1. Regional Health Committee (RHC) Preparing for the Storm: Reducing Health Systems Vulnerability and Building Resiliency in Micronesia

2. 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

3. 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

4. A Proud History of Voyaging the Unknown

5. Our Health Systems: A Leaking Canoe Heading into the Storm…

6. 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 disease- based); too many uncoordinated health plans; plans often linked to funding sources so sustainability is a problem

7. The Leaking Canoe Continued….  Qualified human resource base – insufficient resources and evidence- based 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

8. 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.

9. 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

10. 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 locally- adapted 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

11. 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

12. 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)

13. 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 1 Last JM, editor, Dictionary of Epidemiology, 4 th ed. New York: Oxford University Press; 2001. p. 61

14. 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

15. 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

16. 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.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 b.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!

17. 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

18. 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 core- funded function and positions within the ministries/departments of health

19. 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.

20. 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!