surveillance System Evaluations and improvement interventions
Methods:
Formal Capacity Building MOUs are developed through consultation between our Board members and
the regional epi unit (REU). MOUs cover selection and expectations for Epi Technician trainees, and
selection of system elements to be built, and the roles and support to be provided by both the
Director/Secretary/Minister and the REU.
REU epidemiologists will work as a team to execute the MOU for each USAPI, with Dr. Cash especially
(but not entirely) focused on NCDs, and Dr. Hancock on CDs and preparedness. In country we will work
directly with our Epi-Tech counterparts to do the work called for in the Agreements. A key objective of
REU epidemiologists is to help their counterparts advance toward Epi Technician Certification through
delivery of DDM courses. Later on, advanced epidemiology fellowship candidates will be selected by
Heads of Health from those who have completed Epi Tech Certification. These candidates will enter the
Pacific SHIP fellowship (once it is up and running) to receive advanced degree training in epidemiology.
REU epidemiologists will meet with each Board member once per year to review and update their MOU.
Activities of REU epidemiologists:
1) Outreach Training Services: DDM training will be offered to Epi Tech cohorts in each jurisdiction.
This will be a way of taking the DDM training into the islands (and away from hotel conference
rooms).
2) Site Visits for Capacity Building Work: REU epidemiologists will work in-country to build system
elements called for in the MOUs. They will always work directly in collaboration with their Epi
Tech trainee counterparts.
3) Outreach extension services by REU Epidemiologists for other tasks on request: These tasks may
include design of needed surveys, data set analysis, outbreak investigations, EHR planning,
guidance for effective use of registries, project assist in preparing funding proposals, and
trouble-shooting of data system components.
4) Additional work plan elements prescribed by CDC PH Preparedness Program, National Center for
Chronic Disease Prevention & Health Promotion and other funding sources that are supporting
REU epidemiologists.
REU Coordination:
 Regular phone conferences among REU epidemiologists to triage requests and coordinate
services delivered;
 Copying each other on all REU related correspondence;
 Unified quarterly progress reports to PIHOA ED & Board;
 Letters of Notification to Board members via Emi Chutaro for all upcoming site visits;
 Annual REU retreat to evaluate progress and prepare next steps.