Regional Health Committee (RHC)
Preparing for the Storm:
Reducing Health Systems Vulnerability and
Building Resiliency in Micronesia
RHC Members and Contributors
 Presenter: Dr. Thane Hancock,
 Yap Health Services Team:
 Director of Yap Health Services, James Gilmar
 Deputy Director of Yap Health Services, Dominic Taruwemai
 Chief of Public Health, Julie Yoruw
 Lab Supervisor, Maria Marfel
 NCD Program Coordinator, Geraldine Dugwen
 Ancillary Services Chief, Jesse Haglelfeg
 Quality Assurance Coordinator, Lucy Gubgow Bigelow
 Guam Speaker and APIL President, Judy Won Pat
 Thank you to the ministers, directors, and secretaries of health of the RMI, ROP, FSM
National, Kosrae, Pohnpei and Chuuk states, Guam and the CNMI who remotely
contributed to the discussions of the RHC
 Thank you to Emi Chutaro (PIHOA), Larry Goddard, and Damian Hoy (SPC) for their
advice and support
Presentation Outline
 Analogy of the Leaky Canoe and our Health Systems
 Describing the Canoe: Vulnerable Health Systems
 The Health Storm: Upcoming Challenges
 Navigating the Health Storm: Building Resiliency
 Strengthening Health Workforce
 Defining Epidemiology
 Strengthening Epi Capacity in the Northern Pacific
 Regional Healthcare Plan
 MCES Commitments
 MCES Resolution
A Proud History of Voyaging the Unknown
Our Health Systems: A Leaking Canoe
Heading into the Storm…
The Leaking Canoe: Highly Vulnerable
Health Systems
 Narrow financial resource base – too many eggs in one basket; highly
reliant on external funding sources to maintain a significant proportion of
core clinical and public health infrastructures and services
 Financial management systems and bureaucracies – current systems
often create significant bottlenecks in healthcare service delivery and
fund utilization, jeopardizing funding eligibility and negatively affecting
health outcomes; also strong need for improved leveraging and
coordination of existing financial resources to increase cost-effectiveness
and realize value-for-money
 Strategic Health Planning – often quite siloed (i.e. program or diseasebased); too many uncoordinated health plans; plans often linked to
funding sources so sustainability is a problem
The Leaking Canoe Continued….
 Qualified human resource base – insufficient resources and evidencebased policies and means to enable and encourage new generations
into needed health profession fields, including improving K-12 outcomes;
existing critical gaps in strategic and long-term planning and investment in
up-skilling and incentivizing current health workforce; need for
comprehensive human resource management plans and systems
 Capital improvement – need for evidence-based policies and strategic
planning processes for long-term and cost-effective procurement,
maintenance and utilization of equipment and other health infrastructure,
including IT
The Leaking Canoe continued…
 Health policies and legislation – need for better enforcement and
promotion of existing health policies and legislation, and alignment
of existing policies and legislation to health services; continuing gaps
in legal framework for health promotion and health protection
 Health Information Management Systems (HIMS) – need for robust
and accurate data and information collection and analysis to
regularly inform appropriate and relevant evidence-based strategic
health planning, program design, performance monitoring and
improvement, etc.
The Health Storm: 2023 and Beyond
1. Ending of the Compacts of Free Association between the US and the RMI and
FSM; anticipated increase in Compact impact for Guam, CNMI, Hawaii and
other US mainland destinations once compacts end
2. Increasing Congressional monitoring of US federal dollars to the US Pacific
Island Jurisdictions for health – may mean future difficulties in maintaining and
sustaining US federal funding eligibility and continued access to some
categorical funding programs, including possible decreases in funding ceilings
3. Demands for accurate and regularly collected health data to show evidence
of impact on health indicators/outcomes, including value-for-money and
other fund utilization measures are increasing from external funders such as
the US and other international donors
4. The high burden of infectious disease and non-communicable disease in the
Pacific has economic impacts that will increasingly strain national/state and
even personal budgets
5. A crisis of human resources for health is looming with an aging health
workforce, and few qualified trainees in the pipeline
Navigating the Health Storm and Building
Resiliency
We cannot solve all challenges and barriers
We can better navigate the health storm by build our resiliency to dealing
with inevitable shifts in our economic, political, socio-cultural and
geographical environments
As such, we need to:
1. Establish new or strengthen existing cost-effective and locallyadapted data collection systems;
2. Train local health staff to analyze data and be able to formulate
sound recommendations for program improvement, public health
response and health policies; and
3. Establish new or strengthen evidence-based health workforce
development mechanisms and human resource management
systems to ensure sustainable and long-term supply of local, qualified
health professionals
Committing to and investing in health workforce development as part of a
comprehensive process for health system strengthening and performance
improvement in the immediate and long term:
Builds a strong foundation for guiding and directing health system
performance across all the health components, including:
 Human Resource Management Systems and Health Workforce Succession
Planning
 Clinical Services
 Hospital and Emergency Preparedness
 Communicable and Non-Communicable Disease Prevention and Control
 Medical Supplies Procurement
 Laboratory Services
 Public Health Prevention Programs/ Community Health Interventions
 Health Policy Development
Current Health Workforce Development
