1. Health-Related Investments in the USAPI US Department of Health and Human Services

2. Health and Human Services Objectives Provide an overview of DHHS agencies, programs and funding Provide an overview of DHHS agencies, programs and funding Provide info on purpose, types and mechanisms of HHS funding Provide info on purpose, types and mechanisms of HHS funding Describe coordinating strategies and activities Describe coordinating strategies and activities

3. Health and Human Services HHS MISSION: To protect the health of all Americans and provide essential human services, especially for those who are least able to help themselves HHS MISSION: To protect the health of all Americans and provide essential human services, especially for those who are least able to help themselves HHS Agencies and offices perform a wide variety of tasks and services, including research, public health, food & drug safety, grants and other funding, health insurance, and many others HHS Agencies and offices perform a wide variety of tasks and services, including research, public health, food & drug safety, grants and other funding, health insurance, and many others

4. Health and Human Services Centers for Disease Control and Prevention Centers for Disease Control and Prevention Health Resources and Services Administration Health Resources and Services Administration Center for Medicare and Medicaid Services Center for Medicare and Medicaid Services Substance Abuse and MH Services Administration Substance Abuse and MH Services Administration Administration for Children and Families Administration for Children and Families Administration for Community Living Administration for Community Living Agency for Healthcare Research and Quality Agency for Healthcare Research and Quality National Institutes of Health National Institutes of Health Agency for Toxic Subst. and Disease Registry Agency for Toxic Subst. and Disease Registry Food and Drug Administration Food and Drug Administration Indian Health Service Indian Health Service

5. Health and Human Services HHS FUNDING !

6. Health and Human Services Federal Funding is Used To: Promote an agenda (e.g., HP 2020) Promote an agenda (e.g., HP 2020) Meet a legislative requirement Meet a legislative requirement Fulfill part of a “Strategic Plan” Fulfill part of a “Strategic Plan” Pilot test an idea Pilot test an idea Promote special initiatives Promote special initiatives

7. FEDERAL FUNDING How Does It Work?

8. Health and Human Services TYPES OF FUNDING TYPES OF FUNDING –Entitlement funding –Competitive funding FUNDING MECHANISMS FUNDING MECHANISMS –Grants: not for direct benefit or use of USG –Contracts: for direct benefit or use of USG –Cooperative Agreements: like grants but HHS shares responsibilities with grantee

9. Health and Human Services Centers for Disease Control and Prevention (CDC) - Amounts and types of investments (COAG, grants, TA, in-region staff, etc.) - Consultation and priority setting practices and protocols (how are program priorities aligned with USAPI needs? How does consultation/alignment occur?

10. Centers for Disease Control and Prevention CDC support to the USAPI… CDC support to the USAPI… –goes mostly to Ministries and Departments of Health –targets categorical public health programs (with a couple of exceptions) –comes through Cooperative Agreements –is in the form of money and direct assistance –includes technical assistance through site visits, grantee meetings and ad hoc requests

11. CDC Cooperative Agreements and Grants to the USAPI (2011) Total $18,913,907

12. How are CDC program priorities and support aligned with USAPI needs? How are CDC program priorities and support aligned with USAPI needs? –Begins with Congressional appropriation –Initial estimates of funding levels are usually formula-based (population, morbidity) –Needs are then outlined by grantee in application for funding –Project officers work with grantees to further refine grantee needs based on availability of funding, grantee capacity and performance Centers for Disease Control and Prevention

13. How does consultation and alignment occur? How does consultation and alignment occur? –Through interactions between project officers and grantees (usually program managers) –Through interactions between health officials and CDC leadership or Senior Public Health Advisor –Through regional or national grantee meetings –Through requests by CDC for USAPI input on program planning Centers for Disease Control and Prevention

14. How’s it going? Some good…some not so good How’s it going? Some good…some not so good –Examples of success: More USAPI specific FOA’s (STD/HIV/TB, NCD) More USAPI specific FOA’s (STD/HIV/TB, NCD) More CDC funding in the region (PHEP, TB, ELC, NPHII) More CDC funding in the region (PHEP, TB, ELC, NPHII) More CDC field staff support to USAPI in the region (Immunization, TB, OSTLTS, DGMQ, PHPS) More CDC field staff support to USAPI in the region (Immunization, TB, OSTLTS, DGMQ, PHPS) Establishment of OSTLTS Establishment of OSTLTS Centers for Disease Control and Prevention

15. How’s it going? continued How’s it going? continued –Examples showing that we’re not there yet. Most of CDC still doesn’t understand the unique needs and challenges in this region Most of CDC still doesn’t understand the unique needs and challenges in this region FOA’s and grant requirements are still less relevant to USAPI than to US states and large urban areas FOA’s and grant requirements are still less relevant to USAPI than to US states and large urban areas Cooperative Agreement funding doesn’t align with public health priorities in the region Cooperative Agreement funding doesn’t align with public health priorities in the region CDC funding mechanisms make it difficult to share grant funded resources across programs or across the region CDC funding mechanisms make it difficult to share grant funded resources across programs or across the region Centers for Disease Control and Prevention

16. What next? What next? –Some of our thoughts Solicit USAPI input more often before policies affecting the region are adopted Solicit USAPI input more often before policies affecting the region are adopted Make better use of the CDC USAPI Work Groups (to provide written guidelines for FOA development, program planning, management and TA support) Make better use of the CDC USAPI Work Groups (to provide written guidelines for FOA development, program planning, management and TA support) Improve field based assistance through more regional meetings and more frequent or better coordinated site visits (including increased use of information technology) Improve field based assistance through more regional meetings and more frequent or better coordinated site visits (including increased use of information technology) Increase the number of CDC staff and fellows/associates in the region Increase the number of CDC staff and fellows/associates in the region Centers for Disease Control and Prevention

17. What next? What next? –Some of your thoughts ?? ?? Centers for Disease Control and Prevention

18. Health and Human Services Total amount provided to the Pacific by HHS in FY 2011 (approx.): Total amount provided to the Pacific by HHS in FY 2011 (approx.): –$153 million Percentage of USG funding to the Pacific in FY 2011 by department (approx.): Percentage of USG funding to the Pacific in FY 2011 by department (approx.): –USDA = 33% –HHS = 26% –Education = 11% –HUD = 9%

19. Health and Human Services “Grants to the Outer Pacific FY 2011” report –Issued annually by Federal Regional Council’s “Outer Pacific Committee” –Annual compilation of many funding programs provided to USAPI (not comprehensive!!!) –Includes narrative description of grant programs and points of contact –Tables list annual funding amounts and program eligibility info –Can see at a glance if you’re missing a program –However, there may be grant programs available that aren’t listed

20. Health and Human Services How are program outcomes evaluated? - Agency administrators and P.O.s meet with elected officials, health officers and program managers/staff to discuss priorities/challenges/outcomes - Project officers use site visits, calls and email to review reports and evaluate program performance -Communication is challenging element

21. Health and Human Services What are mech. for intra-agency and cross- agency coord. for work in the USAPI? Federal Regional Council mtgs/initiatives Federal Regional Council mtgs/initiatives Joint FRC/MCES meetings + 1-on-1 mtgs. Joint FRC/MCES meetings + 1-on-1 mtgs. Outer Pac. Comm. + Guam Buildup T.F. Outer Pac. Comm. + Guam Buildup T.F. Insular Health and Human Services Policy Group (+ Working Group) Insular Health and Human Services Policy Group (+ Working Group) CDC Pacific Workgroup/Epi/Lab mtgs. CDC Pacific Workgroup/Epi/Lab mtgs. CNMI Task Force CNMI Task Force Interagency Group on Insular Affairs Interagency Group on Insular Affairs

22. Health and Human Services Cross-agency HHS Coordination (cont.) WH Initiative on AAs and PIs WH Initiative on AAs and PIs –WHIAAPI: HHS Plan focusing on NCDs Native Hawaiian and Pacific Islander HHS Work Group (meets internally & with NHPI Stakeholder group) Native Hawaiian and Pacific Islander HHS Work Group (meets internally & with NHPI Stakeholder group) National Partnership for Action to End Health Disparities National Partnership for Action to End Health Disparities –Regional Health Equity Council HHS participation in WHO reg/int’l mtgs. HHS participation in WHO reg/int’l mtgs.

23. Health and Human Services Cross-agency HHS Coordination (cont.) Consultation with PIHOA Affiliates Consultation with PIHOA Affiliates –Health workforce dev/nursing –Pharmacy –Behavioral Health –Environmental Health HHS internal strategizing on USAPI issues HHS internal strategizing on USAPI issues Coordination with ASTHO, WHO, SPC Coordination with ASTHO, WHO, SPC

24. Health and Human Services Linking US FDA to NPEHA and curriculum development in Environmental Health Linking US FDA to NPEHA and curriculum development in Environmental Health –FDA conducts quarterly calls with USAPI EH Coord. with PEACESAT staff on HIS dev. Coord. with PEACESAT staff on HIS dev. Coord. with USAPI USEPA and UoH on safe drinking water issues Coord. with USAPI USEPA and UoH on safe drinking water issues Coord. with USAPI and DOI/DOD/CDC/ EPA on dengue fever response Coord. with USAPI and DOI/DOD/CDC/ EPA on dengue fever response Coord. with USAPI, CDC, HRSA and others on MDR-TB response Coord. with USAPI, CDC, HRSA and others on MDR-TB response

25. Health and Human Services Coord. w/DOI and FAS on Compact Impact issues Coord. w/DOI and FAS on Compact Impact issues Ongoing coord. with DOI/OIA on JEMCO/JEMFAC & topical USAPI issues Ongoing coord. with DOI/OIA on JEMCO/JEMFAC & topical USAPI issues Participating in Pacific NCD Forum in NZ to dev. linkages with regional entities and policies to address NCD epidemic Participating in Pacific NCD Forum in NZ to dev. linkages with regional entities and policies to address NCD epidemic Connected to APIAHF and Native Hawaiian Pacific Island Alliance Connected to APIAHF and Native Hawaiian Pacific Island Alliance

26. Health and Human Services Coord. with USAPI and HHS/HRSA and CDC on Hansen’s disease response Coord. with USAPI and HHS/HRSA and CDC on Hansen’s disease response

27. Health and Human Services CAPT John Walmsley CAPT John Walmsley –John.walmsley@hhs.gov John.walmsley@hhs.gov –415-437-8114 CAPT Cathy Wasem CAPT Cathy Wasem –Cathy.wasem@gmail.com Cathy.wasem@gmail.com –808-541-2015