1. US Department of Health and Human Services
Investments, Activities and Opportunities for Collaboration in the Freely Associated States
April 5, 2013
CAPT Cathy Wasem MN, RN
CDR Tai-Ho Chen MD
Bill Gallo MBA

2. Presentation Objectives
Provide an overview of the Department of Health and Human Services (HHS) and its agencies
Describe types and amounts of HHS support to the Freely Associated States (FAS)
Provide examples of HHS coordination with government and non-government agencies
Recommend strategies for improving interagency coordination

3. HHS MISSION:
To protect the health of all Americans and provide essential human services, especially for those who are least able to help themselves

4. The Department of Health and Human Services (HHS)
HHS Agencies and offices perform a wide variety of tasks and services, including
public health technical assistance
health care systems support
research
food & drug safety
health related grants and cooperative agreements
health insurance

5. HHS Agencies Centers for Disease Control and Prevention
Health Resources and Services Administration
Substance Abuse and MH Services Administration
Administration for Children and Families
Office of the Assistant Secretary for Health
Administration for Community Living
Agency for Healthcare Research and Quality
National Institutes of Health
Agency for Toxic Subst. and Disease Registry
Food and Drug Administration
Indian Health Service
Center for Medicare and Medicaid Services

6. HHS Agencies Supporting the FAS
Centers for Disease Control and Prevention
Health Resources and Services Administration
Substance Abuse and MH Services Administration
Administration for Children and Families
Office of the Assistant Secretary for Health
Administration for Community Living
Agency for Healthcare Research and Quality
National Institutes of Health
Agency for Toxic Subst. and Disease Registry
Food and Drug Administration
Indian Health Service
Center for Medicare and Medicaid Services

7. Health and Human Services Support to the Freely Associated States
Centers for Disease Control and Prevention
18 different grant programs totaling $12.8m
Funds support disease prevention and health promotion programs, public health emergency preparedness, and cross cutting public health improvement programs
Health Resources and Services Administration
3 different grant programs totaling $4.6m
Funds support Maternal and Child Health Services, Community Health Centers and HIV Care

8. Health and Human Services Funding to the Freely Associated States
Substance Abuse and Mental Health Services Administration
4 different grant programs total $3.5m
Funds support Community Mental Health Services, Substance Abuse Services and Drug Free Communities
Administration for Children and Families
3 different grant programs totaling $1.8m
Funds support Head Start and teen pregnancy prevention
Office of the Secretary
1 grant program totaling $568k
Funds support Family Planning Services

9. HHS Funding to the FAS (2012)
SAMHSA
CDC

10. Other types of HHS Support to the FAS
Personnel
HQ and Regional Staff
Hawaii and Pacific Island Field Staff
Regional Partnerships
PIHOA, PIPCA, SPC, WHO
On-site Training and Technical Assistance
Program and Grants Management Training
Outbreak Response

11. 2011–12 RMI and FSM Dengue Outbreaks Lessons Learned
Dengue Fever
Mosquito-borne disease
Fever, rash, joint pain  can cause complications: bleeding, death
Not routinely present in RMI and FSM before 2011
Late 2011
Separate dengue outbreaks detected in RMI and Yap, FSM
HHS reached out to RMI and FSM to offer assistance
Coordinated USG and international partner responses initiated
RMI: over 1600 cases, no deaths
Yap: over 1400 cases, 2 deaths
No translocation to Hawaii or Guam
CDC PHIL

12. Strengths
USG inter-agency coordination and support of unified response
US Embassies, USAID, DOI, DOD, HHS, USCG
International coordination with WHO and SPC
Rapid deployment after request for assistance
Clinical management support saved lives
Public-private partnerships

13. Challenges/Areas for Improvement
Long-term waste management and vector control
Local procurement mechanisms
Communications with deployed personnel
Insufficient regional information sharing with other countries and jurisdictions
Shipping issues delayed outbreak confirmation

14. RMI-specific issues Strengths Challenges Early outbreak detection
Early request for USG assistance facilitated
High level RMI government commitment
DOD support
NAMRU-2, NEPMU-6, PHCR-Pacific, USAKA, Guam defense rep
USCG air transport support
Challenges
Inventory awareness and projections
Majuro/Ebeye information sharing
Outer atoll surveillance
I. Sutherland, NAMRU-2

15. FSM-specific Issues Strengths Challenges Yap State response
Inventory management
Internal FSM surge capacity deployed
Department of Interior re-allocation of funds
USAF Christmas Drop of IV fluids to Fais
Challenges
Delayed FSM request for USG assistance
FSM challenges in accessing USAID Disaster Emergency Assistance Funds
T. Hancock, CDC

16. Human Resources for Health in the FAS Nursing Workforce – an Education Perspective
Nurses are the backbone of the health care systems in the FAS
Issue: Lack sufficient numbers of nurses with the level of education/skill mix required to address complex health care problems
What we know – Double burden of disease
Diseases of developing countries – high infant mortality rates, Hansen’s disease (leprosy) and TB/MDRTB epidemics,
Diseases of ‘developed’ countries – obesity, diabetes, tobacco and substance abuse