Efforts
 HR Management mentoring and coaching – special thank you to the Minister of
Palau for releasing his HR Manager and IT staff to provide training and technical
assistance to the FSM states to set up their HR systems
 Oral Health Workforce Education Planning and Implementation
 Formal undergraduate Public Health training network with local community
colleges
 Environmental Health strategic planning and workforce training and education
 Nursing Education - training local clinical faculty, establishing and implementing
Bachelors in Public Health Nursing and Nurse Practitioner Training Programs at
local community colleges, and supporting Chief Nurse Association
 Home Caregiving training to families for the homebound
 Foundations Sciences implementation (preparation for health professions)
 Continuing health professional development – all levels
 Health licensure boards and professional associations, including improved
coordination (e.g. Health Leadership Council)
Epidemiology: Navigating for Health
 “The basic science of Public Health”
 The study of the distribution and determinants of health related
states, and the application of this study to control health problems.1
 The practice of epidemiology involves the collection of data,
processing and analysis of data, creating and using reports to guide
programs planning, systems design, and monitoring interventions
Last JM, editor, Dictionary of Epidemiology, 4th ed. New York: Oxford
University Press; 2001. p. 61
1
Uses of Epidemiology
 Public Health Surveillance – Assessing the community’s health;
monitoring NCDs and health risk factors
 Field Epidemiology – Searching for causes; identifying what is causing
an outbreak of fever and rash in a community
 Monitoring and Evaluation – Assessing public health services and health
activities for relevance, effectiveness, efficiency and impact; human
resources for health, immunization programs
 Linkages – Develop and maintain collaboration across disciplines and
jurisdictions
 Assists Policy Development – Utilizes data to provide input and
recommendations for health policy development
Committing to and investing in epidemiology capacity as part of a
comprehensive process for health system strengthening and performance
improvement in the immediate and long term:
Enables identification of key problem areas and successes to allow for
implementation of appropriate interventions/policies in:
 Human Resource Management Systems and Health Workforce Succession
Planning
 Clinical Services
 Hospital and Emergency Preparedness
 Communicable and Non-Communicable Disease Prevention and Control
 Procurement and Medical Supplies/Pharmaceuticals
 Laboratory Services
 Public Health Prevention Programs/ Community Health Interventions
 Health Policy Development
Current Efforts to Strengthening Epidemiolgy
Capacity in the Northern Pacific
 Since 2013, PIHOA and SPC, further supported by the CDC, FNU, UOG, and WHO
have been working to develop and implement a series of regional epidemiology
training programs for local health staff across all health departments:
a.
b.

EpiTech/Data for Decision-Making (DDM)
1.
Outbreak Surveillance and Response
2.
Basic and Advanced Epidemiology and Data Analysis
3.
Public Health Surveillance (routine systems and surveys, M&E and
project management)
4.
Local improvement projects
Strengthening Health Interventions in the Pacific (SHIP) – Pacific
adaptation of the Epidemic Intelligence Service training program
developed by CDC
Since 2013, over 60 local health staff have initiated EpiTech training. Special
thank you to Guam and Palau for hosting the last 2 regional Epi trainings!
Request MCES Commitment
Regional
 Commitment #1 – Commit to and invest in health workforce
development, including support of current efforts by PHIOA,
FNU, UOG, UH and the USAPI local community colleges, to
develop and deliver accredited health professions training
programs focused on critical health professions gaps
 Commitment #2 – Commit local resources to support current
and joint efforts amongst SPC, PIHOA, US CDC, FNU, UOG and
WHO to establish and implement regional epidemiology
training programs
 Commitment #3 – Commit to and support sub-regional efforts
through PIHOA, the US CDC and SPC to establish and place
regional Epidemiologic technical expertise within the US
jurisdictions
National/state
 Commitment #4 – Commit to and support the establishment
and expansion of HR Management Systems and HR
positions as essential and core-funded function and
positions within the ministries/departments of health
 Commitment #5 – Commit to and support local health
ministries and departments to establish/sustain national and
local-level Epidemiology positions as essential and corefunded function and positions within the
ministries/departments of health
MCES Resolution: Continuing the Fight Against
Non-Communicable Diseases (NCDs)
In recognition of:
 The multitude of technical assistance efforts and providers
available to the Pacific region;
 And, that these same efforts and providers operate in both the
Northern and Southern Pacific;
 And, that despite some good examples of specific areas of health
coordination, collaboration and resource-sharing amongst the
varying technical providers and funding agencies;
It is clear that the current levels of coordination, collaboration and
resource-sharing amongst the regional technical and funding
agencies still falls short of realizing true and long-term gains in
combatting NCDs.
This resolution is aimed at addressing:
 Greater and improved coordination and collaboration between
and amongst the regional health agencies operating in the
Northern and Southern Pacific for:
 Improved cross-sharing of technical resources; and
 To establish stronger synergies between the South and the North,
and to support cross-fertilization of efforts in the South to the
North.
Critical to ensuring an effective response to NCDs
across the Pacific region!