55th PIHOA Board Meeting Minutes
11-13 March 2014
Pohnpei, Federated States of Micronesia (FSM)
College of Micronesia-FSM National Gym, Palikir
Meeting Participants:
Executive: Secretary Vita Skilling (FSM National DHSA), Director Tuileama Nua (American Samoa DOH), Minister Gregorio Ngirmang
(Palau MOH), Dr. Suzanne Kaneshiro (Guam DPHSS, proxy for Director James Gillan), Assistant Secretary Russell Edwards (RMI MOH,
proxy for Minister David Kabua), and Warren Villagomez, (CNMI CHCC, proxy for CEO Esther Muna)
Associate: CEO Joseph Davis-Fleming (American Samoa LBJ Hospital and proxy to Director Nua), Director Livinson Taulung (Kosrae
DHS, FSM), Director Paulino Rosario (Pohnpei DHS, FSM), Deputy Director Dominic Taruwemai (Yap DHS, FSM), Director Julio Marar
(Chuuk DHS, FSM), Jesse Tudela (CHCC Hospital), Edgar Santos (Director, Pohnpei State Hospital and proxy to Director Rosario), Dr.
Debbie Ngemaes (Director of Hospital Services and Administration, Palau MOH and proxy to Minister Ngirmang)
Affiliate: Clifford Chang (ED, PIPCA), Dr. Yvan Souares (SPC), Tebuka Taoto (SPC), Salaseini Elbourne (SPC), and Kasian Otoko
(President, AUL)
Guests: Dr. Rohko Kim (WHO), Dr. Sevil Huseynova (WHO), Dr. Rodel Nodora (WHO), Dr. Peter Hoejskov (WHO), Patrick Moses
(President, NPEHA), Bill Gallo (Associate Director, CDC OSTLTS), Capt. John Walmsley (Region IX HHS), Sameer Gopalani
(Epidemiologist, FSM National), Karl Ensign (ASTHO), Katie Sellers (ASTHO), Allison Mendoza (ASTHO), Patricia Coleman (CNMI NMC),
Dr. Shyamajanaka Mahakalanda (FNU), Dr. Ilisapeci Kubuabola (FNU), Temengil Temengil (Executive Assistant, Palau MOH), Marcus
Samo (Assistant Secretary, FSM National, Dr. Dorina Fred (Chuuk DHS, FSM), Deputy Chief of Mission Miguel Ordonez (US Embassy,
FSM), and Australian Embassy AusAID representative
Remote Presenters: Mark Burchess (Perry Point) and Theresa Morrison-Quinata (HRSA EMSC)
PIHOA Staff: Alicia Sitan, Regie Tolentino, Dr. Greg Dever, Vasiti Uluiviti, Dr. Mark Durand, Cerina Mariano, and Emi Chutaro
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Agenda Item
PIHOA Board Closed Meeting
Opening Prayer
Roll Call / Welcome and
Opening Remarks
Acting President Skilling
Remarks by Emi
Review and adoption of the
54th PIHOA meeting minutes
Review and adoption of the
55th Meeting Agenda
PIHOA Board Election
DAY 1
Discussion
Decisions/Action Needed
Dr. Livinson Taulung, Director of Health Services, Kosrae State Department of
Health.
The meeting commenced at 9:20am by PIHOA Acting President, Dr. Vita Skilling,
Pohnpei Secretary of Health. Dr. Skilling welcomed the traditional leaders of
Pohnpei, PIHOA Board Members, Associates, Affiliates, and Secretariat Staff to
the meeting. She also extended her appreciation to College of Micronesia, FSM
Staff and other who helped prepare the facilities for the meeting.
PIHOA Secretariat Executive Director (ED) Emi Chutaro also provided remarks as
this is her first official PIHOA meeting, after her hiring in October 2013. ED
Chutaro shared that priority concerns facing PIHOA right now are financial
Issues and the question of whether PIHOA should be the united voice for the
Region.
Dr. Skilling expressed her appreciation to ED Chutaro for her diligence and work
conducted for PIHOA thus far.
Dr. Skilling requested recommendations, feedback and a motion to adopt the
minutes from members who were present at the 54th meeting. Minister
Ngirmang replied that he was present at the meeting and the minutes look
accurate to him. He moved to adopt the minutes.
Dr. Skilling opened the floor for discussion on the meeting agenda, calling for
additions, deletions, etc. A motion was made to approve the agenda.
Current PIHOA Board Executive Members: FSM is Acting President/Vice
President; CNMI is Secretary; and RMI is Treasurer. Dr. Skilling opened the floor
for nominations for all positions.
Presidential nominations:
 Republic of the Marshall Islands (RMI) nominated FSM; seconded by Palau.
 American Samoa (AS) nominated Palau. Director Nua shared his thoughts
that the upcoming year will be very challenging and he is not sure that 6
members will be able to carry the load and it is fortunate to have ASTHO,
which brings value to what PIHOA is doing. He has had the opportunity to
The motion was carried
and the minutes
adopted.
The agenda was
approved as is.
Newly elected PIHOA
Executive Board
Members are as follows:
President: Secretary
Skilling, FSM National
Vice-President: Director
Nua, American Samoa
Secretary/Treasurer:
Minister Kabua, RMI
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speak with Minister Ngirmang about how the Affordable Care Act applies to
the territories and Freely Associated States (FAS); and about how Palau has
a system in place that addresses this. As such, he nominates Palau for
President.
o Minister Ngirmang respectfully declined the nomination as he is
relatively new to the Board.
Vice-Presidential nominations:
 Commonwealth of the Northern Mariana Islands (CNMI) nominated AS;
seconded by Palau & RMI.
 Nominations closed.
Hand-over of the President’s
Anvil and special recognition
of outgoing and incoming
Executive Officers
Plenary Discussion
Guam Regional Lab
Dr. Suzanne Kaneshiro, Chief
Public Health Officer, Guam
Department of Health and
Social Services, on behalf of
Director Jim Gillan
Palau recommended that the offices of Secretary and Treasurer be combined
into one position. Secretary/Treasurer nominations:
 Palau nominated RMI; seconded by CNMI.
 Nominations closed.
Dr. Skilling officially opened the meeting as the newly elected PIHOA President.
Dr. Kaneshiro presented a PPT presentation, prepared by Josie O’Mallan, on the
Guam Regional Lab (clinical). Cindy Naval presented on the Guam Mosquito
Lab, operated by the DPHSS Mosquito Surveillance and Control Program based
out of the Northern Community Health Center in Dededo, Guam. Food testing
services will also be conducted at this lab. Guam DPHSS hopes to build capacity
to provide support to the region. They are still trying to train their staff and get
their facilities in place. Board members and other meeting participants engaged
in a discussion with these key points:
 Interest in the menu of services that will be provided by both labs.
 Interest and support in ability of other USPIJs to send specimens to Guam
for testing, instead of to more distant countries/locations.
 Staff from other USAPIs participating in lab training, along with Guam staff.
Dr. Skilling requested
that the Secretariat
follow up on discussions
with the Association of
Pacific Island Legislators
(APIL) on fees/funding to
access Guam’s regional
lab.
Guam requested a letter
of support to the Guam
Legislature for both labs
in case they go before the
legislature for funding.
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RMI suggest that while Guam is working on lab constructing the facilities,
perhaps other USAPIs should work on logistical issues in their islands so that
they are ready to access Guam’s services as soon as they are operational.
AS suggested that PIHOA connect all islands to come under the regional lab.
This would build justification and sustainability for the future. Hopefully, this
would include satellite labs in Micronesia, so that no tests are sent outside of
the region in the future.
PIHOA Operations Manual –
selected items for Board
review and approval:
1. New PIHOA Board
Member Orientation
Packet
2. PIHOA by-laws
3. PIHOA Employee
Handbook
4. Fiscal policies and
procedures
PIHOA Secretariat:
Cerina Mariano, Project
Manager
Alicia Sitan, Finance Officer
Emi Chutaro
Dr. Kaneshiro distributed copies of the Guam NCD Plan to Board members.
All Board members were provided a flash drive containing meeting documents.
Emi reviewed the content with the Board.
Board Orientation Packet: Cerina reviewed the newly developed orientation
packet which is geared to new Board members.
 Dr. Skilling requested that a statement be included on financial
management, specifically explaining how membership dues are used and
accounted for.
Orientation packet:
Approved with addition
of a statement on
management of
membership dues.
PIHOA Bylaws: Emi requested Board guidance on how to address updating the
bylaws. In her review, there are inconsistencies in the guidelines per the bylaws
and how the board actually operates. Key discussion points are as follows:
 Convene a committee that is comprised of all 6 Pacific Island Jurisdictions
(PIJs) and the Secretariat. Representatives don’t have to be just Board
members – Associates can be designated.
 Each PIJ review bylaws and submit recommended changes to Secretariat in
a week or two, meet in the Pacific to discuss and make changes. Meeting
face-to-face will be budget dependent and decided by Emi. Another option
is to meet via teleconference.
 Have recommended revisions by the next PIHOA meeting.
Bylaws: Each PIJ is to
review the bylaws and
submit recommended
changes to Emi two
weeks from today (March
25th).
Employee Handbook: Alicia and Cerina provided a brief explanation about
PIHOA’s split from the Research Corporation of the University of Hawaii (RCUH)
in June 2012, which resulted in the need to develop policies and procedures as
Employee Handbook:
Approved with suggested
revisions.
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PIHOA is now a freely standing, independent non-profit organization. Cerina
and Alicia reviewed the Handbook with the Board, which was adapted from
PIHOA’s Human Resources contractor in Hawaii. Key discussions points and
suggested edits are as follows:
 Include specific positions that should always be filled.
 Personalize greetings for all PIJs – not just Aloha.
 Policies should defines the salaries, roles and responsibilities, pay raises,
operations, how decisions are made, etc. Staff are in the process of creating
Personnel, Administrative, and other policies and procedures. Eventually a
PIHOA manual will be created as an overall package. Some of this
information would not be included in the Employee Handbook.
 Employee benefits: Extended Health Insurance (coverage similar to COBRA).
PIHOA is not eligible because of the size of the staff (under 10 employees).
 Hawaii Family Leave Act – eligible to staff after 6 months of employment.
Does the Board want to set a limit on the length of leave? Board members
endorsed 4 weeks of leave, with the provision that at a minimum, Hawaii
State law is met and that maternity leave is specified.
Other Board member comments (not directly relevant to the Employee
Handbook) include:
 PIHOA needs to be less dependent on contracts.
 What is the administrative fee for contracts now that PIHOA is not under
RCUH?
Due to time constraints, the Fiscal Policies were not discussed at this time.
Open Meeting
Welcome Remarks and Round
of Introductions
PIHOA Board President
PIHOA Regional Initiatives
PIHOA Regional Initiatives
Update
Regional Lab Strengthening
Dr. Skilling appointed Emi to begin the Open Meeting. Emi welcomed all guests
and announced the newly elected PIHOA officers.
Vasiti provided a report on Lab Strengthening activities throughout the region
since the last Board meeting. Board members expressed appreciation of Vasiti’s
work in the PIJs. Key discussion points/questions/responses:
All Board members asked
to review the letter and
give input for a decision
on endorsement by the
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Vasiti Uluiviti, PIHOA Regional
Lab Strengthening
Coordinator and Kasian
Otoko, AUL President




PIHOA Regional Initiatives
Update
QA/QI/PM/HIS
Dr. Mark Durand, PIHOA
QA/QI/PIM Coordinator
Dr. Kris Qureshi
Lab certification – the plan to certify labs with some kind of certifying
organization is the choice of the labs/PIJs. It is not based on per capita
health spending. Guam, CNMI & AS must be CLIA certified due to Medicaid
funding.
Two feasible requirements toward implementation that labs can try to
achieve: 1) documentation of lab system; and 2) consistency of supplies to
maintain testing capacity or delivery of service. PIHOA has assessed all
USAPI labs, using a WHO Lab assessment tool. Start there and move
forwarding making improvements based on assessments. Developing the
lab workforce is also important, but it will take time to get everyone trained.
If staff could get PPTC training as a minimum would be a good goal.
AS suggested that labs start with policies and procedures which align with
federal regulations – don’t wait for external inspections; ensure
maintenance of equipment; commit to ongoing staff training. Suggested
that Vasiti share more about scholarship programs and POHLN.
Although it is unclear how Medicare plays into lab certification, labs do not
have to be regulated by a US organization. There are other organizations to
choose from that are international.
Kasian Otoko, AUL President, presented on AUL Accomplishments 2009-2013
and requested Board endorsement of the following:
1. PPTC Diploma Medical Lab Program as minimum qualification for all non –
regulated USAPI labs.
2. Minimum NCD lab tests in all labs at all times.
3. AUL have formal status as a PIHOA Affiliate member – a letter was issued to
all Board members that they are hoping the members will sign.
HIMS items for Board endorsement and discussion points:
1. USAPI Immunization data sharing agreement – will give access to one or two
specific people in each jurisdiction access to data from other jurisdictions to
help clarify
 Board members asked for more information.
end of the PIHOA
meeting.
Dr. Durand will contact
each Board member to
seek nominations for
EpiTech course.
2. Communique to CDC for help on:
a. Epi TA via NCD regional Epi
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

b. Adequate BRFSS & YRBS funding support
c. Adapt BRFSS & YRBS for physical measurements and fit with new
WHO NCD Surveillance Framework
d. Help support delivery of EpiTech and Pacific FETP
Epidemiology is needed across the board (generalists), not just for NCDs
The idea behind this regional Epi is to stop doing things by disease category.
It is NCD focused because of the CDC office that is helping with funds /
support. One way to address this is to require Terms of Reference to
include general training in Epi and also to train with SPC.
3. Invite corrections to USAPI NCD Progress Profile
4. Use of new Epi/Data regional infrastructure strategically:
a. Clear identification of surveillance teams in PIJs
b. Endorse EpiTech competencies
c. Encourage/require enrollment of team members in EpiTech
certification program (for credit)
d. Start with nominations to upcoming regional EpiTech courses (or
arrange delivery in your jurisdiction)
 Who are targeted for regional EpiTech training? At jurisdiction level,
identify targeted people in your agency that will be the key for training.
 EpiTech training in Palau in May is going to include a day on regional
planning focused on BRFSS and STEPs, as well as how to connect this with
funders. USAPI is in a position to have resources available to address NCD
surveillance that the rest of the Pacific doesn’t have.
QI/PM endorsement requests:
5. Invite requests for:
a. SOP development projects
b. QA/QI/PM assessment and strengthening
c. Performance indicator development and methods > dashboards
d. Support for college-partnered QI courses
6. Give permission for PIHOA and ASTHO to share consultation reports with
one another
7. Consider whether to end PIHOA QA/QI/pm initiative
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
PIHOA Regional Initiatives
Update
Human Resources for Health
Dr. Gregory Dever, PIHOA
HRH Coordinator
Panel Presentation - Health
Leadership
1. ASTHO/PIHOA Leadership
and Resource
Management Projects
(Emi & Kris Qureshi)
2. ASTHO Leadership
Development Program
and other leadership
support (Katie Sellers)
Health Leadership
Health Leadership for
Legislative Change
How can we connect QA/QI and NCDs, in terms of prevention to strengthen
our attempts to address NCDs? Diabetes has made efforts in this direction,
using data via CDEMS to establish clinical guidelines. QI can be used to
measure how well you deploy preventive services to patients – you can then
use them to establish targets for improved services and to establish action
plans/strategies, to make improvements and continue checking progress.
 QI can boost the impact by having the health agencies work together and
not working in silos.
 Yap: In the last Compact Impact budget consultation, funds were requested
for the STEPS survey. Dr. Durand suggested two ways to approach this:
adapt BRFSS to STEPS or vice versa. Another way is to make something that
is easy in-country that meets requirements of all funders.
Dr. Dever requested endorsement of Oral Health Strategic Training Framework
activities for the region.
 Board members expressed interest in sending staff to RMI training
 Need an assessment of the health workforce in the USAPI to help drive
planning and recruitment efforts. PH is not a field of interest, so recruiting
staff is difficult. PIHOA Board needs to focus on workforce as current
workforce is aging and needs to focus on future staff/leadership.
 Dr. Skilling thanked all partner agencies for their support in HRH efforts.
Dr. Skilling asked that PIHOA work with other partner agencies for effective use
of resources.
 International Council of Nurses (ICN) is appreciated – we need to give our
Chief Nurses the chance to get trained in management.
 ASTHO Senior Health Leaders Initiative was very good, but time difference
was a challenge. This is also a challenge for participating in all SHO calls.
Oral Health Program
Resolution needs Board
review.
Speaker Won Pat gave a presentation on Guam’s efforts to address NCDs. She
encouraged PIHOA to educate and provide data to policy makers as they are not
the experts in health and they need guidance to conduct effective legislation.
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Honorable Speaker Judith
Won Pat, President,
Association of Pacific Island
Legislators
Meeting wrap-up and close
PIHOA Board President
Agenda Item
PIHOA Board Closed Meeting
Call to Order, Opening Prayer
and Roll Call
PIHOA Secretariat Financial
Status
PIHOA Secretariat’s Current
Financial Profile and Future
Steps
Dr. Skilling noted that Guam is using PIHOAs 15 Commitments to grade
themselves. She encouraged all PIJs to revive use of their 15 Commitments.
 Patty Coleman, CNMI, shared how CNMI passed the Smoke Free Air Act.
Health programs need to support policymakers by “sensitizing” the
community for some time before policymakers introduce legislation
addressing health issues.
 Discussed how Tobacco Settlement lawsuit occurred and how data was used
to justify/support lawsuit. Tobacco Settlement funds were used to create
the Healthy Future Funds on Guam for prevention and cessation programs.
Dr. Skilling gave a brief summary of the day’s events and thanked everyone for
their work and support to PIHOA.
DAY 2
Agenda Item
Agenda Item
Dr. Skilling opened the meeting at 9:15am, followed by a prayer by Joe Fleming.
Alicia and Emi reviewed Fiscal Policies and Procedures with the Board. Key
policies/discussions/decisions:

Policy #6 – Board review of fiscal policies and procedures every 2 years or 5
years?
Approved for review
every 2 years.

Policy #6 – Board review and approval of all budgets submitted to granting
agencies. Currently, an annual overall budget, inclusive of all new grant
budgets, is provided to the Board. Changes to new grant budgets approved
by the Board are communicated by the Executive Director (ED).
Status quo.

Policy #16 – Increase ED purchasing power to $50k. Current policy limits the
ED to $10k – contracts are often over this limit, so we aren’t following it;
otherwise, PIHOA rarely has purchases this high. Quarterly statements are
provided to the Board for additional information.
Approved at $50K.

Policy #16 – Procurement guidelines are as follows:
o >$2,500 no documentation needed
Amounts approved.
Require verbal quotes for
(Alicia and Emi)
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o
o
$2,500 - $5k verbal quotes
$5k> three written quotes
amounts over $2,500;
bids for $5k and over.

Policy #20 – Credit card limit for ED and Finance Officer is $7500 combined;
Administrative Assistant (AA) is limited to $2500. An increase in the limit is
requested as current policy can limit operations.

Policy #21 – Request to increase travel per diem from $45 to $63/day.
Approved increase to
Policy is modeled after other non-profit organizations, such as ASTHO. Costs $63; receipts required if
are broken down based on how some meetings provide lunch, which we can traveler exceeds $63.
exclude if provided.

Policy #23 – Contracted services – requires RFP for contracts over $100k.
Decrease amount to $50k for consistency with procurement policy which
allows ED approval.
Require RFPs for $50k.

Policy #23 – Contracted services – requires competitive bid for all contracts
$5k-$100k; all contracts over $50k require Board approval.
Approved.

Policy #23 – Sole source procurement – requires written documentation for
all purchases over $5k.
Approved.

Policy #26 – Capital assets – defined as any assets valued over $500. It is
common practice and more for accountability and tracking.
Approved at $500.

Policy #27 – Operating reserve – recommends $250k which is 3 months of
operational budget. Board recommendations also requested for type of
account to be utilized. Finance Officer recommends keeping $100k in
savings in case we need to access; with balance in better interest bearing
account. There may be times when cash flow is limited and we may need
access.
Approved for a minimum
of $250k in savings
account, with 3 month
amount evaluated
annually. Use of funds
requires Board approval
and must be restored in
12 months.
Approved increase of
credit card limit to $10k.
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Contractor Template
Board will review and decide on Thursday.
Financial Packet – Alicia reviewed the Board Financial Packet in detail.
 Operating Reserve: Reserve balance is currently about $80-$100k, but
some dues are past due and once paid the reserve will be increased.
 Donations – Alicia has never experienced accepting contributions; Board
members suggested consideration of accepting donations.
 Membership dues – how are dues spent? The HRSA grant has sustained
most administrative costs; a 50% in 2012 required reshuffling of budget.
Dues are covering daily operating costs and expenses not allowed under
federal grants, such as hosted dinners.
 Funding base is very limited in terms of source of funding, being highly
reliant on federal grants is not a sustainable way to operate; Secretariat
suggests that Board think about how we can diversify funding for flexibility
and continuity of funding from various sources. PIHOA doesn’t have a policy
or mechanism to accept donations. Under Hawaii state and federal law,
rules exist which we’d have to follow. What is the big picture decision about
how we will address our finances?
 AS asked if the Board should reconsider restoring all or part of the dues that
were cut. CNMI agreed and recommended increasing dues up to $15k to
help with the operational budget; maybe 2 years from it can increase back
to $20k.
o Dr. Skilling put a vote to the Board to increase membership dues to $15k
or keep it at $10k
 Palau recommended that PIHOA focus on evaluating initiatives to see if
money spent has been worthwhile in each PIJ. Secretariat staff have begun
discussions to address this.
Secretariat to look at
establishing policy and
procedures for receiving
donations and fund
raising.
PIHOA Focus for the next 5 years – Alicia and Emi provided the following options
and requested Board guidance on PIHOA’s focus for the next 5 years:
 Option A: Continue with current combination of secretariat support and
technical assistance provision as requested by the board membership (and
Continue current
operations as a technical
assistance arm for the
USAPI
For 2015, membership
dues will increase to $15k
 Associates remain at
$500
Secretariat begin building
evaluation plan for
PIHOA
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

ASTHO/PIHOA Health
Leadership and Resource
Management Development
Projects
Setting Regional Health
Leadership and Resource
possibly a scaled down version until such time as more funding becomes
available);
Option B: Revert back to pure secretariat support work to the PIHOA board
with scaled down technical assistance staffing; or
Option C: Discontinue PIHOA as an organization.
Board members considered options and consensus is to continue option A. Key
discussion points:
 Support from ASTHO: Some funding via ASTHO is end-of-year CDC funding
that must be used in one year. Emi gave an overview of the approved
projects and budgets. This is the mechanism which allows support from
ASTHO.
o ASTHO is a large organization, but territories are a lower priority than
others they serve. Consider a PIHOA event that we could ask ASTHO to
sponsor to assist PIHOA.
o Bill Gallo has been a strong advocate for PIHOA. What happens when Bill
Gallo is gone? How will we secure other grant funding? Can ASTHO
advocate that PIHOA be funded by RWJ?
o Emi encouraged the Board to discuss these concerns with ASTHO staff
who are present for the meeting.
 Goes back to discussion of sharing the burden/assistance so we can
efficiently work – not just with ASTHO but other orgs such as WHO and SPC;
the FAS have the advantage of being members of both WHO and ASTHO. If
ASTHO is providing assistance to PIHOA, PIHOA can complement or share
the burden of the organization. PIHOA needs to keep their relationships
open and not identify with one specific organization.
Tabled and discussed on DAY 3:
Emi presented an overview of this project and requested the Board’s input on
content for a Leadership Development program: what is an effective health
leader in the Pacific? Brainstorming ideas included values, competencies, and
characteristics.
Members to submit
names of staff from their
PIJs that will work with
Emi on this project.
Draft to be submitted for
Board input & approval.
The brainstorming process was used to gather Board input for an effective and
efficient resource management project, with considerations for planning,
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Management Competency
Standards
(PIHOA President & Emi)
Guest Speaker and Special
Announcement
USAPI NCD Law and Policy
Summit – Strengthening
Engagement Between PIHOA
Board, APIL and MCES
(Speaker Won Pat & Minister
Ngirmang)
execution, monitoring/evaluation and reporting. Who are key people; what
process is needed?
Key board discussion points:
 Secretariat lead this effort with assistance from PIJ staff appointed by Board;
present plans to Board for input/approval.
 We have leadership and resource management, but this is a time when we
have to move away from where we are to improve ourselves.
Speaker Won Pat presented on APIL’s efforts and the need for strengthening the
relationship between PIHOA, APIL and the Micronesia Chief Executives Summit
(MCES). Speaker Won Pat encouraged Board members to lobby legislators and
educate them on the health issues facing their jurisdictions. Key points of
discussion:
APIL has various regional healthcare initiatives, such as a study for Guam and
CNMI on Medicaid and MIP; they recently met with UC Davis Health System
officials who are providing some services, such as tele-health / tele-medicine;
and advocating for the FSM to be included in Medicare. Speaker Won Pat
requested a Letter of Support from PIHOA Board for APIL’s regional healthcare
initiatives.
NCD Law & Policy Summit:
Emi gave a summary of efforts to promote The Commitment and finalize the
NCD Toolkit, leading to the next step of convening a regional summit. Federal
funds can’t be used for meetings on policy that might be construed as lobbying.
Minister Ngirmang asked his staff, Temmy Temengil to share the results of a
meeting with Taiwan’s Ambassador to Palau: They are open to idea and very
positive. Requested more detail on budget, purpose, and general timeline for
proposal – provided an estimated cost of $120k, which was submitted on behalf
of PIHOA. Palau would be the hosting island and would take the lead in
coordinating meetings. Minister Ngirmang wanted to get Board input before
proceeding with plans. Some things to consider:
1. Requesting PIHOA
endorsement of APIL
regional healthcare
initiatives, due by the
end of April.
2. Requesting a Letter
of Support from
Governors/Presidents
of each USAPI for DOI
grant application by
the end of March
(due April).
3. Letters to Hawaii
Senators to reinstate
Medicare in FSM.
By March 30th or sooner,
give feedback to Palau on
political positions of each
PIJ regarding Taiwan’s
sponsorship of summit.
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
One China policy – some members of PIHOA may have challenges with
engaging with China. At last Pacific Islands Forum meeting in Marshalls,
there were some issues with having China attend the meetings. If China
sponsors the summit, they will expect to participate.
 Will representatives from U.S. federal agencies be allowed to participate?
 RMI, FSM and CNMI requested time to discuss with jurisdiction leaders
 Dr. Skilling thanked Palau for effort to help with summit; but advised Board
to consider an alternate plan for the summit in case of more political
concerns. Also, if plans with China fall through, PIHOA could consider asking
other partners who don’t have political issues to co-sponsor the summit
with PIHOA.
 AS has no problem with the opportunity as health is a worldwide issue, not
a political one; maybe this is one way to bridge gaps in the name of NCDs.
 Board members suggested a draft agenda be developed to serve as
discussion points with jurisdiction leaders and other potential sponsors.
 Emi developed a concept note for the summit. The Health Leadership
Council has been in discussions and has a role in planning the summit. The
Board will hear more at a later presentation.
 It was suggested that a summit may not be necessary – can NCD policy be
addressed in other ways such as TA? Emi suggested that the Summit will
provide opportunities not available through other efforts such as crossjurisdictional sharing that includes community members, traditional leaders,
education, trade, agriculture. Also, legal counsel can be available to help
review draft policy. It will allow PIHOA to assess what has been done since
the 2010 NCD Emergency Declaration.
Open Meeting – Regional NCD Response
Panel Presentation and
Cerina presented an overview of the HLC. Although Va’a Tofaeono, HLC Chief
Discussion: Regional NCD
Councilor, was expected to participate via teleconference, the connection was
Response
not successful. Clifford Chang, HLC member from PIPCA, assisted Cerina with
1. Progress Report on NCDs
addressing Board questions and concerns. Key discussion points/concerns:
and current epidemiology  HLC name implies they are equal to PIHOA Board
(Dr. Mark Durand)
 Board members are not clear about the relationship with HLC; HLC role
2. The USAPI NCD Health
 Are PIJs adequately represented on HLC?
Leadership Council and
Discuss Board concerns
with HLC for discussion at
next PIHOA meeting.
Page 14 of 27
Progress and Gaps Against
the Regional NCD Road
Map – (Va’a Tofaeono)
Panel Presentation and
Discussion:
Regional NCD Response
1. WHO - Global and
regional NCD
commitments (global
voluntary targets and PI
Crisis Response Plans)
[Dr. Peter Hoejskov]
1. Monitoring Alliance for
NCD Action (MANA) [Dr.
Ilisapeci KubuabolaSamisoni]
2. Regional NCD Surveillance
– considerations and ways
forward (Dr. Mark
Durand)
Panel Presentation and
Discussion:
Regional NCD Response

Board members do not know some of the representatives from their PIJs on
regional organizations and the HLC
 Appoint the HLC to carry out the NCD initiative for PIHOA
Dr. Hoejskov of WHO presented on NCDs, highlighting tools and surveillance.
Dr. Ili on Pacific MANA (Monitoring Alliance for NCD Action) – a survey was
distributed by the Board for input on MANA.
 Joe Fleming requested survey form electronically
Dr. Durand on Regional NCD Surveillance:
 Bill Gallo – CDC is well aware of some of the shortcomings that Dr. Durand
pointed out; some people may question comparisons between USAPI and
US surveillance data. Data can help justify higher awards for USAPIs.
Tailoring BRFSS for the islands is a good approach. Dr. Ursula Bauer has
organized a team at CDC to focus on insular areas, with Loren Cadena at the
lead. CDC is very interested in working with SPC and WHO, etc. to discuss
ways to combine resources to meet needs. Dr. Bauer has reached out to
WHO, such as prior to the MANA meeting. Let’s continue to work together.
 Dr. Seville, WHO – echoed Bill’s sentiment, encouraging health partners to
have discussions to help PIJs and not work in a vacuum or in isolation.
 Bill Gallo – MANA questions being solicited from the Board are really
important and information is going to be key for next steps/direction.
 Dr. Yvan Souares – MANA is a long and tedious process; questions need to
be asked about the organization/location/role of MANA; how does MANA
tie into existing groups; curious about MANA governance; feels that there is
a gap in data collection.
Board members to
submit nominations for
EpiTech training in Palau
at the end of May
Members asked to
answer survey from Dr. Ili
and submit by Thursday
morning
Board members expressed appreciation and support of these efforts, but also
shared concerns with the limited personnel/resources in PIJs to support these
efforts, as well as to ensure that efforts are relevant to individual PIJs.
Ms. Coleman provided an update on the CHL Initiative progress to date. Key
discussions points:
 Clarification on project timelines and sampling
Page 15 of 27
1. CNMI Childhood Obesity
Study, CNMI Response
and CHL Initiative (Ms.
Patricia Coleman)
2. FNU/PIHOA Hemodialysis
Economic Feasibility
Study and Findings (Dr.
Shyam Mahakalanda)
NCD Presentation by Chuuk
State Health Services
Director Julio Marar, Chuuk
State Department of Health
Services

Concern with new groups conducting new surveys, when so many surveys
have been completed. Requested that programs focus on addressing survey
results. CHL project plans to package interventions to feature what was
used and found successful in their study.
 PIJs are faced with the double burden of having both malnourished and
obese children.
 PIHOA policy efforts must address unhealthy foods, specifically soda and
ramen. FSM is completing draft bill to address unhealthy food/drinks as
well as taxes those items. That’s what the NCD Law & Policy summit is
about – bringing these issues to a forum; there is a lot of promotion going.
Dr. Mahakalanda presented DOI Study results. Key discussion points:
 The exponential rate on patients in dialysis treatment has doubled. Patients
are on a waiting list in Hawaii and elsewhere. It may take a generation to
slow the trend down.
 Early detection is important and reverse works. The burden on the system
will decrease on the health budgets. The answer is to make them have
dialysis treatment.
 Study confirms our fear – the need is increasing; we’ve talked about defining
the issue and we’ve done that – we have a crisis; we now need to find
innovative interventions to address this concern.
 The region is not enjoying economies of scale. We need to look at this for
efficiencies and cost-savings – perhaps like FSM states are centralizing
dialysis in Pohnpei, other PIJs can merge services. Also need to focus on
policy for greatest impact.
 Food policy in PIJs is likely to be very different in the islands vs. other areas
and most food is imported; we need to do this right in the islands. We need
to continue with risk reduction, prevention and early treatment.
Dr. Fred, PH Physician presented on Chuuk’s efforts to address NCDs, focusing
on Multi-drug Resistant TB patients. Highlight is that efforts focused on treating
44 MDR TB patients; 6 still on treatment. No new cases of MDRTB in one year
and Leprosy rates reduced to 10%.
 Dr. Dever – physicians in FSM are good examples of being challenged with
both communicable diseases and NCDs; many go without recognition for
Need PIHOA to continue
TA; to monitor and
evaluate the response
efforts.
Page 16 of 27
Presentation and Discussion:
Regional NCD Response
Web-Based USAPI NCD Policy
Toolkit (Emi)
Meeting wrap-up and close
(PIHOA President)
Agenda Item
Call to Order and Opening
Prayer (PIHOA President)
Guest Speaker
Emergency Medical Services
for Children (EMSC) Program
for the USAPIs –
Teleconference Connection
(Theresa Morrison-Quinata,
Director, Maternal and Child
Health Bureau, HRSA)
Facilitated Discussion
Hospital Administration in the
USAPIs – Challenges and Next
Steps (Joseph Davis-Fleming)
really hard work in apply skills in working with communicable diseases and
applying to non-communicable disease.
Tabled. On Day 3, Emi advised that although the Board was not able to discuss
this matter, she did send the Board the web link, and requested that members
view it and give feedback.
Dr. Skilling expressed appreciation for the healthy food provided and thanked
everyone for great work throughout the day.
DAY 3
Agenda Item
The meeting was called to order, followed by a prayer by Director Nua.
Ms. Morrison-Quinata provided an update on EMSC Program efforts in the
USAPIs. A meeting is planned for June 14-16, 2014 in Hawaii and PIHOA will be
invited to participate. Any questions that may arise after this meeting may be
brought up there. Key discussion points:
 How can the EMSC Program work in the FSM which has challenges with
their infrastructure?
 With uniqueness of PIJs, compliance may be a challenge. Requesting that
HRSA be considerate of PIJs as they are different from states, with different
needs and ask that failure to comply or meet deadlines doesn’t result in
HRSA cutting off funding or grants.
Mr. Joe Davis-Fleming presented on challenges faced by hospitals in the USAPI.
1) For flag territories Medicaid reimbursement rates have increased from $1
local vs. $.045 federal match to $0.43 local to $1 federal match, as of
January 1, 2014.
2) Discussion about flag territory specific issues like required conversion from
ICD-9 to ICD-10 coding, Affordable Care Act EHR meaningful use incentives,
status of eligibility of Freely Associated States citizens for US Medicare and
Medicaid programs.
3) USAPI member states have a much stronger voice if there is a united
message. PIHOA, ASTHO can channel this message.
4) Possible areas unified action include:
Agenda Item
Secretariat staff will
assist hospital associates
in drafting a resolution to
address #1.
Page 17 of 27


5)
6)
7)
8)
9)
10)
Advocacy to change CMS eligibility requirements.
Cross-jurisdiction sharing of technical personnel (e.g. biomedical
techs), including by telemedicine
 Regional development of hospital health professional training
programs (including hospital managers)
Lots of discussion about policy advocacy chances of success, invoking issues
of contributions of FAS to US military, and possible allies in Hawaii, Guam,
Arkansas, California, Washington and Oregon congressional delegations (to
address compact impact)
Board should decide whether PIHOA should develop improved TA resources
and capacity for hospital issues vs. remain as an informal venue for sharing
across jurisdictions.
Dialysis is a key area to address since costs are so huge, and threat to core
funding to FAS compacts with current agitation from HI congressional
delegation to pin these costs on FAS.
Hospital management training programs would be very helpful for USAPI.
Regional clinical and admin temp service might also be useful.
Hospital stats (to complement public health stats) also a great need.
Board members expressed appreciation, understanding and support of these
efforts, although more information may be needed in some areas. Key
discussion points:
 Biomedical training: equipment procurement should include training by the
company for staff using the equipment as well as minor repairs and
maintenance. In future, consider cost-sharing a biomedical engineer that
can rotate among jurisdictions. This could be feasible for all PIJs. RMI
should be able to share costs for biomedical training. Problems are caused
when we purchase equipment but no one is able to do maintenance locally.
Yap reminded Board about discussions on standardizing biomedical
equipment so that training can be shared across jurisdictions.
 RMI is interested in creating professional training in hospital management, a
hard to recruit area.
 Re compact funding negotiations – remember that FAS compacts are
perpetual – it is the public law that appropriates money to fund things – for
Page 18 of 27
Facilitated Discussion
PIHOA Communiques,
Resolutions and Follow-up
(PIHOA President and
Secretary)
the FSM it ends in 2023 – can definitely bring up to foreign affairs and heads
of state.
 Reaching out to neighboring areas to help with the burden of chronic
diseases is good, but the Board would need specific strategies on how you
propose we do this.
 Sharing specialists – a really good idea – have talked about rotating
specialists throughout islands – idea of medical mission is a good one – FAS
is capitalizing on medical missions for specialized care. In FSM, policy for
medical mission requires medical team have a local counterpart to carryout
follow up as well as include training for local healthcare providers.
 Feedback from consultants from Tripler and others is that when they
communicate with PIJs, there are no replies. Get discouraged and think that
services are not wanted. We need to do a better job at responding when
they communicate with us.
 Sometimes when there are changes in government leadership, transitions
are not done well – this needs to be improved.
 ACA does not fit well with USAPIs – but concern is for FAS – we need to
ensure that islands that fall short of healthcare get their needs met; we
need to educate our legislators to keep them on board with us; PIHOA is the
lead health org in the USAPI – we should participate in a good political fight
on Capitol Hill. Request that Board task Secretariat to work with UH, etc. to
identify available services that we can tap into. Request that when Board
comes to PIHOA meetings, we speak on behalf of the people of the Pacific –
not just individual PIJs.
AUL Request:
 Affiliate Membership: AUL has attended meetings in the past to address
regional issues; their organizational mission/vision supports PIHOA’s
mission/vision.
 Endorsement of PPTC as minimum qualification for lab staff: This is the
diploma in medical lab technology currently offered by POLHN. This will not
affect AUL membership. Instead, it would require that lab staff complete
the diploma program.
o Board members discussed standardized compensation, which can first be
addressed by AUL, but must include health administrators and HR.
Approved AUL affiliate
membership.
Approved PPTC as
minimum qualification
for lab staff.
Secretariat to draft
communique on
Page 19 of 27

o Yap – if supported by the PIHOA board, this will be a powerful statement.
This can be brought to HR as agreed at a higher level.
o It would be helpful to collect salaries of jurisdictions so that the Board
can agree to a lowest rate of compensation, possibly modeling after the
recent efforts of the Pacific Basin Dental Association.
o This may be a challenge for FAS jurisdictions that have a cap on
personnel budgets from funders. This is an area where advocacy to
legislators may be needed.
Minimum NCD tests in the USAPI: it is understood that each PIJ will cover
costs of minimum testing.
minimum salary
compensation for lab
staff who complete
minimum training, for
advocacy to legislators
and funders.
Approved minimum NCD
tests for all USAPIs.
Communique on NCD Surveillance: This is not a new program – it is asking to
enhance and support what is being done already. It is not committing any
jurisdiction to take a certain approach – it is just enabling another approach to
take, other than those already in existence. Board members expressed concern
such as gaps in data collection and delays in reports (Palau – last STEPs survey
was 2003; just did another in 2011; report coming out in April 2014); and
continuous funding (FSM BRFSS is funded annually, with leftover of funds from
other grantees). Dr. Durand advised that this is a high level request to CDC for
enhanced support and committed (not just leftover) funds.
Endorsed
WebIZ Data Sharing Agreement for Immunizations: Dr. Durand explained that
this would give staff the opportunity to search other PIJ data on the WebIZ for
patients that they are trying to serve – not just for them to provide data to other
areas. Understand that all PIJ programs are working to get WebIZ fully
functional. In most PIJs, immunization coverage rates are lower than target; this
can be attributed to migration between islands; you can’t properly immunize if
you don’t know status and you can’t know status without shot card; often
patients don’t have shot card, so WebIZ access will help in this process; this
gives the OK for PIJ immunization staff to work with CDC immunization staff to
move forward on this matter. Confidentiality risk is low as information is not
highly sensitive and access would be limited.
 Web-based systems can be more difficult due to bandwidth; it can take
hours to upload data into the system.
Tabled until next
meeting. Request to
insert that data won’t be
used for research or
other information unless
they get approval from
respective jurisdictions.
Page 20 of 27


If this is read-only and a way of tracking immunization status outside of your
jurisdiction, this is a good way to start.
No problem with WebIZ but think there is some kind of organizational body
of immunizations in the Pacific Islands; what is the purpose of sharing
immunization data – will that improve our program?
Palau and RMI requested to table this matter so that this issue can be discussed
with managers and staff first. Palau would like to meet with Dr. Durand when
he is in Palau for EpiTech training to discuss this matter with Immunizations
Program staff.
Resolution on Oral Health Workforce:
Dr. Skilling commented that this is ok as it is supporting efforts that are already
underway in the region.
Other items
Emi requested that other pending items be reviewed by Board via email:
 Hemodialysis feasibility study has been extended twice. Requested that
Board review overview of study, which was sent last week for Board review.
Send comments to Secretariat by next week, if possible to enable
completion of report and compilation of final report for submission to DOI.
 Board noted as an action to provide feedback to the Secretariat on Bylaws
by March 25th. Yap requested that Secretariat highlight the bylaws items
that may need attention.
 Some items of support from Speaker WonPat – she will draft for us and send
for review
 Guam mosquito / regional lab: Dr. Kaneshiro will forward information to us
for inclusion in the letter.
Endorsed
Board will review overall
hemodialysis study and
feedback to Secretariat
for finalization of report.
Open Meeting
Regional Public Goods and Services
Panel Presentation and
Principles of Engagement (US federal agencies):
Discussion
Bill expressed Capt. Walmsley’s regrets for missing the meeting as he was ill;
Regional Public Goods –
however, HHS Lead Herb Schultz was able to call into the meeting.
goods and services which can
Page 21 of 27
be more effectively and
efficiently delivered at a
regional level for the benefit
of the region
1. Principles of Engagement
(US federal agencies) with
Teleconference
Connection (Capt
Walmsley & Bill Gallo)
2. WHO country-based
approach (Dr. Sevil
Huseynova)
3. SPC country-based
approach and PHD
Strategic Plan for the
North (Gerald Zackios &
Dr. Yvan Souares)
Discussed the issue of working together as a one HHS; ongoing conversation on
communication with PIHOA to ensure ongoing dialogue and appropriate
mechanisms for steady feedback between individual PIJs and PIHOA overall.
HHS Washington, DC office is very interested in ensuring a more formal
communication mechanism. Requested PIHOA’s input as the Board is new;
draft proposal provided. Does Board want to continue to prioritize discussions
on effective communication? Please give feedback on draft document.
 Requested that Bill go through contents with Board to seek feedback from
Board
 Once Region IX gets feedback from PIHOA, they will work with HHS
Secretary’s office. They are very flexible moving forward. This is only a
draft and intended to get previous conversations started back up. Intent is
to ensure that PIHOA issues/concerns are addressed at the highest HHS
levels.
 How will the end of FAS Compact agreements affect this issue? If you’d like
language that talks about the compact, you should provide that feedback
and HHS will see how they will address it. They don’t know how U.S.
Congress will act, but they are here to work with PIHOA to include compact
issues.
 How will the FSM states be involved in this process? This will not replace
any current arrangements/processes between states/HHS that currently
exist. This is meant to strengthen communication, not take away any
current, past or future discussions. This is additive, in response to requests
from the prior Board. For FSM states, much of funding comes through DOI
Compact funding. For CDC, grant programs for FSM are dealt with
exclusively at National level. This process will not change any of that.
 Would this process apply to common issues across the PIJs or can they be
issues more specific to each PIJ? We can look at both – we want to facilitate
as much open dialogue as possible – for PIHOA as one, but also for
individual PIJs. It’s up to PIHOA to decide if this conduit is to be used by
PIHOA overall or for individual PIJs or both.
 Bill stressed that PIHOA is fortunate to have engagement/support from the
highest level of the department in the region. Mr. Schultz is the highest
ranking official from HHS in the region. When hearing from Mr. Schultz, you
Page 22 of 27

are talking about the entire HHS department – not just CDC via Bill or Capt.
Walmsley, etc.
Mr. Schultz expressed appreciation of this opportunity to engage; he
acknowledged the many issues faced by PIJ governments to address health
issues; and stands ready to get this process going and to hear more from
PIHOA.
Dr. Skilling thanked Mr. Schultz for the open-door communication he is
proposing and ensured that Board will do its part and meet the timeline as
requested for providing feedback. She also thanked Bill Gallo, Capt. Walmsley
and Capt. Wassem for their work with the USAPI.
Presentation on WHO country-based approach:
 It’s very important, when considering policies, to conduct impact
assessments to take into account new behaviors, such as increased chewing
of betel nut with tobacco resulting from increased smoking policies.
 WHO has examples of legislation/regulation regarding taxes on tobacco
products, but it is still low. Requested that PIJs share examples of tobacco
legislation.
 WHO colleagues have developed a taxing model that you can use to asses
increases and potential scenarios; have model legislation to share. Salt
reduction is another area that they have resources they can share.
 E-cigarettes are a major discussion area for WHO. It is a totally unregulated
market without any guidance or standard. There are different chemicals
with no global regulation. Next month in Manila, there will be a technical
consultation to address this issue.
 The NCD Law & Policy summit will address how to develop policy that is
effective. Also, the NCD Toolkit includes this kind of information, with
model legislation included. There are links to the WHO and other websites.
SPC country-based approach and PHD Strategic Plan for the North:
 In terms of surveillance in anticipation of Micro Games – is there a
possibility to extend an invitation to other people from Kosrae or Chuuk to
work with the Pohnpei team? It is up to Secretary Skilling to extend this
Page 23 of 27
Panel Presentation and
Discussion - Making External
Technical Assistance More
Effective
1. Regional Pharmaceuticals
Formulary (Capt.
Walmsley)
2. Pacific Regional
Procurement Mechanism
– the Global Fund HIV and
TB Experience (Dr. Yvan
Souares)
invitation; but SPC would not be able to provide financial support for staff to
travel to Pohnpei. The only cost they would cover is related to the
surveillance effort. Pre-work, site work during Games, and post-work will be
included. Since one of the major aspects is to improve surveillance, what
they could arrange is that one training that will be provided that could be
supported by States.
Regional Pharmaceuticals Formulary:
Mr. Mark Burchess of Perry Point presented by teleconference. Perry Point is
exploring the feasibility of having a satellite distribution center in Hawaii or
Guam. The timeframe to have the center operational is dependent on time to
ship goods to Guam and the USAPIs ability to commit $2.4 million; as well as
development of a formulary for the region. Perry Point is happy to support any
additional research such as price comparisons for development of a formulary;
the common formulary would help to address concerns with price fluctuations.
Once initial progress is made in developing a formulary, we could pursue the
satellite warehouse. The number I have is $2.4M for sale to the PIJs; the cost of
the facility would be covered; it’s only initial filling of $2.4M stock. Perry Point is
trying to find options for funding this effort; but funding may have to come inpart from PIJs as well as the HHS Supply Service Center.
Key board comments/discussions:
 Due to the lag in time from purchase to payment, PIJs have experienced that
Perry Point’s prices were changed. If the Distribution Center is in Guam,
prices should be less. Delivery time is also an issue with ordering through
Perry Point.
o Perry Point can work with PIJs for a 3month or 6month demand, setting
prices that won’t fluctuate during that window. Use of a common
formulary and a satellite warehouse would help address this issue.
 Would PIJs be allowed to place smaller orders versus Perry Point’s
requirement for bulk orders? Perry Point would ship bulk orders to Guam;
then distribute in Guam at the pay per bottle level. The supply service
center can purchase 50vcases of acetaminophen bottles, then send them to
the satellite warehouse where they can be distributed to the PIJs one bottle
at a time; in addition, the supply service center has the capability of gross
repackaging into smaller amounts.
Secretariat to contact the
Association of USAPI
Pharmacies to request
they take the lead on
developing a regional
formulary for
medications.
Page 24 of 27







FSM: Discouraged the 2nd option of repacking gross amounts into smaller
amounts.
CNMI: Is Perry Point asking for endorsement to support their plans? Feel
that Perry Point should have the satellite in Guam first; skeptical that
warehouse will not be realized after endorsing plans.
o Perry Point wants PIHOA endorsement for the idea to establish a satellite
center, is asking PIHOA to send ideas on a standardized formulary to the
Association of USAPI Pharmacies and that a timeline be set for
development of the standard formulary for PIHOA. The satellite center
would be happy to assist anytime during the process.
Emi: Purpose of the formulary is to have common needs of essential
medicines for the PIJs. Suggest the questions are: a) does PIHOA agree that
a formulary is needed; and b) what would those medicines be?
RMI: Suggested that Each PIJ create their own formulary, then analyze for
common regional needs. This should not be a sole source for us to purchase
supplies.
o Timeline for the formulary is as soon as possible.
o Emi: In the NCD Roadmap, the Association of USAPI Pharmacies (AUP)
was looking at a regional formulary for NCD meds.
o Dr. Dever: Chief Pharmacists could be a great technical working group
that could asked to work on this. They could provide a recommendation
to the Board and the Board can make a decision from there.
o Dr. Skilling agreed and requested the Secretariat to contact AUP to make
this request.
Dr. Durand: Perry Point is a non-profit, quasi-government agency.
Traditionally, they are the lowest priced supplier. There may be an
opportunity to get a large percentage of pharmaceutical needs in bulk that
could be cheaper than purchasing from a for-profit provider.
Emi: Comment for Board consideration: FAS has had experience with a
similar regional approach for TB grants. This allowed SPC to purchase goods
in a similar manner as proposed; it would be good to review this experience.
The FAS are able to purchase generic drugs – do drugs have to be US FDA
approved? The HHS Supply Service Center is required to use only US FDA
approved drugs. They have been working with the CDC TB office on their
Page 25 of 27



formulary and development of a mechanism to store material for them.
One reason for their success is that they have a working formulary which is
crucial to the success of the operation. They can obtain generic drugs but
they also have to be FDA approved.
What happens if PIHOA doesn’t endorse establishment of the satellite
warehouse in Guam? What’s our alternate means for getting orders on
time and at a lower cost? The satellite warehouse would be a future goal;
there could be immediate costs savings that results from development of a
common formulary.
Kosrae: If Perry Point can offer lower prices and timely delivery, I would
order directly from them. If this is an avenue to improve supply purchasing,
then I support this effort.
Is there training or orientation for procurement (and other) staff in terms of
how to do business with Perry Point? Yes. This needs to be revisited, but
there a local college helped develop a program on supply chain
management. Courses could be offered online thru the college. If there
was a need for less expensive or more streamlined training, Mr. Burchess
would be happy to lead that effort.
o Dr. Skilling: Include newly formed USAPI Pharmacy Association – they
are key stakeholders in this effort and should benefit from training.
Pacific Regional Procurement Mechanism – the Global Fund HIV and TB
Experience: The purpose of this presentation is to present different options for
addressing the PIHOA procurement mechanism for medicines, etc.
 Geographic location of islands leaves us at a disadvantage when procuring
supplies. Funding is needed for fuel to get supplies to outer islands.
 The Global Fund has been in place for maybe 10 years. In fact, SPC has been
asked to present a model that PIHOA can think about to establish a model
that can be adapted.
 Although it addresses malaria/TB, the system is also used for outbreak
supplies. A lot of times the outbreak supplies are purchased in collaboration
with PIHOA who purchases and SPC reimburses.
Page 26 of 27
Clinical and Primary Care Services
Panel Presentation and
Dr. Dever presented on behalf of Dr. Ian Rouse and Dr. Ili:
Discussion - Clinical Services
 Licensing Board needs to address this issue.
 How do we know what medical schools are accredited/affiliated with
1. Cuban Medical Doctor
international bodies? There doesn’t seem to be a standard globally. Many
Training Program for the
countries send people away to school, but when they return they’re told
Pacific (Dr. Ian Rouse)
they are substandard.
2. Environmental Health in
 The World Federation for Medical Education in Copenhagen has regional
the Pacific / NPEHA (Dr.
counterparts which look into basic standards and competencies that should
Rokho Kim)
be part of a curriculum. Accreditation is a national level issue. FNU has
3. Addressing Oral Health
obtained this accreditation. Another one is a private school in Fiji.
Workforce Training in the
Pacific (Dr. Rodel Nodora) Environmental Health in the Pacific / NPEHA (Dr. Rokho Kim and Moses
Pretrick):
 Until NPEHA is mature enough to stand alone, they request PIHOA’s
continued support, especially in liaison with global and other partners; want
support as NPEHA works to ensure they don’t make the same mistakes as
they did in the past and as they work on their strategic planning.
Meeting Wrap-up and Official
Closure
Special acknowledgement to
guest speakers and invited
guests (PIHOA President)
Board endorsed NPEHA
as PIHOA Affiliate
member, pending letter
of request from NPEHA.
Addressing Oral Health Workforce Training in the Pacific (Dr. Rodel Nodora):
 Dental training in AS went really well and opened the door for other
trainings and to incentivize staff. Highly recommend this opportunity.
Dr. Skilling expressed appreciation to PIHOA Secretariat for confidence in FSM to
host PIHOA meeting and for coordination with local contractors. The FSM
presented gifts to the 6 voting Board members.
Emi thanked President Skilling, Vice President Nua and Secretary/Treasurer
Kabua for taking on new Board leadership; and thanked all who participated in
the meeting by presenting, speaking, and helping in one way or another.
Dr. Skilling adjourned the meeting.
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