17. Primer: Levels of Nursing Education
Licensed Practical Nurse (hospital-focused care – basic skills)
6-12 month hospital training program (certificate) OR
12-18 month college program (PCC-AAS degree, ASCC –certificate)
Registered Nurse
Associate Degree (ADN) - 2 year
Hospital focus with intro to public health
Baccalaureate Degree (BSN) – 4 year
Emphasizes public health, leadership, management, specialty care
Masters in Nursing
Required to direct LPN or AD and to teach in LPN, AD & BSN programs
Nurse practitioner or nurse/midwifery or specialty
Doctorate
Required to direct a baccalaureate nursing program
Research Doctorate (PhD) or Practice Doctorate (DN)
Post AD/BSN Certificate
Nurse practitioner/midwife or specialty care through the Fiji School of nursing)

18. Nursing Workforce in the FAS
Jurisdiction
H = Hospital
PH =
Public Health
Total Nurses
Total LPNs
LPN
Training
Total
RNs
RN-ADN
RN-BSN
% LPN and type of preparation
% AD / # of BSN
Hospi- tal
College
RMI – Majuro H 84 13 71
16% LPNs (hospital-based tx)
84% RNs (majority are ADNs)
RMI – Ebeye 27 5 22 6 16
19% LPNs (hospital-based tx)
81% RNs (majority BSN- Philippines) PH 17 10 X 7
59% LPNs (hospital-based tx)
Pohnpei 52
25/*
52% LPNs (hospital-based tx)
48% RNs (majority are ADNs) 19 8 11
42% LPNs (hospital-based tx)
Kosrae 36 29
19% LPNs (hospital-based tx)
81 % RNs (majority are ADNs)
Chuuk 96 55 41
57% LPNs (hospital-based tx)
43% RNs (majority are ADNs)
Palau 76 51 * 35
67% LPNs (hospital-based tx)
33% RNs (majority are ADNs)
Data from the Directors of Nursing Jurisidiction Reports – APNLC 2012

19. Challenges / Initiatives
Lack of awareness – educational levels
Lack of faculty
Isolation
Lack of solid student preparation
Sector Blinders
____________________________________________________________________________________________
RWJ Foundation Partners Investing in Nursing’s (PIN) Future Initiative / Partner philosophy
FCMI Foundation, Bank of Guam, WHO, HHS, DOI, DOD, PIHOA, APNLC, UH, Dreyfus Foundation
Faculty training, new faculty development
PINNED Alliance (Pacific Island Network of Nursing Education Directors)
Regional Nursing Education Strategic Plan
Quality Improvement Initiative
Regional BSN-distance education program at University of Guam
AHEC student preparation programs
DOI/HHS initiative - AHEC supplement to support PINNED activities
Lack of awareness among policy leaders of implications of nursing education levels
Lack of faculty - Pool from which to draw is limited b/c few baccalaureate and fewer master’s prepared nurses
lack of educational standards for program / outcomes
Lack of solid background in math, science & English in elementary/secondary schooling
Sector Blinders: belief that nursing education is solely the realm of higher education & nursing workforce is a ministry of health issue
WHO, DOD, University of Hawaii, Friends of the College of the Marshall Islands foundation

20. HHS Recommendations for Improved Coordination Across Agencies
Identify priorities of mutual interest
Ex. Climate change, NCD Emergency, Federal Grants Management
Educate one another on our agencies’ capabilities and limitations (OPM)
Work closely with embassies to coordinate activities with other USG agencies as well as international partners/donors
eyes & hears in jurisdiction
Foster public/private sector “health in all policy” approach (see notes)
For human resources for health this includes an understanding that a local, quality health professions workforce is critical to all sectors of the nation and is therefore a joint responsibility
Foster awareness of & coordination with the local college (see note)
– USG, other govts, international groups & foundations – ensure awareness of local colleges & their nursing/health professions programs

21. HHS Recommendations (cont.)
Ambassadors/ Embassies
Foster public/private sector “health in all policy” approach
Foster awareness of & coordination with the local college
Other USG Departments & Agencies
Inclusion of college faculty in trainings / foster budding research capacity in the colleges
Innovative utilization of college/health professions students
Recognition of educational levels/base when providing training
eyes & hears in jurisdiction
Foster public/private sector “health in all policy” approach (see notes)
For human resources for health this includes an understanding that a local, quality health professions workforce is critical to all sectors of the nation and is therefore a joint responsibility
Foster awareness of & coordination with the local college (see note)
– USG, other govts, international groups & foundations – ensure awareness of local colleges & their nursing/health professions programs

22. HHS Recommendations (cont.)
Establish mechanisms for regional coordination of emergency responses that do not trigger currently established response protocols (USAID or FEMA)
Enhance disease surveillance and laboratory capacity for early detection of public health emergencies

23. Thank you Tai-Ho Chen, MD Cathy Wasem, MN, RN Bill Gallo MBA
CAPT, USPHS Commissioned Corps
Senior Public Health Advisor
Office of Pacific Health, HHS-Region IX
Office of the Regional Health Administrator
300 Ala Moana Blvd., Rm / PO Box Honolulu, HI
(cell)
Tai-Ho Chen, MD
CDR, U.S. Public Health Service
Quarantine Medical Officer
Division of Global Migration and Quarantine
National Center for Emerging and Zoonotic Infectious Diseases
Centers for Disease Control and Prevention
CDC Honolulu Quarantine Station
300 Rodgers Blvd #67
Honolulu, HI 96819
Phone:
Fax:
Bill Gallo MBA
Associate Director for Insular Area Support
Office of State, Tribal, Local and Territorial Support
Centers for Disease Control and Prevention
300 Ala Moana Blvd. Room 8-125
Honolulu HI 96850
office:
cell: